Social and Emotional Development in Infancy and Early Childhood

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SOCIAL AND EMOTIONAL DEVELOPMENT IN INFANCY AND EARLY CHILDHOOD

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SOCIAL AND EMOTIONAL DEVELOPMENT IN INFANCY AND EARLY CHILDHOOD EDITORS-IN-CHIEF

JANETTE B. BENSON and

MARSHALL M. HAITH Department of Psychology, University of Denver, Denver, Colorado, USA

Academic Press is an imprint of Elsevier The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, UK 525 B Street, Suite 1900, San Diego, CA 92101-4495, USA First edition 2009 Copyright ã 2009 Elsevier Inc. All rights reserved The following articles are US Government works in the public domain and are not subject to copyright: PARENTING STYLES AND THEIR EFFECTS PLAY No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher. Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford, UK: phone (+44) (0) 1865 843830; fax (+44) (0) 1865 853333; email: [email protected]. Alternatively, your request may be submitted online by visiting the Elsevier web site at http://elsevier.com/locate/permissions, and selecting Obtaining permission to use Elsevier material. Notice No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Catalog Number: 2009927181 ISBN: 978-0-12-375065-5 For information on all Elsevier publications visit our website at books.elsevier.com

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CONTENTS

Contents

v–vii

Contributors

ix–xi

Preface

xiii–xiv

A Abuse, Neglect, and Maltreatment of Infants Adoption and Foster Placement Anger and Aggression Attachment

D Benoit, J Coolbear, and A Crawford

K Bernard and M Dozier

R E Tremblay

G Posada

Autism Spectrum Disorders

1 12 18 30

G Dawson and L Sterling

41

B Birth Order

D L Paulhus

Breastfeeding

49

R A Lawrence

56

C Child and Day Care, Effects of Crying

A Clarke-Stewart and J L Miner

B M Lester and L L LaGasse

69 80

D Depression

J Luby, M M Stalets, and A Belden

Discipline and Compliance Divorce

J E Grusec, A Almas, and K Willoughby

J S Wallerstein

91 98 108

E Emotion Regulation

R A Thompson, S Meyer, and R Jochem

Empathy and Prosocial Behavior

J Robinson

119 129

v

vi

Contents

F Family Influences

B H Fiese and M A Winter

139

Fear and Wariness

J Kagan

148

Friends and Peers

C Howes

156

G Gender: Awareness, Identity, and Stereotyping

K M Zosuls, L E Lurye, and D N Ruble

167

H Head Start Humor

J W Hagen and F G Lamb-Parker

179

D Bergen

189

I Imitation and Modeling

A N Meltzoff and R A Williamson

Independence/Dependence

S C Mangelsdorf and M S Wong

199 208

M Marital Relationship D E Szwedo

M J Cox, N Heilbron, W R Mills-Koonce, A Pressel, C W Oppenheimer, and 219

Maternal and Paternal Employment, Effects of Mental Health, Infant

W A Goldberg and R Lucas-Thompson

P D Zeanah, M M Gleason, and C H Zeanah

229 241

N Nature vs. Nurture

B M D’Onofrio

251

P Parental Chronic Mental Illness Parental Leave

T Ostler and B Ackerson

J S Hyde and J L Petersen

Parenting Styles and their Effects Play

M H Bornstein and D Zlotnik

M Sumaroka and M H Bornstein

Postpartum Depression, Effects on Infant Pragmatic Development

274 280 293

D M Teti and N Towe-Goodman

N Akhtar and K Herold

Preschool and Nursery School

263

H H Raikes, C Edwards, and J Jones-Branch

302 313 322

R Risk and Resilience Routines

L M Gutman

B H Fiese and R S Everhart

333 343

Contents

vii

S Self Knowledge

A E Bigelow

Self-Regulatory Processes

C B Kopp

Separation and Stranger Anxiety Shyness

353 364

A Scher and J Harel

J B Asendorpf

Siblings and Sibling Rivalry Smiling

389 N Howe and H E Recchia

D Messinger

Stress and Coping

C R Thomann and A S Carter

E Tronick

420 429

Social–Emotional Development Assessment Socialization

397 407

Social and Emotional Development Theories Social Interaction

380

L Godoy, A S Carter, and R Clark

R D Parke, M S Leidy, T J Schofield, M A Miller, and K L Morris E M Cummings and C D Kouros

437 446 457

T Television: Uses and Effects Temperament Theory of Mind Twins

J P Murray and A D Murray

M K Rothbart and M A Gartstein J W Astington and L A Dack

L F DiLalla, P Y Mullineaux, and K K Elam

471 480 495 508

V Vygotsky’s Sociocultural Theory Index

M Gauvain

519 529


CONTRIBUTORS

B Ackerson University of Illinois at Urbana–Champaign, Urbana, IL, USA

A Crawford University of Toronto, Toronto, ON, Canada Mount Sinai Hospital, Toronto, ON, Canada

N Akhtar University of California, Santa Cruz, Santa Cruz, CA, USA

E M Cummings University of Notre Dame, Notre Dame, IN, USA

A Almas University of Toronto, Toronto, ON, Canada J B Asendorpf Humboldt-Universita¨t zu Berlin, Berlin, Germany J W Astington University of Toronto, Toronto, ON, Canada A Belden Washington University School of Medicine, St. Louis, MO, USA D Benoit University of Toronto, Toronto, ON, Canada The Hospital for Sick Children, Toronto, ON, Canada D Bergen Miami University, Oxford, OH, USA K Bernard University of Delaware, Newark, DE, USA A E Bigelow St. Francis Xavier University, Antigonish, NS, Canada M H Bornstein National Institutes of Health, Bethesda, MD, USA A S Carter University of Massachusetts, Boston, MA, USA R Clark University of Wisconsin, Madison, WI, USA A Clarke-Stewart University of California, Irvine, Irvine, CA, USA J Coolbear University of Toronto, Toronto, ON, Canada The Hospital for Sick Children, Toronto, ON, Canada M J Cox University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

L A Dack University of Toronto, Toronto, ON, Canada G Dawson University of Washington, Seattle, WA, USA L F DiLalla Southern Illinois University School of Medicine, Carbondale, IL, USA B M D’Onofrio Indiana University, Bloomington, IN, USA M Dozier University of Delaware, Newark, DE, USA C Edwards University of Nebraska–Lincoln, Lincoln, NE, USA K K Elam Southern Illinois University School of Medicine, Carbondale, IL, USA R S Everhart Syracuse University, Syracuse, NY, USA B H Fiese Syracuse University, Syracuse, NY, USA M A Gartstein Washington State University, Pullman, WA, USA M Gauvain University of California, Riverside, Riverside, CA, USA M M Gleason Tulane University Health Sciences Center, New Orleans, LA, USA L Godoy University of Massachusetts, Boston, MA, USA W A Goldberg University of California, Irvine, Irvine, CA, USA

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Contributors

J E Grusec University of Toronto, Toronto, ON, Canada

L E Lurye New York University, New York, NY, USA

L M Gutman University of London, London, UK

S C Mangelsdorf University of Illinois at Urbana–Champaign, Urbana, IL, USA

J W Hagen University of Michigan, Ann Arbor, MI, USA J Harel University of Haifa, Haifa, Israel N Heilbron University of North Carolina at Chapel Hill, Chapel Hill, NC, USA K Herold University of California, Santa Cruz, Santa Cruz, CA, USA N Howe Concordia University, Montreál, QC, Canada C Howes University of California, Los Angeles, Los Angeles, CA, USA J S Hyde University of Wisconsin, Madison, WI, USA R Jochem University of California, Davis, Davis, CA, USA J Jones-Branch University of Nebraska–Lincoln, Lincoln, NE, USA

A N Meltzoff University of Washington, Seattle, WA, USA D Messinger University of Miami, Coral Gables, FL, USA S Meyer University of California, Davis, Davis, CA, USA M A Miller University of California, Riverside, Riverside, CA, USA W R Mills-Koonce University of North Carolina at Chapel Hill, Chapel Hill, NC, USA J L Miner University of California, Irvine, Irvine, CA, USA K L Morris University of California, Riverside, Riverside, CA, USA P Y Mullineaux Southern Illinois University School of Medicine, Carbondale, IL, USA

J Kagan Harvard University, Cambridge, MA, USA

J P Murray Kansas State University, Manhattan, KS, USA

C B Kopp Los Angeles, CA, USA

A D Murray Kansas State University, Manhattan, KS, USA

C D Kouros University of Notre Dame, Notre Dame, IN, USA

C W Oppenheimer University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

L L LaGasse Warren Alpert Medical School of Brown University, Providence, RI, USA F G Lamb-Parker Columbia University, New York, NY, USA R A Lawrence University of Rochester School of Medicine and Dentistry, Rochester, NY, USA M S Leidy University of California, Riverside, Riverside, CA, USA B M Lester Warren Alpert Medical School of Brown University, Providence, RI, USA

T Ostler University of Illinois at Urbana–Champaign, Urbana, IL, USA R D Parke University of California, Riverside, Riverside, CA, USA D L Paulhus University of British Columbia, Vancouver, BC, Canada J L Petersen University of Wisconsin, Madison, WI, USA G Posada Purdue University, West Lafayette, IN, USA

J Luby Washington University School of Medicine, St. Louis, MO, USA

A Pressel University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

R Lucas-Thompson University of California, Irvine, Irvine, CA, USA

H H Raikes University of Nebraska–Lincoln, Lincoln, NE, USA

Contributors

H E Recchia Concordia University, Montreál, QC, Canada J Robinson University of Connecticut–Storrs, Storrs, CT, USA M K Rothbart University of Oregon, Eugene, OR, USA D N Ruble New York University, New York, NY, USA A Scher University of Haifa, Haifa, Israel T J Schofield University of California, Riverside, Riverside, CA, USA M M Stalets Washington University School of Medicine, St. Louis, MO, USA L Sterling University of Washington, Seattle, WA, USA M Sumaroka National Institutes of Health, Bethesda, MD, USA D E Szwedo University of Virginia, Charlottesville, VA, USA

xi

N Towe-Goodman The Pennsylvania State University, University Park, PA, USA R E Tremblay University of Montreál, Montreal, QC, Canada E Tronick University of Massachusetts, Boston, MA, USA J S Wallerstein The Judith Wallerstein Center for the Family in Transition, Corte Madera, CA, USA R A Williamson University of Washington, Seattle, WA, USA K Willoughby University of Toronto, Toronto, ON, Canada M A Winter Syracuse University, Syracuse, NY, USA M S Wong University of Illinois at Urbana–Champaign, Urbana, IL, USA P D Zeanah Tulane University Health Sciences Center, New Orleans, LA, USA

D M Teti The Pennsylvania State University, University Park, PA, USA

C H Zeanah Tulane University Health Sciences Center, New Orleans, LA, USA

C R Thomann University of Massachusetts, Boston, MA, USA

D Zlotnik National Institutes of Health, Bethesda, MD, USA

R A Thompson University of California, Davis, Davis, CA, USA

K M Zosuls New York University, New York, NY, USA


PREFACE

In 2008, Elsevier published the three-volume Encyclopedia of Infant and Early Childhood Development, encompassing all aspects of development in the 0–3 age range. Articles were selected on the basis of where there were significant bodies of research and/or significant interest in what constitutes normal development, how it progresses, milestones, and what may adversely or positively affect that development. The original three-volume work was a successful publication for library purchase. It seems a shame, however, to have such succinct, eminently readable research summaries by our most distinguished researchers be limited only to libraries. Hence the birth of this volume, selecting only those articles relating to social and emotional development, and intended for individual purchase. Because the articles are only those that were included on this topic in the larger work, we cannot say that the coverage is necessarily soup to nuts on all topics relating to social and emotional development. We were looking for balance in the larger work across all elements of development, and hence we were selective in topic coverage relative to other aspects of development. What this means is that you have larger, more inclusive articles on those topics with the strongest research base rather than more numerous but narrowly focused topics that could have been largely theoretical.

Contents Several strands run through this work, and they reflect the current themes inherent in the work of developmental psychologists, including the interaction of genes and environment. Of course, the nature-nurture debate is one strand, but no one seriously stands at one or the other end of this controversy any more. Although advances in genetics and behavior genetics have been breathtaking, even the genetics work has documented the role of environment in development, and researchers acknowledge that experience can change the wiring of the brain as well as how actively the genes are expressed. There is increasing appreciation that the child develops in a transactional context, with the child’s effect on the parents and others playing no small role in his or her own development. There has been increasing interest in brain development, partly fostered by the Decade of the Brain in the 1990s, as we have learned more about the role of early experience in shaping the brain and, consequently, personality, emotion, and intelligence. The ‘‘brainy baby’’ movement has rightly aroused interest in infants’ surprising capabilities, but the full picture of how abilities develop is being fleshed out as researchers learn as much about what infants cannot do as well as of what they are able. Parents wait for verifiable information about how advances may promote effective parenting. The central focus of the articles is on typical development. However, considerable attention is also paid to psychological and medical pathology in our attempt to provide readers with a complete picture of the state of knowledge about early social and emotional development. We asked authors to tell a complete story in their articles, assuming that readers will come to this work with a particular topic in mind, rather than reading the volume whole or many articles at one time. As a result, there is some overlap between articles at the edges; one can think of partly overlapping circles of content, which was a design principle in as much as nature does not neatly carve topics in human development into discrete slices for our convenience. At the end of each article, readers will find suggestions for further readings that will permit them to take off in one neighboring direction or another, as well as web sites where they can garner additional information of interest. Coverage in this volume includes articles that span a broad array of topics. For example, there are articles on basic social processes (e.g., attachment, gender awareness and identity, play, friends and peers, siblings, separation anxiety, risk and resilience, theory of mind), emotions and their expression (e.g., anger and aggression, crying, empathy, emotion regulation, fear and wariness, humor, shyness, smiling, temperament), factors that influence social and emotional

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Preface

development (e.g., abuse, neglect, and maltreatment, birth order, child and day care, divorce, nature vs nurture, parental chronic mental illness, television) and theories and frameworks that guide and challenge research on the study of social and emotional development (e.g., attachment, self-regulatory processes, independence/dependence, socialization, temperament, and Vygotsky’s sociocultural theory). Interest in and opinion about early human development is woven through human history from as early as the Greek and Roman eras, repeated through the ages to the current day. Even earlier, the Bible provided advice about nutrition during pregnancy and rearing practices. But the science of human development can be traced back little more than 100 years, and one cannot help but be impressed by the advances in methodologies that are documented in this volume for learning about infants and toddlers. Scientific advances lean heavily on methods, and few areas have matched the growth of knowledge about human development over the last few decades. The reader will be introduced not only to current knowledge in this field but also to how that knowledge is acquired and the promise of these methods for future discoveries.

Audience Articles have been prepared for a broad readership, including advanced undergraduates, graduate students, working professionals in allied fields, parents, and even researchers in their own disciplines. We plan to use several of these articles as readings for our own seminars. A project of this scale involves many actors. We are very appreciative of the advice and review efforts of our original editorial advisory board as well as the efforts of our authors to abide by the guidelines that we set out for them. Nikki Levy, the editor at Elsevier for this work, has been a constant source of wise advice, consolation, and balance. Her vision and encouragement made this project possible. Barbara Makinster, also from Elsevier, provided many valuable suggestions for us, and we thank her, along with the Production team in England. It is difficult to communicate all the complexities of a project this vast; let us just say that we are thankful for the resource base that Elsevier provided. Finally, we thank our families and colleagues for their patience over the past few years. Janette B. Benson and Marshall M. Haith

A Abuse, Neglect, and Maltreatment of Infants D Benoit and J Coolbear, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children, Toronto, ON, Canada A Crawford, University of Toronto, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada ã 2008 D Benoit. Published by Elsevier Inc.

Glossary Adrenocorticotropin-releasing hormone (ACTH) – Hormone released from the pituitary gland through the action of corticotropin-releasing hormone (CRH) as part of the hormonal cascade triggered by stress. ACTH then acts on the adrenal glands to stimulate the release of cortisol. Corticotropin-releasing hormone (CRH) system – In response to stress, a hormonal cascade is triggered by the release of CRH from the hypothalamus. Release is influenced by stress, by blood levels of cortisol, and by the sleep/wake cycle. CRH activates the release of ACTH, which in turn stimulates the release of cortisol from the adrenal glands. Cortisol – Stress hormone that mediates the body’s alarm response to stressful situations. It is produced by the adrenal glands as a result of stimulation by ACTH. Cortisol, secreted into the blood circulation, affects many tissues in the body, including the brain. Hypothalamic–pituitary–adrenal (HPA) axis – The HPA axis is one of the two stress response systems of the body (the other is the sympathetic–adrenal–medullary system), which consists of the hypothalamus, the pituitary gland, and the adrenal glands. The HPA axis activates and coordinates the stress response, through the action of hormones, by receiving and interpreting information from other areas of the brain (amygdala and hippocampus) and from the autonomic nervous system. Reported case of maltreatment – A case where physical, sexual, and emotional abuse, neglect, or exposure to interpersonal violence is suspected and reported to a child protection agency. In many

jurisdictions, the reporting of cases of suspected child maltreatment is required by law. Substantiated case of maltreatment – A case where child maltreatment is confirmed following an investigation.

Introduction The history of childhood is a nightmare from which we have only recently begun to awake. The further back in history one goes, the lower the level of child care and the more likely children are to be killed, abandoned, beaten, terrorized and abused. Lloyd De Mause, The History of Childhood

Infant maltreatment has existed across all cultures, all socioeconomic strata, and in all historical epochs. In fact, there is evidence of infanticide from antiquity. The increasing recognition that children have the right to protection, and that they are not the property of their caregivers, led to the modern child protection movement. In 1874, the advocacy of the Society for the Prevention of Cruelty to Animals in the case of Mary Ellen, a young girl who was severely abused by her stepmother, led to an unprecedented judicial intervention and protection. Shortly afterward, the New York Society for the Prevention of Cruelty to Children was established, which gave rise to the founding of similar societies. Since then the complex social and familial dynamics of child maltreatment have been increasingly recognized. It was not until 1962, however, following a medical symposium the previous year, that several physicians, headed by Denver physician C. Henry Kempe, published the landmark the ‘battered child syndrome’ in the Journal of the American

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Abuse, Neglect, and Maltreatment of Infants

Medical Association. The battered child syndrome described a pattern of child abuse that included both physical and psychological aspects and established it as an area of academic and clinical focus. In the early twenty-first century, the enormous social burden of child maltreatment remains timely, unresolved, and an important public health and policy issue. Every day, clinicians and investigators continue to attend to individual infants and children who are maltreated and make their way through the complexities of healthcare and judicial systems. The impact of maltreatment on infants and children, particularly early and repeated abuse, is one of the most significant emotional and psychological traumas that a child can endure. Unlike other traumatic events in which the infant or child may be soothed by the ameliorating comforting of their caregiver, child maltreatment is most often committed by a caregiver or attachment figure. This double rupture, the lost sense of the safety and predictability of the world, and the loss of caregiver protection and security, make maltreatment a breach of profound magnitude for many infants.

Incidence and Prevalence The incidence and prevalence rates of maltreatment in infancy (i.e., ages 0–3 years) are difficult to ascertain, in part because of the lack of universally accepted definitions of various types of maltreatment across countries. Further, there is consensus that much maltreatment goes unreported and that each year infants die as a result of their caregivers maltreating them. In the US, 3 million reports of child abuse or neglect are made each year and at least 1.5 million are substantiated. In Canada, recent data indicate that, in 2003, over 38 child abuse investigations per 1000 children were conducted and nearly half of the cases were substantiated. Estimates from various European and Eastern European countries reveal that between 3 and 360/1000 of children are maltreated. The wide range of incidence and prevalence rates reflect the varying definitions of maltreatment used in various jurisdictions around the world and the inconsistent reporting, investigation, and recording practices. In every country where relevant data have been collected, neglect occurs up to three times as often as abuse and incidence rates of maltreatment are highest for infants from birth to age 3 years.

Definitions There are no universally accepted definitions of infant or child maltreatment. Definitions also vary depending on the professional discipline involved (e.g., child protection, law enforcement, judiciary, clinical). This

inconsistency hinders the collection of reliable vital statistics and interferes with scientific research on infant maltreatment. The lack of universally accepted definitions of maltreatment may also contribute to delays in protecting maltreated infants and in providing them and their families with adequate assessment and intervention. Table 1 lists various definitions of child maltreatment.

Risk Factors for Maltreatment Infant maltreatment occurs in complex social and interpersonal circumstances. There is no single factor that predicts risk to an infant, and the absence of identifiable risk factors does not confer immunity from maltreatment. Rather, a profile of risk indicators must be considered within the individual, familial, economic, and social contexts of each infant. Most of the data on risk indicators for child maltreatment come from the study of child physical and sexual abuse. Data regarding risk indicators for emotional abuse and neglect are limited. Risk indicators may be broadly separated into child and household or caregiver characteristics. Further, there is support for the position that environmental factors beyond the child’s immediate family or household – such as factors within the local community – may also play a role in creating high-risk caregiving situations. This perspective on the human ecology of child maltreatment posits that social impoverishment, such as low socioeconomic neighborhoods, poor community social support networks, observable criminal behavior within the community, poor housing conditions, and poor access to social services and programs, are environmental correlates of child maltreatment, and that rates of child maltreatment may be responsive to social change. Most information about risk factors related to child maltreatment comes from research on children older than age 3 years and this is reflected in the information provided in the following. Child Factors 1. Age. American epidemiologic data indicate that incidence rates for child maltreatment are highest in infants, up to age 3 years. 2. Gender. In the 0–3 age group, based on Canadian data, rates of substantiated maltreatment for males and females are similar overall (51% vs. 49%, respectively). More females are physically abused (57%) sexually abused (53%), and emotionally maltreated (56%) in this age group, while more males are neglected (58%). 3. Child psychological and developmental functioning. Problems in the areas of psychological and developmental functioning and disability in children who are maltreated are likely under-reported, as not all children receive professional assessment. A large-scale Canadian study


Table 1

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Definition of child maltreatment

1. Emotional maltreatment a. Emotional abuse (child has suffered or is at substantial risk of suffering from mental, emotional, or developmental problems caused by overly hostile, punitive treatment, or habitual or extreme verbal abuse such as threatening, belittling, etc.) b. Nonorganic failure to thrive c. Emotional neglect (child has suffered or is at substantial risk of suffering from mental, emotional, or developmental problems caused by inadequate nurturance/affection) d. Exposure to nonintimate violence (between adults other than caregivers) – e.g., child’s father and an acquaintance 2. Exposure to domestic violence a. Child directly witnesses the violence b. Child indirectly witnesses the violence (e.g., sees the physical injuries on caregiver the next day or overhears the violence) 3. Neglect a. Failure to supervise – physical harm (including situations where child was harmed or endangered as a result of caregiver’s actions, e.g., drunk driving with a child, or engaging in dangerous criminal activity with child) b. Failure to supervise – sexual abuse (caregiver knew or should have known of risk and failed to protect) c. Physical neglect (e.g., inadequate nutrition, clothing, unhygienic or dangerous living conditions) d. Medical neglect (caregiver does not provide, refuses, or is unavailable/unable to consent to treatment, including dental services) e. Failure to provide psychological/psychiatric treatment (also includes failing to provide treatment for school-related problems such as learning or behavior problems, infant development problems) f. Permitting criminal behavior (caregiver permits or fails/unable to supervise enough) g. Abandonment (caregiver died or unable to exercise custodial rights and no provisions made for care of child) h. Educational neglect (knowingly allows chronic truancy (5 days/month), fails to enroll child, repeatedly keeps child at home) 4. Physical abuse a. Shake, push, grab, or throw (including pulling, dragging, shaking) b. Hit with hand (e.g., slapping and spanking) c. Punch, kick, or bite (also hitting with other parts of the body – e.g., elbow, head) d. Hit with object (e.g., stick, belt; throwing an object at a child) e. Other physical abuse (e.g., choking, stabbing, strangling, shooting, poisoning, abusive use of restraints) 5. Sexual abuse a. Penetration (penile, digital, or object penetration of vagina or anus) b. Attempted penetration c. Oral sex d. Fondling e. Sex talk (proposition, encouragement, or suggestion of a sexual nature; face to face, telephone, written, internet, exposing child to pornographic material) f. Voyeurism (perpetrator observes child for own sexual gratification) g. Exhibitionism (perpetrator exhibited self for own sexual gratification) h. Exploitation (e.g., pornography, prostitution) Adapted from Trocme´ N, Fallon B, MacLaurin B, et al. (2005) Canadian incidence study of reported child abuse and neglect – 2003: Major findings. Minister of Public Works and Government Services Canada. http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/index.html (accessed on May 2007).

that relied on reports by child protection workers, found that child functioning, in the areas of physical, cognitive, behavioral, and/or emotional health, is estimated to be impaired in 50% of cases where child maltreatment has been substantiated. In about onethird of cases at least one problem related to physical health and emotional and/or cognitive functioning is documented, with the most common concerns being depression or anxiety, followed by learning disability. Ten per cent of maltreated children have a developmental delay. In 40% of cases where child maltreatment is investigated, behavioral concerns are identified. It is important to remember that these child-functioning characteristics are not necessarily causal in the maltreatment, and may be sequelae of the maltreatment. An American study reported that, in 34 states surveyed,

6.5% of all victims of child maltreatment had a disability, defined as mental retardation, emotional disturbance, visual impairment, learning disability, physical disability, behavioral problem, or medical problem.

Household and Caregiver Factors 1. Family structure. Estimates suggest that 43% of maltreated children live in single-parent families. Nearly one-third of cases involve children living with both biological parents. Approximately 16% of maltreated children live in blended families with a step-parent as caregiver. In cases of sexual abuse, the absence of a biological parent in the household or the presence of a stepfather are particular risk indicators, whereas


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single-parent status is a risk indicator for physical abuse and neglect. Age of primary caregiver. Overall, both male (80%) and female (64%) caregivers who maltreat children tend to be over 30 years of age. The proportion of females under 30 years of age is somewhat increased for neglect and emotional maltreatment. Gender of perpetrator. The majority of nonmentally ill caregivers who cause child maltreatment fatalities are male; however, the younger the maltreated child is, the more likely the perpetrator is to be the child’s mother. Men and women both appear to be equally culpable of nonaccidental injury. Men are overwhelmingly more often the perpetrators in the sexual abuse of both girls and boys (95% and 80% of the time, respectively). Children are twice as likely to be neglected by women than by men, reflecting the fact that women are more often primary caregivers of young children than men. Number of siblings in the household. In 65% of cases the maltreated child has at least one other sibling who is living in the household and is also investigated for allegations of child maltreatment. Socioeconomic status. The primary income in families where there is child maltreatment is from full-time employment in the majority of cases (57%); 24% of the time, income is from benefits and/or social assistance; and 12% of the time from part-time or seasonal work. In cases of neglect, a higher proportion of families obtain their income from benefits or parttime employment. Housing. The majority of children who are maltreated live in rental accommodations (56%), while 32% live in purchased homes, and 1% live in hostels or shelters. Mental illness. American data demonstrate that of caregivers convicted of criminal offenses pertaining to child maltreatment, more than 50% had received psychiatric treatment, and almost one-third have been admitted to hospital for psychiatric treatment. Forty two percent of these mothers were suffering from either major depression or schizophrenia. Another study estimated that 27% of female caregivers and 18% of male caregivers were identified as having a mental health impairment. Substance abuse. Approximately 18% of female caregivers and 30% of male caregivers abuse alcohol in cases of substantiated child maltreatment. Retrospective data show that rates of physical and sexual abuse are doubled in cases where caregivers are also reported to have a history of alcohol abuse, with rates markedly increased when both caregivers are substance abusers. Caregiver history of maltreatment as a child. There is controversy and conflicting research evidence as to

whether a childhood history of maltreatment in the caregiver increases the risk for abusive or neglectful behavior as a caregiver. In retrospective studies documenting a link between a history of childhood abuse or neglect and abuse or neglect of one’s children, the link is weak. For example, one study indicated that 25% of abusive female caregivers and 18% of abusive male caregivers were maltreated as children; these rates were higher in cases of child neglect and emotional maltreatment. In general, 20% of caregivers who were abused as children go on to abuse their own children, whereas 75% of perpetrators of child sexual abuse report having been sexually abused as children. 10. Prior history of criminality. Men who injure their children more commonly have a history of prior criminality and antisocial personality traits. One study estimated that 16% were involved in criminal activity. Women in these partnerships often have a psychiatric history, and may be incapable of providing protection to the child. 11. Domestic violence. Approximately 50% of female caregivers who maltreat their children have themselves been victims of domestic violence, including physical, sexual, or verbal assault, in the 6 months prior to the child maltreatment.

Impact of Maltreatment During infancy, abuse, neglect, or exposure to interpersonal violence are stressful experiences that can be devastating and may result in pervasive psychological, behavioral, cognitive, and biological deficits. An infant or young child may witness interpersonal violence by being present; or hearing the violence from another room; or seeing bruises, black eyes, broken bones on the caregiver; or by having an incapacitated or unavailable caregiver. Infants and toddlers are more negatively affected when they witness their primary caregiver being threatened or harmed (e.g., being exposed to interpersonal violence) than when they are injured themselves. During infancy, most maltreatment is perpetrated by a caregiver or attachment figure rather than a stranger, and this may have a particularly deleterious impact on the infant. The infant who is maltreated, or is not protected from harm by a caregiver or attachment figure, comes to view the world as unsafe and dangerous; adults as untrustworthy; and the self as unworthy of love, affection, and protection. Such an infant is likely to develop an attachment relationship with his or her primary caregiver that is insecure-disorganized. In turn, insecure-disorganized infant–caregiver attachment is linked to the most negative socioemotional outcomes and the most severe forms of psychopathology (e.g., aggression, social incompetence,


dissociation, difficulty regulating and expressing negative emotions, low self-esteem, and poor school achievement). There is growing evidence to suggest that emotional abuse and neglect, including exposure to interpersonal violence, can create even more harmful consequences for the child’s functioning and outcome than physical and sexual abuse. Chronic childhood trauma interferes with the capacity to integrate and process sensory, cognitive, and emotional information and sets the stage for unfocused and maladaptive responses to subsequent stress. Long-term maltreatment has more pervasive effects than single-incident traumas. Impact on Brain and Development There is considerable evidence to indicate that maltreatment experiences in the early years have a profound effect on the developing brain, affecting both acute and long-term development of neuroendocrine, cognitive, and behavioral systems. Alterations in the central neurobiological systems that occur in response to adverse early-life stress lead to increased and abnormal responsiveness to stress, increase the risk of psychopathology in both childhood and adulthood, and can lead to lifelong psychiatric sequelae such as mood disorders and anxiety disorders (e.g., generalized anxiety disorder, post-traumatic stress disorder (PTSD), and panic disorder). The association between childhood trauma and the development of mood and anxiety disorders may be mediated by changes in the same neurotransmitter and endocrine systems that modulate the stress response and are implicated in adult mood and anxiety disorders (Figure 1). The impact of early adversity may differentially

Stress

Hippocampus

Hypothalamus CRH

Brain

Negative feedback ACTH

Pituitary gland

Cortisol

Adrenal gland

Figure 1 The hypothalamic–pituitary–adrenal (HPA) axis.

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affect individuals; some people with a history of severe maltreatment are well adjusted, while others manifest more profound developmental and psychiatric consequences. This likely has to do with complex gene–environment interactions which are only beginning to be delineated. One theory underlying the relation between genetic predisposition to major psychiatric disorders and the impact of early traumatic experiences during critical phases of development is that persistent changes occur in specific neurobiological systems in response to early stress, which later mediate adaptation to subsequent stressful life events and mood and anxiety symptoms. Specifically, stress has a major impact on the hypothalamic–pituitary–adrenal (HPA) axis, which is one of the two stress response systems of the body and consists of the hypothalamus, the pituitary gland, and the adrenal glands (Figure 1). The HPA axis activates and coordinates the stress response by receiving and interpreting information from other areas of the brain (amygdala and hippocampus) and from the autonomic nervous system. In response to acute situations of stress, a hormonal cascade is triggered with the release of corticotropin-releasing hormone (CRH) from the hypothalamus, which stimulates the release of adrenocorticotropin-releasing hormone (ACTH) from the pituitary gland. ACTH then triggers the production of cortisol within the adrenal cortex which is secreted into the blood circulation. Cortisol then provides negative feedback at the level of the hypothalamus, the pituitary, and the hippocampus, thereby shutting off the stress response. This sequence of hormonal responses and negative feedback allows humans to deal with experiences of stress in ways that allow them to recover from stressful events. There is empirical evidence to suggest that following early-life stress, the set point of HPA-axis activity in response to stress is permanently altered so that subsequent adaptation to stressful situations throughout the lifespan may be affected. In other words, infants who are maltreated and traumatized might later react with overwhelming stress to innocuous or mildly stressful events. There is also evidence to suggest that early-life stress is related to persistent sensitization of pituitary–adrenal and autonomic stress responses, most likely caused by CRH hypersecretion, and may increase risk for psychopathology during adulthood. For example, research shows the implication of the CRH system in adult mood and anxiety disorders. This is because the HPA axis is involved not only in the stress response but also in the development of mood and anxiety disorders. Dysregulation of the CRH and the other downstream hormones (ACTH and cortisol; Figure 1) may explain the symptoms of increased vigilance and enhanced startle response observed in patients with anxiety disorders, such as PTSD, and may in part explain the high incidence of comorbid anxiety and mood disorders. It is important to note that most clinical studies evaluating the impact of childhood trauma on the brain

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have been conducted in adults or children who have a history of physical or sexual abuse. However, different results in these various studies suggest that the effects of early-life stress may be variable and influenced by numerous factors. When the HPA axis is overactivated over long periods (e.g., when an infant is repeatedly stressed by experiences of maltreatment), it becomes dysregulated and creates the production of stress hormones at levels that can be harmful, particularly to a developing brain. Some structural brain changes have been documented in individuals who are victims of child maltreatment, specifically in the hippocampus, prefrontal cortex, and amygdala. Recent data suggest that CRH hypersecretion itself (leading to high levels of cortisol) may be one causative factor in these structural alterations. The stress hormone cortisol prepares us to withstand threatening or stressful events. However, too much cortisol for too long is detrimental to the brain and linked to marked changes in brain activity and structures. Multiple brain regions may be affected by chronic and frequent high levels of cortisol. Specific areas of the brain that are negatively affected by sustained elevations in cortisol over time include: 1. The hippocampus, the brain structure involved in learning and explicit memory (remembering where one left one’s keys is an example of explicit memory); a shrinkage of the hippocampus has been documented in adults who experienced PTSD and presumably produced high levels of cortisol at the time of trauma. 2. The anterior cingulate gyrus, the brain structure involved in selective attention; disruption in this may lead to difficulty focusing attention and inhibiting inappropriate actions.

Healthy brain

Front

3. The amygdala, the brain structure involved in the processing of frightening and negative events; the affected individual becomes more sensitive to negative emotions and is more likely to produce a hormonal stress reaction in situations of perceived threat. 4. The prefrontal cortex is the brain structure that is sensitive to information about the social environment and social partners; affected individuals may find it difficult to act appropriately in social situations (especially for children; however, this area is also developing until late adolescence and early adulthood). 5. The cerebral cortex and corpus callosum. Studies have shown lower intracranial volumes in individuals with PTSD compared to carefully matched controls, in addition to smaller volumes of the corpus callosum (and hippocampus). More global effects include intelligence, which was negatively correlated with duration of maltreatment, and intracranial volume which was correlated with age of onset of maltreatment (Figure 2). Recent data suggest that effects of exposure to increased levels of maternal cortisol, in cases where pregnant women have PTSD, can be observed very early in the life of the offspring and underscore the relevance of in utero contributors to putative biological risk for PTSD. Taken together, these findings strongly suggest that early trauma can be toxic to the developing brain. Neuroimaging studies have documented significant neurobiological changes in three specific areas of the brain of individuals with PTSD compared to individuals without PTSD: the hippocampus (responsible for some aspects of memory), the amygdala (responsible for the emotional and somatic contents of memories), and the

An abused brain

Front

This PET scan of the brain of a normal child shows regions of high (red) and low (blue and black) activity. At birth only primitive structures such as the brainstem (center) are fully functional; in regions like the temporal lobes (top), early childhood experiences wire the circuits.

This PET scan of the brain of a Romanian orphan, who was institutionalized shortly after birth, shows the effect of extreme deprivation in infancy. The temporal lobes (top), which regulate emotions and receive input from the senses, are nearly quiescent. Such children suffer emotional and cognitive problems.

Most active

Back

Back

Figure 2 Effects of maltreatment on brain structures. Reproduced from the CDC website. (see color plate 1).

Least active


medial frontal cortex (responsible for the modulation of the cognitive control of the anxiety response and is probably essential for habituation in normative stress reactions). A current hypothesis attributes the hallmark symptoms of PTSD, exaggerated startle response and flashbacks, to the failure of the hippocampus and medial frontal cortex to dampen the exaggerated symptoms of arousal and distress that are mediated through the amygdala, in response to reminders of the traumatic event.

Impact on Behavior The internal neuroendocrine and neurobiological changes associated with early exposure to maltreatment are often ‘translated’ into observable behavioral symptoms. For example, a subgroup of maltreated infants and young children can suffer from PTSD (Table 2 lists symptoms of PTSD in infants). PTSD is important to recognize in infants exposed to violence and maltreatment as its symptoms are not likely to resolve spontaneously and the associated risk for long-term adverse outcomes if left untreated is high. However, it is important to recognize that not all infants exposed to a traumatic event will develop PTSD and that some infants who develop PTSD will resolve their PTSD symptoms – for example, with appropriate intervention, without long-term consequences.

Table 2

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While PTSD is a serious sequela of early exposure to violence and maltreatment that requires treatment, clinicians must be aware that a group of infants exposed to traumatic events, especially infants who are chronically traumatized by their attachment figures’ abusive and/or neglectful caregiving, may not display prominent symptoms of PTSD. Instead, infants and toddlers who have endured repeated maltreatment, complex trauma, exposure to violence, and other chronic forms of maltreatment often do not meet criteria for PTSD but experience developmental delays across a broad spectrum, including physical, cognitive, affective, language, motor, and socialization skills. As a result of their multiple developmental delays, they tend to display complex disturbances with a variety of often fluctuating presentations that are qualitatively different from the clinical presentation of an infant with PTSD. The lack of capacity for emotional self-regulation is probably the most striking feature of infants who have experienced chronic and complex trauma and may contribute to the various associated symptoms which can be grouped into five major categories: 1. Intrapersonal thoughts/self-concept, such as lack of a continuous, predictable sense of self, a poor sense of separatedness, disturbances of body image, low selfesteem (and related behaviors), shame and guilt, and negative life view.

Diagnostic criteria for post-traumatic stress disorder in infants and young children

1. The child has been exposed to a traumatic event – i.e., an event involving actual or threatened death or serious injury or threat to the physical or psychological integrity of the child or another person 2. A re-experiencing of the traumatic event(s) as evidenced by at least one of the following: a. Post-traumatic play b. Recurrent and intrusive recollections of the traumatic event outside play c. Repeated nightmares d. Psychological distress, expressed in language or behavior, at exposure to reminders of the trauma e. Recurrent episodes of flashback or dissociation 3. A numbing of responsiveness or interference with developmental momentum, appearing or being intensified after the trauma and revealed by at least one of the following: a. Increased social withdrawal b. Restricted range of affect c. Markedly diminished interest or participation in significant activities d. Efforts to avoid activities, places, or people that arouse recollection of the trauma 4. Symptoms of increased arousal that appear after a traumatic event, as revealed by at least two of the following: a. Difficulty going to sleep, evidenced by strong bedtime protest, difficulty falling asleep, or repeated night waking unrelated to nightmares b. Difficulty concentrating c. Hypervigilance d. Exaggerated startle response e. Increased irritability, outbursts of anger or extreme fussiness, or temper tantrums 5. This pattern of symptoms persists for at least 1 month. Associated features include a temporary loss of previously acquired developmental skills; aggression toward peers, adults, or animals; fears not present before the trauma (e.g., separation anxiety, fear of toileting alone, fear of the dark); and sexual and aggressive behaviors inappropriate for a child’s age. Adapted from The DC:0–3R Revision Task Force (2005) DC:0–3R – Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Rev. edn. Arlington, VA: Zero to Three Press.

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2. Emotional health, such as dissociative experiences (e.g., distinct alterations in states of consciousness, amnesia, depersonalization and derealization, impaired memory for state-based events); problems with affect regulation (e.g., difficulty with emotional self-regulation, difficulty labeling and expressing feelings, problems knowing and describing internal states, and difficulty communicating wishes and needs); impaired behavioral control (e.g., poor modulation of impulses, self-destructive behavior, aggression toward others, pathological self-soothing behavior, sleep and eating disturbances, substance abuse, excessive compliance, oppositional behavior/ difficulty understanding and complying with rules, re-enactment of trauma in behavior or play with sexual, aggressive themes); anxiety disorders (e.g., separation anxiety disorder, PTSD); mood disorders; suicidal thoughts (e.g., children exposed to domestic violence have a six times higher likelihood of attempting suicide compared to children who did not grow up in violent homes); personality disorder (e.g., borderline, narcissistic, paranoid, obsessive–compulsive). 3. Interpersonal relationships (e.g., disorganized infant– caregiver attachment; problems with boundaries; distrust and suspiciousness; social isolation), interpersonal difficulties (low social competency, difficulty attuning to other people’s emotional states, decreased capacity for empathy/sympathy for others, difficulty with perspective taking); noncompliance; oppositional defiant disorder; disruptive or antisocial behaviors; delinquency/criminality (74% greater chance of committing crimes against a person); sexual maladjustment (abuse toward dating partner; 24% greater chance of committing sexual assault crimes; sexual dysfunctions in women); dependency. 4. Learning/cognition (e.g., difficulties with object constancy, attention regulation, focusing on and completing tasks, executive functioning, planning and anticipating, processing novel information, understanding responsibility; lack of sustained curiosity); learning difficulties or low academic achievement; problems with language development and orientation in time and space; impaired moral reasoning. 5. Physical health/biology (e.g., increased medical problems or complaints across the lifespan such as failure to thrive, asthma, skin problems, pseudoseizures, somatization, pelvic pain, autoimmune disorders; high mortality; sensorimotor developmental problems; analgesia; problems with coordination, balance, muscle tone).

Assessment Maltreated infants represent a heterogeneous population. Maltreatment refers to a range of abusive/neglectful caregiver behavior that varies along a number of different

dimensions (e.g., severity, duration) and, as a result, the outcomes for these infants are not uniform or universal. Some infants may be asymptomatic, while others present as being significantly impacted by their adverse experiences. A comprehensive clinical assessment helps to determine the unique impact of maltreatment on the individual infant. Because of potential police, child protection, and court involvement, assessments need to be forensically sound. Various published guidelines summarize the domains to be addressed when assessing the impact of child maltreatment and determining the most appropriate treatment recommendations. The American Academy of Child and Adolescent Psychiatry has published several separate assessment guidelines depending on the age of the child, the presenting problem, and the focus of the assessment. For example, the following assessment guidelines would be relevant when assessing concerns related to child maltreatment: the assessment of infants and toddlers, the forensic evaluation for children and adolescents who may have been sexually abused, the assessment of PTSD, the assessment of sexually abusive children, and the assessment of reactive attachment disorder. The American Professional Society on the Abuse of Children has also published guidelines, including guidelines for the assessment of suspected psychological treatment in children and adolescents. Finally, the Zero to Three/National Center for Clinical Infant Programs also provides guidelines for the assessment of very young children. These various guidelines generally recommend a multidimensional approach to gathering information, including obtaining information from multiple sources (e.g., caregivers, child, daycare or school, child protection workers, police) and using a variety of assessment methods (e.g., clinical interview, structured and semistructured diagnostic interviews, questionnaires, observation). Evaluation of the young child’s strengths and vulnerabilities within the various overlapping domains of development (e.g., biological, social, emotional, behavioral, cognitive) is essential. This information must then be placed within the child’s environmental context (e.g., caregiver–child relationship, family systems and beliefs, socioeconomic circumstances). Interviews with the child’s caregivers allow the assessor to gather information about the developmental history of the child to determine the child’s overall level of functioning before and after the child’s experiences of maltreatment. It also allows the assessor to gather information about the child’s caregivers (including trauma history, mental health history, substance abuse history, and environmental stressors such as poverty, exposure to domestic or community violence) in order to determine the caregivers’ strengths and vulnerabilities and their ability to support the child and participate in recommended interventions.


A direct interview with the very young child may not be possible due to language limitations and cognitive immaturity. Even a young child, however, may be able to provide valuable information about his or her experiences. Information may be gathered from a younger child during a play-based interaction with the assessor using materials appropriate for this age group (e.g., age appropriate toys representing aspects of daily life), and/or direct observation of the child interacting with significant others (e.g., caregivers, teachers, peers). Collateral information provides the assessor with information about the nature and history of the child and family’s involvement with other services and agencies (e.g., mental health, child protective services, education). It is important to gather information about previous child welfare involvement to determine the extent of previously reported child maltreatment. This provides information about the chronic nature of the maltreatment, and the child and family’s response to previous intervention. Interviews with the child’s siblings and other family members (e.g., grandparents) may yield additional information. The main goals of gathering this information are to determine the child’s level of functioning before and after the incident(s) of maltreatment, to determine the presence of any specific psychiatric disorder (e.g., PTSD; Table 2), and to develop an appropriate treatment plan for the child and family. During the first 3 years of life, the quality of the caregiver–child relationship is of primary importance, and therefore is often the central focus of both assessment and intervention. Components of the caregiver–child relationship to be assessed include both the observable interactions between child and caregiver during various structured and unstructured activities (e.g., play, feeding, limit setting) and the caregivers’ perceptions and subjective experience of the child and their relationship with the child (e.g., attributions about the child’s behavior, importance of their role as caregivers). In addition, an assessment of the quality of the child’s attachment relationships with his or her caregivers should be completed. Structured protocols should be used to assess the internal and external aspects of the caregiver–child relationship. Structured protocols can provide valuable information about areas of strength and vulnerability in the caregiver–child relationship which can be targeted during treatment. The assessment should focus on both the child’s general functioning and any maltreatment-specific issues. The assessment of the child’s general functioning is informed by the various overlapping domains of development and the salient developmental tasks and challenges for a child at a particular age and stage of development. The various domains of functioning include: 1. Neurophysiological regulation (e.g., eating, sleeping, and capacity to self-soothe).

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2. Affect regulation (e.g., accurate identification of internal emotional states, differentiation, interpretation, and application of appropriate emotional labels; safe emotional expression; and ability to modulate/regulate internal experiences). When children have an impaired capacity to self-regulate and self-soothe, they may present as emotionally labile, often in response to minor stressors. 3. Social skills and relational difficulties. 4. Emotional – including anxiety, mood, and attachment (separation anxiety, establishing a secure attachment relationship); self-esteem, self-efficacy. 5. Behavioral regulation – undercontrolled (e.g., aggressive, controlling, oppositional) or overcontrolled (e.g., compulsive compliance) behavioral patterns. 6. Cognitive/language development (e.g., expressive/ receptive language, problem-solving, attention, abstract reasoning, executive function skills). 7. Temperament and constitutional characteristics. The assessment of maltreatment-specific issues involves gathering details about each incident of maltreatment that the child has experienced. Relevant information includes the frequency, severity, and chronic nature of all incidents of maltreatment; the nature of the relationship between the child and the individual(s) who is/are maltreating the child; and the family/situational context in which the abuse has occurred. Gaining an understanding of the relationship between each of these factors assists in determining an appropriate intervention. The response of the nonoffending caregiver(s) to the child’s disclosure of maltreatment is one of the strongest predictors of outcome for young children. The level of caregiver support has a significant impact on the child’s level of functioning, and therefore is an important aspect of assessment, and a target for intervention. The presence of a supportive primary caregiver, or a supportive relationship with another important adult, is associated with decreased levels of distress and lower levels of behavior problems. The assessment of the caregiver’s support involves determining the caregiver’s level of belief in and validation of the child’s experience, the caregiver’s emotional availability for the child (e.g., caregiver’s ability to experience a range of emotions, to label the child’s emotional experiences accurately, to tolerate the child’s distress), the caregiver’s own level of distress, and how the caregiver is managing his or her own emotional response.

Treatment Young children who have been maltreated and their families represent a heterogeneous population. Therefore, they require individualized treatment approaches that

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address the unique needs of the child and family. Some treatments target specific individuals (e.g., child, caregiver, family, caregiver–child dyad), specific issues (e.g., anger management, caregiving or parenting skills, addressing mental health concerns, child behavior management), or vary according to treatment modality (e.g., individual, family, group). When children are very young, however, caregivers play a particularly significant role in the child’s assessment, treatment, and recovery. Although interventions vary according to the unique needs of the child and family, and may specifically target the child, caregivers, family, or environment, or various targets simultaneously, all forms of treatment for maltreated infants and their families have three essential, basic components in common, including: 1. Establishing a sense of safety by providing reassurance to the child, and in some situations actually creating a safe environment by removing the child from an unsafe situation, or removing the individuals who are creating an unsafe and/or high-risk situation for the child. The treatment process is hindered if the child experiences repeated exposure to unsafe and stressful situations (e.g., remaining in a home where there is ongoing exposure to domestic violence). 2. Addressing issues of engagement/motivation, as many caregivers involved with the child protection system are obligated to attend treatment rather than seeking treatment voluntarily. 3. Addressing practical issues that may create obstacles to attending treatment (e.g., child-care, transportation, provision of snacks, financial assistance). Other components of interventions may then focus specifically on helping the child and/or the caregiver in the following ways: 1. Helping the ‘child’ to: . Reduce the intensity of affect (e.g., fear, anger) and to regulate their affect, as experiencing maltreatment is often associated with affective dysregulation. . Develop a coherent narrative (the complexity of the narrative will vary depending on the age of the child) of their negative experiences, and to integrate these experiences at a level appropriate to the child’s developmental stage. An aspect of this process may also involve the therapist challenging distorted cognitions associated with the negative experiences (e.g., guilt, responsibility) with children who are old enough. 2. Helping ‘nonmaltreating caregivers’ to: . Be emotionally available and able to respond empathically to the needs of the child. This may include psychoeducation about outcomes associated with different types of maltreatment and helping

caregivers link specific symptoms to the child’s adverse experiences, helping caregivers manage the child’s symptoms within the home environment and develop effective behavior management strategies, and assisting caregivers to negotiate the child welfare and legal systems. This may also involve referring the caregiver for individual treatment as many nonoffending caregivers may also have experienced trauma or violence within the home. 3. Helping the ‘child and caregiver(s)’ to: . Deal with the negative sequelae of the maltreatment (e.g., manage the child’s behavioral disturbance, developmental delay, adjusting to a change in residence, separation from caregivers, financial hardship). Referral for specialized assessment may be necessary (e.g., occupational therapy, speech and language pathology). . Address both abuse-specific (e.g., PTSD) and general psychopathology (e.g., depression, disrupted behavior) in the child and/or caregivers. In recent years there has been an increase in the research exploring the efficacy of a number of different interventions that target maltreated children and their families and incorporate the aforementioned components of intervention. In 2003, the National Crime Victims Research and Treatment Center published a report summarizing the review of several different interventions that have some level of empirical support. Several of these interventions are now considered ‘best practice’ when working with maltreated children and their families. However, these interventions have not been validated for use in children under 3 years of age. The intervention that has received the highest rating and the most empirical support is trauma-focused cognitive behavioral therapy (TF-CBT). This intervention is designed for children as young as 3 years who have experienced sexual abuse, and who are displaying symptoms of PTSD and associated mental health problems (e.g., anxiety, depression, inappropriate sexual behaviors). The treatment model can be adapted to the developmental level of the child. TF-CBT is based on learning and cognitive theories, and is designed to reduce children’s negative behavior and emotional responses, and to identify and correct maladaptive attributions and beliefs related to the sexual abuse. This intervention also involves providing support and teaching skills to the nonoffending caregiver(s) to enhance their coping and their ability to respond to the child’s needs. No comparable intervention has been validated for use with children under 3 years of age. Based on both learning theory and behavioral principles, abuse-focused cognitive behavioral therapy (AB-CBT) focuses on child, caregiver, and family characteristics related to physical abuse. This intervention addresses both the risk factors associated with physical abuse and


the common sequelae for children who have experienced physical abuse (e.g., aggression, poor social competence and relationship skills, trauma-related symptoms). The intervention is comprised of primary caregiver, child, and family systems components and is appropriate for maltreated infants and their families. The third intervention that received a high rating is parent–child interaction therapy (PCIT). This intervention is used with physically abusive caregivers who have children as young as 4 years. PCIT is a caregiver–child relationship intervention that focuses on several goals including improving parenting skills, decreasing child behavior problems, and improving the quality of the caregiver–child relationship. Specifically, the intervention addresses the coercive relationship that has developed between the caregiver and child and pattern of parent response to the child (e.g., high rates of negative interaction, low rates of positive interaction, ineffective parenting strategies, over-reliance on punishment). It also addresses the child’s behavioral difficulties (e.g., aggression, defiance, noncompliance, and resistance in response to caregivers’ requests). Although there are no published reports of its efficacy in treating infants, there is clinical evidence that PCIT may be appropriate for maltreated infants and their families. Lieberman and Van Horn’s (2000) child–parent psychotherapy for young children who have been exposed to family violence is a relationship-based treatment model that has several basic premises. These include the premise that the child–caregiver attachment relationship is of paramount importance as the main organizer of children’s responses to danger and safety within the first 5 years of life, that emotional and behavioral problems in young children need to be addressed within the context of the child’s primary attachment relationships, that risk factors during the first 5 years of life operate within the context of transactions between the child and the child’s ecological environment (e.g., family, neighborhood, community), and that interpersonal violence is a traumatic stressor that has specific adverse effects on those who witness and/or experience it. Although this intervention has not yet received the empirical support of the previously described interventions, it is based on sound theory, and is an accepted clinical approach used by experts in the field. Research exploring the efficacy of this intervention would provide additional support for its use.

Conclusion Maltreatment during infancy, a formative period of both physical and psychological growth, presents serious challenges to development. Such disruptions continue to

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impact many maltreated infants and produce deleterious short- and long-term effects on the infant’s brain and behavior. Maltreated infants require early identification along with appropriate assessment and interventions. The aim and ongoing task, at both a policy and clinical practice level, involves the prevention of serious, negative longterm sequelae of maltreatment. See also: Attachment; Emotion Regulation; Mental Health, Infant; Risk and Resilience; Stress and Coping; Temperament.

Suggested Readings Glaser D (2000) Child abuse and neglect and the brain – a review. Journal of Child Psychology and Psychiatry 41: 97–116. Kaplan SJ, Pelcovitz D, and Labruna V (1999) Child and adolescent abuse and neglect research: A review of the past 10 years. Part 1: Physical and emotional abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry 38: 1214–1222. Larrieu JA and Zeanah CH (2004) Treating parent–infant relationships in the context of maltreatment: An integrated systems approach. In: Sameroff AJ McDonough SC, and Rosenblum KL (eds.) Treating Parent–Infant Relationship Problems – Strategies for Interventions, pp. 243–267. New York: Guiford Press. Lieberman AF and Van Horn P (2000) Don’t Hit My Mommy! A Manual for Child–Parent Psychotherapy with Young Witnesses of Family Violence. Washington DC: Zero to Three Press. Nemeroff CB (2004) Neurobiological consequences of childhood trauma. Journal of Clinical Psychiatry 65(supplement 1): 18–28. Osofsky J (ed.) (2004) Young Children and Trauma: Intervention and Treatment. New York: Guilford Press. Perry BD (2004) Maltreatment and the Developing Child: How Early Childhood Experience Shapes Child and Culture. The Margaret McCain Lecture Series. http://www.lfcc.on.ca (accessed May 2007). Scheeringa MS and Gaensbauer TJ (2000) Posttraumatic stress disorder. In: Zeanah CH (ed.) Handbook of Infant Mental Health pp. 369–381. New York: Guilford Press. The DC:0–3R Revision Task Force (2005) DC:0–3R – Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Rev. edn. Arlington, VA: Zero to Three Press. Trocme´ N, Fallon B, MacLaurin B, et al. (2005) Canadian incidence study of reported child abuse and neglect – 2003: Major findings. Minister of Public Works and Government Services Canada. http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/index.html (accessed on May 2007).

Relevant Websites http://www.nctsn.org – National Child Traumatic Stress Network. http://www.musc.edu/ncvc – National Crime Victims Research and Treatment Center – Child Physical and Sexual Abuse: Guidelines for Treatment (Revised Report: April 25, 2004). http://www.apsac.org – Practice guidelines from the American Professional Society on the Abuse of Children. http://www.aacap.org – Practice parameters from the American Academy of Child and Adolescent Psychiatry pertaining to the psychiatric assessment of infants and toddlers (0–36 months).

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Adoption and Foster Placement

Adoption and Foster Placement K Bernard and M Dozier, University of Delaware, Newark, DE, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Adoption – The permanent placement of a child in surrogate care involving the legal transfer of parental rights from the biological parents to the adoptive caregiver(s). Attachment – The affectional tie from a child to his or her caregiver which is further characterized by a child’s use of that figure as a safe haven for comfort and a secure base for exploration. Foster care – The temporary placement of a child in surrogate care through the public child welfare system.fm>/glossary-def> Institutional care – A common pre-placement experience of internationally adopted children involving group care in a residential facility, such as an orphanage. Kinship care – The formal or informal foster care placement with biological relatives rather than unrelated foster caregivers. Maltreatment – Acts of physical abuse, sexual abuse, emotional abuse, and/or neglect against a child. Open adoption – Type of adoption involving continued contact among biological parents, adoptive parents, and children. Surrogate care – The general term for a caregiving arrangement in which someone other than the biological parent is caring for the child; different types of surrogate care vary in duration and degree of permanency.

Introduction Children’s early relationships have important effects on physical, emotional, and social development. Needs of nutrition, affection, and stimulation are all met within the immediate context of caregiving and the broader context of family environment. Adverse prenatal conditions (e.g., malnutrition, drug exposure) along with postnatal adversities (e.g., poverty, maltreatment, neglect) threaten the well-being of a child and may result in removal from biological parents and placement in alternative care. Whereas these disruptions in care may be necessary for the safety of the child, any changes may have considerable effects on development.

Foster care and adoption are two types of surrogate care with inherent developmental risk factors. The foster care system serves to protect children from adverse living and family environments by placing them in out of home care. Placement in foster care may result from child neglect, abuse, homelessness, abandonment, or parental problems (e.g., incarceration, substance abuse, illness). Adoption is the permanent placement of a child with substitute caregivers involving the legal transfer of parental rights. Adoptions can be classified as domestic or international. Domestic adoption (i.e., adoption of children from within the US) often takes place through the public child welfare system. Private domestic adoptions can be arranged directly between birth parents and adoptive parents with the help of an intermediary or through private statelicensed agencies. Although nearly twice as many children are adopted domestically as internationally, the number adopted internationally has increased dramatically since the mid-1990s. Children adopted internationally have often spent a considerable amount of time in institutional care, many experiencing inadequate nutrition, poor medical care, and lack of social interaction during that time. While we will primarily focus on foster care and adoption, there are other types of care that are worth mentioning. Kinship care refers to arrangements where relatives care for children when biological parents are unable to do so. In some instances, kinship care allows for children to continue contact with family members. Children in kinship care, however, often remain in problematic environments. Foster children are sometimes placed with relatives through the child welfare system, but informal arrangements, both temporary and long-term, are often made as well. Adopted and foster children have a range of experiences before and during care which account for individual differences in later adjustment. Infants adopted at birth experience continuous care and show positive outcomes as a group. These children look comparable to children raised continuously by a biological parent. Thus, we will mainly focus on children who have not experienced continuity in care, specifically children placed in foster care or adoptive homes following experiences with a previous caregiver (e.g., biological parent, institutional caregiver). Pre-placement experiences of children who are not placed at birth may involve multiple stressors. Furthermore, changing caregivers represents a major disruption in a child’s life. Whether or not significant problems result depends considerably on the quality of subsequent care.


Attachment

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According to attachment theory, as proposed by John Bowlby, there is an evolutionary benefit of forming a close relationship with a primary caregiver. Attachment behaviors (e.g., crying, reaching, crawling) serve to increase proximity between an infant and his or her caregiver. The attachment is the tie from a child to a specific attachment figure characterized by the use of that figure as a secure base for comfort and exploration. The attachment behavioral system is activated when an infant perceives a threat. An infant seeks his or her primary caregiver upon becoming frightened, hurt, or distressed, but engages in exploration of the environment when threat is minimal. Typically, a pattern of attachment develops within the first year of life. By 12 months of age, most infants will have expectations of attachment figures that are based on repeated interactions. Infants form coping strategies, or organized behavioral responses, that reflect these expectations. Given that a key developmental task for infants and young children is forming and maintaining attachments to primary caregivers, it is not surprising that the conditions associated with foster and adoptive care are often challenging for children.

in the US was fewer than the number of couples wishing to adopt. Recent US legislation has focused on policy regarding the domestic adoption of children in foster care. In 1980, the Adoption Assistance and Child Welfare Act established the goal of permanent placement of children in foster care through either timely return to biological parents or planning for adoption. Although there was a reduction in the number of children in foster care immediately following this legislation, it did not last and length of time spent in foster care remained high. The Adoption and Safe Families Act (ASFA) of 1997 reiterated goals of serving the best interests of the child. The ASFA stressed that children’s safety was of primary concern when planning for reunification or adoption. The legislation further ordered that attempts at reunification with biological parents should not continue after 15 months of foster care placement; that is, after a child has been in foster care for 15 months of a 22-month period, a petition should be filed for the termination of parental rights. Thus, a primary goal of the ASFA is shorter timeframes for permanent placements. To facilitate permanency planning, the ASFA provides guidelines for adoption policies and increased funding to support adoption planning.

History of Care

Overview of Foster Care

Substitute care was a necessary social convention long before formal legal policies were established. Orphaned children were often cared for by relatives or placed in group care facilities. Early foster care and adoption practices generally served the needs of the caregiver over the needs of the child. Children were placed into homes or adopted into families in order to provide indentured service or labor. In the 1800s, there was an increase in the number of orphaned children in urban areas due to the Industrial Revolution and massive immigration. These dependent children were often sent west by way of ‘orphan trains’ to homes of farm families who provided free care in exchange for the children working for them. In the early 1900s, local foster families were proposed as an alternative to previously accepted solutions for orphans. Formal agencies were established to supervise this practice. In 1851, the first legal adoption policies were established in Massachusetts which outlined the nature and requirements of transferring care. By 1929, all states had developed legislation for adoption practice. Infant adoption became popular during the early 1900s due to decreased birth rates. Following World War II, international adoption became prevalent to aid in the care of children orphaned as a result of the war. International adoption persisted as the number of adoptable infants

The US Department of Health and Human Services estimated that there were 518 000 children under the age of 20 years in foster care in 2004. This figure represents a significance increase since 1980. The mean age of children in care is 10 years old, but recent trends show increasing numbers of infants and younger children in the system. Of the 305 000 children who entered foster care in 2004, it was estimated that one-third were between birth and 3 years old. In attempts for prevention and early intervention, child welfare agencies have increasingly focused on identifying infants and toddlers who have experienced abuse or neglect. For example, the Child Abuse Prevention and Treatment Act (CAPTA) amendments of 2003 addressed the needs of infants born affected by illegal substance abuse by requiring the notification of child protective services and the development of a plan of safe care. As a result, the identification of cases of prenatal drug exposure may account for the growing number of infants and toddlers entering care. Neglect, the failure to provide adequate care for a child, is a common reason for foster care placement. Abandonment and failure to provide healthcare are considered acts of physical neglect, whereas emotional neglect includes inattention to needs for affection, failure to provide psychological care, and domestic violence. Neglect is associated with numerous stressors including parental

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substance abuse, poverty, and homelessness. Other reasons for entry into foster care include child abuse, parental illness, parental incarceration, and parental death. Decisions about where to place a child involve multiple factors, including availability or willingness of relatives to provide care, proximity of caregivers to birth parents, special needs of the child, and goals of permanence. Placement in nonrelative foster family homes accounted for 46% of the foster care settings in 2004. Other placements included kinship care (24%), institutions (10%), group homes (9%), pre-adoptive homes (4%), trial home visits (4%), runaways (2%), and supervised independent living (1%) as reported by the US Department of Health and Human Services. For the most part, case goals reflect the ASFA of 1997 in supporting reunification with parents or adoption in a relatively short timeframe. Other goals include long-term foster care, emancipation, living with other relatives, and guardianship. Estimates from the US Department of Health and Human Services report that 283 000 children exited foster care in 2004, of whom 54% were reunited with parents or primary caregivers, and 18% were adopted.

US Department of State, that number has grown to approximately 23 000 children who were adopted from other countries in 2005. Asia and Eastern Europe have generally been the major sources of internationally adopted children. In 2005, the top countries of origin for adopted children included China (35%), Russia (20%), Guatemala (17%), and Korea (7%). Many of the children adopted from outside of the US have spent 8 months or more in an institution.

Challenges to Children in Surrogate Care Many children who are adopted or placed in foster care face multiple challenges that put them at risk for maladjustment. Some of these risks relate to the circumstances that they encounter prior to placement (e.g., drug exposure, maltreatment, institutional care) and others relate to the nature of surrogate care itself (e.g., changing caregivers, instability of placement). In considering how these children develop as compared to a normal sample, it is important to keep these factors in mind. Prenatal Substance Exposure

Overview of Adoption Domestic Adoption Adoption is ideal for foster care children for whom reunification with biological parents is not an option because it establishes a stable and permanent home and family environment. According to the US Department of Health and Human Services, there were approximately 52 000 children adopted from foster care in 2004, which represents a recent increase likely due to the ASFA. Of these children, 59% were adopted by foster parents, 16% by other nonrelatives, and 24% by relatives. About one-third years were between the ages of 0 and 3. Private domestic adoptions involve the adoption of infants within the US. Independent adoption refers to the selection and placement of an infant directly between birth parents and adoptive parents, possibly involving a third party for legal assistance. Private adoptions can also be arranged through a profit or nonprofit agency. Stepparent adoptions are another common subcategory of private domestic adoptions, but they typically are not associated with a change in primary caregiver. The number of private domestic adoptions is not easily measured because states are not required to collect or report this information. International Adoption Approximately 6000 children were adopted into the US from overseas following World War II. According to the

According to the National Institute of Drug Abuse, 5.5% of mothers report using illicit drugs while pregnant. Prenatal exposure to harmful substances (e.g., cocaine, tobacco, alcohol) is common among children who are removed from the home. Testing positive for substance use at the time of delivery is the primary reason for foster placements at infancy. Findings concerning the immediate and longterm effects of prenatal drug exposure are inconsistent, but a number of studies do suggest an increased risk for developmental problems. Challenges of studying children with prenatal drug exposure arise due to the confounding effects of other prenatal adversities, such as poor maternal nutrition and poor prenatal care during pregnancy. In substance-exposed infants, there is an increased tendency for physical deficiencies, specifically low head circumference, low birth weight, and growth retardation. Prenatal substance exposure also has subtle developmental effects on the quality of motor responses and regulatory behavior displayed at 1 month of age. Prenatal substance exposure introduces a general susceptibility to significant developmental problems; the environment plays an important role in mediating its effects. Maltreatment Children who are placed into foster or adoptive care have often experienced maltreatment. Maltreatment poses a serious problem, especially when it occurs early in life, at a time when children depend on their parents for almost everything. Adverse experiences during these first few years


threaten the optimal development of attachment relationships, neurobiological regulation systems, and emotional stability. When needs are not met (i.e., cases of neglect) or interactions are frightening (i.e., cases of abuse), children are unable to depend on their caregivers for support. Although infants form attachments to maltreating caregivers, these attachments are often disorganized, leaving children without a strategy for interacting with parents when distressed. Experiences of maltreatment can be overwhelmingly stressful to a child. Facing trauma is especially difficult for infants because they are dependent upon caregivers for help with regulating behavior and physiology. Evidence at the neurobiological level supports the disrupting effects of early adversity. For example, the hypothalamic–pituitary– adrenocortical (HPA) system serves as a regulator of daily functioning and also as a stress response system. Children who have experienced maltreatment often show disruptions to diurnal patterns of hormone (i.e., cortisol) production as well as abnormal neuroendocrine reactions to stressful situations. Institutional Care Many internationally adopted children are in institutional care prior to placement. Early research has been critical in illuminating the debilitating effects of institutional rearing and driving policy change worldwide. In the 1940s and 1950s several researchers, including Rene Spitz and John Bowlby, observed the conditions of institutions and described the devastating effects of minimal stimulation and social isolation. They suggested that sterile caregiving led to significant and sometimes irreparable delays in cognitive and socioemotional development. Researchers continue to study the effects of institutional care through longitudinal studies using comparison samples. The Bucharest Early Intervention Project, for example, studies children raised in Romanian institutions, previously institutionalized Romanian children raised in foster care, and Romanian children raised continuously by their birth parents. Ongoing research initiatives are beneficial in exposing the nature of present-day institutions and in informing policy decisions for children in out-of-home care. Although there are differences in levels of privation between institutions and even within institutions, there are multiple factors that potentially put children at risk. For one, there are often problems with providing physical care and healthcare for children in institutions. Due to the nature of institutional care as a public facility serving many children at the same time, these basic needs may go unmet if funding is poor and number of staff members is low. Delays in physical growth result from inadequate nutrition and medical care, but many adopted children do catch up to the normal range after leaving institutions. The environment of an institution also inhibits development in multiple ways. Limited resources, both

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interpersonal (e.g., staff) and environmental (e.g., toys), lead to inadequate stimulation. Infants may be kept in cribs without opportunities to explore their environment. Another major issue with institutional care is the changes in caregivers. Due to frequent changes in staff and high staff-to-child ratios, children rarely have one primary caregiver. Interactions are often minimal and unaffectionate. The formation of an attachment relationship is difficult when interactions are infrequent and inconsistent. Immediately following institutional care, children also show developmental delays in motor, cognitive, and language abilities as a result of suboptimal levels of stimulation. Recovery of functioning is seen in some domains following adoption, but there is often limited catch-up in areas such as developing discriminating attachments. Changing Caregivers With the exception of children placed into foster or adoptive care at birth, all children in surrogate care have experienced a transition to a new caregiver at least once. Children in foster care often face multiple placements before permanency is established. The experience of changing caregivers has important implications for a child’s representation of self as effective and others as reliable. Older children may reflect on the experience of foster placement or adoption as a form of rejection or abandonment. Infants and younger children, who are unable to conceptualize this experience consciously, are still affected by separations from caregivers. Instead of verbally expressing feelings of rejection, they show difficulty in adjusting to new attachment relationships and difficulty in self-regulation.

Issues in Providing Care Adoptive and foster parents have a unique role in providing care to a child who is not biologically their own. The decision to take on this role is made for different reasons, such as infertility, or a desire to help children in need. Regardless of the reason, providing surrogate care can be a rewarding yet challenging experience. The Caregiving System John Bowlby suggested that there is a behavioral caregiving system that involves a set of parental behaviors (e.g., picking up, carrying) that serve to protect a child. Evolutionarily, the caregiving system functions to ensure reproductive fitness through the survival of one’s child. The development of this set of caregiving behaviors occurs across the lifespan. Thus early experiences with a caregiver have implications for later experiences as a caregiver. Also contributing to a caregiver’s behaviors are the specific experiences and history with his or her child. A child’s set

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of characteristics and behaviors affects how that child’s parent will provide care (parenting style); similarly a parent’s set of characteristics and behaviors affects how that parent’s child will seek and accept care (attachment quality). Commitment Whereas in a biologically linked dyad there is the assumption of a stable lasting relationship, this is not always the case with foster care dyads. In foster care, the level of emotional investment from the caregiver is challenged by the nature of foster care as a temporary situation and the lack of biological relatedness. Mary Dozier and colleagues have found that the degree to which foster parents are committed to their children varies with past experience as a foster parent and age of child placement. Specifically, caregivers who have had higher numbers of children in the past reported lower levels of commitment to children presently in their care. Caregivers reported higher levels of commitment to children who were placed at younger ages compared to children placed at older ages. Further, commitment is an important determinant of whether a placement disrupts or endures. Quality of Attachment Attachment quality refers to a child’s expectations of his or her caregiver’s availability and responsiveness. Mary Ainsworth developed the Strange Situation procedure to measure attachment quality. From observations of infants’ behaviors in response to multiple stressful stimuli (e.g., an unfamiliar room, an unfamiliar person, brief separations and reunions from a primary caregiver), Ainsworth generated three primary classifications: secure, avoidant, and resistant. An infant with a secure attachment generally has a caregiver who is nurturing and sensitive to his or her needs. This infant seeks out the caregiver directly when distressed for reassurance. An infant with an avoidant attachment to a particular caregiver typically ignores or turns away from that caregiver in times of stress. Rejecting and unresponsive caregivers generally have infants with avoidant classifications as these infants learn that their caregivers are not available in times of need. An infant with a resistant attachment tends to have inhibited exploration and a mixed strategy in using the caregiver as a secure base characterized by both proximity seeking and angry resistance. A resistant pattern of behavior is the result of inconsistent responding by a caregiver to an infant’s needs. A fourth category of attachment quality was identified by Main and Solomon in 1990 to account for infants who did not clearly fit into the established organized patterns of attachment behavior. The disorganized/disoriented category reflects a breakdown in an infant’s strategy. Behaviors displayed by infants in this category may include contradictory behavior (e.g., approaching the parent with sharply

averted head), apprehensive behavior (e.g., jerking away from the parent with a fearful expression), or confused behavior (e.g., greeting the stranger upon the return of the parent). Disorganized attachment appears to be at least partially the result of caregiving experiences that are frightening, such as abuse. Although infants need their attachment figure as a secure base, they simultaneously fear that figure. Within intact mother–infant dyads, attachment formation is a gradual development over the first year. Because foster children are often placed at developmental points when they would have already developed attachments, the process by which new attachments develop can be observed at an accelerated rate. When young children older than about 1 year of age are first placed with new caregivers, they often show avoidant or resistant behaviors when distressed. These behaviors elicit non-nurturing behaviors from caregivers. Thus, these young children in foster or adoptive care seem to be ‘leading the dance’ with their parents initially. Nonetheless, after several months, children develop attachments to parents based on parent characteristics rather than their own. Unfortunately, these children are prone to develop disorganized attachments unless parents behave in nurturing ways. Some infants in foster care and institutional care display behaviors toward strangers that are extremely disordered, including indiscriminate friendliness and responses of terror. Indiscriminate friendliness describes attempts by infants to use all adults as potential attachment figures. Terror of strangers refers to infants’ responses to all new adults as threatening. Both patterns of response place infants at significant risk, as seeking of any available adult is dangerous and failing to form new relationships is equally detrimental. These anomalous behaviors are captured in the Diagnostic and Statistic Manual (4th edition) criteria for reactive attachment disorder (RAD).

Adjustment Outcomes Although it is difficult to disentangle the effects of surrogate care from the effects of pre-placement experiences and disruptions in care, numerous studies report a heightened risk for maladjustment among these children. In considering how surrogate care affects children’s abilities to regulate their behavior, it is important to look at later outcomes. Due to differences between types of care, we will consider adjustment for each group separately. Infants adopted at birth consistently show favorable outcomes, whereas later-placed children are at increased risk for adjustment problems. Adopted children are at risk for developing problems across multiple domains, including problems in school (e.g., poor concentration, restlessness, ‘attention deficit hyperactivity disorder’) and in peer relationships (e.g., oppositional behavior, aggression).


Externalizing behaviors (e.g., delinquency, substance use) are more common for adopted children than internalizing problems (e.g., depression, anxiety). Adjustment problems greatly diminish by young adulthood. Compared to adopted children, children in foster care are at a higher risk for behavioral and psychological problems. Foster children are more frequently diagnosed with internalizing and externalizing disorders than comparison peers. Children who have experienced foster care are at significant risk for high rates of problems in academic adjustment, social functioning (e.g., antisocial behavior), and emotional competence (e.g., low self-esteem, negative emotionality). The differences in adjustment between foster care children and adopted children may be the result of variations in several factors, such as number of disruptions in care, caregiver characteristics, and preplacement experiences. Factors Affecting Children’s Adjustment Resiliency of children in adoptive and foster care is significantly affected by experiences in subsequent care. Characteristics within the new environment contribute to child functioning, including aspects of the family (e.g., number of children in care, level of income), aspects of the home (e.g., availability of a stimulating and safe environment), and aspects of the community (e.g., school district, support resources). Positive adjustment is associated with authoritative parenting styles, parental acceptance, realistic parental expectations, and flexibility, whereas poorer adjustment is associated with parental annoyance, unrealistic expectations, excessive physical punishment, and inflexibility in parenting. Parental state of mind (autonomous, dismissing, preoccupied, or unresolved), as measured by the ‘Adult Attachment Interview’, reflects how responsive a caregiver is to his or her child’s attachment needs. Autonomous parents, who are consistently sensitive to their infants’ needs, tend to have securely attached infants. Security of attachment is also associated with children’s social and emotional competency. Children’s perceptions of experiences in surrogate care can further contribute to their adjustment. If adopted children represent placement experiences as rejection by biological parents, they may develop negative selfconcepts. Furthermore, these children may have difficulties with identity formation because they do not have access to information from the biological family (e.g., culture, race, history). Open adoption permits the continued connection among all units of the adoptive triad: birth parents, children, and adoptive parents. This practice is becoming more common. Potential benefits include the availability of a child’s medical and preadoption history to the adoptive parent, ability of a birth parent to select an adoptive family, and fewer feelings of abandonment experienced by the child.

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Interventions Adoption and foster care are interventions in and of themselves. Despite the positive intentions of these practices, changes in caregiving pose significant challenges to children. Further intervention programs have been developed to target the needs of children in surrogate care. Research concerning the effectiveness of many of these programs is ongoing. Several interventions for foster children target the need for permanent care. Such programs either focus on achieving timely adoption or preserving the birth mother as a primary caregiver. Shared family foster care is one example of the latter, in which foster parents care for both a biological mother and her child. Thus, caregiving is continuously provided by the biological mother. She is supported and mentored in developing appropriate parenting techniques. Though the models of these programs are empirically based, evidence for their effectiveness is limited at this time. Other intervention programs serve to enhance attachment to a caregiver. Mary Dozier and colleagues developed the Attachment and Biobehavioral Catch-up program which focuses on fostering attachment quality and self-regulation. This 10-session intervention has three primary aims. First, it teaches foster parents how to reinterpret signals from an infant who may appear not to want support. Second, it helps foster parents overcome their own difficulties in providing sensitive care. Third, it helps foster parents learn to provide a very responsive interpersonal world to improve children’s biobehavioral regulation. Thus, parents are helped to change the way in which they respond to their infants’ needs (e.g., behavioral cues, need for contact). Preliminary results from this program support the possibility of helping develop secure behaviors and better regulatory capabilities. Interventions beyond infancy are generally behaviorally based. Philip Fisher developed the Early Intervention Foster Care (EIFC) program for preschool-age children. Through parent training and family therapy, the development of behavioral control abilities in the child. The EIFC targets several domains including case management, child needs, and the caregiver–child relationship. Parents are taught to respond to their children’s needs, support positive child behavior, set limits, and maintain close supervision. The EIFC program also aims to affect neuroendocrine regulation by decreasing child behavior problems and supporting positive parenting processes. Behavioral interventions in middle childhood also teach parents skills in behavior management. The strategies of these programs reflect the changing nature of parent–child relationships later in life. By focusing on parenting strategies, they continue to address any problems as occurring within the dyad rather than within the child.

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Anger and Aggression

Conclusion Children in surrogate care face many challenges that put them at risk for maladjustment. Postplacement experiences have a significant effect on the development of problems later on. Research on interventions that can increase the protective effects of subsequent care can inform policy regarding adoption and foster care practices. See also: Abuse, Neglect, and Maltreatment of Infants; Attachment; Depression; Emotion Regulation; Family Influences; Parenting Styles and their Effects; SelfRegulatory Processes.

Suggested Readings Brodzinsky DM and Palacios JP (eds.) (2005) Psychological Issues in Adoption. Westport, CT: Praeger.

Brodzinsky DM, Smith DW, and Brodzinsky AB (1998) Children’s Adjustment to Adoption: Developmental and Clinical Issues. London: Sage Publications. Dozier M, Albus K, Fisher PA, and Sepulveda S (2002) Interventions for foster parents: Implications for developmental theory. Development and Psychopathology 14: 843–860. Gunnar MR, Bruce J, and Grotevant HD (2000) International adoption of institutionally reared children: Research and policy. Development and Psychopathology 12: 677–693. Lawrence CR, Carlson EA, and Egeland B (2006) The impact of foster care on development. Development and Psychopathology 18: 57–76. Stovall KC and Dozier M (1998) Infants in foster care: An attachment theory perspective. Adoption Quarterly 2: 55–88.

Relevant Websites http://www.adoptioninstitute.org – Evan B. Donaldson Adoption Institute. http://www.acf.hhs.gov – US Department of Health and Human Services, Administration for Children & Families. http://travel.state.gov – US Department of State: Children & Family.

Anger and Aggression R E Tremblay, University of Montreál, Montreal, QC, Canada ã 2008 Elsevier Inc. All rights reserved.

Glossary Aggression – The initiation of an attack. These attacks can directly or indirectly attempt to hurt the victim. The attacks can use different means: physical (e.g., fists, guns, noise), psychological (e.g., insult, blame, shame), or social (e.g., exclude, reject, prevent access to resources). Anger – Considered one of the basic emotional states. Anger can vary in intensity from mild irritation and annoyance to intense fury and rage. It is usually well-expressed by facial expression. Anger is sometimes distinguished from rage with reference to the intensity of the emotional reaction and the capacity to maintain control of one’s behavior. Development – Refers to the physical, psychological, and behavioral changes that occur with time from conception to death. The developmental studies of a specific phenomenon (e.g., anger, aggression) describe the changes over time, the phenomena that are associated with the changes, the causes of these changes, and their consequences. Prevention – Planned activities to avoid the development of a disorder (e.g., chronic anger and

aggression). The activities can target an entire population or a specific subpopulation considered at high risk following studies of risk factors (see ‘risk factor’). Risk factor – A characteristic of individuals shown to precede and be statistically related to the disorder we want to predict (e.g., chronic anger or aggression). A risk factor may be a dichotomy (e.g., boys/girls), a category (e.g., ethnic groups), a rank order (e.g., birth order of sibling), or a continuum (e.g., age). There are generally many risk factors associated with a mental health problem. Risk factors are generally used to divide the population into a high-risk subpopulation and a low-risk subpopulation for preventive interventions (see ‘prevention’).

Introduction To understand present-day ideas concerning human development it is useful to take a historical perspective. Many of our apparently new ideas are in fact old ones that are now packaged with a modern flavor. Much of this


article takes this historical perspective to the development of anger and aggression, as it relates to infancy and early childhood. Anger is considered one of the basic emotional states. Joy, sadness, and fear are among this group of ‘primitive’ emotions, while pride, guilt, and shame are apparently more complex emotions and appear later in life. Aggression is a behavior which often follows anger, but nonhuman animals and humans also use aggression without being angry. A lion hunting for its prey, like a hunter or a hired killer, will be more effective if it remains calm and collected. Anger and aggression are often studied separately. Anger has probably most often been studied in the context of coronary heart disease. In these medical studies of adults, anger is an important part of the Type A Behavioral Pattern, considered one of the best predictors of coronary heart disease. Aggression is also part of the Type A Behavioral Pattern, but it has been most often studied in relation to children’s antisocial behavior problems, conduct disorders, and adult criminality. The aims of this article are to summarize knowledge on the early development of anger and aggression, to highlight to what extent these two developments are linked, and to what extent early development of anger and aggression has consequences for development during later childhood, adolescence, and adulthood. An intergenerational approach is also taken to show that early childhood development of anger and aggression is not only linked to future development of the individual, but also to the past development of his parents, and the future development of his own children. Chronic problems of anger and aggression are thus discussed with reference to risk factors, outcomes, and prevention.

The Development of Anger In the 1972 edition of his psychology textbook, Donald Hebb, a founder of modern neuroscience, wrote: ‘‘Neither a human nor a chimpanzee baby needs to learn how to have a temper tantrum.’’ Is this statement really true? Are humans wired for angry feelings and expression of anger? Have we always believed that this could be true? One of the first extensive discussions on anger was written by Seneca, a Roman lawyer–philosopher–writer born 5 years before Christ. Seneca had been exiled to the isle of Corsica by Emperor Claudius on a charge of adultery. He was obviously angered himself by this exile and decided to reflect on the origin, development, consequences, and prevention of this terrible emotion, of which he said: ‘‘No plague has cost the human race more dear. You will see bloodshed and poisoning, the vile counter charges of criminals, the downfall of cities and whole nations given to destruction, princely persons

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sold at public auction, houses put to the torch, and conflagration that halts not within the city-walls, but makes great stretches of the country glow with hostile flame.’’ His description of an angry human is an excellent introduction to our topic: ‘‘His eyes blaze and sparkle, his whole face is crimson with the blood that surges from the lowest depths of the heart, his lips quiver, his teeth are clenched, his hair bristles and stands on end, his breathing is forced and harsh, his joints crack from writhing, he groans and bellows, bursts out into speech with scarcely intelligible words, strikes his hands together continually, and stamps the ground with his feet; his whole body is excited and performs great angry threats; it is an ugly and horrible picture of distorted and swollen frenzy – you cannot tell whether this vice is more execrable or more hideous.’’ This description of an angry man by Seneca is a splendid caricature of the Type A man who has been shown to be at high risk for coronary heart disease. Seneca went on to compare this behavior pattern to the rage of boars, lions, snakes, and dogs. However, he concluded that only humans experienced anger, because anger is a loss of reason and animals do not possess reason. Seneca had observed early childhood angry reactions and noted that children will, for example, hit the floor in anger because they fell. He thus emphasized the importance of calm educators for children because he believed that children learn angry behavior by imitating their tutors, especially their parents. From this perspective he had anticipated, by 2000 years, the social learning theory of modern psychology. In this he was following the Greek philosopher Aristotle who wrote, in his book on Politics published 400 years earlier, that children’s misbehavior was the result of imitation of adults. One of the first descriptions of anger in an infant by a modern ‘emotion scholar’ comes from Charles Darwin (1809–82). This British geologist and naturalist is also a pioneer of modern psychology with his works on evolution and the expression of emotions in humans and animals. He seems to have written his first description of a temper tantrum in a letter to one of his sisters following a visit to the London Zoo, some 30 years before he published his book on emotions humans and animals : ‘‘I saw also the Ourang-outang in great perfection: the keeper showed her an apple, but would not give it to her, whereupon she threw herself on her back, kicked & cried, precisely like a naughty child. She then looked very sulky & after two or three fits of passion, the keeper said, ‘Jenny if you will stop bawling & be a good girl, I will give you the apple.’ She certainly understood every word of this, &, though like a child, she had great work to stop whining, she at last succeeded, & then got the apple, with which she jumped into an arm chair & began eating it with the most contented countenance imaginable.’’ In the following year, Darwin became father to a son and carefully noted his

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development. He wrote the following description of anger expression at 11 months: ‘‘During the last week has got several times in passion with his playthings, especially when the right one has not been given him.When in a passion he beats & pushes away the offending object.’’ The difference between Darwin’s and Seneca’s view of anger was the evolutionary perspective that Darwin slowly came to construct. Seneca believed that only humans were endowed with reason and passion, while animals had only instincts. Children behaved like animals until they were old enough to receive the ultimate gift, reason. From then on they could feel and express anger. For Seneca, the tantrums of young children were similar to the tantrums of adults, as the tantrums of adults were similar to the rage of animals, but the dividing line was the gifts of reason and passion that were given only to humans. Darwin produced a quantum leap in our perception of the place of humans in the nature of things when he identified the mechanisms that could explain how humans were the product of evolution. The gifts of reason and passion were now simply differences that appeared over time, but functioned with the mechanisms shared with our cousins the great apes, rats, birds, and even mollusks. Darwin suggested that anger had evolved as a mechanism to attain a desired goal. Human and nonhuman animals become angry when they do not get what they want, and anger gives them the energy and determination to overcome the blockage. In fact, that was essentially what Aristotle appeared to mean when he wrote: ‘‘Anger is necessary; without it we cannot succeed at anything. We must use it, not as a leader, but as a soldier.’’ Investigators have recently tried to model temper tantrums of young children mathematically. The main behaviors during a tantrum are kicking, throwing, stamping, and crying. The modal tantrum duration is between 30 and 60 seconds. Tantrums are shorter when the child drops to the floor at the beginning of the tantrum. The longer the tantrum lasts the more likely the child will go from anger expression to distress. Kicking and throwing are mostly associated with anger expression, while stamping and crying tend to be more frequent in the last phase of the tantrum when distress dominates. Modern research with infants has also shown that anger expression can be observed very soon after birth. Infants who express anger on their face when frustrated are more likely to work harder at overcoming the obstacle than children who express sadness. The experiments that reveal these facts are in the true tradition of Darwin’s experiments with animals and children. The infants are seated in a reclining seat. They face a projection screen and a speaker. Infants’ faces are filmed. Their gestures and the emotional expressions on their faces are eventually categorized with a sophisticated coding system of muscle movements. A string is attached to the wrist of the infant. The movement of his arm activates the projection of

infant smiling faces and recording of singing by children. Once children have learned that their arm movement produces the attractive visual display and music, the projector and speakers are turned off. As expected, a substantial increase in frequency of angry facial expressions follows this manipulation. Sad facial expressions also increase, but are almost four times less frequent than anger expressions. At the same time, expressions of joy and surprise almost completely disappear. Investigators have recently shown that infants who show an increase in expressed sadness also have an increase in the cortisol levels assessed from their saliva. Saliva cortisol usually increases when an individual is stressed. Interestingly, no increase in cortisol is observed for infants who become angry. This difference in hormonal reaction gives support to Aristotle and Darwin’s hypothesis that anger is a tool for solving problems, clearly a better tool than sadness. Trainers and athletes clearly use this primitive tool for achieving a goal. The presence of angry reactions following frustration, in the first few months after birth, is a good indication that Seneca was probably wrong when he concluded that children learn from adults to react with anger. However, although infants appear to react with anger spontaneously, they may learn from their environment to gain control over that emotional reaction. Studies of infants’ perceptions of anger expression can help in understanding to what extent their expressions of anger are influenced by their environment. One of the clever observational strategies to test this hypothesis with infants who can crawl (around 8 months of age) is the ‘visual cliff ’: a large table made of thick transparent safety glass, with a design under the glass that gives the crawling child the impression that he is crawling over a shallow cliff that suddenly becomes a deep cliff. The child has to do this crawling in order to get to the other side of the table, where his mother is waiting for him. Mothers are asked through earphones to attract the child by smiling and showing an attractive toy. When the child gets to the middle of the table over the deep end of the cliff, mothers are asked to express on their face one of the following emotions: joy, interest, sadness, anger, or fear. Each mother was previously trained to make the exact facial expression they were meant to use. Results of this experiment clearly show that parent’s expression of the basic emotions are well perceived by the infant, and that their behavior changes accordingly. Indeed, 75% of the children crossed the deep end of the cliff when their mothers expressed joy or interest. Results for the other three emotions were 33% for sadness, 11% for anger, and 0% for fear. Similar results are obtained in a different experiment where children can not see their mother’s facial expressions, but can hear her express the emotions with her voice. The results are similar even when a stranger expresses anger or disgust.


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of children with different ages (cross-sectional studies) such as this one can provide an indication of developmental changes with age. However, following the same children as they grow up (longitudinal studies) will provide more adequate estimates of changes in behavior with age. There are very few longitudinal studies of anger development during early childhood. Interestingly, a Belgian longitudinal study of temper tantrums reported by the mothers of a sample of 126 children at the end of the 1950s essentially replicated the results Goodenough obtained with her Midwest US sample 30 years earlier. Figure 1(b) shows that the percentage of children who threw at least one temper tantrum per day increased from 50% at 9 months of age to 70% at 18 months, and then steadily decreased to a low of approximately 35% at 72 months of age. A recent cross-sectional study of temper tantrums between 18 and 48 months of age among Midwest US children shows the same type of increasing and decreasing curve, but the peak is between 30 and 36 months with somewhat higher percentages at each age.

Thus, soon after birth children express anger, and very soon after, if not at the same time, will react appropriately to angry expressions of parents and strangers. Are children influenced by their environment to the point where they will increase the frequency of angry reactions as they are exposed more and more to angry reactions around them? In the late 1920s, Florence Goodenough, a professor at the University of Minnesota Institute of Child Welfare, did a study that provided interesting information on this question. She asked parents, mostly college graduates, to keep records of their child’s anger outbursts during a 1-month period. Two children were not yet 1 year old (7 and 11 months), nine were between 17 and 23 months, 13 were between 26 and 35 months, 10 were between 36 and 46 months, and the 11 others ranged from 53 to 94 months. One thousand eight hundred seventyeight anger outbursts were recorded, for a mean of approximately one outbursts per 10 h of observation. As shown in Figure 1(a), the number of angry outburst reached a peak between 17 and 23 months of age (1.3 outbursts per 10 h) and decreased afterwards. Comparisons

Frequency of anger outbursts

1.4 1.2 1.0 0.8 0.6 0.4 0.2 0 7–9 months

17–23 months

26–35 months

Children having temper tantrum (%)

53–62 months

72–94 months

Age

(a)

70 60 50 40 30 20 10 0 9 months

(b)

36–46 months

12 months

18 months

24 months

36 months

48 months

60 months

72 months

Age

Figure 1 (a) Frequency of anger outbursts for 10 h of observation. (b) Percentage of children reported to have a temper tantrum at least every day. (a) Adapted from Goodenough FL (1931) Anger in Young Children. Westport, CT: Greenwood Press. (b) Adapted from Sand EA (1966) Contribution a` l’E´tude du De´velopment de l’Enfant: Aspects Me´dico-Sociaux et Psychologiques. Bruxelles: E´ditions de l’Institut de sociologie de l’Universite´ libre de Bruxelles.

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The Development of Aggression Who Becomes a Physically Violent Adolescent? Temper tantrums of 2-year-olds do not often make the newspaper headlines. But the angry adolescents who shot dead 13 school friends in a Columbine high school in 1999 shocked the whole world. Is there a link between temper tantrums of infants and physical violence by adolescents and young adults? To answer this question we need to follow children from early childhood to adolescence. But let us start with one of the longest longitudinal studies of criminal behavior ever. This is a recent analysis of official crimes committed by 500 males between 7 and 70 years of age who had been labeled delinquents during their adolescence. The analysis showed clearly what criminologists are calling the ‘age–crime curve’: the frequency of arrests for physical aggressions increases with age up to early adulthood, and then decreases steadily up to old age. Thus, compared to pre-adolescents and adults, the adolescents and young adults are more likely to be arrested for physical aggression. Much research has been done on adolescents and young adults to understand this phenomenon. Seneca and modern learning theorists believed the explanation came from the fact that young humans learn to physically aggress by imitation of aggressions observed in the home, in the neighborhood, and in the media. This learning would obviously take time, since it peaks during adolescence. Many believe that this is caused by the fact that adolescents are bombarded by media violence and are also victims of bad-peer influence. The older they are, the more they have observed acts of physical aggression, hence are more likely to imitate what they have seen. Two important recent reviews of the literature of violent behavior concluded that physical violence appears during adolescence. Note that the term ‘adolescent violence’ is generally used to refer to behaviors ranging from bullying at school to murder. The first is a 2001 report on violence by the Surgeon General of the US. The second is a 2003 World Health Organization report on violence and health. The latter cites the former and concludes: ‘‘The majority of young people who become violent are adolescent – limited offenders who, in fact, show little or no evidence of high levels of aggression or other problem behaviors during their childhood.’’ However, there is a rival hypothesis to the social learning theory of aggression. This one suggests that there is a biological cause to the age–crime curve. The level of a hormone, testosterone, increases exponentially during adolescence, and this increase is much larger in males than in females. After its peak in early adulthood, testosterone level decreases steadily up to old age. Thus, the hypothesis that testosterone is the cause of increase in violent crimes during adolescence is based

on the observation that increase and decrease in levels of testosterone with age mirrors the increase and decrease in violent crimes, including the sex difference. There is also evidence that the most aggressive animals and humans tend to have higher levels of testosterone. The beauty of the age–crime curve is that it appears to be an extremely robust finding. Adolphe Quetelet, a nineteenth century Belgian astronomer–statistician, came to the same conclusion when he analyzed data he collected on criminal statistics from France in the late 1820s. More recently, a Swiss sociologist replicated the age–crime curve with data on homicides in the seveteenth, eighteenth, and nineteenth centuries. Thus, the violent adolescent and young adult is not a result of life in our modern societies and the advent of movies, television, and computer games. There are, however, at least two major problems with the belief that the age–crime curve describes well the development of human physical aggression: first, it describes the mean trajectory of a sample of highly deviant juvenile males, not the trajectory of the majority of humans; and second, the studies of that curve limited their focus on adolescents and adults. The curve gives the impression that physical aggressions appear with the legal age for criminal responsibility, as if lawmakers had chosen the age for criminal responsibility after detailed studies of child development. Those who decided to study elementary school children to understand the precursors of adolescent delinquency discovered that the children used physical aggression much more than expected. In fact, a North Carolina longitudinal study in the 1980s and 1990s showed that the mean level of physical aggression was decreasing from 10 to 18 years of age in samples of males and females. One explanation for this observation could be that, although the majority of youth reduce the frequency of physical aggressions as they grow older, a minority are increasing their frequency of physical violence and are being processed through the legal system. This would generate the statistics represented in the age–crime curve. To test this hypothesis, we needed to go beyond a description of the mean developmental trajectories of delinquents, and identify the different types of developmental trajectories that children are following. This was done with a longitudinal sample of more than 1000 boys in schools from low socioeconomic areas in Montreál, Canada. The Canadian boys were followed during the 1980s and 1990s, as were the North Carolina children, but this time from kindergarten to high school. Why use males from low socioeconomic areas to study the development of physical aggression? Because poverty has long been associated with higher levels of physical aggression. Results from teacher ratings of the Montreál boys confirmed the North Carolina data. The large majority


of boys from the poorest inner city areas of Canada were using physical aggression less frequently as they grew older. Only a very small group of boys (4%) did not show the declining trend; these were the boys who had the highest level of physical aggression in kindergarten and remained at that level until adolescence. When interviewed at ages 15 and 17 years, they were the boys who reported the highest frequency of physical violence. They were also the ones most frequently found guilty of infractions before 18 years of age. Thus, the increase in physical aggression observed in the age–crime curve during adolescence appears to be produced by the fact that, during this period, the police and judicial system start arresting and convicting individuals who have been physically aggressing others at least since kindergarten. An international team of investigators replicated these finding using five other longitudinal studies in Canada, New Zealand, and the US. When Does Physical Aggression Start? The studies of physical aggression during the school years described earlier show that school children are at their peak frequency during their kindergarten year. If this is the case, when do they start to use physical aggression? There is a long history of case studies of young children being physically aggressive with siblings, peers, and parents. One of the first observation of the ‘developmental origins of aggression’ was published by Augustine of Thagaste in AD 397. This Roman citizen from North Africa, later known as Saint Augustine, was writing his best-selling book Confessions and wanted to reveal to the readers all his sins. Realizing the recall limits of childhood memories, he wondered: ‘‘Who will bring to my mind the sins of my infancy?’’ His solution to the problem was what most modern investigators of aggression development almost never did, being focussed on the learning hypothesis. Since aggression peaked in adolescence, learning of aggression must occur either during adolescence or during elementary school. Augustine reasoned differently. He followed Aristotle in thinking that if the development of something is to be understood, it should be done so from the beginning. He believed that he would learn how he behaved at the beginning if he observed young children, ‘‘for in him I now perceive what I do not remember about myself ?’’ So, after having carefully observed very young children he concluded: ‘‘My parents, and many other prudent people who would not indulge in my whims . . . I struck at them and tried to hurt them as far as I could because they did not obey orders that would be obeyed only to my harm . . . . Thus it is not the infant’s will that is harmless, but the weakness of infant limbs . . . These things are easily put up with, not because they are of little or no account, but because they will disappear with increase in age. This you can prove from the fact that

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the same things cannot be borne with patience when detected in an older person.’’ Almost 1600 years later, in the ‘rage’ section of the The Expression of the Emotions in Man and Animals, Darwin wrote: ‘‘Every one who has had much to do with young children must have seen how naturally they take to biting, when in a passion. It seems as instinctive in them as in young crocodiles, who snap their little jaws as soon as they emerge from the egg.’’ Many present-day child-development experts deny that the physical aggressions of young children are ‘true’ aggressions. Like Seneca’s reasoning concerning anger, they argue that to qualify as an aggression, there must be intent, and infants are not endowed with the capacity to ‘will’. Augustine was probably responding to Seneca when he wrote: ‘‘Thus it is not the infant’s will that is harmless, but the weakness of infant limbs’’. We have seen in the section titled ‘The development of anger’ that experiments with infants clearly show ‘will’ and ‘anger’ within the first few months of life. There is certainly a huge difference between the will of a 16-month-old and the will of a 16-year-old; but the reasoning power of a 16year-old who is physically aggressive with a rival or a girlfriend in a state of rage is often not that different from the 16-month-old who attacks a peer to take an attractive toy. As Augustine writes, the main difference is the weakness of the infant’s limbs. That difference in strength is not in the eyes of the peer who is attacked, but in the eyes of the adult who concludes that there is no real physical aggression in infants because of lack of the ability to will. If we accepted the ‘lack of will’ argument, we would have to declare that there are no true physical aggressions between animals since they cannot ‘will’ like human adults can. Recently, a number of longitudinal epidemiological studies of thousands of children followed from infancy showed that, from the first to the third year after birth, the proportion of children reported by their mothers as using physical aggression increases substantially. This remarkable increase is then followed by a continuous decline in frequency, as seen in Figure 2. The same general developmental picture is drawn whether we use data from different periods, data from different countries, data from different reporting sources (filmed interactions in daycare, parents’ detailed records, or parents’ recall of behavior in the past months), or data from different methodologies (cross-sectional or longitudinal, calculated as an absolute frequency over a given period of time, a relative percentage of social behaviors, a percentage of individuals using the behavior, or a general estimate of the frequency of the behavior). As we described for anger in the previous section, frequency of physical aggression increases rapidly from the first year after birth to approximately the third, and then decreases. Unfortunately, none of the longitudinal studies tracing the

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3.0

2.5

2.0

1.5

1.0

0.5

0 1.5

2.5

3.5

4

5

6

7

8

9

10

11

Figure 2 Trajectories of physical aggression from 1.5 to 11 years after birth. Adapted from Tremblay RE, Nagin D, Se´guin JR, et al. (2004) Physical aggression during early childhood: Trajectories and predictors. Pediatrics 114: e43, and Coˆte´ S, Vaillancount T, LeBlanc JC, Nagin DS, and Tremblay RE (2006) The development of physical aggression from troddlerhood to pre-adolescence: A nation wide longitudinal study of Canadian children. Journal of Abnormal Child Psychology 34: 71–85.

developmental trajectories during early childhood are old enough to report on trajectories of physical aggression during adolescence and adulthood. However, we know from predictive studies that aggression during childhood is the best predictor of aggression during adolescence and adulthood. Thus, although physical aggressions by very young children appear qualitatively different from physical aggressions by adolescents and adults, the trajectory of the former appears to generally lead to the trajectory of the latter. An overview of the available data on the development of physical aggression over the lifespan is summarized in Figure 3: most humans started using physical aggression before they reached 20 months of age; humans use physical aggression most often between 18 and 42 months after birth; if humans are learning to be physically aggressive through imitation, this learning is happening in the first 2 years after birth, and not by watching television and playing video games in middle childhood or adolescence. Humans clearly learn not to use physical aggression, they learn to use alternative solutions, and this learning starts well before they enter school. It appears important to note that this phenomenon does not appear to be restricted to physical aggression and anger. There is growing evidence that it is true also for hyperactivity, stealing (taking things from others), vandalism (destroying others’ belongings), and fraudulent behavior (e.g., lying).

From Physical Aggression to Other Forms of Aggression The preceding discussion focused on the development of physical aggression for two reasons. It is the first form of aggression to appear during development, and it is the form of aggression that has been best studied from a developmental perspective. The second form of aggression to appear is verbal aggression. Children do use their voice to express anger from the start (they yell), but verbal aggression requires ability to use language, like physical aggression requires motor coordination. So, verbal aggression will appear with the development of language during the second and third year after birth. A third form of aggression will appear still later: indirect aggression (sometimes named relational and social aggression). In a physical and verbal aggression the victim is directly confronted; hence the victim knows that he or she is being attacked. An indirect aggression is different, in that it is done behind the victim’s back. For example, the aggressor convinces others not to play with the child he dislikes, or he attempts to destroy his reputation. This type of aggression obviously needs more sophisticated cognitive abilities than physical and verbal aggression. Recent studies have shown that it is clearly present before the end of the fourth year after birth, and that it tends to increase in frequency with age. Interestingly, girls start to use

Frequency of physical aggression


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6 5 CPA 4 3 2 1 0

1

3

10

15

20

30

Age Figure 3 Probable age–physical aggression trajectories from birth to adulthood. Adapted from Tremblay RE (2003) Why socialization fails? The case of chronic physical aggression. In: Lahey BB, Moffit TE, and Caspi A (eds.) Causes of Conduct Disorder and Juvenile Delinquency, pp. 182–224. New York: Guilford. With permission from Guilford Press.

indirect aggression before boys do, and tend to use it more often. This is the exact opposite of the sex differences for physical aggression. One obvious reason is that cognitive skills, language, and self-control develop more rapidly in girls than in boys. From an evolutionary perspective, it also makes sense that females learn to use alternatives to physical aggression more rapidly than males, since they are physically less likely to have an advantage in a physical fight. Recent studies have also documented the links between the development of physical aggression and indirect aggression. As physical aggression decreases, indirect aggression increases, but almost all of the children on a trajectory of very frequent physical aggression since infancy go on a high trajectory of indirect aggression.

From Anger to Aggression We have seen that anger appears in the first few months after birth, and physical aggression increases from the end of the first year after birth to a peak around the third year. How does anger get transformed into physical aggression? To answer this question we must take into account that motor development is important for physical aggression. To push, kick, attack, and throw objects at others, one needs to have the required motor coordination. At 2 months after birth, the angry infant already expresses himself with his muscles. The facial muscles create the angry face, the limb muscles make his arms and legs move in a way that looks erratic, and the muscles of his trunk and legs often succeed in making his whole body arc. By 6 months, the hand and arm movements will be much more coordinated. The child can grasp objects at will and let them drop but throwing objects towards a target will come later. Learning to use his muscles to crawl will then enable the child to approach others and their toys.

Aggressive interactions around toy possession can already be seen between two crawling 9-months-olds. Standing up, walking, and running will then be a major motor progress from the end of the first to the end of the second year. The hands are freed, and running towards and from someone gives the liberty needed to threaten, to attack, and to flee. By 24 months, a normally developed child can do most of the physically aggressive acts that an adult can. The coordination will get much better with neural maturation and practice but, as noted by Saint Augustine, the main difference between a child and an an adult is the weakness of the limbs. There is often no better way to understand development than to observe it on fast-forward. You probably have all seen movies using the fast-forward approach to show the growth of a flower or the movement of an animal. To understand the links between anger in the first year of life and aggression over the next 2.5 years, we can use this approach with notes written by Charles Darwin. In his book Expression of the Emotions in Man and Animals, he writes: ‘‘With one of my own infants, from his eighth day and for some time afterwards, I often observed that the first sign of a screaming-fit, when it could be observed coming on gradually, was a little frown, owing to the contraction of the corrugators of the brows; the capillaries of the naked head and face becoming at the same time reddened with blood. As soon as the screaming-fit actually began, all the muscles round the eyes were strongly contracted, and the mouth widely opened . . .; so that at this early period the features assumed the same form as at a more advanced age.’’ In the following notes he describes the anger and aggressions of his son, William Erasmus (Doddy), from 11 to 38 months. Doddy was born on 27 December 1839 when Darwin was 30 years of age. We start with the entry we cited earlier in this article.

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. 1840, December 8 (11 months): During the last week has got several times in passion with his playthings, especially when the right one has not been given him. When in a passion he beats & pushes away the offending object.

. 1841, January 26 (13 months):

Has for some time often gone into passions for smallest offences – for instance with Anne the nurse for trying to take piece of cake from his lips with her fingers, when he wished her to take it with her mouth – out of his mouth–he tried to slap her face, went scarlet, screamed & shooked his head. How has he learned that slapping gives pain-like the just-born crocodile from egg, learns to snap with its weak jaws, i.e., instinctively.

. 1841, April 15 (16 months):

Jealous of a doll for last fortnight, jealous of Anny (born 2 March 1841), few days ago jealous of my weighing Baby.

. 1842, February (25 months):

I have long observed that the horse-shoe lip of misery is the endeavour to keep mouth closed just before it opens wide for a roar. I have observed during last two months, how curiously Doddy expresses by a modulation of humph of assent ‘‘Yes to be sure’’: As he formerly used to express by a negative whine ‘‘No that I won’t’’ or rather a sort of defiance as much as to say ‘‘if you do so–I will do so’’–I suspect many expressive modulation of tone, come to children before appropriate expressions for their feelings.

. 1842, March 20 (27 months):

Doddy is a great adept at throwing things & when choleric he will hurl books or sticks at Emma. About a month since, he was running to give Anny a push with a little candlestick, when I called sharply to him & he wheeled around & instantly sent the candlestick whirling over my head—He then stood resolute in the middle of the room as if ready to oppose the whole world–peremptorily refused to kiss Anny, but in short time, when I said ‘‘Doddy wont throw a candlestick at Papa’s head’’ & he said ‘‘no wont kiss Papa’’–I shall be curious to observe whether our little girls take so kindly to throwing things when so very young. If they do not, I shall believe it is hereditary in male sex, in the same manner as the S. American colts naturally amble from their parents having been trained.

. 1842, March 26 (27 months):

Doddy was generous enough to give Anny the last mouthful of his gingerbread & today he again put his last crumb on the sofa for Anny to run to & then cried in rather a vainglorious tone ‘Ok kind Doddy, kind Doddy’.

. 1842, April 2 (27 months):

Doddy used bit of a stick as lever to break doll.

. 1842, April 4 (27 months):

During the last fortnight has shown much suspicion (his characteristic) & could not endure anyone laughing, thinking it directed at him. He has lately been very

contradictory; by mistake he one day graciously gave Elizabeth a kiss, but repenting said ‘‘Doddy did not kiss Dziver’’ & when Elizabeth remonstrated by saying ‘‘you may be sorry for it, but you did kiss me.’’ He stuck to it, ‘‘No Doddy did not.’’

. 1843, January 20 (37 months):

Threw some cards at my head for alluding to something he used to say when a baby (Mother writes).

. 1843, February (38 months):

Willy (Doddy) says ‘‘No’’ in the fiercest possible way possible unlike any other child I ever saw (Mother writes).

Risk Factors for Anger and Aggression Problems We have seen that all infants experience anger and use physical aggression. However, most learn to deal with angry emotions and aggressive behavior in a way that will help them integrate well in society, live a healthy life, and have a sense of wellbeing. Children who have problems with anger and aggression are those who are on the high-frequency trajectory shown in Figure 3. The behavior of these children is extremely hard to accept both by their peers and adults, including parents and teachers. Thus, they rightly feel rejected, and this feeling supports their anger and aggression. They are at high risk for school failure, accidents, delinquency, substance abuse, sexual promiscuity, adult criminality, poverty, spouse abuse, child abuse and neglect, coronary heart disease, suicide, and of having children who will repeat this pattern of behavior. Interestingly, there is recent evidence that chimpanzees, who have frequent behavior tantrums, are the most likely to behave in an antisocial way with other members of their group. There are at least three important reasons to understand the risk factors for anger and aggression problems during early childhood. First, because risk factors give an indication of the causal mechanisms leading to the problems. Second, because they suggest means of preventing these problems during early childhood. Third, because prevention of these problems during early childhood should help in preventing lifelong problems, since early childhood appears to be the time when humans naturally learn to regulate anger and aggression. Individual and Environmental Risk Factors As Aristotle suggested a long time ago, if we are to try to understand something, we might as well start at the beginning. Unfortunately, few longitudinal studies have looked at the association between prenatal and perinatal risks of anger and future aggression problems during early childhood. The studies that did address this issue showed that the results were very similar to results from


studies with older children, adolescents, and adults. The main risk factors are family characteristics, parent characteristics, and child characteristics. Family characteristics

Anger and aggression appears to run in families. Genetic causes are clearly involved, and are discussed ahead in the section titled ‘Genetically informative studies’. As children with anger and aggression problems are more at risk of failing in school and not finding a stable job, there is also greater possibility of them forming families that will have low income and thus live in poor environments. These angry and aggressive parents are also more likely to have communication problems, to create a dysfunctional family environment, and to divorce. Thus family poverty, dysfunctional family, and single parenthood are predictors of early childhood anger and aggression problems. Parent characteristics

The intergenerational chain of consequences can especially be seen when we focus on maternal characteristics during pregnancy. Mothers who show more anger during pregnancy are more likely to have infants with early brain activity typical of children with frequent anger expression (greater right-to-left frontal brain activity). Mothers who smoke during pregnancy are more likely to have children on the high physical aggression trajectory. This is true also for pregnant women with low education, pregnant women who report behavior problems during adolescence, pregnant women who had their first child before age 21 years, and mothers of 5-month-old infants who report angry reactions towards their child. Note that many of these characteristics are found in the same mothers, and each additional negative characteristic increases the risk. Child characteristics

Sex of the child is one of the most basic (genetic) risk factor for both anger-expression and high frequency of physical aggression. Girls appear to learn more quickly to regulate their emotions and behavior during early childhood. Thus, with time, the difference between females and males increases. This appears to be true for humans and a number of nonhuman species. From a socially adaptive perspective this makes sense, because in most mammal species females are physically less strong than males. It also makes sense from a reproductive perspective since, as we have seen, female control of their behavior is important for the development of their offspring, both during and after pregnancy. Other child characteristics associated with anger and aggression also tend to have important sex differences, for example, temperament and right-to-left frontal brain functioning in infancy, as well as language development and effortful control during toddlerhood.

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Genetically Informative Studies The longitudinal data on the development of anger and physical aggression from infancy onwards, summarized earlier, indicates that anger and physical aggression are not learned like reading or writing, or an illness children ‘catch’ such as poliomyelitis or smallpox. They are more like crying, smiling, eating, grasping, throwing, and running, which young humans do when the physiological structure is in place. The young human learns to regulate these ‘natural’ behaviors with age, experience, and brain maturation. The learning-to-control process implies regulating your needs to adjust to those of others, and this process is generally labeled ‘socialization’. It is clear that the evolutionary process would have given humans a genetic program coding for all the basic mechanisms so as to react to care, hunger, and threat. Young children’s muscles are activated to cling, yell, push, kick, grab, hit, throw, and run with extreme force when hungry, when angry, or when they are strongly attracted by something. However, stating that humans are genetically programmed to become angry or to physically aggress when needed, is different from stating that the frequency of the anger and physical agressions is genetically programmed. Since all infants who have developed normally show anger and physical agression, but not all do so at the same frequency and with the same vigor, to what extent are these individual differences due to the genetic program they have inherited or to the environment in which they have been growing? The developmental trajectories of physical aggression shown in Figures 2 and 3 clearly indicate that these individual differences exist at any given point, starting in early childhood, but the most interesting phenotype is the development over time. There is obviously intraindividual change over time. We see from the reduction in temper tantrums and physical aggression with age that most children learn to reduce the frequency of behaviors, which they apparently did not need to learn. However, relatively stable differences among individuals remain. What are the gene–environment mechanisms that explain the change and stability? They are possibly very similar to the mechanisms, which explain the developmental trajectories of growth in height. Genes code for the growth mechanisms, but there are individual differences in these codings, as well as environmental differences (e.g., access to food) which lead to stable individual differences. Thus, the individual differences in the frequency of temper tantrums and physical aggressions at one point in time, and over time, can be due to a large number of ‘causes’, for example, individual differences in the genetic coding for neuromodulators (e.g., serotonin and dopamine); hormones (e.g., testosterone); language development, cognitive development, or environmental differences such as mother’s tobacco use during pregnancy; birth complications; sibling and peer behavior;

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and parental care. However, the individual differences that we observe are very likely to be due to interactions between many of these mechanisms, and to what has been labeled epigenetic mechanisms, that is, the changes in gene expression under the influence of the environment. Knowledge on genetic factors which could explain the early development of anger and physical aggression is perilously close to zero. The first reason is that gene– environment interaction studies are recent. The second reason is that there are very few longitudinal studies that have included repeated assessments of anger and physical aggression from early childhood to later childhood. However, the most important problem is that molecular genetic studies and twin studies have concentrated on a global antisocial behavior phenotype and a global type A behavior phenotype. This is an old problem in both the type A behavior and antisocial behavior literature. Genetic studies have simply followed the main trend which tends to rely on measurement scales constructed by lumping items that are shown to correlate at one point in time.

Twin studies

Twins are used to study the genetics of behavior for the same reason that some twins physically look identical while others do not. The twins who look alike have exactly the same genes, while those who do not look alike share only half of their genes, like normal brothers and sisters. If angry and aggressive behavior is determined by genetic factors, we expect that the twins who share the same genes (monozygotic (MZ)) will behave in a similar fashion more than the twins who share only half of their genes (dizygotic (DZ)). The genetics of anger was recently studied with a sample of 2500 adult twin pairs living in the Netherlands. Results showed that almost half (49%) of the variation in anger for the males could be explained by genetic effects. For females, genetic effects explained only 36% of the variation in anger. A strong heritability of the frequency of antisocial behavior was also shown with British, Swedish, and US preadolescent samples. The earliest study of twins to assess gene–environment effects on physical aggression was done with 18-month-old Canadian children. Results showed that 58% of the variation in mother’s reports of physical aggression was explained by genetic factors and 42% by environmental factors, suggesting that there are strong genetic effects on frequency of use of physical aggression during early childhood. Molecular genetic studies

A few molecular genetic studies have shown that levels of anger in males are related to genetic polymorphisms which code for the neurotransmitter, serotonin, often associated with different forms of behavior problems.

The lack of association for females may partly explain the lower genetic effects observed for females in twin studies. Recall that in social situations females appear to be more in control of their anger than men. One of the rare molecular genetic studies of infants’ behavior showed that children with a specific gene (L-DRD4), which codes for the neuromodulator, dopamine, expressed less anger in a frustration test (physical restraint). Interestingly another version of this dopamine-related gene (DRD4-7) appears to prevent the association of cognitive problems and behavior problems. Many molecular genetic studies have attempted to identify polymorphisms related to aggressive behavior, mainly with animal and human adult samples. A large longitudinal study of children born in New Zealand was used to understand specifically to what extent violent behavior during adolescence and adulthood is related to a specific gene (MAOA) which influences neurotransmitters (e.g., dopamine and serotonin) linked to behavior problems. The investigators also took into account to what extent the children who had been brought up in an abusive environment , a well-known risk factor for aggression problems, were affected. Results showed that, of all the most maltreated males, the ones who were at higher risk of being convicted of a violent crime before 27 years of age had the short version of the functional polymorphism in the gene coding for MAOA. This association was also found for conduct disorder assessed between 10 and 18 years of age, antisocial personality symptoms, and disposition to violence measured at 26 years of age. Individuals with a history of chronic physical aggression may be the driving force in these associations, since they are the most likely to be found in each of the assessed categories.

Conclusion: Prevention of Anger and Aggression Problems Seneca was convinced that we could prevent people from ixhibiting angry behavior, and that this would have a major impact on society. He wrote: ‘‘Let us be rid of it altogether; it can do us no good. Without it, we shall more easily and more justly abolish crimes, punish the wicked, and set them upon the better path. The wise man will accomplish his whole duty without the assistance of anything evil, and he will associate with himself nothing which needs to be controlled with anxious care.’’ We saw that Aristotle’s approach was substantially different. He believed that anger and the aggressive disposition that it generates was useful to solve problems when well-controlled. His observation of human development led him to the conclusion that with age and experience, the young child learns to use his cognitive capacity to control and make good use of


his impulses: ‘‘Anger is necessary; without it we cannot succeed at anything. We must use it, not as a leader, but as a soldier . . . as the body is prior in order of growth to the soul, so the irrational is prior to the rational. The proof is that the anger and will and desire are implanted in a child from their very birth, but reason and understanding develop as they grow older.’’ He added: ‘‘Moral virtue is concerned with pleasures and pains. It is pleasure which makes us do what is base, and pain which makes us abstain from doing what is noble. Hence the importance of having a certain training from very early days, as Plato says, so that we may feel pleasure and pain at the right objects; for this is true education. (. . .) So the difference between one and another training in habits in our childhood is not a light matter, but important, or rather, all-important.’’ We can see that the importance of early childhood development is not a new idea. But have there been any scientific experiments showing that we can prevent the developmental of anger and aggression problems by educational interventions with infants? The majority of anger-control experiments have been done with adults at risk of coronary heart disease, and with school-age children with behavior problems. These experiments target individuals who have failed to learn to control themselves during early childhood. They show some impact on anger control. The experiments to change the trajectories of physical aggression showed long-term impact when they started in the early elementary grades and were very intensive, but only if parents, teachers, and children were all supported for at least 2 years. Aristotle would argue that interventions during early childhood will have a greater impact. But from our knowledge of genetic and intergenerational effects we can be bolder than Aristotle and suggest that interventions, which would start during the pregnancy of at-risk parents, would have still more of an impact. Young pregnant women with a history of behavior problems could be trained to control their anger and aggressive behavior during pregnancy, and then trained to help their child learn to gain control of these emotions. There have been some long-term experiments where investigators randomly allocated a nurse home-visitation program to young underprivileged pregnant women at high risk of child abuse and neglect. These children were obviously also at high risk of chronic anger problems and physical aggression. The long-term follow-up of the children from the intervention groups have shown that, compared to the control group, they were less frequently abused and neglected, and were also less likely to exhibit delinquent behavior during adolescence. One would expect that the intervention group learned more rapidly to control their anger and regulate physical aggression. Unfortunately the development of anger and physical aggression was not included in the follow-up assessments of these

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experiments. There is also clear evidence that the same interventions do not have any positive impact if they are done with mothers who are already abusing their children. The conclusion from our knowledge of the development of anger and aggression, as well as from these prevention experiments, seems clear. It is the same that was reached 2400 years ago by Plato, Aristotle’s mentor: that to help humans learn to control their emotions and their behavior, the most appropriate time is early childhood. In fact, it seems that the closer to conception the intervention, the more likely it will have beneficial effects for the parents, their children, and their grandchildren. There is no doubt that if Socrates, Plato, Aristotle, Saint Augustine, and Darwin were to read this conclusion, they would be very surprised that knowledge gained from our sophisticated data collections and statistical analyses are simply concluding what to them appeared obvious. But modern science makes it more probable that they were right. Hopefully modern science will help us find ways of giving the needed cognitive control to those who are most at risk of living a life of misery because they have not acquired the necessary control. This is again not unlike the British philosopher Thomes Hobbes’ 1647 conclusion concerning the importance of early education for becoming a citizen: ‘‘It is evident therefore that all men (since all men are born as infants) are born unfit for society; and very many (perhaps the majority) remain so throughout their lives, because of mental illness or lack of training (disciplina) (. . .) Therefore man is made fit for society not by nature, but by training.’’ See also: Emotion Regulation; Self-Regulatory Processes; Temperament.

Suggested Readings Cosmides L and Tooby J (2000) Evolutionary psychology and the emotions. In: Lewis M and Haviland-Jones JM (eds.) Handbook of Emotions, 2nd edn., pp. 91–115. New York: Guilford. Coˆte´ S, Vaillancount T, LeBlanc JC, Nagin DS, and Tremblay RE (2006) The development of physical aggression from toddlerhood to pre-adolescence: A nation wide longitudinal study of Canadian children. Journal of Abnormal Child Psychology 34: 71–85. Darwin C (1872/1998) In: Ekman P (ed.) The Expression of the Emotions in Man and Animals, 3rd edn. London: Harper Collins (US edit.: New York: Oxford Press). Goodenough FL (1931) Anger in Young Children. Westport, CT: Greenwood Press. Lemerise EA and Dodge KA (2000) The development of anger and hostile interactions. In: Lewis M and Haviland-Jones JM (eds.) Handbook of Emotions, 2nd edn., pp. 594–606. New York: Guilford. Lewis M (2000) The emergence of human emotions. In: Lewis M and Haviland-Jones JM (eds.) Handbook of Emotions, 2nd edn., pp. 265–280. New York: Guilford.

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Sand EA (1966) Contribution a` l’E´tude du De´velopment de l’Enfant: Aspects Me´dico-Sociaux et Psychologiques. Bruxelles: E´ditions de l’Institut de sociologie de l’Universite´ libre de Bruxelles. Seneca LA (1979) On Anger in Seneca: Moral Essays. Loeb Classical Library. Tremblay RE (2003) Why socialization fails? The case of chronic physical aggression. In: Lahey BB, Moffitt TE, and Caspi A (eds.)

Causes of Conduct Disorder and Juvenile Delinquency, pp. 182–224. New York: Guilford. Tremblay RE, Hartup WW, and Archer J (eds.) (2005) Developmental Origins of Aggression. New York: Guilford. Tremblay RE, Nagin D, Se´guin JR, et al. (2004) Physical aggression during early childhood: Trajectories and predictors. Pediatrics 114: e43.

Attachment G Posada, Purdue University, West Lafayette, IN, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Attachment – An enduring emotional bond that an individual forms toward another, and that ties them together in time and across contexts. Attachment internal working models – Mental representations about attachment relationships. Attachment security – Confidence in the attachment figure’s availability and responsiveness, and skillful use of an attachment figure as a secure base. Secure base phenomenon – The apparently purposeful balance between exploring away from an attachment figure and going back to that figure. Sensitivity – The ability to be aware of and interpret an infant/child’s signals correctly,and respond to them promptly and appropriately.

Introduction John Bowlby and Mary Ainsworth’s theory of attachment is concerned with the development of human close relationships. Also, it is concerned with the role that those relationships play in individuals’ development. Since its inception in 1958, attachment theory has become an influential theoretical framework to study social, emotional, and relationship development. The point of Bowlby’s departure was a series of observations about children’s reaction to separation from, and loss of, important figures in their lives, and the effects that such experiences may have on personality development. Those observations pushed Bowlby to search for an explanation to such an emotional reaction. His initial theoretical account provided the basis for Ainsworth’s ground-breaking studies in Uganda and Baltimore. These studies contributed to Bowlby’s further elaboration of his developmental model, and to Ainsworth launching the study of individual

differences in the development of infant–mother attachment relationships in infancy. A central feature of the Bowlby–Ainsworth perspective is the role attributed to real-life experiences in relationships. According to Bowlby, it is in the context of interactions that infants develop preference for, organize their behavior around, and become attached to their principal caregivers. Yet, he did not consider the organization of the attachment behavioral system simply as the outcome of learning, but of the interactions between biases in infant abilities and continuous experience in infant–caregiver transactions. Furthermore, such experience provides the raw materials for children’s and individuals’ representations of attachment relationships later on, and for the maintenance or change of such representations. Interaction experience plays a key role in attachment theory and was a point of departure from traditional psychoanalytic theory at the time Bowlby proposed his account. Being a clinician, some of Bowlby’s core interests were to investigate the impact that attachment relationships have on the notion of the self, emotional security, intimate relationships, and social adaptation, and to explain the role that child–parent relationships play in personality disorders and maladaptation. Indeed, attachment theory has proved both generative, in terms of the number of articles, chapters, and books published, and extensive, in terms of the degree to which attachment is a central construct for several subdisciplines within psychology (e.g., developmental, social, and clinical/health). This article focuses on attachment relationships during infancy and early childhood. First, it will briefly introduce John Bowlby and Mary Ainsworth and address the definition of central constructs in the theory. Then, it describes the evolutionary rationale Bowlby proposed and attends to normative and individual differences matters in the development and construction of attachment relationships during infancy. Subsequently, it presents and discusses the caregiver sensitivity–child security link. Finally, it covers the same topics during the preschool

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years. Methodological issues in the study of attachment relationships both in infancy and childhood are also discussed. However, it is important to note that this article does not pretend to be a review of the literature related to those topics, and that most of the literature reviewed is concerned with infant/child–mother attachment. The term ‘mother’ will be used in many instances instead of caregiver, as most children are still being raised predominantly by their mother. Also, occasionally when mentioning child–mother interactions, we refer to the child as ‘he’ to avoid confusion.

John Bowlby and Mary Ainsworth John Bowlby was a British psychoanalyst who emphasized the context provided by relationships when studying individual development. Bowlby introduced attachment theory in 1958. During the following years, he elaborated it and published the now famous trilogy of books Attachment, Separation, and Loss. The theory he proposed offers (1) an integrative perspective that brings together notions from ethological, evolutionary, control systems, psychoanalytic, and cognitive psychology in an attempt to explain the construction and elaboration of attachment relationships; (2) a clear dialog between research and theory elaboration; and (3) a wide range of implications for central domains of people’s lives (e.g., intimate relationships, self, and emotional security, among others). Mary Ainsworth, born in Ohio and raised in Toronto, became familiar with Bowlby’s ideas, when she worked with him in London during the 1950s. Subsequently, she went to Uganda where she conducted her initial study of 28 infants and their mothers, visiting them every 2 weeks during 9 months. Her study was the first to document attachment in the making. Based on her observations, Ainsworth proposed a normative developmental model. Further, she described individual differences as far as infant–mother relationships were concerned. Due to her interest and training on Blatz’s security theory, and specifically on the notion that parents provide a secure foundation from which children feel the can safely initiate explorations of their world, Ainsworth construed those differences in terms of security. The Uganda study provided the basis for Ainsworth’s landmark Baltimore study in which she aimed at systematically replicating her previous study.

Central Constructs in Attachment Theory and Research Faced with the problem of accounting for children’s reactions to separation from and/or loss of their mother, Bowlby elaborated a theoretical account that provided an initial explanation. In collaboration with James Robertson,

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he proposed that children’s emotional reaction to separation and loss follows a sequence: protest, despair, and, if the separation is long lasting, detachment. This emotional reaction, he argued, is due to the nature of the relationship that children and their mothers develop. Based on studies about child–mother separation and infant–mother interactions, research on different primate species, and on control systems and psychoanalytic theories, Bowlby suggested a normative developmental model (see below) that starts with infant–mother exchanges that interact with an infant’s learning biases, grows into an infant’s discrimination and preference for those who provide care, and then, consolidates such preference during the second half of the first year, when an infant’s behavior becomes clearly organized into a system with the goal of proximity to one or more caregivers. Behavioral organization later develops and expands into a representational modus operandi that impacts the child–mother relationship and transforms it into a goal-corrected partnership. Attachment Bowlby defined attachment as an emotional tie that an infant constructs and elaborates with his principal caregiver(s) in the context of everyday interactions. This bond is specific in that it is directed toward a particular individual, is long lasting, and ties the two individuals together across contexts. Attachment is distinct from attachment behavior; while attachment refers to the emotional bond, and to a strong predisposition to seek proximity to, and contact with, a specific caregiver, attachment behavior is concerned with the conduct manifestations that allow the child to achieve the desired proximity and contact. Importantly, attachment is conceptually different from dependency. While the latter has negative connotations (e.g., clinginess), attachment does not. On the contrary, attachment enables children to explore and learn. Secure-Base Behavior Mary Ainsworth contributed the notion of the securebase phenomenon. This construct was empirically derived from field observations conducted in rural Uganda and it captures well Bowlby’s notion that while attachment ties the child to his mother, it also allows him to explore his surroundings. In other words, the secure-base phenomenon refers to the apparent purposeful balance between proximity seeking and exploration away from an attachment figure at different times and across contexts. How a child uses his mother as a secure base, that is, the organization of a child’s secure-base behavior is the basis for inferring how secure he feels when exploring his surroundings and retreating to her, and whether a child demonstrates confidence in mother’s availability and response.

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Internal Working Models of Attachment John Bowlby recognized preschool children and suggested that infants create a primitive cognitive map, that is, a representation of their relationship with mother. Initially, those maps are about mother moving in a specific spatial and temporal layout. These representations are based on interactions and are expected to be elaborated through relationship experience and cognitive development. Bowlby called those representations internal working models. Quality of Care Maternal behavior plays a central role in attachment theory and research. Bowlby suggested that a caregiving system complementary to the attachment behavioral system is necessary for attachment relationships to develop. Further, based on her studies, Ainsworth concluded that it was not the quantity but the quality of care that mattered most in accounting for the different types of infant–mother relationships. Although she observed specific maternal behaviors during interactions with infants, Ainsworth conceptualized four categories of behavior to describe the overall features of maternal care: sensitivity–insensitivity, cooperation–interference, acceptance–rejection, and accessibility–ignoring. Because those categories of maternal behavior turned out to be highly intercorrelated, the overall quality of maternal care was subsumed under the label of sensitivity. Sensitivity to an infant’s signals and communications refers to a mother’s ability to see things from the baby’s perspective; that is, a mother’s ability to perceive her baby’s signals, interpret them correctly, and respond to them appropriately and promptly. Cooperation– interference refers to a mother’s ability to respect her baby as a separate individual, to intervene in the baby’s activities in a skillful and collaborative manner so that the baby does not experience it as interfering. Acceptance– rejection refers to the balance between a mother’s positive and negative feelings about her baby, and the extent to which she is able to resolve those negative feelings. Accessibility–ignoring refers to a mother’s ability to notice and attend to her baby’s signals despite demands from other sources on her attention.

Attachment in Infancy An Evolutionary Rationale Bowlby proposed an account of how child–mother attachment relationships develop and are organized during the first 3 years of a child’s life. He argued that all infants organize an attachment behavioral control system in the context of interactions with their mother during

the course of the first year. That is to say that the system does not emerge automatically and it is not fully functional at birth. Its elements, behaviors such as crying, sucking, smiling, clinging, and following become integrated and coordinated into a system of behavior through learning, practice, and feedback from the mother. The system goal is that of proximity and contact with an attachment figure. The behavioral system becomes functional during the second half of the first year and it is clearly seen in operation during children’s implementation of the secure-base game in everyday life circumstances and especially, not exclusively, in emergency situations. To explain the existence of this particular behavioral system, Bowlby offered a rationale that included the survival advantages of proximity seeking and contact afforded during the course of human evolution. Specifically, infants who sought and maintained some degree of proximity to, and/or contact with, their caregivers, he suggested, were more likely to survive than those who did not. To be sure, Bowlby proposed that by virtue of our primate heritage, human infants are endowed with learning biases and predispositions that make it possible, even likely, for them to put together an attachment behavioral system, as long as they are exposed to a caring environment. He used available evidence concerning offspring–mother relationships in each of the great apes species, chimpanzees, gorillas, and orangutans to support his reasoning. The biological function of attachment behavior is that of protection and, although it is most obvious during infancy and childhood, it can be observed throughout the lifecycle. A testable hypothesis derived from such a rationale is that human infants in all cultures have the capacity to construct secure-base relationships in the context of interactions with caregivers. That is, all infants exposed to ordinary parental care will organize their behavior in interactions with caregivers in ways that resemble the secure-base phenomenon. Curiously, despite being at the core of Bowlby and Ainsworth’s theoretical foundations, very little research work on the cross-cultural generality of secure-base behavior has been conducted. Empirical tests of this hypothesis are important to help resolve discussions and debates regarding the ubiquity of attachment relationships. In the only explicit test of the cross-cultural generality of secure-base behavior, Germań Posada and colleagues in the mid-1990s gathered information about secure base behavior at home in infants and children from seven different countries representing a variety of cultures. Specifically, data were collected in China, Colombia, Germany, Israel, Japan, Norway, and the US. Using a methodology that does not presuppose the existence of the secure base phenomenon (i.e., the attachment q-set), descriptions of infants’ and children’s behavior during

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interactions with their mother at home indicated that secure base behavior was evident in all countries. This study, in conjunction with other reports based on samples from one culture, provides support for the idea that secure base behavior characterizes infant and child behavior when interacting with its mother in naturalistic settings. Far from settling the issue, those studies open the door for further exploration of the relationships between hypothesized propensities and cultural and social contexts. In other words, even if secure base behavior turns out to be characteristic of children’s behavioral repertoire in diverse cultural contexts, its specific forms and patterning may not be the same. What has been selected for in evolution is better understood in terms of a propensity to organize a secure base behavioral system within the context of child–mother interactions. The study of specific manifestations or configurations of the secure base phenomenon is not trivial for it will help us determine its flexibility (range) and the impact of context (e.g., cultural) in the construction of attachment relationships. We also need to be aware that existing research has barely included developmental considerations as far as changes over time in secure base behavior are concerned. This issue is key when studying the cross-cultural generality hypothesis for specific cultural influences may be more limited during the first 2 years of life, when most research has taken place. That is, the impact of specific cultural influences on secure base behavior may be obvious once the acquisition of language and representation is in full motion and new channels of influence in child–parent relationships are open. Even if common across cultures, secure base relationships may be used and impacted differently depending on the specific cultural mandates of the group as the child grows older. Little, if anything at all, is known about this. Normative Issues All infants form an attachment to their main caregivers. Yet attachment does not appear at once. It takes time to be constructed and elaborated. Indeed, one of Bowlby’s key insights was to suggest attachment as a relational outcome tied to interaction experience. To be clear, although Bowlby referred to attachment as the child’s emotional bond toward his main caregiver(s), he discussed, at considerable length its dyadic nature, placing child–mother exchanges and the contributions of each member of the dyad at the center of the phenomenon; this is frequently ignored. He proposed four phases in the development of attachment: (1) orientation and signals with limited discrimination of figure; (2) orientation and signals toward one (or more) discriminated figure(s); (3) maintenance of proximity to a discriminated figure by means of locomotion as well as signals; and (4) formation of a goalcorrected partnership.

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Orientation and signals with limited discrimination of figure

Although from very early on infants show discrimination of their mother’s voice and scent, they do not exhibit a clear preference for any particular caregiver. Infants are not attached to their caregivers at birth. Any caregiver responding to their needs would be as effective; infants tend to respond similarly to any individual who tends to their signals or interacts with them. Yet, from the beginning, babies contribute to their interactions and exchanges with others. Built-in bias to orient toward, look at, and listen to certain stimuli will contribute to paying attention to and eventually developing preference for those who interact with him and provide care on a regular basis. The infant uses characteristic reflexive responses in his behavioral repertoire (e.g., crying, head-turning, reaching, grasping) when interacting with others. These behaviors typically have as a consequence to increase the time the baby is in proximity with those around him. Orientation and signals toward one (or more) discriminated figure(s)

In the course of everyday exchanges, the infant experiences patterns of interaction and care from those looking after him, typically but not necessarily the infant’s biological parents. These repeated experiences allow the child to learn, through exposure, the perceptual and behavioral features of his caregivers, and discriminate them from other individuals. Repeated exposure to patterns of care leads to familiarity with those figures and their interaction routines. Familiarity leads to preference. The infant continues to be friendly and open, but now distinguishes his caregivers from others and responds differently to them. Thus, for example, differential smiling toward mother and differential crying (i.e., infant cries when held by someone other than mother, and stops crying when mother holds him) were reported by Ainsworth as early as 9–10 weeks of age. During these first months, experience, that is, practice, establishes the secure base game foundations: the baby signals, mother comes close and joins the child in interaction either cooperating with his behavior and vocalizations, or easing the discomfort the infant is experiencing. The caregiver expands the child’s activities in time and space, and/or restructures his behavior and context in ways that the infant is comfortable and/or can re-engage his surroundings. These experiences are likely to provide the behavioral and cognitive substrates for the rapid appearance of the secure base phenomenon soon after the child develops locomotion. Maintenance of proximity to a discriminated figure by means of locomotion as well as signals

The third phase begins soon after locomotion arises. The infant’s way of participating is now more complex.

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Behavior becomes organized in a goal-corrected basis. Not only does the infant orient and signal toward his main caregiver(s), but in addition, he is active in approaching and maintaining proximity by crawling and/or walking. Now he has new means; his motor behavior is increasingly more integrated and efficient and thus he can use it to achieve his goals for proximity and contact when the situation requires it (e.g., a visitor, a loud noise, a new place). Strangers are treated with caution and attachment figures are clearly preferred. The foundations of the secure base phenomenon are in place and readily observable by 1 year of age in most children. This does not imply that its development is complete. Although established, it needs to be consolidated. In sum, the process of attachment development thus far can be succinctly stated as going from interaction to familiarity and preference to attachment. Formation of a goal-corrected partnership

This is the last phase in Bowlby’s developmental model. By continuously participating in interactions with its mother, and observing maternal behavior and the factors that influence it, the child begins to conceive of the mother as an individual with her own set goals and plans to achieve them. Thus, according to Bowlby, at around a child’s third year, a partnership begins where the child will increasingly modify his behavior and expectations based on those of the attachment figure. There the rudiments of a goal-corrected partnership, one that will eventually move the child–mother relationship increasingly and slowly toward a more symmetrical one. Bowlby was general about this phase and did not elaborate much. Individual Differences in Attachment Relationships Although all infants who are cared for form attachments to their caregivers, not all attachment relationships are the same. They vary in their quality. Ainsworth pioneered the study of individual differences in the quality of attachment relationships. Her studies established and shaped the field. Her findings have subsequently generated hundreds of studies. Investigating the effects of weaning on Ugandan infants, Ainsworth both sketched the normative development of attachment during the first year or so of life, and set the foundations for her influential Baltimore longitudinal study of 23 infant–mother dyads during the first year of life. In Baltimore, she conducted careful, frequent (every 3 weeks from week 3 until the infant was 54 weeks of age), and extensive (4 h) observations of child–mother interactions at home. When infants were 12 months old, Ainsworth brought infant–mother dyads to the laboratory and conducted the now well-known strange situation procedure.

This laboratory procedure consists of eight episodes. Each episode lasts a maximum of 3 min except for the first episode that lasts 30 s. In episode 1, infant and mother are brought into a room with toys and two chairs by a research associate. Episode 2 begins when the associate leaves; mother and infant stay in the room and the infant plays with the toys; mother is instructed to be responsive if infant initiates interaction. In episode 3, a stranger walks in; initially, she remains silent for 1 min, then, she talks to mother, and after 1 min, she talks and/or plays with the infant during another minute. In episode 4, the first separation occurs; mother leaves and the infant remains with the stranger; if the infant is too upset and the stranger cannot soothe him, the episode is cut short. In episode 5, the first reunion episode mother comes back in the room and stranger leaves unobtrusively. During episode 6, the second separation episode, mother leaves and the infant stays alone; again if the infant is too upset the episode is cut short. In episode 7, the stranger returns; if the infant continues to be upset, the episode is cut short and mother comes back into the room. Finally, in episode 8, the second reunion episode, mother returns and stranger leaves. After careful examination of infants’ behavior during the entire strange situation procedure, but especially during the reunion episodes, Ainsworth came up with three major groups of infants based on the configuration or patterning of behavior exhibited. Ainsworth construed the differences among the groups in terms of security when using mother as a secure base. Two of these groups, ‘A’ and ‘C’, are considered as consisting of infants in anxious/insecure attachment relationships with their mothers; the other group, ‘B’, of infants in secure relationships. Specifically, secure infants (group B) are able to use their mother as a secure base for exploration in the novel room. If distressed during separation, they seek proximity and contact with mother during reunion, and contact is effective in promptly reducing stress. If not openly distressed by separation, the baby responds to mother with active greeting and interaction during reunion episodes. There is little or no tendency to avoid or to resist and be angry with mother upon reunion. As just mentioned, the infant may or may not be distressed during the separation episodes, but when he is, it is clear that he wants his mother, even though he may be somewhat consoled by the stranger. Although secure infants tend to be affiliative with the stranger in mother’s presence, they are clearly more interested in contact and interaction with their mother than with the stranger. Infants in group A are considered to be anxiously avoidant. They exhibit little affective sharing with mother and readily separate to explore toys. They treat the stranger much as they treat their mothers, and are affiliative with the stranger in mother’s absence; they show little preference for mother. ‘A’ infants show active avoidance

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of proximity to, and contact and interaction with, their mother in reunion episodes. The babies look, turn, or move away, and ignores their mother when she returns. Alternatively, they greets her casually. If there is approach, the infants mix their welcoming with avoidance. If the babies are picked up by mother, there is little or no tendency to cling or resist being put down. During separation episodes, the babies are typically not distressed; but if there is distress, they seems to be due to having been left alone for they tends to be alleviated when the stranger returns; there is little or no stranger avoidance. Infants in group C are labeled anxious resistant. They exhibit poverty of exploration even in preseparation episodes; they seem wary of novel situations and of the stranger. These infants are likely to be very distressed upon separation and are not easily calmed by the stranger. Upon reunion, babies in group C are not easily calmed by mother’s return. They may show proximity seeking and contact mixed with resistance (hitting, squirming, or rejecting toys); alternatively, they may continue to cry and fuss, and show extreme passivity. Babies in this group show no or little tendency to ignore their mother during the reunion episodes. Because upon reunion ‘C’ infants are likely to seek proximity and contact, but these are not effective in calming them down as shown by their resistance and inability to be soothed, they have also been labeled anxious ambivalent. Ainsworth considered that these infants may show general maladaptive behavior in the strange situation, because they tend to be angrier than infants in the other groups. Mary Main and Judith Solomon proposed in 1986 a fourth classification group ‘D’. Infants in this group often cannot maintain a clear and coherent strategy in the organization of their attachment behavior. Because of this, infants in this group are labeled ‘disorganized/ disoriented’ and are considered to be anxiously attached. This classification is assigned in addition to an alternate best-fitting category of A, B, or C. Infants classified into this group exhibit patterns of behavior that lack a readily observable goal, purpose, or explanation. The most characteristic theme in the list of behaviors is that of disorganization or an observed contradiction in movement pattern. A lack of orientation to the immediate environment is also characteristic of these children. Indices of disorganization and disorientation are: sequential and/or simultaneous display of contradictory behavior patterns, undirected, misdirected, incomplete, and interrupted movements and expressions; stereotypies, asymmetrical movements, mistimed movements, and anomalous postures; and freezing, stilling, and slowed movements and expressions, direct indices of apprehension regarding the parent, and of disorganization and disorientation. The importance of that classification system and the resulting groups is determined by the associations reported between infants’ organization of behavior both

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at home and in the strange situation. In other words, it is the patterning of behavior, not individual behaviors that were found significantly related in both contexts. The validity of the strange situation attachment classification system rests on the demonstration of the association between patterns in the organization of secure base behavior at home and in the laboratory. Importantly, discrete behaviors were not found to be associated in both contexts. For example, in the case of crying, while securely attached infants were found to cry the least at home, they may or may not have cried in the strange situation. In contrast, anxiously attached babies who cried the least (avoidant) or a lot (resistant) in the strange situation were the infants who cried the most at home during both the first and fourth quarter of their first year, and were not distinguishable from each other. Thus, Ainsworth assigned meaning to an infant’s behavior in the strange situation based on her findings about different ‘patterns’ of interaction she had observed at home. Individual Differences in Attachment Security and Quality of Care While studying the development of child–mother relationships, Ainsworth also gathered information about maternal behavior that led her to formulate the hypothesis that the quality of care is important when studying individual differences in infants’ attachment security. Findings from her Baltimore study indicated that many aspects of caregiving behavior were significantly related to infant’s quality of attachment at 12 months. Ainsworth collected detailed information on specific maternal behavior such as responsiveness to infant crying, behavior relevant to separation and reunion, close bodily contact, face-to-face interactions, feeding, and behavior relevant to child obedience (e.g., frequency of physical interventions). In addition, she rated mothers on the four broader categories of behavior described above. Each category was found to be highly and significantly related to attachment security in the strange situation. Ainsworth’s identification of sensitivity to signals, cooperation with ongoing behavior, acceptance, and accessibility as important dimensions of infant care has provided a valuable framework for empirical research on this issue. Her model of early care has served as the theoretical foundation for empirical studies investigating the factors that account for individual differences in infants’ organization of secure base behavior. Most ensuing research on the topic has, however, observed maternal behavior and scored maternal sensitivity in contrived situations, once, and for periods usually lasting under 1 hour. Overall, results indicate that ratings of sensitivity are significantly, if modestly, related to attachment security in middle-class samples.

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A meta-analysis of 65 studies conducted by Marianne de Wolff and Marinus van IJzendoorn published in 1997 reported a correlation coefficient of 0.24 for studies that have investigated the relation between sensitivity and security when assessing the constructs in similar ways to Ainsworth’s. Those findings are remarkable especially in consideration of the fact that most studies, subsequent to Ainsworth’s, have drastically reduced the window of observation time and situations, and thus, perhaps, the representativeness of the phenomena being observed. Low correlations sometimes reflect measurement problems rather than weak effects. Ainsworth’s many hours of naturalistic observations throughout the first year afforded a better assessment of maternal sensitivity and child behavior than the less extensive, structured observations, and narrowly focused measures typical of most subsequent studies. Indeed, the results of more recent studies (conducted by David Pederson, Gregory Moran and colleagues, and Germań Posada and colleagues) that involved observations and measures more akin to Ainsworth’s have yielded comparable results (i.e., correlation coefficients of 0.40–0.61). Clearly, the issue of effect size in research on maternal care and infant security requires further study with special attention to construct definitions, observational strategies, sampling of behavior, and measurement issues. In the meantime, even small correlations should not be dismissed out of hand in contexts where they can be projected through large numbers of events or interactions to produce important effects. Assessment of Attachment and Caregiving Behavioral Organization Information on infant attachment behavior has mainly been collected by means of the strange situation procedure. More recently, Q methodology has been used to describe observations conducted at homes, playgrounds, and hospitals. A third approach consists of observation in naturalistic settings such as Ainsworth did; this alternative, however, has scarcely been employed, presumably because of the extremely high costs of personnel, time, and effort. The strange situation

Ainsworth’s studies have also been foundational because of the methodological innovations offered. The strange situation procedure (see above) was pivotal in launching a generation of studies on individual differences in attachment security, their antecedents, and correlates. The success of the strange situation was such that research with this procedure became synonymous with attachment research up until the mid-1980s. Paradoxically, it could be argued that the success of studying attachment with the strange situation limited the study of infant/child–mother

relationships. Thus, observational studies, central to launching the study of attachment relationships, were set aside likely due to their time- and resource-consuming features compared to studies using the strange situation. One of the consequences of this emphasis on the strange situation has been a lack of research that provides a descriptive base to account for the development of attachment relationships after 12–18 months of age. In fact, the most common strategy followed when studying attachment relationships after infancy has been that of using the strange situation to validate assessment tools for older children, with very little empirical work to study the phenomenon in the contexts where it develops (i.e., naturalistic settings), and using secure base behavior in real life circumstances as the key validation criterion. The attachment Q-set The attachment Q-set (AQS) was proposed by Everett Waters in the mid-1980s as an economic alternative to Ainsworth’s observational methodology, one that allows for efficient descriptions of secure base behavior in infants and children, and affords more analytical alternatives. The AQS allows researchers to describe the functioning of the attachment behavior control system. In brief, it assesses how characteristic secure base behavior is during infant/child–caregiver interactions. The AQS can be used with children aged between 1 and 5 years. It consists of 90 descriptive items; most of them refer to behavior in context, and tap the secure base phenomenon; there are some filler items. After observing an infant interacting with his mother, researchers use the items to describe child behavior by placing the items into nine piles from most characteristic to least characteristic of the infant/child. To determine whether an infant’s behavior is organized in ways similar to the secure base phenomenon, his q-description is correlated with a theoretical description that indicates optimal use of the caregiver as a secure base. The higher the correlation the more an infant’s behavior is organized in ways that resemble the secure base phenomenon. The validity of the AQS has been documented in various studies. More recently in 2004, Marinus van IJzendoorn and colleagues presented a meta-analysis of 65 q-sort studies that supports the AQS validity. The authors indicate that the AQS, as used by trained observers, is a valid tool to assess the organization of attachment behavior. They further suggest caution when using AQS data provided by mothers. Care is need here, however, for the key issue, as with any other methodology, is that of training those who will report on ‘what’ and ‘how’ they are to do it. This includes mothers. For example, Douglas Teti in 1996 showed that mothers, like any other observer, can provide valid and useful information when trained properly.

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Ainsworth’s maternal sensitivity scales

Most research on the associations between caregiving and attachment security has been based on Ainsworth’s construct of sensitivity. Of course, the degree of similarity to her assessment approach has varied from study to study with some investigators using a conceptualization close to Ainsworth’s and some others using a notion removed from the one she offered (e.g., maternal self-efficacy as defined by her attribution style and mood state). This is so, in part, because Ainsworth’s evaluation of maternal care was based upon many hours of naturalistic observation during the first year, and no abbreviated procedure has been devised. The use of the 9-point scales proposed by Ainsworth requires a good deal of insight into a mother’s behavior, and this is dependent on a good observational base. In short, appropriate use of the scales is based on familiarization with, and knowledge of, a mother’s behavior. Here it is important to note that no study has sampled maternal behavior as extensively as Ainsworth did. The maternal behavior Q-set

Much like the AQS, the maternal behavior Q-set (MBQS), designed by David Pederson and Gregory Moran, was proposed as an economical descriptive alternative to Ainsworth’s caregiving scales. It allows researchers to describe the quality of maternal care and its support of an infant’s attachment behavioral system. Although the MBQS has mainly been used with infants, it also has been used with 31-year-olds. It consists of 90 items about maternal behavior based on Ainsworth’s conceptualization. One of its great advantages is the operationalization of Ainsworth’s sensitivity construct. After observing a mother interacting with her infant, researchers use the items to describe maternal behavior by placing the items into nine piles from most characteristic to least characteristic of the infant/child. To determine whether a mother’s behavior is organized in ways similar to the hypothetically sensitive mother, her q-description is correlated with a theoretical description that indicates optimal sensitive caregiving. The higher the correlation the more a mother’s behavior is organized in ways that resemble a sensitive mother. The validity of the MBQS has been built in a series of studies by Pederson, Moran, and colleagues during the 1990s.

Attachment in Early Childhood A look at the empirical work on child–mother attachment relationships reveals a strong initial emphasis on research with infants and, subsequently, for the past 20 years or so, on adult mental representations with not enough consideration of the development and elaboration of attachment relationships during childhood. Bowlby suggested that the child–mother relationship enters a new phase at around

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3 years of age (see above). Yet, he did not expand much on the development of those relationships during the preschool years. Although he conceptualized attachment as a lifespan phenomenon, Bowlby was explicit about the period of time for which he had available data. There was not much information available about what transpires after 2 years of age. Even today, information about what takes place in the child–mother relationship after infancy is scant. Robert Marvin and colleagues’ reports stand as some of the few descriptive data on Bowlby’s proposed fourth phase. Marvin’s data showed associations between security and cooperation and self-control tasks, when mother is busy, and between security and tolerance of separation. This scarcity is likely to reflect the difficulties associated with assessing the functioning of control systems. Defining and describing patterns of behavior is a complex task. Assessing control systems requires focusing on the efficiency and success with which the system maintains itself within its set goals, while taking into account their developmental transformations. Thus, performance assessment of a control system cannot be equated with the quantity of behavioral output. A child who cries more over separation from his mother than another cannot be said to be more attached to her. In an attempt to close the existing gap, Everett Waters and colleagues in the early 1990s suggested a normative developmental sequence for attachment relationships after the first year of life that takes into account Bowlby’s work and elaborates it. Thus, after the appearance of the secure base phenomenon by age 1 year, a consolidation phase is proposed. That is, the appearance of secure base behavior toward the end of the first year is just the beginning of a longer period that expands early childhood during which the secure base game is put together and firmed up. Its temporal and spatial parameters will get solidified, expanded, and reworked as practice, and new representational abilities and circumstances allow. Here it is important to remember that the organization of an infant’s behavior is closely tied to that of the attachment figure. That is, secure base support is essential in maintaining the organization of infant’s secure base behavior. In all likelihood, it takes years for the phenomenon to be consolidated and elaborated; but this has not been studied. There is no reason to expect that a phenomenon, as complex as using mother as a secure base in consideration of information about her, the infant’s own state, and contextual characteristics at the moment, would appear fully developed and in final form at 12 months. It is likely that the secure base phenomenon, similar to other developmental phenomena, takes time to be organized and established. Likely mechanisms involved in the consolidation of the phenomenon include practice (dyadic practice), operant

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learning, improved locomotion, and the development of the semiotic function (i.e., the increased ability to use representational systems like language and representational thought). Also, children’s increased knowledge of diverse environments, and increased familiarity and confidence on their own skills are likely to play a significant role on their ability to use important figures as a secure base. In addition, it is probable that practice in different secure base relationships, each of them unique, allows the child to learn variations on the issue at hand. Nonetheless, input from the attachment figure(s) is key in maintaining behavioral organization. But what does the empirical research literature on attachment relationships during early childhood indicate? Most studies have focused on the investigation of individual differences in security and used as a point of reference the infant strange situation classification groups. Modifications to the strange situation procedure and/or the coding system have been introduced. Fewer studies have undertaken the examination of individual differences in naturalistic settings and have related them to the quality of maternal care. Interactions and Continuous Secure Base Support Attachment relationships are a dyadic phenomenon. Thus, exchanges between child and mother (or father) continue to be important and likely feed the child–mother relationship. Maternal secure base support remains relevant as far as security outcomes and the ability to use the mother as a secure base are concerned. Indeed, various researchers have hypothesized that the child–mother relationship continues to be shaped throughout childhood, and the quality of caregiving has been suggested as central to the maintenance and construction of such relationships. Surprisingly, the topic has remained relatively unexplored. Empirically demonstrating that the concurrent quality of care (e.g., secure base support) is related to children’s secure base behavior and security in early childhood will substantiate claims about attachment relationships as relatively open systems that continue to be elaborated. Also, it would contribute to attributing due weight to interaction experiences after infancy as an important factor in determining attachment relationship outcomes. For years, Alan Sroufe has eloquently argued that although experiences during infancy are important and influential in development, they do not by themselves determine later outcomes. Few studies have assessed the relations between secure base behavior and caregiving during early childhood. Specifically, maternal interactive behavior observed during relatively short intervals at home and in laboratory settings has been shown to be associated with children’s

organization of attachment behavior in the expected direction. Overall, these studies provide summary indices (e.g., sensitive responding) of maternal behavior observed in semi-structured situations. These findings suggest that concurrent sensitive caregiving is an important influence on children’s attachment security during early childhood. Further research is needed to broaden our understanding of the association between quality of care (e.g., sensitivity) and security. Is sensitivity during the first year the same as sensitivity at 3–5 years? Is it useful to refer to a comprehensive construct in all instances, or are we to gain by focusing on parental domains directly related to the phenomenon under consideration (e.g., the secure base phenomenon)? The specification of developmentally appropriate caregiving domains beyond the global notion of sensitivity may help us understand the associations hypothesized better and assess the constructs in natural contexts where the mother–child relationship is formed. In that line, German Posada and colleagues have recently found, in two separate studies, that the overall quality of concurrent maternal caregiving behavior was significantly related to preschool children’s organization of secure base behavior in naturalistic settings (home and park). These findings are consistent with Ainsworth’s assertion that the underlying characteristic of maternal behavior associated with child security is the ability to establish an atmosphere of harmony and cooperation in interactions with the child. In both studies, the more mothers’ behavior contributed to smooth child–mother transactions, the more secure their children were. In other words, attachment security is directly tied to what transpires in child–mother interactions. Maternal behavior was clearly interlocked with that of the child, and children’s contributions to establishing harmonious child–mother interactions (e.g., actively participating in activities with their mothers, exploring away and returning to mother, and following mothers’ suggestions and agreements established) were as important. That is, child behavior is significant in facilitating the different caregiving tasks. Longitudinal studies that investigate child–mother interactions in childhood will provide much needed evidence about the increasingly important role played by the child in the construction and maintenance of the relationship. This would validate Bowlby’s notion of a child–mother goal-corrected partnership. Importantly, specific age-relevant aspects of maternal caregiving behavior such as maternal secure base support and supervision were investigated in an effort to understand the sensitivity–security link by identifying important domains of care that may impact a child’s secure base behavior organization. Findings indicated that the quality of maternal behavior in those domains was significantly associated with the child’s use of the mother as a secure base. Providing a secure base by supporting a child’s increasing departures away from the caregiver and by

Attachment

enhancing a child’s experiences in his surroundings, as well as providing a haven of safety by facilitating a child’s returns, and being readily responsive in stressful situations, are important to foster a child’s sense of security. In those daily exchanges, children construct and maintain their trust on their caregivers as a secure base. Results also indicated that keeping track of the child’s whereabouts and activities, and anticipating problematic situations (e.g., being attentive to intervene when necessary), were salient in child–mother interactions. How mothers went about these issues (e.g., whether mothers kept track of their child’s whereabouts and were balanced in their role as supervisors and participants in their activities) was significantly related to attachment security. In sum, these findings point to the need to elaborate and be explicit about our notions of sensitivity and secure base behavior in child–mother relationships. This will serve attachment researchers well and help establish connections with other relevant domains of child development as child–parent relationships are concerned. Also, they highlight the importance of conducting observations of child–mother interactions in different naturalistic contexts and for relatively long periods of time. Representational Issues The increasing use of representation, evident after infancy, presents a significant challenge to attachment researchers. Clearly, there exists an empirical gap between the biologically grounded behavioral control system biasing offspring toward proximity to caregivers, and mental representations of relationships serving as sources of security in the caregiver’s absence and biasing the child’s behaviors and expectations about interactions and relationships with others. Bowlby recognized this and occasionally invoked the well-established mechanisms of learning (e.g., habituation, observational learning with guided participation) and somewhat less well-established notions, at the time, from cognitive psychology such as episodic and autobiographical memory and even the working model concept itself. Bowlby believed that mental representations of secure base relationships were derived and abstracted from experience; that is, they were learned and co-constructed in the context of dyadic interactions and with the support of attachment figures. He also hypothesized that those representations, although stable, were open to revisions. In this sense, attachment representational models are a product of socialization processes. The study of the development of children’s attachmentrelated representations and their dyadic co-construction process during early childhood is central to our understanding of child–caregiver secure base relationships transition from a sensory-motor to a representational mode, and of the individual’s contributions to his own development. This has been recognized by attachment scholars. However, despite

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the increasingly frequent use of concepts such as attachment representations and internal working models, after Mary Main and collaborators’ pioneering paper in 1985, relatively little is known about what those representations consist of, and what their development is the development of. The issues have remained elusive as far as advancing our understanding about the organization (i.e., structure) of such budding attachment representations. To be clear, there is an extensive literature examining various aspects of relationship verbal representations of children, adolescents, and adults and the range of correlates these representations may have. The availability of the adult attachment interview (AAI) has been central to this research endeavor in that it has inspired and allowed researchers to assess the current state of mind of attachment related representations via narratives individuals produce. Further, researchers concerned with the role that maternal representations play during child–mother relationships have demonstrated a significant association between maternal security as per the AAI and infant attachment classification in the strange situation. Relatively recent conceptual and methodological innovations, by Harriet Waters, which integrate cognitive psychological (e.g., scripts) and attachment (e.g., the secure base phenomenon), related concepts have made assessments of the organization of secure base knowledge in adults and children readily accessible and have opened a window to the study of ‘how’ secure base knowledge is mentally organized and represented. This is an important area of inquiry that may allow researchers to begin specifying the structure of attachment representations and tie those representations to specific aspects of experience. Based on Inge Bretherton’s work and on social-cognitive developmental theory proposed by Katherine Nelson in the 1980s and early 1990s, Waters and associates have suggested that attachment representations could be understood as scripts (temporal–causal sequence) about secure base relationships. The secure base script has an internal order of events: child is engaged in the environment or the attached dyad is interacting in a warm manner, an obstacle or conflict is introduced (such as loss of a desired toy or a minor injury to the attached person), assistance is requested and is offered by the caregiving member of the dyad, the help is successful in resolving the conflict, and the child is able to go back to activity or the dyad is able to return to productive interaction. That order leads to a typical story. Waters rated preschool children’s narratives in response to attachment-related events in terms of secure base scriptedness when children were 37 and 54 months old, and found them significantly related to their attachment security as derived from child behavior at home. The association between the temporal–causal structure of preschoolers’ attachment narratives and their secure base

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behavior organization at home and playgrounds has been replicated recently. Waters and associates have also shown that this script is present in adult stories from many different sociocultural groups, including North and South America, Europe, the Mediterranean countries, the Middle East, and South Africa. Studies in the US suggest that maternal secure base scriptedness is positively and significantly associated with infants’ strange situation classifications and with coherence scores from the adult attachment interview. Further, Brian Vaughn in 2006 reported that script scores derived from narratives provided by mothers in Colombia, Portugal, and the US were associated positively and significantly with AQS security scores for 1–3.5-year-old children. The development of those procedures for children and adults is important because they allow us to address questions about the basic organization of secure base knowledge; the relations between caregivers’ organization of secure base knowledge, the quality of their care, and children’s organization of secure base behavior; and the cross-domain relations between secure base behavior and secure base representation at different points in time and contexts. Child–mother co-constructive processes that involve both behavioral as well as cognitive-verbal input are likely to be at play.

Concluding Comments Attachment theory was proposed by John Bowlby to account for the consequences of maternal separation and loss on an individual’s personality development. Based on empirical data available at the time, he suggested a model of normative development. Mary Ainsworth, who was exposed to Bowlby’s ideas, set the basis for the study of individual differences in infant–mother attachment relationships by conducting the now famous Uganda and Baltimore studies. The conceptual and methodological foundations that Bowlby and Ainsworth crafted are still essential to understand current research and theoretical explorations. Bowlby’s prospective approach and theoretical elaboration led to an initial emphasis on research about attachment relationships during infancy. Ainsworth’s methodological contributions (e.g., the strange situation) opened the gate for a substantial number of studies with infants aged 12–18 months old. More recently, attachment researchers have begun to push the theory beyond infancy

into childhood. Explicit attention to both behavioral and representional issues becomes relevant during the preschool years, as does the development of conceptually and age-appropriate methodological tools to expand the study of attachment relationships. See also: Divorce; Emotion Regulation; Parenting Styles and their Effects; Self-Regulatory Processes; Separation and Stranger Anxiety; Social and Emotional Development Theories; Social Interaction; Social-Emotional Development Assessment; Socialization; Temperament.

Suggested Readings Ainsworth MDS, Blehar MC, Waters E, and Wall S (1978) Patterns of Attachment. Hillsdale, NJ: Erlbaum. Bowlby J (1969/1982) Attachment and Loss, Vol. I: Attachment. New York: Basic Books. Bowlby J (1988) A Secure-Base. New York: Basic Books. Bretherton I and Waters E (1985) Growing points of attachment theory and research. Monographs of the Society for Research in Child Development 50 (1-2, Serial No. 209). Cassidy J and Shaver PR (1999) Handbook of Attachment: Theory, Research, and Clinical Applications. New York: Guilford Press. Greenberg MT, Cicchetti D, and Cummings EM (1990) Attachment in the Preschool Years. Chicago: University of Chicago Press. Sroufe LA (2002) From infant attachment to promotion of adolescent autonomy: Prospective, longitudinal data on the role of parents in development. In: Borkowski JG, Ramey SL, and Bristol-Power M (eds.) Parenting and the Child’s World, pp. 187–202. Mahwah, NJ: Lawrence Erlbaum Associates. Thompson RA (1998) Early sociopersonality development. In: Damon W and Einsberg N (eds.) Handbook of Child Psychology Vol. 3: Social, Emotional and Personality Development, 5th edn., pp. 25–104. New York: Wiley. Waters E, Kondo-Ikemura K, Posada G, and Richters J (1991) Learning to love: Milestones and mechanisms. In: Gunnar MR and Sroufe LA (eds.) Self Processes and Development. The Minnesota Symposia on Child Psychology, vol. 23, pp. 217–255. Hillsdale, NJ: Lawrence Erlbaum Associates. Waters E, Vaughn BE, Posada G, and Kondo-Ikemura K (1995) Caregiving, cultural, and cognitive perspectives on secure-base behavior and working models: New growing points of attachment theory and research. Monographs of the Society for Research in Child Development 60 (2-3, Serial No. 244).

Relevant Websites http://www.johnbowlby.com – Attachment Theory and Research at Stonybook. http://www.richardatkins.co.uk – The attachment theory website.


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Autism Spectrum Disorders G Dawson and L Sterling, University of Washington, Seattle, WA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Autistic regression – A period of typical development for at least 18–24 months followed by a significant decline or loss of language and/or social skills, and the development of autism symptoms. Broader autism phenotype – The presence of one or more impairments in social functioning, communication, and/or a restricted range of interests/behaviors, but without sufficient severity to meet criteria for a diagnosis of an autism spectrum disorder. Concordance – The presence of a given diagnosis or impairment in both members of a pair of twins. Dizygotic twins – Fraternal twins (derived from separately fertilized eggs), sharing approximately 50% of genetic material. Functional play – The conventional and appropriate use of an object or toy as it is intended, or the association of two or more objects according to their common functions. Joint attention – The coordination of attention between interactive social partners with respect to objects or events in the environment in order to share awareness of the objects or events. Monozygotic twins – Identical twins (derived from a single fertilized egg), sharing 100% of genetic material. Parallel play – Play that occurs independently but alongside another child or group of children. Social orienting – Volitional visual orienting to naturally occurring social stimuli in one’s environment. Symbolic or pretend play – The engagement in imaginative activities with toys involving substituting one object (the symbol) for another or reference to objects that are not actually present.

Introduction Autism spectrum disorder (ASD) is the term used to describe the broad range of pervasive developmental disorders, including autistic disorder, asperger syndrome, and pervasive developmental disorder-not otherwise specified (PDD-NOS). As described in the fourth edition

of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), individuals with ASD have qualitative impairments in reciprocal social interaction and language and communication, in addition to stereotyped, repetitive, or restrictive behaviors and interests. Of these impairments, deficits in social interaction are considered to be a core aspect of the disorder. The prevalence of ASD is currently estimated to be 1 in 166, which is 3–4 times higher than in the 1970s. Males are affected about 3–4 times more often than females. On average, females diagnosed with ASD are more severely affected (in terms of cognitive functioning and symptomatology) than males. Impairments in social interaction can include a general lack of interest in others, a lack of affective sharing, and poor peer relationships, among others. Some children with ASD may appear disinterested or disconnected from their peers or their caregivers, whereas others may seek others out for interaction but do so in an odd or awkward manner. Specific signs of social impairment include lack of eye contact with others, restricted range of facial expressions or facial expressions that are not appropriate to the particular situation, lack of seeking to share enjoyment with others, lack of showing and directing attention to things that are of interest (also referred to as ‘joint attention’), and difficulty initiating social interactions and establishing peer relationships. In infants, particular social difficulties may also include poor eye contact, failure to orient to their name being called, delayed or absent joint attention, and lack of reciprocal social smiling. Even high-functioning individuals with ASD tend to have difficulty interpreting social cues from others. This can be especially apparent when interacting or conversing, during which the person with ASD may not read subtle changes in someone else’s tone of voice, facial expression, or eye gaze. Communication impairments include delay in language without use of gestures or other nonverbal forms of communication to compensate. Unlike children with autism and those with PDD-NOS, children with Asperger syndrome do not show significant delays in spoken language, although significant impairments in social use of language are present. Although many children with ASD (about 70%) do develop at least some spoken language, the quality of their speech is often atypical. For example, some children with ASD demonstrate stereotyped use of language, such as repeating lines from videos, repeating phrases they have heard others say, or using odd phrases. The rate, rhythm, or volume can also be atypical. For

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example, a child with an ASD may consistently talk very loudly, too fast, or speak in monotone. Individuals with ASD also typically have difficulties with the pragmatic use of speech, or language used to start, maintain, or end a conversation, making it difficult to establish a reciprocal conversation. The third category of impairments includes restrictive, repetitive, and stereotyped behaviors and interests. These can be motor stereotypies, such as hand and finger mannerisms and complicated whole-body movements, such as rocking back and forth and spinning in circles. Symptoms in this domain also include preoccupations, a restricted range of interests, and sensory interests. For example, some children with ASD may engage in prolonged visual examination (e.g., of themselves in the mirror or of objects near them), peering at things out of the corner of their eyes, repetitive feeling of textures, touching, sniffing, biting, and sensitivity to sounds or lights. Other children may use objects in a repetitive manner (e.g., lining toys up, spinning the wheels of a toy car), rather than using the objects or toys flexibly or as they are intended to be used. Some individuals with ASD also engage in specific rituals in routines, which can include exact placement of objects or arrangement of items, as well as following a certain sequence of actions that must be performed in a particular order or will result in anxiety (e.g., touching the doorknob every time he or she leaves a room). Finally, many individuals with ASD have intense interests that can take up the majority of their time. For example, a child with ASD may have a particular interest in trains or cameras, and spend a large proportion of time playing with these items, talking about them, and possess a high degree of factual knowledge about them. Such interests can interfere with engaging in other more functional or prosocial behaviors. Although there is not currently a ‘cure’ for autism, behavioral intervention can improve a child’s level of functioning, quality of life, and prognosis. The early intervention for infants and toddlers has been a recent focus of research. Current studies suggest that children with ASD are benefiting from approaches such as applied behavioral analysis, especially when delivered in a naturalistic context with a focus on social relationships. Researchers anticipate that as children’s behavior improves as a result of early intervention, the neural pathways involved in the development of language and social processing will also change. These implications are promising and underscore the benefits of early diagnosis and intervention at a young age.

Diagnosis and Early Recognition ASD is a developmental disorder, with symptoms present before the age of 3 years. Speech delay, or the loss of previously acquired speech, is often the first developmental

milestone alerting parents and professionals to possible difficulties related to ASD. Deviances from typical development can sometimes be apparent by 8–12 months of age; however, a diagnosis of ASD cannot be reliably made until the age of 2 years. Because there is currently no known biological test for ASD (e.g., blood test), a diagnosis is based on developmental history and observed behaviors. Structured diagnostic measures, such as the Autism Diagnostic Interview and the Autism Diagnostic Observation Schedule, are administered by highly trained clinicians, and are considered gold standards for diagnosing ASD. Clinicians use information from these measures as well as information collected through any other observation to help determine whether an individual meets criteria for ASD based on symptoms outlined in the DSM-IV. Because a significant proportion of children presenting with ASD have an identifiable genetic disorder, such as Fragile X syndrome, karyotyping and other biomedical tests are often conducted to define the cause of the symptoms for a given child better. Much of current research in the field of autism focuses on methods to detect ASD at even earlier ages, with the goal of providing behavioral and psychosocial interventions to children as early as possible. Clinicians and researchers specializing in early development have begun to make diagnoses of ASD at or before the age of 2 years, and screening measures are currently being tested for infants as young as 6–12 months of age. Given the variability in developmental trajectories and the variability of symptom expression in individuals with ASD, diagnoses before the age of 2 years are considered provisional and the stability of the diagnosis should always be reinvestigated at a later age. There is great heterogeneity among individuals on the autism spectrum. Many individuals with ASD score in the mentally retarded range on IQ tests, often with significant variability in functioning across subtests. The rate of mental retardation also tends to vary depending on the child’s specific ASD diagnosis. For example, recent estimates suggest that the rate of mental retardation in children with autistic disorder is about 67%, compared to approximately 12% of children with PDD-NOS and 0% of children with Asperger syndrome. Virtually all have significant challenges in adaptive functioning and selfcare. Up to 25% of individuals with ASD are high functioning, have average-to-above-average cognitive skills, and are able to live independently in society and establish successful relationships. Symptom severity also varies. A portion of children never acquire spoken language, while others achieve a level of communicative competence that is near normal, with subtle impairments in the pragmatic aspects of language. In terms of social interaction, some individuals show high motivation to interact with others, although they may execute this in an awkward or inappropriate manner. Play skills and repetitive


behavior also vary across individuals. This variability and range in functioning contributes to the uniqueness of each individual with ASD. It also makes diagnosis and treatment of the disorder complicated. Diagnosing children at earlier ages, and growing recognition of individuals with more subtle impairments who have ASD have broadened the definition of autism.

Genetic Influences in ASD For approximately 5–10% of autism cases, there is an identifiable disorder with a known inheritance pattern, such as Fragile X syndrome, untreated phenylketonuria, (PKU), tuberous sclerosis, and neurofibromatosis. For the remaining cases of autism, there is no known specific inheritance pattern or genetic test for the disorder. Researchers are currently investigating the role of genetics in the development of ASD. In order to determine whether a disorder has a genetic basis, it is first necessary to evaluate whether it is familial, that is, whether it runs in families. Evidence suggests that there is a higher rate of ASD and related conditions among family members of individuals with ASD than would be expected in the general population. Much of this evidence comes from studies investigating the concordance of ASD among twins. When one twin has ASD, and the other twin also meets criteria for the disorder, the twins are said to be concordant for ASD. Studies of monozygotic, or identical twins, are especially helpful in investigating the genetic basis of autism. Monozygotic twins share 100% of their genes, whereas dizygotic or fraternal twins share approximately 50% of their genes. Therefore, for the development of a disorder to be completely determined by genes, in theory monozygotic twins should be nearly 100% concordant for the disorder. Studies have reported concordance rates of approximately 70%, with rates of concordance reaching 90% if one considered autism-related symptoms, such as social and language impairment. Thus, some monozygotic pairs are discordant for ASD (i.e., when one twin has ASD, the other does not). This suggests that environmental factors (e.g., infectious agents, toxins, trauma, and pre-, peri-, and postnatal factors) must also play a role in the etiology of autism. Nevertheless, the concordance rates for monozygotic twins are substantially greater than those for dizygotic twins, providing evidence for a strong genetic component in the development of the disorder. The concordance rates for dizygotic twins are similar to those reported for siblings. The reported sibling risk rates for ASD range from about 2.8% to 7.0%, which is still much higher than rates found in the general population, though less than rates reported for identical twins. This would suggest that having more genes in common (monozygotic vs. dizygotic twins) is associated with greater risk

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for ASD concordance. The increased concordance rate for siblings in general, as well as the discrepancy in concordance rates between monozygotic and dizygotic twins, indicates that genes play a significant role in the development of ASD. Even when siblings do not meet full criteria for the disorder, it has been found that about 10–20% show symptoms related to ASD, including language, learning, and communication impairments, as well as social difficulties. Studies of infant and toddler siblings of children with ASD have shown that young non-ASD siblings can show delays in receptive and expressive language, use of gestures, social smiling, adaptive behavior skills, and social communication and social–emotional functioning. Studies have also shown that parents from families that contain at least two children with ASD have elevated risk of particular personality traits (e.g., aloof, rigid, socially anxious), establish fewer closer relationships than typical adults, have communication impairments (including a history of language delay and pragmatic language deficits), and certain cognitive impairments. The tendency for some siblings and parents to exhibit one or more difficulties in social functioning, communication, and interests/behaviors, without actually meeting criteria for ASD, has been termed the broader autism phenotype, and is often conceptualized as a ‘lesser variant’ of autism. Because of the variation and spectrum of autism symptoms and severity, researchers often describe autism as a dimensional disorder, with many different components of varying degrees depending on the individual. Rather than one single gene accounting for the entire autism syndrome, it is possible that multiple genes (perhaps 10 or more) act as risk factors for the development of the components making up the autism disorder. A combination of these susceptibility genes may increase risk for the development of autism, with a greater number of genes leading to a greater risk of development of symptoms. This makes identifying the genes responsible for autism very challenging, given that each of these multiple genes, by itself, could have a very small effect size and the fact that symptoms vary significantly across individuals with ASD. Nevertheless, there is great hope that detection of autism susceptibility genes could ultimately lead to better diagnosis and clues to underlying cause and treatment.

Early Brain Development in ASD Brain imaging and autopsy studies of individuals with ASD suggest that the disorder affects a wide range of brain regions, including the prefrontal cortex, the medial temporal lobe (especially the amygdala), and the cerebellum. The earliest apparent finding is an abnormal head circumference growth trajectory, characterized by

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unusually rapid head growth during their first year of life. Although children with ASD do not necessarily have larger head circumferences at birth, by 1 year of age, head circumference, on average, is one standard deviation larger than that reported by the national Centers for Disease Control (CDC) norms. Some evidence suggests that, after 12 months of age, the rate of head circumference growth in children with ASD may decelerate such that the rate of head growth does not differ from the normative CDC sample. It has also been reported that first-degree relatives (e.g., siblings) of children with ASD tend to have larger than normal head circumferences. This is especially relevant given the findings from genetic studies of autism, suggesting that behavioral symptoms associated with ASD occur at a higher prevalence in firstdegree relatives than would be expected in the normal population. The possible association between head circumference trajectories and behavioral manifestations of autism is of particular relevance. If it can be established that head circumference trajectories are associated with specific autism-related behaviors, this may become a useful screening marker in alerting professionals to the possibility of the development of autism symptoms. By 2–3 years of age, brain imaging studies using magnetic resonance imaging have documented larger than normal total cerebral volume and an unusually large amygdala, which is a structure in the medial temporal lobe that is associated with emotional functioning. Autopsy studies have revealed abnormal neuron development in the amygdala, as well. Similar studies of the cerebellum have consistently shown cellular abnormalities. The cerebellum is involved in complex motor activities, attention, and language. These recent findings show promise in implicating brain regions that might play a role in the development of autism-related symptoms. However, it is important to interpret the findings with caution, given that brain imaging studies often contain small sample sizes and results may vary depending on the age of the children in the sample and other individual characteristics. Recent functional brain imaging studies have also shown that ASD is associated with poor functional connectivity between different brain regions. During resting and complex tasks, whereas typically various regions of the brain operate in synchrony with each other, studies have shown reduced long-range connectivity, especially between the frontal cortex and other regions of the brain. This may help explain why individuals with autism often have difficulty on tasks requiring high-order complex reasoning.

Early Behavioral Development in ASD Joint Attention Children with ASD have general impairments in the ability to attend to social stimuli in their environment.

Social stimuli can include the sound of a mother’s voice, and the movements and features of a human face, particularly eye gaze. Typically developing infants show sensitivity to social stimuli from the first weeks of life. The failure of young children with ASD to attend to these naturally occurring social stimuli in their environment spontaneously has been termed a ‘social-orienting impairment’. This impairment is one of the earliest and most basic social deficits in autism and may contribute to social and communicative impairments that emerge later in life. Young children with ASD also show impairment in joint attention, which refers to the ability to coordinate attention between interactive social partners with respect to objects or events in the environment in order to share awareness of the objects or events. It is a means by which a child can monitor and regulate the attention of another person in relation to objects or events taking place in the outside world. Joint attention behaviors include use of alternating eye gaze, following the attention of someone else by following their eye gaze or point, and directing the attention of someone else through eye gaze or gesture. For example, if a child makes eye contact with an adult, then looks at a toy in the room, and then back to the adult, the child has initiated joint attention by attempting to direct the adult’s attention to the toy. Similarly, if a child follows another person’s gaze, point, or head turn toward a toy across the room, the child has responded to joint attention. Typically developing infants tend to demonstrate joint attention abilities by around their first birthday. In children with ASD, this fundamental social-communication impairment is evident by 12–18 months of age and is actually incorporated into the diagnostic criteria for autism. Because joint attention is a discrete observable behavior, it provides a direct measure of social impairment in ASD. Research has shown that joint attention impairments distinguish preschool-age children with ASD from typically developing children and from children who have developmental delay without autism. Degree of joint attention impairment has also been found to be correlated with present and future language ability in children with ASD, and is considered a skill necessary for the acquisition of communicative language. Play Typically developing children generally develop symbolic pretend play between 14 and 22 months of age. Pretend play is the engagement in an imaginative activity, and includes using an object to represent another object (e.g., using a block to represent a cup), using absent objects as if they were present (e.g., pretending to feed nonexistent food to a doll), or animating objects and using them as independent agents of action (e.g., making an action figure walk, talk, or interact with other figures). Pretend play is


an expression of a child’s imagination. Studies have shown that toddlers with ASD produce significantly less pretend play compared with typically developing and developmentally delayed same-aged peers. In addition to the reduced amount of symbolic or pretend play, children with ASD also tend to produce fewer novel play acts, and engage in play that is less elaborate, spontaneous, flexible, and diverse than would be expected given their age. Their pretend play activities tend to be more simplified and rehearsed, as if carried out as part of a ritual, with little variation. Because pretend play is not typically present until the second year of life, impairment in pretend play is not a distinguishing feature of very young children with ASD; children with other developmental disabilities would also be expected to show deficits in these skills. For example, a child with delayed language development would not be expected to demonstrate elaborate make-believe play skills. However, improving pretend play skills is often a focus of behavioral intervention for children with ASD, as it has been shown to be related to the development of other important skills (e.g., language). Functional play is defined as the conventional and appropriate use of an object or toy as it is intended to be used, or the use of two or more objects according to their common functions. Examples of functional play include using a spoon to stir in a bowl or playing appropriately with miniatures. In typically developing children, functional play skills tend to emerge during the first year of life. In general, children with ASD engage in less functional play and produce fewer functional play acts. Their functional play also tends to be less diverse and elaborate. When provided with opportunities to play freely with toys, children with ASD tend to explore toys less, and often play in isolation, without making attempts to involve others in their play. Their play may also be repetitive, often repeating certain activities over and over (e.g., pressing the same button on a pop-up toy). In addition, a child with ASD is more likely to engage in sensory exploration of a toy or play materials. This can include mouthing a toy or banging toys together, as well as more repetitive activities such as spinning the wheels of a toy car or lining up objects. Both independent and peer play are considered to be social activities, because children’s themes and scripts incorporate aspects of their surrounding environment, in addition to serving as a means of reciprocal social interaction. In terms of peer play, children with ASD often play independently and alongside a group of children, rather than joining them in their play. This is referred to as ‘parallel play’. This lack of interactive play with peers can exacerbate the social impairments characteristic of children with ASD, making it difficult to develop the foundations necessary to form friendships or nurture social relations with others. It can also contribute to the isolation often experienced by children with ASD, resulting in

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fewer opportunities to interact with others and greater social impairment. Motor Imitation Impairments in motor imitation – both immediate and deferred – are common in ASD. Typically developing infants demonstrate the ability to imitate actions, such as facial expressions, from birth, and by 9 months of age, can actually imitate actions on objects. An infant’s ability to imitate is a manifestation of their social connectedness with others, in that it involves attending, listening, and learning from others. Imitation also serves as a means of communicating and sharing experiences with social partners. Children with ASD show significant impairments in object imitation, imitation of facial and body movements, and imitation of actions on objects. Studies have shown that the ability to imitate body movements (e.g., waving a hand) is more difficult for children with ASD than the imitation of actions with objects. This pattern of imitation skills is also found among typically developing children and children with developmental delay. In fact, research has indicated that children with ASD acquire simple motor imitation skills in a typical sequence, suggesting that the impairments in imitation in young children reflect a delayed, rather than disordered pattern of acquisition. Infants and toddlers with ASD also show impairments and delays in the development of social imitative play. This includes engaging in social imitative games with others, such as peek-a-boo and pat-a-cake, that involve the tracking and imitation of another person’s movements. Additionally, although infants and toddlers with ASD may participate in such activities with a parent, a child with ASD will rarely initiate such a game or take on both roles, reflecting a lack of social initiation and perspective taking. In fact, it has been suggested that failure to engage in such social imitative activities is associated with deficits in social reciprocity, joint attention, play, and language skills in children with ASD. Imitation skills in general have been shown to correlate with early language ability in children with ASD. Language Although social impairments are core diagnostic symptoms in children with ASD, parents of children with ASD often first become concerned about their child’s development when speech is delayed or when previously acquired speech is lost. There is extreme variability in the developmental outcome of language ability in children with ASD. While some children (about 30%) never learn to talk, others develop speech but continue to show qualitative communication challenges, such as impairments in nonverbal and pragmatic language skills, atypical speech patterns, and repetitive and stereotyped use of language.

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In terms of nonverbal communication, children with ASD tend to use less frequent eye contact, pointing, and other gestures. In very young children, there is a delay in the use of gestures that are used for the purpose of sharing interest and directing social interaction. Examples of these gestures include extending one’s arms to show a toy or object that he or she is holding, extending arms to be picked up, requesting something by extending one’s arm and opening and closing a hand, and waving goodbye when someone leaves. Children with ASD are more likely to use pointing or other gestures for the purpose of requesting something in particular (e.g., a toy or snack) than for indicating and sharing interest in an object or activity. Even when using language to communicate, children with ASD are less likely to coordinate gestures and eye contact with their vocalizations. Some children with ASD engage in the direct manipulation of an adult’s hand in order to request help. For example, a child with ASD may take the finger or hand of a nearby adult and use their finger or hand as a tool, to press a button, turn a knob, or open a door. In the majority of cases, this act is not accompanied by eye contact or vocalization; it is not a social act, but rather a means of acquiring help without actually involving the adult in the child’s play or behavior. The pragmatic use of speech refers to language used to start, maintain, or end a conversation. Although deficits in these skills are often more apparent and applicable as individuals become older, emerging difficulties with reciprocal conversation are also evident in young children. Deficits in pragmatic language can include a failure to respond to questions and comments made by another person. For example, a young child with ASD may not use eye contact, facial expression, or vocalization to acknowledge that another person has directed a statement or question toward them. This failure to respond to others marks a lack of reciprocity on the part of the child. Additional examples of pragmatic language impairments include providing excessive details in conversation or a tendency to monopolize a conversation, often when a child is focused on a particular topic of interest. Although the child is participating in conversation, this also makes it difficult to establish reciprocity, as the conversation is one-sided. Children with ASD may also have difficulty understanding how to interact appropriately with someone else during a conversation, such as knowing how close to stand to someone else or how to participate without interrupting. Atypical speech patterns in children with ASD include immediate or delayed echolalia, (i.e., a child’s immediate or delayed repetition of a word or statement), unusual prosody (e.g., atypical intonation, volume, rhythm, or rate), and semantic difficulties such as pronoun reversal (e.g., ‘‘you want a drink’’ or ‘‘he wants a drink’’ instead of ‘‘I want a drink’’). These atypical speech patterns can persist into adulthood. Repetitive and stereotyped use of language

refers to the repetition of phrases that may or may not be used in combination with functional speech. Often, children have heard these phrases in movies, as part of a game, song, or routine. A child with ASD may repeat the phrase while playing on their own, when attempting to converse with someone else, or even when agitated. In some cases, repetition of these phrases becomes compulsive, such that the child feels compelled to repeat the phrase over and over or even insists on someone else repeating the phrase or responding in a particular way. Another example of stereotyped speech includes the use of words or phrases that are more formal than would be expected given the child’s developmental level. Delays in language development affect both receptive and expressive language. Studies have shown that while typically developing children show early signs of language understanding before the end of the first year of life, such signs may not occur in children with ASD until much later in development. The production of words tends to be significantly delayed in children with ASD; word and phrase comprehension have been shown to be even more delayed. Moreover, even once a child has developed the ability to use speech and demonstrates the ability to respond to the speech of others, he or she may continue to have difficulty actually deciphering the meaning of a sentence. For example, children with ASD may interpret phrases in concrete or literal terms, making metaphors or jokes challenging to understand. Studies have also shown that children with ASD not only show a delayed course of language development; in many cases, the course of development is actually atypical. For example, compared to the normative pattern of development, the production of words may be relatively advanced in comparison to the understanding of words and phrases for children with ASD. It is also important to note that among children with ASD, there is great variability in the development of language, with some children achieving language competence in the typical timeframe. Nonetheless, as a whole, children with ASD tend to have significant delay in the development of language compared to typically developing children. In addition to a frank delay in language development, children with ASD tend to show a lack of communicative intent, or the motivation to communicate with others. In other words, the language impairment evident in young children with ASD is a result of fewer attempts to comment, engage in conversation, or direct someone else’s attention through the use of words, gestures, and eye contact, in addition to the lack of specific language skills. It has been reported that in approximately 20–47% of cases, children with ASD develop typically for about 18–24 months, at which point they experience a decline or loss of language skills. This decline or loss of skill has been termed a ‘regression’ in development. The period of regression in ASD can be acute or gradual, during which parents report that their child stops using words


or word-like sounds that he or she consistently used in the past. Although additional impairments become evident during regression, such as less frequent use of eye gaze and pointing and failure to respond to their name being called, the decline in previously acquired language skills often first alerts parents of a potential developmental problem.

Conclusion Children with ASD experience deficits in communication and social skills, and have repetitive and restricted interests and behaviors. Individuals diagnosed with ASD are characterized by heterogeneity in terms of their symptom profiles and severity of impairments. High concordance rates are found among identical twins with ASD, and siblings and family members are also at increased risk for the development of autism-related symptoms and the disorder itself. Evidence for a strong genetic component in the development of autism has led to an increase in current research efforts focusing on the genetic etiology of the disorder. It has also been shown that on average, children with ASD exhibit atypical head circumference trajectories, a reflection of abnormal brain growth patterns. One study found that these trajectories correlate with the development of autism symptoms in the second year of life, and may be a useful marker to alert professionals to autism symptom vulnerability. Infants and toddlers with ASD show specific impairments in early development and cognition, specifically in the areas of play, joint attention, language, and imitation. As the age of diagnosis becomes increasingly younger, children with ASD will have the opportunity to receive effective behavioral and psychosocial intervention in the first years of life, hopefully leading to improvement in functioning and preventative methods for the development of the disorder. Recent studies have shown that early intervention can have a significant impact on outcome in individuals with ASD.

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See also: Empathy and Prosocial Behavior; Imitation and Modeling; Play; Social Interaction.

Suggested Readings Charman T, Baron-Cohen S, Swettenham J, et al. (2003) Predicting language outcome in infants with autism and pervasive developmental disorder. International Journal of Language and Communication Disorders 38: 265–285. Charman T, Swettenham J, Baron-Cohen S, et al. (1997) Infants with autism: An investigation of empathy, pretend play, joint attention, and imitation. Developmental Psychology 33: 781–789. Dawson G and Toth K (2006) Autism spectrum disorders. In: Cicchetti D and Cohen D (eds.) Developmental Psychopathology, 2nd edn., vol. 3, pp 311–357. Risk, Disorder, and Adaptation. New York: Wiley. Dawson G, Toth K, Abott R, et al. (2004) Early social attention impairments in autism: Social orienting, joint attention, and attention to distress. Developmental Psychology 40: 271–283. Dawson G, Webb S, Schellenberg GD, et al. (2002) Defining the broader phenotype in autism: Genetic, brain, and behavioral perspectives. Development and Psychopathology 14: 581–611. Mundy P and Crowson M (1997) Joint attention and early social communication: Implications for research on intervention with autism. Journal of Autism and Developmental Disorders 27: 653–676. Stone W, Ousley OY, and Littleford CD (1997) Motor imitation in young children with autism: What’s the object? Journal of Abnormal Child Psychology 25: 475–485. Stone W, Ousley OY, Yoder PJ, Hogan KL, and Hepburn SL (1997) Nonverbal communication in two- and three-year-old children with autism. Journal of Autism and Developmental Disorders 27: 677–696. Zwaigenbaum L (2001) Autism spectrum disorders in preschool children. Canadian Family Physician 47: 2037–2042.

Relevant Websites http://www.autism-society.org – Autism Society of America. http://www.autismspeaks.org – Autism Speaks. http://www.washington.edu – University of Washington, UW Autism Center.


B Birth Order D L Paulhus, University of British Columbia, Vancouver, BC, Canada ã 2008 Elsevier Inc. All rights reserved.

Glossary Between-family research – Involves the comparison of individuals from different families. Therefore, when birth orders are compared, the large genetic differences between families are not controlled and add much extraneous variance. Big five personality traits – Factor analyses of comprehensive personality questionnaires typically yield five super-factors. They are named extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience. This simple taxonomy of personality has proved useful in describing birth-order effects. Birth order – The numerical sequence of a child’s arrival into a family. Environmental theories focus on the functional order (actual rearing order) whereas biological theories include all births. Intellectual achievement – This term subsumes scholastic performance (e.g., GPA, number of years of attained education) and performance on scholastic-related tests (e.g., standardized intelligence tests, SATs). Self-fulfilling prophecy – The dynamic process whereby an expectation about birth order difference becomes a reality. Social development – In this article, the term social development is simplified to refer to age changes in personality and political attitudes. Teaching effect – The long-term intellectual advantage conferred by the opportunity to help one’s younger siblings. Within-family research – Within-family research involves data collected on at least one sibling as well as the target individual. In many studies, one family member reports on the whole set of siblings including

himself or herself. It does not seem to matter which family member does the reporting because family members tend to corroborate each other’s judgments.

Introduction The notion that birth order has an influence on child development has undergone several cycles of popularity and disrepute. This uneven history applies to birth-order effects on social development as well as intellectual development, although the two literatures have unfolded quite independently. In this article, a brief history of this cycling of popularity in each of these literatures is provided followed by elaboration on the major theories and research. Most discussions of the topic focus on differences between firstborn and laterborn children. This simplification results in part from a reluctance on the part of researchers to differentiate among birth orders with small frequencies. While there are sufficient numbers of firstand secondborns in most samples, the frequencies are small for thirdborns and higher. Hence all laterborns are lumped together for analysis purposes. This article will follow suit in focusing almost entirely on the firstborn vs. laterborn differences – with the exception of some notable findings regarding middle-borns and lastborns.

A Brief History Social Development Alfred Adler, the second born of six children, was weak, sickly, and continually tormented by his older brother. In early childhood, Alfred envied his brother and felt

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that they were always in competition. But he worked hard to overcome his handicaps and became a popular member of the community. His success was such that his older brother grew to resent him. Undoubtedly, these family dynamics played a role in Adler’s seminal writings about the psychology of birth order. His ideas, published largely in the 1920s, anticipated many of the later perspectives on the subject. He suggested, for example, that firstborns are typically given more family responsibilities than laterborns and are expected to set an example. Consequently, they often become authoritarian and construe power as their natural right. This attitude can eventuate in an insecurity around the possibility of being ‘de-throned’ by laterborns. Adler went further to write that achievement expectations are high for firstborns and they attempt to live up to them. Laterborns, in contrast, try to compensate for their inferiority in size and power by turning to alternative notions of achievement. For example, the laterborns might turn to more social or creative endeavors. Thus Adler’s writings addressed both of the two primary domains, intellectual and personality development. It was not until the 1960s that mainstream researchers raised the legitimacy of studying birth-order effects in personality development. Stanley Schachter, for example, conducted a series of archival and laboratory studies of birth-order differences. Other prominent psychologists (e.g., Robert Sears, Phillip Zimbardo, Edward Ziegler, and Mary Rothbart) all added to the body of research on birth order as well as its credibility. During this period, sociologists and economists also contributed both theory and data to the birth-order literature. Although popular right up to the 1970s, the credibility of birth-order effects on personality faltered badly in 1983 with the publication of a comprehensive review by Ernst and Angst. The scope of their review was impressive: virtually every published study was included. After adding a variety of controls, including gender and family size, the authors concluded that associations between birth order and personality traits were minimal. The reputation of birth-order effects remained in quiet disrepute until the 1996 publication of Frank Sulloway’s book, Born to Rebel. In applying a bold new theoretical perspective, Sulloway revitalized the view that personality and social attitudes differ systematically across birth order. Sulloway’s treatment was persuasive, in part, because he offered two complementary forms of evidence. One was a catalog of captivating stories about the family life of historical figures. The second form of evidence was a metaanalysis of the large number of studies on personality and birth order. To great advantage, he organized the studies within the influential ‘Big Five’ or Five Factor Model of personality. That model is now generally accepted as the best organizational system (taxonomy) of personality traits.

Using that organizational system, Sulloway’s metaanalysis of the apparently chaotic literature exposed a clear pattern. In particular, firstborns were more conscientious and socially conservative but less agreeable and open to experience than laterborns. These claims form the hub of debates that continue to swirl around birth-order effects on social development. Follow-up studies from other quarters have varied from highly supportive to highly critical of Sulloway’s claims. Intellectual Development Scholarly interest in the relation between birth order and achievement can be traced to 1874 when Francis Galton published English Men of Science: Their Nature and Nurture. The book chronicled the lives of 180 eminent men from various scientific fields. Galton found that 48% of them were eldest sons, far higher than would be expected by chance. Anticipating later arguments, Galton provided three speculations on how the birth-order difference might come about. First was the impact of the primogeniture tradition: firstborn sons were given priority in the inheritance of family wealth. Accordingly, they would be more likely have the financial resources to continue their education. Second, firstborns were more likely to be treated as companions by parents and be assigned more mature responsibilities than their younger siblings. Galton’s third speculation was that, in families with limited financial resources, firstborns received more attention and better nourishment than other siblings. The latter two notions remain central to current debates regarding birth-order effects. Although the primogeniture tradition has waned, recent surveys by anthropologists confirm that firstborns occupy special status in every human society. Other things being equal, they are awarded more respect and given priority in legal, religious, and social matters, even when all siblings are grown to maturity. Almost a century of sporadic studies of intellectual development yielded inconsistent associations with birth order, partly because the sample sizes were insufficient. It was not until Robert Zajonc’s research in the 1960s that massive data sets were given theoretical scrutiny in major psychology journals. Zajonc’s analyses provided persuasive evidence that the intellectual achievement of firstborns tends to surpass that of other birth orders. This advantage applies across a wide range of measures including school grades, intelligence quotient (IQ ) scores, and SATs. Partly due to his credibility as a hard-nosed scientist, Zajonc’s theoretical and empirical analyses were taken seriously: much of his research and follow-up studies were published in medical, economics, and hard-science journals. As detailed below, his work provoked an avid interest that continues to this day.

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Theories of Birth-Order Differences

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As noted above, the literatures on social and intellectual development have only minimal overlap. The various theories of birth order have developed primarily in the context of one field or the other. In reviewing the five most important theories, however, this article will attempt to draw out implications for both social and intellectual development.

Confluence Model. Differential parental attention, even out of practical necessity, should affect the nature of the parent–child relationship across the birth order. Firstborns should be more attuned to their parents’ aspirations for their children, more needy of their parents’ approval, and expect to maintain the special status they enjoyed as children in future social settings. Together, these sequelae could eventuate in the different personality trait and value profiles typically found across the birth orders.

Confluence Model

Resource Dilution Model

Proposed by Zajonc, this theory explains the firstborn advantage in terms of the intellectual environment evolving within the family. With only two propositions, the theory was able to explain birth-order effects as well as intellectual deficits deriving from five other family constellation effects: family size, close child spacing, multiple births, and being lastborn or an only child. The first proposition of the model is simply that intellectual stimulation of children has enduring benefits for their later intellectual success. Only firstborns have a period of time where they receive 100% of their parents’ attention. For secondborns, the maximum quality time involves sharing the parents’ attention with the firstborn. With each successive child, the available parental attention gets watered down even further. In addition, the linguistic environment becomes increasingly less mature as more children enter the family. The second proposition of the confluence model was that lastborns miss out on the intellectual stimulation involved in teaching younger siblings. We consider that second proposition in the section below on lastborns. Zajonc’s first proposition does not seem radical or especially controversial: in retrospect, it seems more like commonsense. But he spelled out the various consequences and quantified them in a simple but persusive arithmetic formula. To represent the quality of the intellectual atmosphere at any point in a child’s development, one simply has to calculate the current mean mental age in the family. Integrated over the childhood years, this mean is higher for firstborns: they receive the most intellectual stimulation because they spend a larger portion of their time in a high-quality atmosphere. This stimulation stays with them in the form of superior cognitive abilities. Intellectual deficits due to family size also follow from this watering-down mechanism. Increasing the spacing between children helps modulate this watering down effect by allowing the mental ages of the older children to increase before adding the new contributor of zero mental age. Finally, the extra deficit seen in children of multiple births follows from the extra drop in average mental age due to the addition of several zeros to the equation. Although they are seldom spelled out, implications for social development can also be derived from the

This theory, originally proposed by the economist Judith Blake and extended by the sociologist, Downey, goes beyond the Confluence Model to argue for a more comprehensive decrease in resources for each successive child. In particular, there is a progressive watering down of financial and educational sources such as books, travel, and tuition. Differences in such concrete parental resources across birth orders can culminate in different scores on IQ tests. For example, parents with limited incomes may not be able to afford to send all their children to college. Any limitation in the opportunity for higher education will certainly diminish the likelihood of intellectual achievement. In combination with the decrease in parental attention, these other drawbacks handicap laterborns relative to firstborns. As noted for the Confluence Model, any special status, even if endowed arbitrarily by financial practicalities, may have implications for social development. Writers adhering to the Resource Dilution Model seldom allude to differences in social development across the birth order. Nonetheless, it seems reasonable to speculate that the differential allotment of financial resources could influence personality. The model is consistent with a small number of studies suggesting that firstborns feel more entitled to special treatment and that laterborns experience more resentment and jealousy. Parental Feedback Theory This theory suggests that parents adjust their parenting style as they move from the firstborn to laterborns. This adjustment is not out of financial or attentional necessity, but out of increasing comfort and decreasing anxieties. The result is that parents are less demanding of laterborns, especially with regard to their school performance. Beyond the firstborn, parents may allocate their love and approval in a manner that is less contingent on the child’s achievement. In one of the few experimental studies examining the transmission of birth-order effects, Irma Hilton observed how mothers treated children in a laboratory setting. In the waiting-room, firstborn children were observed to remain physically closer to their mother, often holding on for security. After the children returned from a putative

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‘testing session’, mothers were told that their child had performed extremely well or extremely poorly – based strictly on random assignment. Observation via a one-way mirror revealed that mothers of firstborns gave contingent feedback: if told their child performed well, mothers coddled and praised the child. If told their child performed poorly, mothers berated the child. Laterborns, however, received noncontingent treatment: mothers responded to the child as they had before the testing session – regardless of performance feedback. It is easy to see how such differential treatment could set off rather different developmental trajectories for firstborns and laterborns. In firstborns, superior intellectual achievement should be accompanied by a number of personality traits: they should possess higher achievement motivation, a greater concern with approval from parents and subsequent authorities. In turn, such qualities may well diminish their popularity among peers. The need for approval from authorities should also engender more conservative political attitudes in firstborns. Family Niche Theory In Frank Sulloway’s theory, parents play only indirect roles. Instead, birth-order effects unfold during the inevitable competition among siblings as they struggle for a family niche. Firstborns, having the first choice of niche, attempt to please their parents in traditional fashion, namely, by good performance at school and by generally responsible behavior. But, as other siblings arrive, firstborns must deal with threats to their natural priority in the sibling status hierarchy. The resulting adult character is conscientious and conservative. Laterborns must contest the higher status of firstborns, while seeking alternative ways of distinguishing themselves in the eyes of the parents. Accordingly, they develop an adult character marked by an empathic interpersonal style, a striving for uniqueness, and political views that are both egalitarian and antiauthoritarian. In short, they are ‘born to rebel’. This attempt to address birth-order differences in political orientation is unique to Family Niche Theory. Although designed to explain birth-order differences in personality, the Family Niche Theory is not without implications for intellectual development. In fact, it makes predictions about two aspects of intellectual life – achievement and creativity. Firstborns strive to achieve via traditional academic means – conscientious striving, to be specific. This development begins with their attempt to please their parents via school success. Although traditionally distinguished as ability vs. motivation, the tight overlap between intelligence and conscientiousness has become more evident in recent work. Laterborns, in contrast, seek out creativity, even radical revolution, in their intellectual lives.

Prenatal Hypomasculinization Theory Drawing on earlier work by Maccoby and others, Jeremy Beer and John Horn have developed a biologically based theory suggesting that the birth orders already differ at birth. The argument does not postulate an average genetic difference in the birth orders but a difference in their exposure to hormones. Previously called the ‘tired mother’ syndrome, the notion is that, with each succeeding male child birth, mothers expose their babies to lower levels of masculinizing hormones. Beer and Horn derived their theory from recent findings indicating that the likelihood of male homosexuality increases with the number of older brothers. The common mechanism, they argue, is the progressive immunization of mothers to the hormones that masculinize the male fetus. Thus male children with older brothers are ‘hypomasculinized’ in both their sexual orientation and their personality characteristics. According to Beer and Horn, this process eventuates in certain parallels between sex differences and birth-order effects. For example, males and firstborns should exhibit higher levels of competitive achievement whereas females and laterborns should exhibit more cooperation and flexibility. Firstborns should also be more disagreeable, and show more masculine interests. This hypothesized pattern of birth-order differences is consistent with the empirical evidence cited by Sulloway, Zajonc, and others. To date, however, there is little direct evidence to support Beer and Horn’s hypomasculinization theory. Yet the possibility that firstborns and laterborns already differ at birth is intriguing and should trigger further research on biological differences across birth orders. Contrasting Mechanisms Even among those writers who accept that children of different birth orders do differ in systematic ways, the disagreement over explanatory mechanisms is striking. According to the Prenatal Hypomasculinization Theory, the differences are already set at birth. For the Parental Feedback Theory, it is a change in parents’ comfort level that is responsible for birth-order differences. For the Resource Dilution Theory, it is the diminishing availability of resources that aid education. For the Confluence Model, it is the devolving quantity and quality of intellectual stimulation. For the Family Niche Theory, birthorder effects are propogated by accompanying differences in age, size, knowledge, and status in the family: The oldest child will always be the oldest. Size, knowledge, and maturity differences will eventually even out but status differences can remain well into adulthood. Of course, people spend most of their lives outside the purview of the family home and its unique interpersonal dynamics. Not surprisingly, then environmental

Birth Order

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theories typically suggest that birth-order forces on social and intellectual achievement should diminish with time. Even if accepting that the power of such differences eventually wanes, most psychologists – and lay observers, for that matter – believe that early environmental factors have a unique and enduring impact.

literatures on social and intellectual development. Yet the controversies have played out in rather different fashion in the two literatures.

Modern Data: The Importance of Research Design

In virtually every cross-sectional survey, a consistent advantage for firstborns continues to appear. Firstborns are over-represented among university students, among Nobel Prize winners, and on virtually any other concrete measure of intellectual achievement (e.g., IQ tests, SATs). Such birth-order differences, first communicated in a scientifically persuasive fashion by Zajonc and colleagues, continue to emerge in modern samples. For the most part, however, such clearcut birth-order effects were observed in between-family (i.e., crosssectional) data. A variety of confounds (e.g., SES, family size) make such results ambiguous. As Joseph Rodgers and others have demonstrated, when such confounds are removed, birth-order effects on measures of intellectual achivement often disappear. Unfortunately, when such important variables are statistically confounded, it is difficult to distinguish which variables are genuine effects and which variables should be controlled. By removing the effects of variables that may have similar causal mechanisms to birth-order effects, such analyses may be ‘throwing out the baby with the bathwater’. As of the writing of this article, the empirical pendulum seems to have swung back to favor the claims made by Zajonc and others. Several Norwegian researchers have recently analyzed data from virtually the entire population of their country. In 650 000 families, firstborn children showed a clear advantage in IQ , educational attainment, and later adult income. Apart from the largest sample size, this research has the most rigorous controls, including family size and SES. The fact that education is free in Norway helps mitigate the counter-argument that family finances play a determining role. So does the finding that the birth-order effects were actually stronger for children with highly educated mothers.

Each of the above theories has some intuitive appeal. But there remain serious questions about the data supporting the very existence of birth-order differences. As with many developmental debates, the key claims are not testable via laboratory-controlled experiments. Under contemporary mores, we cannot – or, rather, will not – randomly assign babies to different birth orders. Instead, social scientists can offer only correlational data and hope to clarify the developmental processes via statistical arguments. The most persuasive birth-order studies entail a large sample of participants evaluated in an efficient experimental design that includes multiple control provisions to handle potentially contaminating variables. One critical design issue is whether the data are collected within families or between familes. Within-family studies involve a comparison of the siblings within each family. If firstborn Jason and secondborn Mark are raised entirely in the same family setting, then they are matched (in large part) on factors such as family socioeconomic status (SES), parents’ child-rearing strategies, parents’ personalities, family events, and many other environmental factors. Of special importance, the researcher need not be concerned with genetic differences because, on average, they do not differ among offspring of the same parents. All of these controls make for a fair comparison of Jason and Mark with respect to birth order. In between-family studies, however, none of those controls are in place. If chosen randomly from a classroom, subject pool, street interview, or telephone survey, Jason and Mark are bound to differ on a host of environmental and genetic factors. Because those variables contribute their own (often larger) sources of variation, any birthorder differences will tend to be obscured. Because birth-order effects are relatively small, large sample sizes are of special importance for teasing out the differences. In the case of within-family research, it is difficult to take seriously any study comprising fewer than several hundred families. For between-family studies, even larger samples are required. Because so many other factors add noise to the measurement, birth-order differences do not become apparent with fewer than 500 participants from a relatively homogeneous sample. Debates over these methodological issues have created comparable levels of controversy in the research

Intellectual Development

Social Development In studies of personality and social attitudes, as well, the empirical debate about birth order is characterized by inconsistency. Sulloway and others have offered large data sets to support the idea that firstborns are more conforming and conscientious whereas laterborns are more agreeable, open to experience, and politically liberal. In response, other reputable scientists have disputed the size and importance of such birth-order differences.

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Birth Order

Again the debate may turn on the choice of withinfamily vs. between-family designs. In this case, however, the advocate and skeptic views are reversed. Birth-order effects are evident in within-family designs whereas minimal results emerge from between-family designs. The within-family design is typified by the method used in a 1999 article by Paulhus and colleagues. They asked a variety of large samples to report on their own families. In one study, for example, participants were asked to rate themselves and their siblings on the Big Five personality traits and on political attitudes. Results firmly supported Sulloway’s predictions. Most recently, Healey and Ellis outlined the conditions that yield the clearest birth-order effects in personality: (1) when firstborns are compared with secondborns, (2) when the age difference is 2–4 years, and (3) when children reared apart are excluded. Again, these withinfamily patterns confirmed predictions from Sulloway’s Family Niche Theory. With respect to between-family studies, a prototypical example is the study conducted in 1998 by Tyrone Jefferson and colleagues. Their data came from large archival samples that included both personality and birth-order data. On self-report measures, they found no significant birth-order effects on personality. On peer-ratings, the only significant finding was the usual conscientiousness advantage for firstborns. Few other studies can boast the feature of peer-raters: they provide a more objective perspective from outside of the family. These conflicting results may have a simple resolution. Studies with weak or null birth-order effects always involve a comparison of individuals from different families. But, as noted above, families differ on a wealth of influential variables and a full range of appropriate controls is seldom available. Within-family data provide a natural control procedure for all between-family differences, including their largest contributor – genetics. Most readers will be aware of the recent confirmation of substantial genetic effects on both intellect and personality. This consensus is helpful in understanding the conflicting conclusions drawn from within- vs. between-family studies: within-family designs remove a large component from the equation, namely, mean genetic differences between families. Accordingly, birth-order differences emerge more clearly in within-family studies. The burgeoning behavioral genetics literature also supports birth-order claims in another way. Second to genetics, the primary source of variance is personality, values, and, even political orientation is within-family environmental variance. In other words, there are family dynamics at work making siblings more different than expected by random genetic effects. Sibling rivalry and differential parental treatment of different birth orders are likely to be part of these within-family dynamics.

Stereotype Effects To repeat, within-family studies of personality inevitably show clear birth-order effects. Whether one asks the firstborn or laterborns, there is agreement on who is more conscientious. Moreover, this agreement seems to last a lifetime. Yet some critics dismiss the importance of that withinfamily consensus, arguing instead that putative birth-order effects derive entirely from within-family stereotypes. As children grow up with siblings of different ages, real differences in size, power, maturity, and knowledge govern the intersibling dynamics. When asked later to compare their siblings, say at the age of 30 years, all family members tend to concur on the traditional family story about how the children differ. Beyond that, these critics argue, the stereotypes have no impact on people’s lives. But research from the social and developmental psychology literature indicates that self- and other-stereotypes run deeper than that. In fact, adult samples show the same pattern and size of birth-order effects as much younger samples, even when the adults have been living apart from their siblings for many years. The stability of these perceptions across the lifespan undermines the accusation that they are artifactual and makes a stereotype perspective difficult to distinguish from standard conceptions of personality. Alternatively, is it possible that birth-order differences in that perceptions of one’s siblings are a fiction inculcated by stereotypes acquired from other sources? It is hard to believe that, throughout their lives, siblings systematically ignore bona fide evidence of their brothers’ and sisters’ actual traits in favor of erroneous stereotypes. It seems far more reasonable to believe that such stereotypes flourish because they have (at least) a kernel of truth. Critics would have to argue further that initially false stereotypes can endure a lifetime without having any impact on personality. According to social psychological research, however, one should expect some reification due to self-fulfilling prophecies. Can the stereotypes, the self-perceptions, and the peer-perceptions all be faulty? Critics such as Judith Rich Harris hold an intermediate position in conceding the reality of within-family personality differences, but caution that the differences remain just that – within the family. In other words, birth-order differences have no effect on life outside of the family home: only on home visits do the old familiar patterns emerge. Many readers will relate to that experience. Nonetheless, that experience may not be an insignificant portion of adulthood. Many children do go on to spend a significant amount of their adult life involved in continuing interactions with the family of origin. Harris’s notion of circumscribed personality differences is also compromised by a number of recent studies reporting on more concrete differences outside of the family.

Birth Order

For example, firstborns show more dismissive attachment styles in later life whereas laterborns disproportionately choose occupations that involve social interaction. To summarize, the stereotype critique is an attempt to explain away the robustness of within-family personality differences as shared fiction. Such counter-arguments must always be taken seriously, but in this writer’s opinion, there is simply too much evidence for the reality of birth-order differences.

Further Complexities Firstborns, Only-Children, and MiddleBorns Most of this article has purposely simplified birth-order issues by limiting the discussion to a comparison of firstborn children to all laterborns. The primary reason was that, in most respects, differences among laterborns are not as apparent as is the contrast with firstborns. Yet there are a few issues where middleborns and lastborns do stand out. The unique findings for lastborn children include both good news and bad news. As noted earlier, Zajonc found an extra decline in the intellectual achievement of lastborns – above and beyond the gradual decline due to successive birth order. A thirdborn child, for example, fares more poorly if no younger children are added to the family. This finding was confirmed in the recent large sample and tightly controlled Norwegian data (described above). Zajonc explained this anomaly in terms of the so-called ‘teaching effect’. Firstborns (and older siblings in general) often have to answer questions posed by their younger siblings and assist with their homework. At the time, the older siblings may experience these tasks as onerous. Rather than a burden, Zajonc argued, this teaching opportunity actually benefits earlier-borns, perhaps by forcing them to engage more deeply with the material they are teaching. That claim is quite consistent with the tutoring research in educational psychology, which shows that teaching benefits the teacher at least as much as it benefits the student. A lack of such opportunities can thus explain why lastborn children show an extra deficit in intellectual achievement and why only, children do not achieve as highly as other firstborns. The good news for lastborns lies in the personal popularity that ensues from their birth order. In surveys of comparative popularity, the lastborns are voted the ‘favorite child’ more often than any other birth order. This popularity may well reflect an inevitable tradeoff with personal achievement. Peers prefer others who are noncompetitive and more socially oriented than achievement oriented. These arguments can also be applied to only-children. The fact that they are also lastborns, may explain why their academic achievement does not match up to that of other firstborns; the fact that they are also

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firstborns may explain why they are not as popular as other laterborns. The tradeoff between the respect accorded to firstborns and the personal popularity of lastborns often leaves the middleborns feeling left out. Studies by Canadian researchers, Salmon, Daly, and Wilson has confirmed that, in various ways, the middleborns feel less attached to the parents. For example, they are less likely than either first- or lastborns to nominate their mothers as their favorite family member. Gender Compared to the prominent role that gender plays in many developmental issues, it has made surprisingly little difference in birth-order studies. The intellect and personality profiles that emerge for females are comparable to those emerging for males. Certainly, over the long history of birth-order research, a number of statistical interactions have been reported where gender was involved. When found, the results of a particular combination – say, firstborn males with secondborn females and thirdborn males – were not difficult to explain with a ‘just-so story’. But the fact that such interaction effects rarely replicate suggests that the original findings were due to chance. With larger families, the number of possible combinations escalates quickly. With increasing parity in male vs. female achievement, any such interactions with birth order may eventually vanish. For these reasons and others, recent research has paid little attention to possible gender differences in birth-order effects. A couple of recent findings constitute exceptions to this rule. An interesting finding reported by Sulloway was that secondborn boys often develop with firstborn personalities if the firstborn is a girl. Perhaps boys do not see firstborn girls as competitors and react only to their brothers. Or parents may still place more value on the firstborn male child. The lack of difference in the size of birth-order effects has played a role in evaluating the Prenatal Hypomasculinization Theory. The credibility of that theory is weakened by the fact that its predicted larger effect size in males has not materialized in recent (tightly controlled) research.

Summary The impact of birth order on social and intellectual development seems at once self-evident and empirically elusive. When found, the pattern is consistent: firstborns are the most intelligent, achieving, and conscientious, whereas laterborns are the most rebellious, liberal, and agreeable. In competition to explain these profiles are such diverse theories as Differentiatal Parental Feedback, Resource Dilution, Family Niche, and Prenatal Hypomasculinization.

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Breastfeeding

The difficulty in confirming these birth-order differences is disconcerting. Although intially evident in most large-sample studies, the differences often disappear when key variables are controlled. The fact that significant reverse effects (e.g., firstborns less conscientious than laterborns) are rarely found, suggests that birth-order effects are at work, but that they are masked by certain research designs. Even statistical experts cannot seem to agree on how to tease apart birth-order effects from those of family size and SES. The fact that birth-order differences are small to begin with makes them especially difficult to confirm. Indeed, all the contending theories predict small differences. In the case of IQ differences, for example, the expected firstborn vs. secondborn difference is only two IQ points. The effect sizes of birth order pale in comparison with sex differences, and most important, with temperament differences instilled by genetic and congenital factors. As Jerome Kagan has pointed out, stereotypes about birth order are widespread and have a powerful intuitive appeal. But surely this wide appeal derives, at least in part, from some real commonality in human experience. Those of us with siblings have spent considerable time evaluating our relationships with them. The consensus within our families emerged long before we learned about birth-order stereotypes. The fact that most adults are eventually made aware of these stereotypes does not undo their validity. Even stereotypes can have a selffulfilling effect as family members strive to live up to their expected roles. At this point in the history of birth-order research, the informed reader must live with the fact that experts

disagree and the continuing empirical debates are abstruse. Nonetheless, in this writer’s opinion, the current weight of evidence favors the view that birth order does matter for both intellectual and social development. See also: Attachment; Family Influences; Social and Emotional Development Theories; Temperament.

Suggested Readings Bjerkedal T, Kristensen P, Skjeret GA, and Brevik JI (2007) Intelligence test scores and birth order among young Norwegian men (conscripts) analyzed within and between families. Intelligence 35: 503–514. Healey MD and Ellis BJ (2007) Birth order, conscientiousness, and openness to experience: Tests of the family-niche model of personality using a within-family methodology. Human Evolution and Behavior 28: 55–59. Jefferson T, Herbst JH, and McCrae RR (1998) Associations between birth order and personality traits: Evidence from self-reports and observer ratings. Journal of Research in Personality 32: 498–509. Paulhus DL, Trapnell PD, and Chen D (1999) Effects of birth order on achievement and personality within families. Psychological Science 10: 482–488. Rodgers JL, Cleveland HH, van den Oord E, and Rowe DC (2000) Resolving the debate over birth order, family size and intelligence. American Psychologist 55: 599–612. Salmon CA and Daly M (1998) The impact of sex and birth order on familial sentiment: Middleborns are different. Evolution and Human Behavior 19: 299–312. Schachter S (1963) Birth order, eminence and higher education. American Sociological Review 28: 757–768. Sulloway FJ (1996) Born to Rebel: Birth Order, Family Dynamics, and Creative Lives. New York: Pantheon. Zajonc RB (1976) Family configuration and intelligence. Science 192: 227–281.

Breastfeeding R A Lawrence, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Alveolus – A glandular acinus or terminal portion of the alveolar gland where milk is secreted and stored, 0.12 mm in diameter. From 10 to 100 alveoli, or secretory units, make up a lobulus. Colostrum – The first milk. This yellow, sticky fluid is secreted during the first few days postpartum and provides nutrition and protection against infectious disease. It contains more protein, less sugar, and much less fat than mature breast milk.

Induced lactation – Process by which a nonpregnant female (or male) is stimulated to lactate. Lacteal cells – Cells that produce the milk. Lactiferous ducts – The main ducts of the mammary gland, which number from nine to 15 and open onto the nipple. They carry milk to the nipple from the alveoli where it is made. Lactogenesis – Initiation of milk secretion. Lobulus – A subunit of the parenchymal structure of the breast made up of 10–100 alveoli, or secretory units. From 20 to 40 lobuli make up a lobus.

Breastfeeding

Mammogenesis – Growth of the mammary gland. Oxytocin – A chemical hormone synthesized in the cell bodies of neurons located mainly in the hypothalamus. Oxytocin stimulates the ejection reflex by stimulation of the myoepithelial cells in the mammary gland. Prolactin – A hormone present in both males and females and at all ages. During pregnancy it stimulates and prepares the mammary alveolar epithelium for secretory activity. During lactation it stimulates synthesis and secretion of milk. At other ages and in the male it interacts with other steroids.

Introduction The human infant is born to breastfeed. It is not just a simple matter of nutrition but survival and optimal growth itself. Mammals nurse their young. At birth, the offspring finds the teat and latches on. The length of feeds, the duration of feeding at the breast, and the time for weaning are unique to each species and vary with the offspring’s level of development at birth and rate of growth and development. The human infant is the most immature of the mammalian species at birth with the exception of marsupials who are suckled in a pouch until they can forage for themselves. The very survival of the mammalian offspring depends upon successful nourishment from the mother. Those who are too weak or those whose mother has insufficient milk do not survive, which is the basic principle of survival of the fittest in all other species until modern times. The human infant was equally challenged and often succumbed because of the lack of wet nurses or adequate nourishment if the mother could not, or would not, breastfeed. Mortality in infancy was high especially among nobility who farmed their infants out to wet nurses. Because artificial feeding utilizing bovine milk is readily available, breastfeeding has become less common. The tremendous benefits of being breastfed are continually being confirmed with strong scientific studies and public health initiatives are encouraging women to breastfeed. The true understanding of the significance of breastfeeding to human development begins with understanding the benefits of being breastfed or more dramatically the risks of not being breastfed.

The Benefits of Being Breastfed for the Human Infant Nutritionally, human milk is designed for the human infant. The constituents are specific for the needs of the

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human species. No other mammal drinks another species’ milk. Although emphasis in nutrition has been on physical growth, the compelling nutritional needs of the human infant are for brain growth. The brain will double in size in the first year of life. The nutrients in human milk are ideal for this growth when in the proper ratios and accompanied by enzymes and ligands that facilitate the digestion and absorption of these nutrients including the microminerals. Unique features of human milk include the presence of cholesterol, which is not found in infant formulas. No matter how the maternal diet is manipulated with high or low cholesterol and high or low fat, the cholesterol levels in her milk are consistent until weaning is completed. Cholesterol is a constituent of nerve myelination and the biochemical basis of many essential enzymes. Docosahexaenoic acid (DHA) and arachidonic acid (AA), two essential fatty acids that have been associated with brain and neural tissue growth, are found in high levels in human milk and minimally in bovine milk. Controlled studies of both term and preterm infants have demonstrated clearly that those infants who are fed mother’s milk (or donor human milk) are more advanced on developmental scales, have greater visual acuity, and auditory acuity compared to those fed on cow’s milk, infant formula, and even formula supplemented with DHA. Human milk promotes brain growth so that infants reach their full potential. Protein is another important dietary constituent and each mammalian species’ milk has a milk protein important to the offspring. Human milk has less protein than cow’s milk, but it is predominantly whey protein which is easily digested and absorbed. The amino acid profile is equally important. Human milk is low in tyrosine and phenylalanine, which are essential but in excessive amounts can be detrimental to the brain. This is seen in individuals who lack sufficient enzymes to digest phenylalanine, which results in elevated levels and mental retardation as seen in untreated phenyl ketonuria (PKU) disease. An amino acid, taurine, is also necessary for brain growth and present in human milk but not in cow’s milk. Although the adult can produce taurine so it is not considered an essential amino acid for adults, infants cannot produce it well and require it in the diet for proper brain development. Even carbohydrate plays a significant role as the energy for the brain. Human milk has the most lactose of all mammalian milk. When the size of the brain (weight of brain per size of adult of species) is compared, the more lactose in the milk the larger the brain of the species (Figure 1). The human has the largest brain per pound of body weight and is the most advanced intellectually. Clearly, human milk has been carefully engineered biochemically to support and promote the growth of the human brain.

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Breastfeeding 40 Sea lion

30

Fat (%)

Reindeer 20

Rat Rabbit Buffalo

10

Dog

Camel Human Horse

Cow 0

0

1

2

3

4

5

6

7

Lactose (%) Figure 1 Concentration of lactose varies with source of milk. In general, less lactose, more fat, which can also be used by newborn animal as energy source. Reproduced from Lawrence RA and Lawrence RM (2005) Breastfeeding: A Guide for the Medical Profession, 6th edn, figures 4–11, p. 137. Philadelphia, PA: Elsevier, with permission.

Health Benefits of Being Breastfed It has long been observed that breastfed infants have fewer infections. Data are dramatic in illustrating the rise in infant death from infection in developing countries as the rate of breastfeeding falls. Fifty per cent of infants in developing countries die in the first year of life if not breastfed. In industrialized countries, the rates of diarrhea, otitis media, and respiratory infections are considerably higher in bottle-fed infants. This is confirmed by increased use of antibiotics and the number of hospitalizations occurring in bottle-fed infants. The infection protection constituents in human milk have been well studied and are numerous. The value of colostrum, the first milk, is recognized for all species and dairymen and other specialists in animal husbandry know that the offspring cannot be deprived of the colostrum or it will die of infection. Human milk contains human blood cells including T-lymphocytes and macrophages. Other immunologic components include lactoferrin, lysozyme, and many antibodies as well as cytokines and interleukins; all are important host defense mechanisms against bacteria, viruses, and other agents of infection. The immunologic significance of human milk has been demonstrated in a number of epidemiologic studies reporting that breastfeeding for 4 months or longer can

provide some immunologic protection against some childhood-onset diseases. It was noted that a rise in childhoodonset diabetes in Scandinavia was associated with a decline in breastfeeding. In 1991, a prospective long-term study among children in Finland showed a significantly lower incidence of childhood-onset diabetes in children at high risk if they had been breastfed for at least 4 months. Other epidemiologic studies have shown a decreased incidence of insulin-dependent diabetes in breastfed children. A decreased incidence of childhood cancers, especially leukemia, in children breastfed for at least 4 months has been demonstrated by other investigators. Reduction in the incidence of inflammatory bowel disease and celiac disease was similarly associated with breastfeeding. A large number of bioactive factors have been identified and measured in human milk over the course of lactation. Protection against allergy or at least postponement of the onset of allergic symptoms (eczema, rhinitis, and asthma) in children at high risk for developing allergies (parent or sibling with symptoms) has been associated with exclusive breastfeeding. That bovine protein causes allergies in humans is central to this issue and thus the absence of exposure to bovine protein while breastfeeding prevents allergies. Crossspecies intolerance of other milk is demonstrated by the fatal effects of bovine protein on rabbits.

Breastfeeding

The only contraindications to being breastfed are galactosemia, a genetic ezyme disorder, where the enzyme that digests lactose is missing. HIV or AIDS is the only infection in the mother that contraindicates breastfeeding in developed countries. In developing countries where alternatives to breastfeeding are of poor quality and at risk for contamination, it may well be better to exclusively breastfeed if the mother is HIV positive.

Benefits for the Mother Who is Breastfeeding Breastfeeding is also the physiologic completion of the reproductive cycle. The breast prepares for lactation during pregnancy as it responds to the milieu of hormones from the placenta and ovaries. The alveolar system develops and arborizes developing a lining of lacteal cells which prepare to make milk. When the placenta is delivered, the breast is ready to respond to the hormones prolactin and oxytocin to produce and release milk. The oxytocin also causes the uterus to contract. As a result, uterine involution is initiated promptly, there is less total blood loss, and there is earlier return to prepartum state in lactating women. Women who breastfeed also return to their normal weight utilizing the stores deposited during pregnancy to produce milk. In the long range, breastfeeding women are also at less risk for long-term obesity if they breastfeed. Although it would seem counter-intuitive that a woman who breastfeeds would be at lower risk for long-term osteoporosis given the amount of calcium and phosphorus provided to the infant in the milk, the body protectively absorbs more minerals during lactation and during the weaning process. Thus, women who have children and breastfeed them are at lowest risk for osteoporosis, those who have children but do not breastfeed them are at modest risk, and those women who never have children (or breastfeed) are at the greatest risk for osteoporosis. Epidemiologic studies of breastfeeding women have also demonstrated a lower risk of breast cancer in women who breastfeed. Ovarian cancer has also been shown to be reduced with increasing numbers of pregnancies and increasing duration of time spent breastfeeding, possibly related to the decrease in estrogen during pregnancy and lactation.

Disadvantages of Breastfeeding Disadvantages to breastfeeding are those factors perceived by the mother as an inconvenience to her because there are no disadvantages for the normal infant. A common concern for some mothers is the fact the mother has to feed the baby every feeding unless she pumps her milk and someone else feeds the baby. The responsibility of caring for a newborn

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and the time and energy involved is a major cause of maternal fatigue. The infant’s father should be encouraged to participate. If the infant is going to receive a bottle of pumped milk or formula, providing it during the night allows the mother some uninterrupted sleep. This may be necessary for the employed mother, unless there is on-site daycare. In traditional societies, the infant is carried with the mother at all times whether she is working in the fields or working in the home and feeding on-demand is traditional. In addition, certain maternal medications may be a contraindication such as antimetabolites, street drugs, and a few of the antipsychotic medications. There are excellent references available to consult so that breastfeeding is not unnecessarily stopped.

Physical Growth of Breastfed Infants It has been determined by an international committee of experts that the ideal mechanism for measuring childhood growth is the growth of the exclusively breastfed baby who is otherwise healthy and well-cared for. The important concept is that growth standards should be how children should grow, not how an average number of children do grow. The growth charts that have been in use in the US and elsewhere for a number of years were prepared by the Center for Disease Control by taking multiple small studies of children, sick and well, fat and thin, mostly formula-fed and occasionally breastfed. These data were averaged, and the curves were smoothed and these are the growth charts that have been used for a decade or more in the US. The World Health Organization (WHO) supported an international study to learn how children should grow. Eight thousand six hundred children were followed very closely in six countries (Brazil, Ghana, India, Norway, Oman, and the US) of the world for the first 2 years of life and a little less closely until all of the children had reached 5 years of age. These children were exclusively breastfed for at least 4 months and partially for 1 year. The mothers were healthy. The infants were healthy, and they received sufficient medical care and adequate nutrition. These growth charts have been released by the WHO and make an international standard possible. The experts observe that when nutrition was adequate and health was cared for, the children all over the world grow with a similar pattern.

Psychological Impact of Breastfeeding The breast prepares to nurse the young during pregnancy. For the many decades when women embraced artificial feeding and wished to raise their children by the book, they sought formulas to relieve them of the total responsibility of nourishing their young. The psychologic benefit

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Breastfeeding

of breastfeeding was described during the era of attachment research and ‘bonding’ to one’s infant shortly after birth. The work of Righard and others showed that an infant when placed on its mother’s abdomen right after birth would find its way to the breast unassisted in 20 min, crawling, squinching, and wiggling toward the breast. The baby would also latch on and begin to suckle unassisted. Other adaptations of this research showed that when one breast was washed before birth, the infant chose the unwashed breast. Other studies described challenging infants to identify their own mother’s nursing pads by presenting the infant with several nursing pads. The infant always chose his mother’s. The interpretation of these studies was that infants recognize their mothers by many sensory means including smell. Animal studies of parenting behavior in various species have shown a strong urge for the female of the species to groom, coddle, and feed her young after delivery. The male of species when given hormones, prolactin, oxytocin, the hormones of lactation, were also stimulated to groom and nurture the offspring. When other females of the species who were not pregnant were given these hormones, they too would groom and nurture a newborn of the species. In the human, the two hormones that are in abundance during lactation are prolactin which stimulates the production of milk and oxytocin which stimulates its release from the breast. These hormones increase the nurturing tendencies of the human mother as well. The observation has been made that when a woman cradles her baby to the breast, the distance between the mother’s eyes and the infant’s eyes are equal to the estimated visual range of a young infant. In addition, when the baby suckles, it stimulates the release of oxytocin and prolactin so the mother reflexively reacts to this stimulus at her breast. The psychologic benefit to the infant of being breastfed is not easily measured, but it can be observed that when the mother breastfeeds, she has to feed the baby herself. Without extreme effort of pumping and bottling she cannot pass the baby off to someone else to feed. If she’s breastfeeding, she has to be there for the infant. So the infant has the advantage of being held closely, abdomen-to-abdomen, of being able to look into the mother’s eyes, to hear the same heart beat that it had heard in utero and smell the same smells. Breastfeeding is an act of comfort and support for the infant in addition to the nutritional advantages so that the psychologic benefits of being breastfed have also been the benefits that have been unchallenged by artificial feeding.

community. In traditional societies, one generation lives with the older generation. Families are big and families stay together. Young children grow up knowing that breastfeeding is the norm. A young girl has the opportunity to observe the young women in the family nourishing their newborns by breastfeeding. It is a natural act. When the young woman comes of age to have her own children, there are generations of women who are experienced and supportive of breastfeeding. The culture mothers the mother, providing her with special foods, teas, and personal care. She is relieved of household obligations and her work is done for her by other women in the clan. The culture supports childbirth and supports breastfeeding so that infants can be breastfed exclusively for months and continued for years. In industrial countries, in our modern times, the community is not supportive of childbirth or breastfeeding. There is no family structure with knowledgeable, experienced nursing mothers available to help the new mother. That is the source of one of the greatest problems with breastfeeding today. Women do not have the social experience of how breastfeeding happens, and there is not a circle of women in their surroundings ready to help them nurse their infant. It is clear that significant changes in the number of women who initiate breastfeeding and successfully and exclusively breastfeed for at least 6 months will not change markedly until children grow up knowing that breastfeeding is a norm. To that end, a curriculum has been developed by the department of education in the state of New York in cooperation with the department of health. This curriculum directed at children from kindergarten through high school was developed and trialed in the 1990s and is available on the website of the New York State Health Department. A national advertising campaign was initiated in 2004 by the office of Women’s Health at the National Institutes of Health (NIH). This campaign used up-to-date advertising tactics to sell a social concept. The campaign was outspoken, assertive, and ‘in-your-face’. It had been well established that the general public, and women in particular, knew that breastfeeding was best but that was not a strong enough message to persuade many young women to initiate breastfeeding. The campaign was based on the tagline, ‘‘Babies were born to breastfeed’’ but the message was that there was risk of otitis media, allergy, and other illnesses if one fails to breastfeed one’s infant. Whether this approach will significantly change the behavior of mothers is debatable.

Social Structure

Guilt, Anger, Failure, and an Informed Decision

In traditional societies, childbirth is an important event and involves the women of the family, the clan, and the

Considerable emotion is precipitated when the subject of breastfeeding and its great benefits is presented to some

Breastfeeding

audiences. Many practitioners indicate that they do not discuss the decision about infant feeding in the prenatal period because they do not wish to ‘cause guilt’. Some women, who are well educated and very knowledgeable about the benefits of breastfeeding but have failed to succeed at breastfeeding, express tremendous anger. In some cases, the failure is due to the system and is due to a lack of support and a lack of experienced healthcare providers to assist the mother. Sometimes, however, the cause is a biologic failure to produce milk. There are no formal studies to indicate how many women are unable to actually make an adequate amount of milk. Women with very unusual breast anatomies have been observed to have difficulty breastfeeding. These are women with asymmetric breasts, extremely small breasts, tubular breasts, and extremely inverted nipples. In some occasions, women with extremely large breasts are unable to produce sufficient milk, but the statistical probability of this event has not been calculated. Family history of several generations of women in a given family unable to produce sufficient milk for their offspring would suggest in some cases a genetic origin. The risk of possible failure or insufficiency is very low and does not justify the failure to help a

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mother make an informed decision about how she will feed her infant based on her circumstances and wishes.

The Anatomy and Physiology of Breastfeeding Gross Anatomy The mammary gland as the breast is medically termed comes from the Latin word for breast, ‘mamma’. The human mammary gland is the only organ that is not fully developed at birth. It experiences dramatic changes in size, shape, and function from menarche to pregnancy, lactation, and ultimately involution (Figures 2 and 3). The gland undergoes three major phases of growth and development before pregnancy and lactation: phase I – in utero; phase II – during the first 2 years of life; and phase III – at puberty. Embryonic development of the breast begins with the milk streak in the embryo which appears at the fourth week when the embryo is only 2.5 mm long. It becomes a milk line or ridge during the fifth week and continues to develop from thereon. By 16 weeks, gestation, the

Figure 2 Female breast from infancy to lactation with corresponding cross-section and duct structure. (a–c) Gradual development of well-differentiated ductular and peripheral lobular-alveolar system. (d) Ductular sprouting and intensified peripheral lobular–alveolar development in pregnancy. Glandular luminal cells begin actively synthesizing milk fat and proteins near term; only small amounts are released into the lumen. (e) With postpartum withdrawal of luteal and placental sex steroids and placental lactogen, prolactin is able to induce full secretory activity of alveolar cells and release of milk into alveoli and smaller ducts. Reproduced from Lawrence RA and Lawrence RM (2005). Breastfeeding: A Guide for the Medical Profession, 6th edn, figure 2–3, p. 43. Philadelphia, PA: Elsevier, with permission.

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Breastfeeding

Mammary lobus containing several lobuli Mammary lobulus containing 10–100 alveoli

Connective tissue septa Mammary fat

Lactiferous ducts

Areola mammae

Montgomery glands Figure 3 Schematic drawing of the breast to illustrate its orderly construction where the aveoli make the milk and it flows through the duct system to the nipple and is ejected when the breast is stimulated. Reproduced from Lawrence RA and Lawrence RM (2005). Breastfeeding: A Guide for the Medical Profession, 6th edn, figures 2–7, p. 48. Philadelphia, PA: Elsevier, with permission.

branching stage of breast development has produced 15–25 epithelial strips that represent future secretory alveoli. The mammary glands of both male and female fetuses from 13 to 40 weeks, gestation have been carefully studied and the development outlined by ultrasound. At birth, the mammary gland is an important anatomic signpost with which clinicians determine the gestational age of the infant. At the time of birth, in a full-term infant, the nipple is visible, there is a rudimentary duct system and the body of the breast is palpable at 3–4 mm. The breast is relatively quiescent until puberty in the female. Organogenesis begins in most females between 10 and 12 years of age during which the ductal system begins to sprout resulting in the growth of breast parenchyma with its surrounding fat pad. The ductal tree extends and generates its branching pattern, lengthening the existing ducts and growing lateral buds at the side of the ducts that will ultimately form alveolar buds that will develop into the milk-making part of the gland. The breast continues to mature stimulated by the hormones of the menstrual cycle. This microscopic growth continues monthly until about 28 years of age unless interrupted by pregnancy and lactation. Once menses are established and ovulation has occurred, there has been a sufficient hormonal stimulus to the breast so that the breast can continue to mature and develop lacteal cells capable of making milk. Adolescents who become pregnant are anatomically capable of

nursing their infants. The ductal system in the breast develops in a very organized manner. The alveoli develop a lining of lacteal cells that are capable of producing the milk that passes into the duct system. The duct system carries the milk toward the nipple. There are about 16–18 ducts that empty into the nipple, each duct draining multiple lobuli and each lobuli containing several alveoli. The breast is prepared for full lactation from 16 weeks, gestation without any active intervention from the mother. It is kept inactive by a balance of inhibiting hormones that suppress the target cell response during pregnancy. In the first few hours of the first day postpartum, the breast responds to the change in hormonal milieu and the stimulus of the newborn sucking to produce and release milk. When the placenta is delivered, the inhibiting hormones that have blocked the breast from producing a full amount of milk are gone. The energy expenditure during lactation has suggested an efficiency of human milk production that is greater than 95%. It is estimated that the energy cost of human lactation is minimal. In contrast to most organs that are fully developed at birth, the mammary gland undergoes most of its morphogenesis postnatally in adolescence and in adulthood. Lactation is an integral part of the reproductive cycle of all mammals including humans. The hormonal control of lactation can be described in relation to five major stages in the development of the

Breastfeeding

mammary gland. (1) embryogenesis; (2) mammogenesis or mammary growth; (3) Lactogenesis or initiation of milk secretion; (4) lactation or full milk secretion; and (5) involution when the infant is weaned. Some women can express colostrum after about 16 weeks, gestation. The ability to produce milk can be measured by measuring the level of lactose and alpha lactalbumin. Stage I of lactogenesis actually starts during parturition and is heralded by significant increases in lactose, total protein, amino globulins, and by decreases in sodium and chloride and the gathering of substrate from milk production in the mother’s system. The composition of prepartum secretion is fairly constant until delivery. Lactogenesis is initiated in the postpartum period by a fall in the plasma progesterone while prolactin levels remain high. The initiation of the process does not depend on suckling by the infant until the third or fourth day when the secretion declines if milk is not removed from the breast. Stage II lactogenesis includes the increase in blood flow and oxygen and glucose uptake as well as the sharp increase in citrate concentration considered a reliable marker for lactogenesis stage II. Lactogenesis stage II at 2–3 days postpartum begins clinically when the secretion of milk is copious, and biochemically when the plasma alpha lactalbumin levels peak. The major changes in milk composition continue for 10 days changing from colostrum to mature milk. The establishment of a mature milk supply once called galactopoiesis is now referred to as stage III of lactogenesis. The composition of the milk over these first 10 days has been carefully studied, and the pattern is consistent among mothers.

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lactation, it is noted that lactating women maintain a high baseline of prolactin and when the breast is stimulated, the prolactin levels surge to almost double the baseline. It is this surge that has been associated with successful milk production. It has also been observed that the prolactin levels do not rise unless the breast is stimulated either by the infant’s suckling or by pumping even though the mother may be in contact with her infant (Figure 4). The Role of Oxytocin Oxytocin was the first hormone studied in relation to breastfeeding and to the let-down reflex. It was studied in detail because it was measurable and could be isolated in the laboratory. Oxytocin, however, is not just a female hormone. It is produced by both males and females and not just during reproduction in the female. It is credited with producing increased responsiveness to closeness, openness to relationships, and nurturing. The oxytocin circulating during breastfeeding has been credited with producing calm, lack of stress, and an

Hypothalamus

Pituitary gland

Prolactin

Oxytocin

The Role of Prolactin Uterus

Human prolactin is a significant hormone in pregnancy and lactation. Prolactin also has a range of actions in various species that is greater than any other known hormone. Prolactin has been identified in many animal species whether they nurse their young or not. Prolactin, however, has been shown to control nonlactating responses in other species and has been identified with more than 80 different physiologic processes. Prolactin exists in both the male and the female of the species and normal prolactin levels vary physiologically throughout life. Baseline levels of prolactin are essentially the same in normal males and females. Both experience a rise in prolactin levels during sleep. There is normal diurnal variation in levels as well. Many normal activities change the prolactin levels including stress, anesthesia, surgery, and exercise. During lactation, prolactin stimulates the lacteal cells to produce milk. The high prolactin levels that existed during pregnancy gradually drop in the first 2 weeks postpartum if the breast is not stimulated to produce milk. When prolactin levels are measured during

Myoepithelial cell Lacteal

Figure 4 Diagram of ejection reflex arc. When infant suckles breast, mechanoreceptors in nipple and areolar are stimulated, which sends a stimulus along nerve pathways to the hypothalamus, which stimulates the posterior pituitary gland to release oxytocin. Oxytocin is carried via the bloodstream to the breast and uterus. Oxytocin stimulates the myoepithelial cells in the breast to contract and eject milk from the alveolus. Prolactin is responsible for milk production in the alveolus. Prolactin is secreted by the anterior pituitary gland in response to suckling. Stress such as pain and anxiety can inhibit let-down reflex. Sight or cry of infant can stimulate release of oxytocin but not prolactin. Reproduced from Lawrence RA and Lawrence RM (2005). Breastfeeding: A Guide for the Medical Profession, 6th edn, figures 8–18, p. 290. Philadelphia, PA: Elsevier, with permission.

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Breastfeeding

enhanced ability to interact with the infant. The calm and connectedness system is part of a system of nerves and hormones that together trigger these effects. Oxytocin is a polypeptide found in all mammalian species and works through a mechanism whereby it activates receptors on the outer surface of the cell membrane. Oxytocin is produced in the supraoptic and periventricular nuclei of the hypothalamus. Receptors have been identified for oxytocin in the uterus and in the breast. It is well known that oxytocin causes the uterus to contract and in the early days of lactation, the mother will be aware that the uterus is cramping down when the baby goes to breast. It is this effect that allows the mother to recover postpartum more rapidly if she breastfeeds. Oxytocin has been called the hormone of calm, love, and healing. In relation to lactation, however, it is the hormone that stimulates the let-down of the milk in all species. The neuroendocrine control of milk ejection is illustrated in Figure 5. It is noted that when the nipple is stimulated, it sends a message via the afferent nerves to the brain and to the hypothalamus and stimulates the release of both oxytocin and prolactin through neuroendocrine control. The amount of milk produced by a fully lactating woman averages between 750 and 1000 ml a day if she is nursing a full-term, singleton infant. Milk production, however, can exceed that depending on the demand as the breast produces the amount of milk that is demanded by the suckling infant or pumping. Therefore, women with twins and triplets can produce considerably larger volumes. Women have also briefly nursed quadruplets and quintuplets. The problem is not the ability to make milk but the time to feed the infant. Nursing twins is usually done simultaneously with the two

infants at the breast initially. Studies done to try to force breastfed babies to take more milk by having their mothers pump after every feeding so they increase their production have shown that breastfed babies cannot be overfed. The mechanism of this is not clear, although it is assumed that there is a constituent of human milk that turns off the infant’s appetite at an appropriate time. In the human, lactogenesis occurs slowly over the first few days postpartum as progesterone levels drop. Women experience milk come in as the feeling of fullness between 40–72 h usually corresponding to the degree of parity with multiparas sensing this more quickly than primiparas. The volume of milk increases over time for the first 2 weeks starting at less than 100 ml a day and increasing to about 600 ml a day at 96 h.

The Composition of Human Milk The biochemistry of human milk encompasses a mammoth supply of scientific data and information, most of which has been generated since the 1970s. Each report or study adds a tiny piece of the complex puzzle of the nutrients that make up human milk. The answers to some questions, however, still elude us. Even the simple question of the volume of milk consumed at a given feeding is a scientific challenge. The methodology must be accurate, reproducible, noninvasive, and suitable for home-use night and day, and must not interrupt breastfeeding. Advances in analytic methods bring greater sensitivity and speed to the analysis of milk composition. Milk brings both nutrients and non-nutrient signals to

Afferent arcs Hypothalamus ‘Prolactin-inhibiting factor’ Hypophysis

Oxytocin

Direct reflex arc

Oxytocin Prola

ctin

Suckling Cervical dilation

Figure 5 Neuroendocrine control of milk ejection. Reproduced from Lawrence RA and Lawrence RM (2005) Breastfeeding: A Guide for the Medical Profession, 6th edn, figures 3–9, p. 80. Philadelphia, PA: Elsevier, with permission.

Breastfeeding

the neonate. All milk contain the nutrients for physical growth and development. When the offspring develops rapidly as in the case of rats, mice, and rabbits, the milk is nutrient-dense. When it develops slowly as in the human and other primates, the milk is more dilute. All mammalian milk contains fat, carbohydrate, and proteins, as well as minerals, vitamins, and other nutrients. The organization of milk composition includes lipids and emulsified globules coated with a membrane, colloidal dispersions of proteins as micelles, and the remainder as a true solution. At no other time in life is a single food adequate as the sole source of nutrition and wellbeing. Human milk is not a uniform body fluid but a secretion of the mammary gland of changing composition. The fore milk which is the first milk secreted at a feeding differs from hind milk. The fat content increases as suckling continues during a feeding. Colostrum differs from transitional and mature milk. Milk changes over time of day and as time goes by. As concentrations of protein, fat, carbohydrate, minerals, and cells differ, physical properties such as osmolarity and pH change. The impact of changing composition of the physiology of the infant gastrointestinal tract is beginning to be appreciated. Many constituents have dual roles, not only nutrition but infection protection, immunity, or a host of other effects. The 200 or more constituents of human milk include a tremendous array of molecules whose descriptions continue to be refined as the qualitative and quantitative laboratory techniques are perfected. Not only does human milk contain all of the nutrients necessary for the human infant to grow, i.e., protein, fat, carbohydrate, minerals and vitamins, but it also contains enzymes that facilitate the digestion and absorption of these nutrients. The enzymes that digest starch, sugars, fats, and proteins have been identified. There are also hormones in human milk, especially prolactin and oxytocin, but also steroid hormones such as gestagens, estrogens, corticoid, androgens, and opiate, like peptides that contribute to the infant’s growth. Enzymes and hormones lose their activity when the milk is pasteurized. The presence of thyroid hormones is very important for the newborn infant, especially because it protects the hypothyroid infant in the first few weeks of life. There are many other compounds whose role has not been completely identified. The host-resistant factors and immunologic significance of human milk is very important in the protection of the human infant against infection. Some of the most dramatic and far-reaching advances in the understanding of the immunologic benefits of human milk have been made using newer techniques to demonstrate the specific contributions of the numerous ‘bioactive factors’ contained in human milk. The multifunctional capabilities of the individual factors, the interactive coordinated functioning of these factors, and the longitudinal changes in the relative concentrations of them over the duration of

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lactation make human milk unique. The immunologically active components of breast milk make up an important aspect of the host defenses of the mammary gland in the mother. At the same time, they complement, supplement, and stimulate the ongoing development of the infant’s immune system. There are cellular components of human milk in greater number in the colostrum but persisting throughout lactation. The cells are b-lymphocytes and phagocytes, and are active protectors against infection. The cells also include cells from the T-cell system and the B-cell system as well as polymorphonucolecytes. There are hormonal factors such as immunoglobulins which include secretory IgA, IgM, and IgG. Other protective factors include resistance factor, lysozyme, lactoferon, and interferon. Interleukins and cytokines have also been identified in human milk. Their levels are persistent and they have been identified as protective against various infections. Nucleotides have also been isolated and studied. It is well established that human milk not only protects against infection within the gastrointestinal tract but outside the gastrointestinal tract as well.

The Initiation of Successful Breastfeeding Successful nursing depends on the successful interaction of a mother and an infant with appropriate support from the father, the family, and available healthcare resources. Both mothers and infants vary. No simple set of rules in hospitals can be outlined to guarantee success. In fact, one of the difficulties has been a rigid system established for initiating lactation in the hospitals that did not fit all mother–infant couples. Nowhere in medicine do one’s personal interests or prejudices become more evident than in the area of counseling about childbirth and breastfeeding. Having a child does not make one an expert on the subject. Conversely, not having a child does not preclude the development of exceptional skills. Historically, rigid dogmas have directed the management of lactation. In an effort to replace these with more rational management, new dogmas have arisen. The key to the management of a mother–infant nursing couple is establishing a sense of confidence in the mother and supporting her with simple answers to her questions when they arise. Good counseling also depends on understanding the science of lactation. Then, when a problem arises, a mechanism is already in place for the mother to receive help from her physician’s office before the problem creates a serious medical complication. The ability to lactate is characteristic of all mammals from the most primitive to the most advanced. The divergence of suckling patterns, however, makes it urgent that human patterns be studied specifically. Some aquatic animals such as whales nurse under water. Others such as the seal and sea lion nurse on land. A variety of postures

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Breastfeeding

are assumed by different terrestrial animals. Nursing may be continuous as in the joey attached to a marsupial teat or widely different intervals characteristic of the species and parallel to the nutrient concentrations of the milk. The interval may be a half an hour in the dolphin, an hour in the pig, a day in the rabbit, 2 days in the tree shrew, or almost a week in the whale and hippopotamus. Although many anatomic distinctions exist as well between species, the principal mechanism of milk removal common to all mammals is the contractile response of the mammary myoepithelial under hormonal influence of oxytocin released from the neurohypothesis. The key function in all species is effective control of milk delivery to the young in the right amount at the appropriate intervals. This requires a reproduction system, exit channels, prehensile appendage, an expulsion mechanism, and a retention mechanism. The primary, secondary, and tertiary ducts form an uninterrupted channel for the passage of milk from the milk producing alveoli to the mammary duct system. The principal object of the suction produced by the facial musculature of the young is to draw the nipple into the mouth and retain it there. Positive pressure is used to expel the milk from the gland. While many species have been studied in the past, study of the human infant has until recently used artificial feeding with artificial nipple and bottle. The mechanism of suckling at the breast is quite different than sucking on an artificial nipple. When the human infant is put to breast for the purpose of feeding, there are simple guidelines to facilitate the process. The baby should be held so that mother and infant are facing each other and the infant is looking squarely at the breast without turning his head. All normal infants are known to have a rooting reflex which is the response to the stimulus around the mouth toward the direction of the stimulus. Therefore, in order to have the baby latch on to the human nipple, the center of the lower lip of the infant should be stimulated preferably by the maternal nipple. This will cause the infant to extend the tongue and draw the nipple and areolar into the mouth and compress it against the hard palate. The grasp is sealed with the lips. The infant tongue remains in place compressing the elongated areolar and nipple against the hard palate with peristaltic motion. The peristaltic motion begins at the tip of the tongue, goes to the posterior pharynx and down the esophagus, initiating peristaltic motion all the way through the intestinal tract. With this peristaltic motion, the milk is ejected and carried along to the posterior pharynx and swallowed as one action. Therefore, while breastfeeding, it is not necessary for the infant to suck and then swallow as it is with an artificial nipple and bottle where a bollus is formed and the infant has to swallow it. This difference is critical to the smooth ejection of the milk and swallowing it. It is also significant that infants as immature as 28 weeks, gestation can suckle at the breast when they

cannot suck and swallow from a bottle. Normal full-term infants are able to go to the breast shortly after delivery and will latch onto the nipple and areolar and begin to suckle. Infants have been sucking and swallowing amniotic fluid in utero since about 16 weeks, gestation and this is the continuation of that physiologic process. After the initial feeding shortly after birth, the infant usually goes into a deep sleep and recovery phase. The infant usually does not waken to feed again for 4 to 6 h. They maintain their blood glucose very well with this short feeding. It is estimated that the infant receives between 20 and 30 ml of colostrum in this first feeding. Colostrum contains many immunoglobulins, antibodies, and some nutrition. In the first few days, it is appropriate to feed the infant on demand, that is, when the infant begins to rouse and shows signs of hunger. Signs of hunger include moving around, bringing the fist to the mouth, sucking on the fist, and becoming aware of one’s surroundings. Crying is a late sign of hunger and may interfere with the peaceful latching onto the breast. In the first 96 h of life, the infant will probably nurse every 2–3 h and at least 8–12 times a day. In the first month of life, infants continue to feed 8–12 times in 24 h. The emptying time of the stomach of human milk is 90 min. This is in comparison to the emptying time of formula which is 3 h and the emptying time of homogenized milk which is about 6 h. The rapid digestion and absorption of human milk requires more frequent feedings. Frequent feeding is not a sign of inadequate milk; it is a sign of the digestibility of the feeding. As the infant takes a greater volume at the time of feeding, the frequency of eating in 24 h gradually reduces to eight times and then six times a day. It is recommended by the American Academy of Pediatrics and the WHO that infants be exclusively breastfed, that is, receive no other liquid or food except breast milk (by breast or bottle) until about 6 months of age. It is not necessary to begin solid foods until after this time when the infant has begun to not only hold his head up but to sit up and is able to take food into the mouth and swallow it.

Weaning There is no set time for weaning the human infant. After 6 months of exclusive breastfeeding, the infant should be introduced to appropriate solid foods and gradually over the next 6 months develop a feeding schedule of three meals a day and several snacks. Breastfeeding is continued with the feedings and usually a large breastfeeding first thing in the morning and the last at night. By this time, the infant should be sleeping through the night. Different species wean their offspring at different times. Various calculations for the appropriate weaning time of the infant have been based on other anthropologic determinants. The American Academy of Pediatrics has said that the

Breastfeeding

infant should be exclusively breastfed for 6 months, continue to breastfeed until a year, and then for as long thereafter as mother and child wish. In developing countries, infants are breastfed an average of 4.2 years. Because of the social stigma in some countries, mothers do what is referred to as ‘closet nursing’, that is, they continue to nurse their infants beyond a year or two in private. It has been shown that the composition of human milk does continue to provide infection protection and other nutrients to the infant. It is well documented that many children beyond 2 years are nursed usually first thing in the morning, last thing at night and at periods of stress while on a full diet. This is referred to as comfort nursing. The technique for weaning an infant involves preferably a slow process where one feeding a day is discontinued and then another allowing the breast to adjust for lower production and allowing the child to accommodate. The older child who is feeding only once or twice a day may finally be distracted during a period of feeding or substitute activity provided so that the final feeding can be discontinued. Abrupt weaning is to be avoided except in an emergency because of its stress on the infant and its distress to the lactating breast which continues to make milk and may become painfully engorged.

Nursing the Adopted Child and Induced Lactation There are women who have been unable to conceive and adopt a child in order to parent. Some of these women wish to at least provide nourishment for this child they could not. It is possible to induce lactation. The process requires commitment and dedication to the process. It involves stimulating the breast mechanically with a good electric pump on a regular basis increasing the length of time and the frequency. It should in a week or two involve pumping every 3–4 h for at least 20 min around the clock. The double pump system stimulating both breasts simultaneously saves time and increases the stimulus to the

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breast. It is unusual to be able to exclusively breastfeed the adopted child, but it is not the volume of milk but the relationship that is important. A woman who has previously lactated and may wish to relactate following early weaning or to feed an adopted child can do so. The process is similar in terms of pumping as described above. In this case, however, the breast responds more quickly and effectively. Relactation can succeed in producing enough milk to exclusively breastfeed the infant. See also: Attachment; Social Interaction.

Suggested Readings Baumslag N and Michels DL (1995) Milk, Money and Madness: The Culture and Politics of Breastfeeding. Westport, CT: Bergin and Garvey. Huggins K (2005) The Nursing Mother’s Companion. Boston, MA: Harvard Common Press. La LL (2004) The Womanly Art of Breastfeeding, 7th edn. Schaumburg, IL: La Leche League. Lawrence RA and Lawrence RM (2005) Breastfeeding: A Guide for the Medical Profession, 6th edn. Philadelphia, PA: Elsevier. Meek JY (ed.) (2002) AAP. New Mother’s Guide to Breastfeeding. New York: Bantam Books. Schanler R (ed.) (2006) AAP, ACOG. Breastfeeding Handbook for Physicians. Elk Grove Village, IL: American Academy of Pediatrics. Stuart-Macadam P and Dettwyler KA (1995) Breastfeeding: Biocultural Perspectives. New York: Aldine De Gruyter.

Relevant Websites http://www.ars-grin.gov – Agricultural Research Service, United States Department of Agriculture. http:/vm.cfsan.fda.gov – Center for Food Safety and Applied Nutrition, Food and Drug Administration. http://www.consumerlab.com – Consumer Lab. http://www.herbmed.org – HerbMed. http://nccam.nih.gov – National Center for Complementary and Alternative Medicine, National Institutes of Health. http://www.ncahf.org – National Council Against Health Fraud. http://www.quackwatch.com – Quackwatch.


C Child and Day Care, Effects of A Clarke-Stewart and J L Miner, University of California, Irvine, Irvine, CA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Center-based care – Children in center-based care are cared for in an institutional setting where children of different ages are typically divided into different classes. Teachers in childcare centers often have received some training in child development and may offer an educationally enriching curriculum. Centerbased care may have different sponsors, including churches, schools, colleges, universities, social service agencies, Head Start, independent owners and chains, and employers. Child–adult ratio – A ratio of the number of children in a childcare setting to the number of adults available to care for them. This ratio is used as one index of childcare quality. Childcare – Care of children in their home, in someone else’s home, or in a center, where care and education are provided by a person other than the parent. Childcare settings vary in location, design, and quality. Childcare quality – The quality of care children receive in various day-care settings is typically related to child–adult ratios, the sensitivity and educational training of the caregivers, the physical space available in the setting, the structure of the program, and the level of stimulation provided in the environment. Home-based care – Care of children provided in a residential setting, typically by a woman who cares for several children of varying ages. These care providers rarely offer a structured ‘curriculum’ per se, although they may follow a rough schedule of activities during the day. This form of care may alternatively be known as family childcare. NICHD SECCYD – One of the most comprehensive studies of early child development and childcare, the Study of Early Child Care and Youth Development

(SECCYD) was initiated in 1991 with support from the National Institute of Child Health and Human Development (NICHD). The study has tracked over 1000 children from 10 sites across the US for over 15 years to determine how and in what ways childcare experiences influence children’s development.

Introduction Since the 1970s, a dramatic shift has taken place in who cares for infants and young children. In the US, in 1977, approximately 4.3 million children under the age of 5 years were cared for by someone other than their mothers for a significant portion of each week; by 1997 that figure had tripled to 12.4 million children who were regularly in some type of nonmaternal ‘childcare’ or ‘day care’ (see Figure 1). Although there is some indication that the increase in the number of children in childcare has begun to taper off, there is no indication that the trend will be reversed any time soon. Of the 12.4 million children estimated to be in care in 1997, nearly 5 million were children under the age of 3 years, with more than half of these infants and toddlers (2.6 million) in childcare at least 35 h per week. In other industrialized countries, many children do not begin care until their second or third year because of the availability of paid parental leave programs. Regardless of when children enter care, however, there is much concern among parents and psychologists about how childcare affects children’s social and emotional well-being and intellectual development. Empirical research suggests that childcare experiences can influence children’s development in both positive and negative ways.

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Child and Day Care, Effects of

Number of children (in millions)

14 12 10 8 6 4 2 0 1977

1987

1997

Years Figure 1 Number of US children under age 5 years in a regular childcare arrangement.

Types of Child Care Working parents typically choose from the following options for childcare: care in their own home, care in someone else’s home, or care in a center. The distribution of these types of care in the US is shown in Figure 2. Each option has advantages and disadvantages for children and families. Care in the family’s own home is a popular choice for parents of infants. In this setting, care is typically provided by an adult relative; less commonly, by a babysitter or nanny. Educational programs and group activities with peers are uncommon in this type of care. A family childcare home is a care arrangement in which an adult (almost always a woman) cares for a small group of children – usually of different ages – in her own home. These care providers rarely offer a ‘curriculum’ per se, although they may follow a rough schedule of activities; the typical day is relatively unstructured and may include free play, outside time, lunch and snacks, and nap time. The third option for families seeking childcare is a childcare center. A center may provide care for fewer than 15 children or more than 300; on average, in the US, there are about 60 children in a center. About one-third of the children in centers attend full time (at least 35 h per week). They are usually divided into classes or groups according to their age. Most children in childcare centers are 3 or 4 years old, although, in the US, center care for infants and toddlers has risen in popularity. Teachers in childcare centers tend to be young women with training in child development. They are likely to offer children educational opportunities and the chance to play with other children of their age in a child-oriented, safe environment. In fact, center care is significantly safer than care in a private home in terms of protection against child fatalities from violence. Although childcare centers generally offer educational opportunities and protections for children, there is wide variability in the regulations imposed on these facilities,

Center-based care 28%

Relative care 27%

Nanny 4%

Family child care 14%

Parent 27%

Figure 2 Primary care arrangements for children under 5 years with employed mothers.

making the quality of care provided to children vastly different from place to place. In the US, in states with the most stringent standards, specific educational and training requirements are in place for lead teachers and assistants; child–staff ratios are very low (e.g., one caregiver for every three or four infants or toddlers); and the total group size is restricted in an effort to maintain a calmer, quieter, less stressful, and chaotic environment. At the other extreme, in some states, there are no educational requirements for center-based teachers, child–staff ratios allow for as many as 10 or 12 toddlers to be supervised by one adult, and group sizes are unregulated. Differences across states in childcare home regulation are even greater than those for center regulation, in part because there is such wide variability in what is considered a ‘childcare home’ and what kinds of arrangements should be subject to licensing. On average, states allow anywhere from five to 10 young children in a family childcare home to be cared for by a single-adult caregiver. Only 16 states require preservice training or orientation for family childcare providers. Thirty-five states require


some ongoing annual training after a care provider is licensed, but the amount of training varies widely, from as little as 4 h to as much as 20 h.

Effects of Childcare Participation Studies of childcare have offered compelling evidence that participating in childcare has implications for children’s development in several areas, including physical health, language, cognition, social skills, and emotional well-being. Physical Health and Development To find out whether children in childcare differ from children who stay at home with their mothers in physical development and health, a number of researchers have included pediatricians’, teachers’, and mothers’ reports of children’s physical health and growth and standard tests of children’s motor abilities (walking, jumping, throwing a ball, handling tools). The results of their investigations suggest that there is both good and bad news associated with being in childcare. In terms of physical development, being in childcare advances children’s motor development and activity, increases height and weight, and decreases the likelihood of pediatric problems – for infants and young children from poor families. However, if children already come from families who provide ample nutrition, adequate health services, and opportunities for exercise and activity, no benefit in physical development accrues from going to a childcare center; there is no advantage in growth or motor skills for middle-class children attending childcare programs. There is, however, a difference in health. Children in childcare centers, whatever their family backgrounds, get more diarrhea, influenza, rashes, colds, coughs, and ear infections than children at home. On average, children in childcare have two to four gastrointestinal episodes per year, whereas children at home have only half that many. The explanation most often offered for the higher rates of illness in childcare is that children there are exposed to more pathogens because they are with other children. One important concern about childhood illnesses is whether children who experience more of them – because they are in childcare – suffer delayed language and cognitive development. In one prospective study of children in childcare, chronic ear infections were found to be related to lower verbal ability at age 7 years. However, in a much larger study, the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD SECCYD), with other potentially confounding factors controlled, there were no

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associations between the frequency of communicable illnesses and language competence at the age of 3 years. The NICHD SECCYD is a multisite longitudinal study following 1300 children from birth through adolescence. Families from nine different states were selected, soon after their babies were born, in 1991. Children were then observed in whatever childcare arrangements their parents chose for them, allowing researchers to observe the full range of quality and variety of types of care available throughout the US. Observations of the children’s experiences at home and, later, in school supplemented these observations and helped researchers understand the effects of childcare in the context of other influences on the children’s development. Assessments of children’s social, cognitive, language, and physical development were conducted every year from age 1 to 15 years. Future findings from the NICHD SECCYD will clarify whether there are longer-term consequences of early childcare-related illnesses. Intellectual Development Almost all studies of childcare in the preschool period – in Canada, England, Sweden, Czechoslovakia, Bermuda, and other countries, as well as the US – show that care in a decent childcare facility seems to have no detrimental effects on children’s intellectual development. Only when care is of very poor quality have researchers found that scores on tests of perception, language, and intelligence were lower for children attending a childcare center than for children of comparable family backgrounds being cared for by parents at home. In the NICHD SECCYD, participation in center care was related to intellectual development. After researchers adjusted for other influences, such as the parents’ education, income, and psychological adjustment, children in centers performed better on cognitive tasks at 24 months, had better receptive language skills at 36 months, and had better memory skills at 54 months than children with no center care prior to 54 months of age. A number of other studies have shown similar results. Children in childcare centers did better on tests of verbal fluency, memory, and comprehension. Their speech was more complex, and they were able to identify other people’s feelings and points of view earlier. This apparent advantage of childcare attendance occurs most often for children who attend high-quality programs. In the US where care, on average, is mediocre in quality, an analysis of 59 studies revealed no reliable differences in intellectual skills between children who attended care and children who did not. In Europe, however, where childcare tends to be of higher quality, there have been more consistent results suggesting positive effects of care on children’s intellectual and language skills. Participation in a childcare center is also more likely to benefit children’s intellectual development if

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the children come from unstimulating homes. Although it is impossible to give a blanket statement about the effect of childcare on children’s intellectual development, research suggests that care in a center, care of high quality, and care for disadvantaged children is more likely to have positive than negative effects. Social Competence Research on the effects of childcare participation on children’s social competence has focused on children’s relationships with their peers. Because children in childcare have daily experience with other children, researchers had anticipated that their social skills with their peers would be advanced. To see if this was true, researchers observed children in their childcare settings as they interacted with each other. They also brought pairs of children into play situations in the laboratory and watched their interactions, and they tested children on their willingness to cooperate and help each other. The results of their studies suggest that childcare can promote social skills. Children with experience in childcare have been observed to have more complex and mature interactions with their peers than children with no childcare experience. They sustain their play longer and respond more appropriately and immediately to the other children’s behavior, share materials, and behave empathically. They maintain coordinated action at younger ages than is customarily observed. In the NICHD SECCYD, children who had spent more time in childcare settings with other children were more positive and skilled in their peer play in childcare at age 3 years, even controlling for family background factors and other child characteristics. These effects may last. In elementary school, these children have been observed to have more friends and to be more popular. In one 14-year longitudinal study, the amount of time children spent in care prior to 3 years of age shaped their social skills with peers, and these individual differences in social competence remained stable through childhood and early adolescence. Like the differences in intellectual competence, differences in social competence with peers appear frequently, but not invariably. Behavior Problems Although some children appear to benefit from group childcare experiences in terms of social skills, there is also evidence that childcare can predict behavior problems in young children. Some studies show that children in childcare tend to be less polite, agreeable, and compliant with their mother’s or caregiver’s demands and requests, less respectful of others’ rights, more irritable and rebellious, more likely to use profane language, louder and more boisterous, and more competitive and

aggressive with their peers than children who are not or were not in day care. These differences in aggressive and noncompliant behavior appear in tests and natural observations, in the childcare center and on the playground, with adults and with other children, with strangers and with parents – although differences are smaller when the quality of childcare is good. The differences are also more marked for boys and children from lower-income families. Evidence from the NICHD SECCYD suggests that children who spend more time periods in center care before they enter school exhibit higher levels of these behavior problems throughout their elementary school years. How can we integrate these negative differences with the differences in positive social behavior? Are children in childcare more socially competent or less? Are the same children both polite and difficult to manage? To answer this question, researchers in the NICHD SECCYD examined which children were displaying behavior problems and which were socially competent. Results indicated that the children who were high in social skills were not high in aggressiveness; positive social behavior and negative social behavior were unrelated to each other. Therefore, it seems likely that childcare promotes social advancement in some children and leads to behavior problems in others. More intelligent children may be advanced in the social realm, just as they are in the intellectual sphere, and childcare may contribute to their knowledgeability, self-sufficiency, and ability to cooperate. Less intelligent children may learn in childcare that antisocial behavior can get them what they want; they become determined to get their own way in the group and, without the social skills to achieve this smoothly, become aggressive, irritable, and rude as a consequence of being in childcare. In the NICHD SECCYD, children who exhibited more positive social behavior with peers scored higher on tests of cognitive ability; children who exhibited more negative social behavior with peers scored lower. Childcare apparently can be a venue for learning social graces or a breeding ground for aggression. However, if there is an inherent risk of developing poor interaction patterns in childcare, it may be the result of spending a lot of time in the setting. A full day of care is stressful for young children, and the more hours children spend in care, the more likely they are to be aggressive (then and later on) – especially if the care is of low quality. Megan Gunnar and colleagues studied cortisol levels of children in childcare centers. Cortisol is a hormone produced by the hypothalamic–pituitary–adrenocortical system, which increases when demands exceed the individual’s coping resources. They found that cortisol levels of children in centers were the same as or lower than cortisol levels in children at home in the morning, but by mid-afternoon had risen to a significantly higher level than when the children stayed home; children in half-day preschool programs did not show this increase in cortisol.


Relationship with Mother Many psychologists and parents have worried that when children, especially infants, are separated from their mother for 8 or 10 or more hours a day, they will not enjoy as close and secure a relationship with her as children who are at home all day. Fortunately, research has shown that infants in childcare do form attachments to their mothers. But the real question is whether the ‘quality’ of the relationship these children have with their mother is as emotionally secure as the relationship of infants who are raised exclusively at home. Putting together data from studies of infants in childcare that included the standard method of measuring children’s attachment relationships, the Strange Situation, research reviewers at the end of the 1980s found that infants who were in childcare full time, compared with infants in childcare part time or not at all, were more likely to be classified as having insecure avoidant relationships with their mothers. However, researchers later questioned these findings, wondering whether the Strange Situation was in fact the best method for measuring relationships between mothers and children who attended regular childcare. In the Strange Situation, an infant plays with toys in an unfamiliar room, is left by the mother alone in the room with an unfamiliar woman, plays with and is comforted by that woman in the mother’s absence, and then the mother returns and picks up the infant. If the infant greets the mother with pleasure and proximity, that infant is classified as having a secure relationship; if the infant ignores or avoids the mother, the attachment is classified as insecure avoidant. However, children in childcare experience a separation from their mother on a daily basis; researchers wondered if the Strange Situation was the best way to assess the mother–child relationship for children who were more used to separations and reunions. In a study in the Netherlands, researchers compared infants who attended a licensed childcare center for at least 20 h per week with infants reared exclusively at home. They, too, found that in the Strange Situation infants in childcare were more likely to be classified as having an avoidant attachment. But these researchers also measured the infants’ heart rates to determine how stressed they felt in the Strange Situation. When they were alone in the room, home-reared infants who were classified as avoidant showed major increases in heart rate; they indeed felt stressed. However, the childcare infants who were classified as avoidant showed only small heart rate increases. They apparently experienced only very mild stress. In a modified procedure, the researchers added strange sounds to the episodes preceding reunion with mother to increase the stressfulness for all infants, and, indeed, all of them showed increased heart rates. In this more stressful procedure, 70% of the childcare

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infants who had been classified as avoidant in the original Strange Situation were now classified as secure. In another evaluation of the validity of the Strange Situation for childcare children, researchers in California presented children with somewhat frightening novel events instead of separations from mother; these researchers, too, found that childcare children were as likely to be secure as home-care children in this more equitable assessment. Meanwhile, studies conducted since 1990 have shown that the link between childcare participation and insecure avoidant attachment is less likely to be significant – even in the Strange Situation – when other child and family variables are statistically controlled. In the NICHD SECCYD, infants were assessed in the Strange Situation at 15 months of age and in a modified Strange Situation with longer separations at 36 months. No significant main effects of being in infant childcare were found at either assessment. The best predictor of attachment security was the mother’s observed sensitivity with the child at 6 and 15 months and the mother’s psychological health. If children were in care for more than 10 h a week or were in poor quality care and their mothers were rated as insensitive, their attachment security suffered; otherwise, childcare was not related to attachment quality.

Variations in Care But childcare comes in many shapes and sizes, and, as we have already hinted, these variations make a difference in whether and how children’s participation in care is related to their social, emotional, and intellectual development. Most critical for children’s development is the overall quality of care. Assessing Childcare Quality Childcare quality is a complex construct and must be assessed with expert judgment and sensitivity. The best evaluations come from observing children’s actual experiences in the care arrangement. This is time intensive and requires extensive training. Popular measures for assessing childcare quality include the Early Childhood Environment Rating Scale (ECERS) and the Infant/ Toddler Environment Rating Scale (ITERS). These measures focus on the furnishings and room arrangement, the planning and scheduling of activities, the amount and accessibility of materials, and the caregiver’s behavior with the children. Researchers in the NICHD SECCYD used a different instrument – the Observational Record of the Caregiving Environment (ORCE) – which involves a behavior checklist and qualitative ratings of the caregiver’s interactions with a particular child. It, too, requires extensive training so that the observer can evaluate, for example,

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caregiving qualities such as sensitivity and intrusiveness. These measures of childcare quality have consistently been found to be linked to developmental outcomes in children. Effects of Childcare Quality In high-quality childcare, caregivers encourage the children to be actively engaged in a variety of activities, have frequent, positive interactions that include smiling, touching, holding, and speaking at the child’s eye level, respond promptly to children’s questions or requests, and encourage children to talk about their experiences, feelings, and ideas. Using global assessments of childcare quality, investigators have found that childcare quality is significantly associated with children’s cognitive development. Associations have been observed in locations as far ranging as Bermuda, Sweden, Switzerland, and Singapore, as well as Canada, the UK, and the US, and in home childcare settings as well as centers, for children ranging in age from 1 to 4 years. The most compelling evidence that childcare quality affects children’s cognitive development comes from experimental studies in which children from high-risk families placed in high-quality programs consistently make gains – at least as long as the highquality care is maintained. In the social realm as well, children attending highquality childcare settings benefit. Such children are judged by observers and their caregivers to be more sociable, considerate, compliant, controlled, and prosocial. They are more interested, better adjusted, and have higher self-esteem, while children in low-quality care are angry, defiant, and cry more. Moreover, childcare quality is related to children’s cortisol levels. Children who receive more attention and stimulation from their caregivers in childcare are less likely to have increased cortisol levels over the course of the day; their cortisol levels look just like those of children who stayed in the peaceful environment of their own homes. In the NICHD SECCYD, after controlling for family variables that might be associated with childcare quality or the child’s ability level, researchers found that children in higher-quality care, in both home-based and center childcare settings, received higher scores on tests of cognitive and language abilities, exhibited more positive and skilled interactions with peers in childcare, and were reported by their caregivers to have fewer behavior problems, at ages 2 and 3 years. At age 4 years, they performed better on a battery of standardized tests that assessed their abilities to read letters and words, do simple math problems, complete words, remember and recite back sentences, and understand and use language. They were less impulsive in a test of attention, and they were rated by their caregivers as being more socially skilled and as having fewer behavior problems. Childcare quality was not related to the children’s

attachment relationship with their mother or their interaction with a good friend, but consistently, across a variety of measures, it predicted social and intellectual competence. In fact, children in high-quality childcare performed better than children in full-time maternal care; children in lowquality care performed worse. Physical Environments Space is one aspect of the childcare environment that affects how caregivers and children behave, and in turn has implications for the quality of care provided to children. In particular, the amount of space per child has been a focus of research. In one study of children in classrooms ranging from 27 to 52 ft2 per child, those in the more crowded classrooms scored lower on a test of cognitive style. When the space per child is very limited (less than 25 ft2 per child), children have been observed to be more physical and aggressive with their peers and more destructive with their toys; they spend more time doing nothing and less time interacting socially. Fortunately, in the US, licensing standards for childcare centers and childcare homes ensure space that exceeds this lower limit (more than 35 ft2 per child). Therefore, space may not be a major influence on children in most childcare settings, at least those that meet licensing requirements. Another aspect of the physical environment related to childcare quality is the variety of play materials available to the children. If few materials are available and the equipment is fixed, inflexible, or limited, children spend their time watching, waiting, cruising, touching, imitating, chatting, quarreling, and horsing around with peers; their play is of low complexity and little intellectual value. However, when materials are varied, age-appropriate, and educational, children do better. In the NICHD SECCYD, children in settings with more stimulating, varied, and well-organized materials (including materials to stimulate math, movement, music, language, art, and play) received higher scores on tests of language comprehension and short-term memory. Space of good physical quality can be found in both homes and centers, although materials that elicit highlevel constructive play (puzzles, block, art) may be more common in centers, and opportunities for free play and tactile exploration (water, sand, dough, pillows) more likely in homes. In either kind of setting, the quality of the physical space affects the adults’ behavior as well as the children’s. In physical settings of good quality, caregivers can both allow children freedom to explore and spend their time demonstrating constructive activities with the materials available, rather than supervising and scolding all the time. In the NICHD SECCYD, across ages and different types of care – centers, childcare homes, in-home sitters, and grandparents – caregivers consistently provided more sensitive and responsive


attention when the physical environment in the setting was safer and more stimulating. Childcare Activities Another dimension of childcare quality is the type of activities that make up the program. Childcare arrangements range from strictly care-oriented programs, where activities involve only daily routines and children are left to amuse themselves, to explicitly educational programs, in which children are offered a rich diet of intellectual and social stimulation. The first type of program is more likely to provide low-quality care; the second, high-quality care. In more educationally oriented programs, children spend more time in constructive and complex play with materials, engage in more cognitively challenging tasks, converse more with adults and other children, and score higher on tests of intelligence and achievement. These educational programs are particularly beneficial for older preschool children. When children spend their time in childcare just playing around with other children or watching television, they experience less ‘rich’ play and are less competent. In the NICHD SECCYD, children who watched more television while they were in the childcare setting received lower scores on math, vocabulary, and language comprehension. Thus, there is evidence that an educational program promotes more intellectually valuable experiences in the care setting and that these experiences have positive consequences for children. Additionally, there is evidence that the amount of ‘structure’ in the childcare program is related to quality and to child outcomes. Some programs are highly structured and controlled – the children’s activities are planned and directed by adults; others are unstructured and chaotic. Programs that blend prescribed educational activities with opportunities for free choice, that have some structure but also allow children to explore a rich environment of objects and peers on their own without teacher direction, seem to have the most benefit. In such programs, children have more opportunities for constructive activity, for learning academic skills, for problem solving, and for acquiring social skills. They also acquire positive motivation and persistence and these qualities aid them in later academic settings. Regulable Features of Child Care Features of the childcare environment that can be regulated by government agencies also contribute to the overall quality of childcare and are sometimes used as proxy measures of quality. These features include the number of children in the childcare group or class, the ratio of children to adults, and the level of the caregiver’s education and training.

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Group sizes and child–adult ratios The size of the group of children in a childcare setting has been shown to relate to children’s social competence and self-control. Although being with other children offers opportunities to develop and hone social skills, there are limits to how big the group should be. In large classes – classes of more than 20 children – researchers have observed that children are more likely to look apathetic, cry, and act hostile. Having too many children for each caregiver to look after can be especially detrimental. Child–caregiver ratios range substantially from one childcare setting to another. In childcare homes, there may only be one or two children for the caregiver to attend to. In centers in the US, government-mandated ratios range from four to 13 toddlers per caregiver, from seven to 20 preschool children. With too many children for one caregiver, children suffer. Studies have shown quite consistently that overall quality of care suffers when child–adult ratios are high. Caregivers in classrooms with high child–staff ratios are less sensitive, responsive, and positive. Children have less contact with the caregiver, spend more of their time playing with other children, and less time in intellectual activities; fewer of their questions are answered; their conversations are shorter; and contact with the caregiver is more likely to involve prohibitions, commands, corrections, and routines. The children are less likely to develop secure attachment relationships with their caregivers, and, on tests, they receive lower scores for language and communication skills. The benefits of having low child–caregiver ratios showed up clearly in the Cost, Quality and Child Outcomes Study – a study of 100 centers in each of four states, California, Connecticut, Colorado, and North Carolina: lower child–adult ratios were related to better overall quality of care, more caregiver sensitivity, and more effective teaching; children in classes with lower child–teacher ratios also had higher pre-reading scores. In the Florida Child-Care Quality Improvement Study, when child–staff ratios in preschool centers were reduced from 6:1 to 4:1 for infants and from 8:1 to 6:1 for toddlers, overall classroom quality improved, teachers became more sensitive, and children engaged in more cognitively complex play with other children and classroom materials, gained more in cognitive development, and were more securely attached to their teachers. In childcare homes, where there are seldom more than six children for one caregiver, the link with child– caregiver ratio is not as strong – it may even be in the opposite direction. When caregivers who are taking care of more children provide higher-quality care, however, this may be because they are more professional than caregivers with few children – they have higher levels of education and training and are more likely to belong to a professional organization and to have their home licensed for childcare. In the NICHD SECCYD, it was found that

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when caregivers’ training and education were controlled, the number of children in the childcare home was not related to the quality of care or child outcomes. In the California Licensing Study, when researchers added two more children to existing childcare homes, they found that the quality of caregiving declined. Thus, it does seem that, even in homes, children and caregivers benefit from relatively low child–caregiver ratios.

and significant consequences for children’s behavior and development. However, merely providing caregiver training or reducing child–adult ratios is not a guarantee of increased childcare quality – these aspects of the childcare environment must be translated into more sensitive patterns of caregiving to produce higher-quality care and more positive consequences for children.

Caregiver education and training

Effects of Entering Childcare in Infancy

Caregivers and children also benefit when the caregiver has a higher level of education and training. Research has shown that, all other things being equal, caregivers with higher education and training provide the highest quality of care to children. Educated caregivers are more involved and affectionate with the children in their care. They are less authoritarian – restricting children less and encouraging them more. They implement more developmentally appropriate practices in the classroom and provide richer literacy environments. Furthermore, correlational studies suggest that when caregivers have higher levels of training and education, children do better both intellectually and socially. In a number of studies, children whose caregivers had higher levels of education and/or specialized training were more involved, cooperative, persistent, competent in play, and learned more. They also did better on standardized tests of cognitive and language development. In one study of low-income African American children in community centers, for example, girls whose teachers had 14 or more years of education did better on tests of cognitive and receptive language skills than children whose teachers had less education. In the Cost, Quality, and Child Outcomes Study, children whose teachers had associate or bachelor degrees in early childhood education or who reported that they had received training at community workshops had higher scores on a test of receptive language. In the NICHD SECCYD, caregiver training was related to higher caregiving quality and this in turn was related to advanced cognitive and social competence in children. In childcare homes, for example, children with a college-educated caregiver scored seven points higher on the Reynell Developmental Language Scales at age 3 years. Children with college-educated caregivers in centers also displayed advanced school readiness skills and better language comprehension at age 3 years and greater cognitive and social competence at age 4 years. In studies comparing children’s behavior before and after caregiver training programs, too, researchers have found that children make significant gains in complex social and cognitive play and become more securely attached to their caregivers after the training. In brief, then, the amount of training and education caregivers receive has demonstrable effects on the quality of care they provide

Much debate has surrounded the issue of the best age to first enroll children in childcare. Parents, pediatricians, and psychologists have worried that care in infancy, when children are particularly vulnerable and family relationships most fragile, is a risk factor for child development. The problem with studying the effects of being in care in the first year of life, however, is that the researchers have found it difficult to disentangle the effects of timing of care (the age at which the child enters care) and amount of care (the cumulative hours of care), because the two go together. Parents seldom have their children in care as infants, keep them home as toddlers, and send them back to care during the preschool years. Typically, children who are placed in care early on end up having experienced more care by the time they reach school age. We will probably not have an unambiguous answer to the question of whether there are long-term harmful effects of care in infancy until researchers study the issue experimentally. Although we do not yet have a definitive answer to the question, it does appear that infant care is not likely to be harmful – at least in moderation. Researchers in a study in the UK headed by Kathy Sylva found that there were no detrimental effects on cognitive development if infants were placed in a childcare center while their mothers worked, rather than being with relatives or friends, and, in fact, these children did better in terms of intellectual abilities and social skills with other children than children who did not start childcare until they were 3 years or older. In a large, nationally representative study in the US, as well, entry into care in the first year was not related to lower cognitive scores, and, for boys from high-income families, there were even positive effects. A number of researchers have found that children who begin care in infancy are more likely to have externalizing problems – they are less compliant, act out more, have less tolerance of frustration, and are more aggressive. However, these effects are not found in all studies, and when researchers have controlled for the number of different care arrangements children have been in or how much care they attended in the preschool years, the apparent negative effects of childcare in the first year of life disappeared. In the NICHD SECCYD, the age of entering care was unrelated to children’s behavior problems at 2 and 3 years of age,


and it was impossible to determine whether the effect of care on externalizing problems at age 4 years was the result of care in infancy or cumulative hours overall. No significant effects of age of entry on attachment security were found when children were assessed in the Strange Situation at 1 or 3 years of age either. Thus, at the present time, there is no compelling evidence that beginning care in infancy has detrimental effects on children’s development. Moreover, the emotional issues involved in starting care after infancy are just as strong as earlier – perhaps stronger. When toddlers enter care in their second year, they are just as distressed as infants who enter care in the first year, and their cortisol levels rise over the course of a day in care as much as infants’ do. Entry into care in the second year elevates the likelihood that children will develop an ambivalent relationship with their mother. It can also lead to behavior problems. In the NICHD SECCYD and other studies, children who first entered childcare around their second birthday exhibited more behavior problems in childcare than children who began care earlier. In brief, there is no reason to believe that children who enter care as toddlers do better than children who enter as infants. Research on children of this age shows that they are particularly negatively affected by being in large classes with many children and few caregivers.

Effects of Childcare for Different Children Childcare researchers have also investigated whether there are particular kinds of children who are more at risk if they are enrolled in childcare. Children’s gender, temperament, and health all have been examined to see if they create different susceptibilities and lead to different consequences in childcare. Boys and Girls Across the board, boys are more vulnerable to events in the environment and girls more resilient. Therefore, researchers have questioned whether the gender difference between males and females is reflected in different effects of childcare on boys and girls. Specifically, they have wondered whether boys are at greater risk in childcare than girls. Research findings in this area suggest the answer is a weak ‘maybe’. There is some limited evidence that there is a slight disadvantage for boys in childcare. First, in some studies, boys (but not girls) placed in childcare in infancy have been observed to develop less secure relationships with their mothers. Second, boys (but not girls) from high-income families have been found to have somewhat slower intellectual development if they

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are in full-time childcare as infants rather than with their mothers. Third, earlier entry into low-quality care has been associated with problem behavior and anger for boys (but not girls). However, most researchers using large samples, including the National Longitudinal Study of Youth; the Cost, Quality, and Child Outcomes Study; and the NICHD SECCYD, have failed to find significant interactions with child’s gender. One significant interaction in the NICHD SECCYD indicating that boys (but not girls) with many hours of care were less likely to be securely attached to their mothers was not replicated at a later assessment or in another study, and an analysis of the effects of childcare on infant–mother relationships for a combined sample from more than 12 different studies found no significant differences overall for boys and girls. If there is a difference in the effect of childcare for boys and girls, therefore, it is small and unreliable. Vulnerable Children Researchers have further pondered whether children with certain vulnerabilities, such as emotional or physical health problems, are differentially affected by childcare. One emotional problem they have studied is having a difficult temperament in infancy. Infants with difficult temperaments cry intensely and often, are difficult to soothe, adapt to change and new situations slowly. Several researchers have studied whether this temperament style makes it harder for children to adjust to being in childcare. They have found that infants with difficult temperaments are indeed disadvantaged when they enter care. Compared with easy infants, difficult ones are less positive in their emotions, receive less attention from caregivers and the other children, and make less progress in their cognitive development during the first year in a childcare center. Their difficult temperament makes their initial adjustment to childcare difficult. Eventually, they adjust to being in the group, but even then, their problems may not be over. In one study, researchers found that infants with difficult temperaments were more susceptible to the effects of being in long hours of care. If, as infants, they were easily frustrated, they were more likely to develop externalizing behavior problems; if they were especially distressed by novelty, they were more likely to develop internalizing behavior problems (anxiety, depression). Children who are highly anxious may have persistent problems in childcare. Group care seems to be especially stressful for them, and they show more marked physiological reactions to childcare than other children. The length of the day, the need to sustain interactions with many other children, and the need to interact with multiple adults are challenges that tax their emotional resources and coping competencies. This theme is echoed when children have physical health problems. Data from the National Longitudinal

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Study of Youth suggest that childcare provides enriching input that can enhance children’s development only if the children are healthy. In fact, for infant boys with health problems, socioemotional and motor development were most helped by being cared for more extensively by their mothers. One health problem that has received researchers’ attention is otitis media (ear infection). Children with frequent ear infections may suffer hearing loss and have difficulty attending to speech. In childcare environments where the child has little one-to-one interaction with adults, persistent background noise, and caregivers who are not sensitive to the child’s hearing loss, the negative effects of otitis media on children’s language and social development are exacerbated.

How Large are the Effects of Childcare? As we have described, research indicates that there are reliable effects of childcare on children’s development. But how large and how meaningful are these effects? In general, differences between children in childcare and at home, between children in high-quality care and low, and between children who attend care for many hours or few are relatively small. In examining the direct effects of childcare quality on children’s intellectual development, for example, researchers in the NICHD SECCYD found that a 1 standard deviation (SD) increase in childcare quality between age 3 and 4.5 years was associated with an increase of 0.5 to 1.5 points, or about one-tenth of a SD increase, on standard cognitive tests. One way that researchers have evaluated the size of childcare effects has been to compare them to the effects of parenting. Results of these comparisons in the NICHD SECCYD suggest that the effect sizes associated with type and quality of childcare are approximately half the size of parenting effects for cognitive skills (e.g., the effect size of childcare quality on school readiness was 0.39; whereas for parenting, the effect size was 0.83). Another way researchers have evaluated the size of childcare effects is to compute the percentage of children in different childcare conditions who fall above a certain value. In the NICHD SECCYD, researchers used this method to evaluate the effect of spending a lot of time in care on children’s externalizing behavior problems. Children who had spent a lot of time in care were not in the ‘clinical’ range of externalizing behavior problems. However, more of them received high scores on the externalizing scale – at least 1 SD above the mean. When they were 4.5 years old, 24% of the children who were in care for more than 45 h per week received high scores, compared with 15% of those in care for 10 to 45 h and only 2% of those in care for less than 10 h. Differences were most marked at the time the

children were still in care and became less marked in subsequent years.

The Family’s Place Childcare providers are neither the first nor the most important of the child’s caregivers. Those distinctions go to parents. Even if children spend 40 h a week in childcare, this leaves 128 h for them to be at home with their parents – and that time counts. The observations and interviews researchers have used to study parents and children suggest quite clearly that, even though the parents of children in childcare are not intimately involved in their children’s experiences at all times, they do continue to have an influence on their development – just as much as if the children were at home. Researchers interested in the relative contributions of family and childcare to children’s development have included both family and childcare variables in their analyses and compared the two. Such studies generally indicate that family factors predict children’s development more strongly than childcare factors. Family variables such as mothers’ education, sensitivity, and stimulation, and the quality of the home environment have been found to predict children’s cognitive, language, and social development more strongly than whether or not the child attended childcare, the type of childcare attended, or the quality of the childcare program. In the NICHD SECCYD, children’s security of attachment to mother, self-control, compliance and problem behavior, interactions with peers, and cognitive and social competence were all related to maternal sensitivity more strongly and consistently than they were related to childcare quality or the amount of time the child was in care. Furthermore, children who spent a lot of time in childcare (at least 30 h a week) were influenced by their families just as much as children who were in care for less than 10 h a week. Children had better cognitive and language development if their parents were more affluent and well educated and their mothers were more sensitive and warm – regardless of whether they were in childcare for many hours. In other words, family influence is not ‘lost’ when children are in care. However, it has also been found that the best models for predicting children’s development include both family and childcare factors. In such analyses, researchers have found that optimal development is supported when children receive high-quality care, stimulation, and encouragement in both home and childcare settings – or conversely, children’s well-being is most likely to be impaired when children are in poor-quality childcare as well as unstimulating home environments. Childcare does not operate alone; it is part of a complex network of


influences on child development. Moreover, within this network, influences are related and overlapping – for example, better-quality childcare is more likely for children from more stimulating homes, because more highly educated parents provide both environments – making it more difficult for researchers to isolate the effects of childcare.

Summary The quality of research on childcare has improved substantially over the years, providing more insight into how childcare affects young children’s social, emotional, and intellectual development. With large-scale studies such as the NICHD SECCYD, researchers have shed light on the development of children both in and out of childcare. In terms of physical health, children in childcare do appear to experience more illnesses than children not in care, most likely because they are exposed to more germs from other children. However, the increased number of illnesses does not appear to have long-lasting consequences for children’s development. In fact, in terms of intellectual development, children who attend childcare centers may benefit compared with children who have no center experience. Children in high-quality childcare centers perform better on tests of language, memory, and cognitive tasks than children at home or in low-quality centers, and this is especially true for children from impoverished backgrounds. Although center care appears to benefit children’s intellectual performance, it is impossible to state categorically that center care is optimal for all children. The quality of care children receive – in any setting – in combination with the needs of the particular child, is what is related to positive outcomes. Socially, children in childcare arrangements with other children appear to benefit from the increased opportunities to interact with peers. In most, but not all studies, results suggest that children in childcare have advanced peer interaction skills and are more independent and assertive than children not in childcare. These increased opportunities for interaction may be particularly beneficial for children without siblings. However, there is also evidence that children in childcare, especially those who spend large amounts of time in childcare of poor quality, display more behavior problems than children who remain at home. These problem behaviors may be related to spending time in a stressful environment with a number of other children, but the precise reasons are not yet fully understood. The quality of the childcare setting has significant implications for how childcare affects children’s development. High-quality care can promote desirable qualities such as prosocial behaviors and advanced cognitive

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abilities. When the care setting is of poor quality, however, such as when there is a high child–caregiver ratio, inadequate physical space, or an insensitive and unresponsive caregiver, children are observed to be more hostile and aggressive and to perform poorly on achievement tests. The timing of entry into childcare appears to have few major effects. Children who enter care as infants do not seem to suffer in terms of relationships with their mothers, social competence, or intellectual development – unless they spent a lot of time in care. Boys and children with difficult or shy temperaments may react poorly to childcare, as may children with chronic health problems. Thirty years after research on childcare began, the topic continues to be important. As the number of children beginning care early in life remains high, it is vital to use the best research tools to more fully understand how childcare experiences affect children. Thus, research into the effects of childcare will likely continue to be a focus of attention, and it is hoped that as the research improves, so too will our understanding of the mechanisms underlying childcare effects and our ability to improve the quality of care for all children. See also: Friends and Peers; Imitation and Modeling; Maternal and Paternal Employment, Effects of; Preschool and Nursery School; Social Interaction.

Suggested Readings Clarke-Stewart A and Allhusen VD (2005) What We Know about Childcare. Cambridge, MA: Harvard University Press. Howes C and Sanders K (2006) Child care for young children. In: Spodek B and Saracho ON (eds.) Handbook of Research on the Education of Young Children, 2nd edn., pp. 375–391. Mahwah, NJ: Lawrence Erlbaum. Lamb ME and Ahnert L (2006) Nonparental Childcare. In: Damon W, Lerner RM, Renninger KA, and Sigel IE (eds.) Handbook of Child Psychology, Vol. IV, Child Psychology and Practice, 6th edn., pp. 950–1016. New York: Wiley. NICHD Early Child Care Research Network (ed.) (2005) Child Care and Child Development: Results from the NICHD Study of Early Child Care and Youth Development. New York: Guilford. NICHD Early Child Care Research Network (2006) Child-care effects for the NICHD Study of Early Child Care and Youth Development. American Psychologist 61: 99–116. Vandell DL (2004) Early Child care: The known and the unknown. Merrill-Palmer Quarterly 50: 387–414.

Relevant Websites http://www.nccic.org – National Child Care Information Center. http://www.naeyc.org – The National Association for the Education of Young Children. http://www.nichd.nih.gov – The NICHD Study of Early Child Care and Youth Development.

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Crying

Crying B M Lester and L L LaGasse, Warren Alpert Medical School of Brown University, Providence, RI, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Acoustics – The science or study of sound or sound waves including the quality and characteristics of sound. Formants – High-frequency regions in a sound spectrum that determine the characteristic quality of a sound. Innervation – The amount or degree of stimulation by nerves. Phonetics – The science or study of speech sounds including production, transmission, and reception. Prosody – The intonation and melody patterns of an utterance.

prosodic features of speech have their acoustic correlates in the timing (duration), intensity (loudness), and fundamental frequency (pitch) of phonation. It is these features that convey attitudes, and emotional states such as happiness or anger that enable us to recognize familiar voices, in short, what makes human speech sound human. Communication relies heavily on these prosodic features of speech which are basically independent of linguistic elements. Prosodic features come first in the vocal repertoire of the human infant, the cry. Cry is all prosody. Infants communicate their feelings, their needs, and their wants through the prosodic features of pitch, loudness, melody, and intonation. It is the language the infant uses before words.

Crying and Evolutionary Biology Introduction Within the first few minutes of an infant’s birth, the physician examines the newborn and completes the Apgar score which includes a strong, lusty cry (respiratory effort) as a sign of the infant’s health. Crying requires an infant to perform a complicated and sophisticated set of physiological activities that involve the brain and the respiratory, motor, and vocal systems. Crying helps physiology by increasing pulmonary (lung) capacity. But there is more to crying than meets the ear. Crying is a critical survival mechanism. Infants’ cries attract responsible adults who provide basic needs for the otherwise helpless infant.

Cry as Language Crying is an infant’s first language. The word infancy comes from the Latin ‘infans’ which means speechless and, while infants do not have speech, cry is their language and how they communicate. Infant crying contains linguistically salient aspects of human speech that are physiologically based and adapted for communication. Human speech is divided into linguistic and paralinguistic components. The linguistic component refers to the elements that become syllables and words to be organized into phrases and sentences by rules of syntax. Qualitative aspects of speech, the intonation patterns, inflection, stress, intensity or loudness, and general melody constitute the paralinguistic component. These so-called

Crying is attention getting. Humans are particularly responsive to higher pitched sounds – the maximum acoustic response of the ear is above 800 Hz (cycles s1). Ambulance sirens get our attention because they are high pitched and because they change, they are dynamic. Likewise with infant cries. From an evolutionary point of view, we would say that infant cries are programmed to be at certain pitch levels as an infant’s survival mechanism. Crying is an acoustical umbilical cord that keeps the infant close to the mother. Distress Calls Among Mammals Ethologists, who study animal behavior, call crying a proximity-promoting and -maintaining signal, that is, it encourages the mother to stay with and sooth her infant. There are many species that can immediately locomote or in some way follow their mothers at birth. But relative to other species, human infants have a long period of dependency. Many species including cats, bats, elephants, seals, and reindeer, and of course chimps, use a distress vocalization or cry to signal the mother when the infant is isolated, hungry, or cold. The prosodic features of speech described above are the major component of the vocalization of most mammals. Researchers have analyzed acoustic patterns and shown that nonhuman distress vocalizations show similar patterns to human infant cries. Infants depend on vocal communication to signal distress or otherwise summon the mother close. Crying turns out to be an exceptionally effective survival mechanism. It is an information transmission system that sends affective messages, for example, hunger, pain, and need for

Crying

attention. Another example of how this remarkable system works comes from opera. Attention Getting Potential for Sound Similar to Distress Cries Opera singers project their voices so that they carry throughout a theater and can be heard without a microphone and above the orchestra. They are able to do this by using a technique called singer formant in which they shift their voice into a higher vocal register to which human hearing is more sensitive. This is the same vocal register as sirens and infant cries.

Crying as a Biosocial Phenomenon Crying is a biological siren, alerting the caregiving environment about the needs and wants of the infant and motivating the listener to respond. Infant crying is a biosocial phenomenon. Crying provides information about the biological integrity of the infant and is a social signal that affects parenting. Thus, there are two aspects to the cry. There is the cry itself, which is innervated by the cranial nerves modulating the autonomic nervous system and signals emergency status. There is the salience of the cry to any potential caregivers in the environment, producing a visceral reaction that compels action. Infant cries have both infant and caregiver in a state of strong sympathetic nervous system activation. This state is commonly described as the fight or flight response, except in this case only the caretaker can take action. Bystanders may take flight or distance themselves from the crying infant (e.g., avoidance of crying infant in supermarket or airplane) while responsible potential caregivers fight to stop the crisis by alleviating infant’s distress which turns off the siren. Thus, cry is not just an infant behavior, but rather it is a part of a behavioral system in the human species that assures survival of the helpless neonate by eliciting others to meet basic needs. The process underlying the behavioral system can be disrupted in two general ways. First, the cry signal may be poor or atypical. Second, the caregiver may have atypical reactions to the cry including both underand over-responsiveness. Either situation can compromise the effectiveness of the behavioral system. The most extreme case is shaken baby syndrome in which aversive cries trigger aggression toward the infant rather than toward the reason the infant is crying.

The Science of Infant Crying History Before computers, measuring acoustic cry features was difficult and imprecise. The first attempt at ascribing

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meaning to the acoustic structure of cry patterns was in 1838 by William Gardiner, who used musical scores to illustrate the cry of a spoiled child, as well as other human cries and nonhuman vocalizations. In 1855, Charles Darwin used photographs and line drawings to describe crying and other emotional expressions. The science of infant crying began in 1906 after the invention of the Edison phonograph when T. S. Flateau and H. Gutzmann recorded the vocalizations of 30 infants on wax cylinders and used a phonetic alphabet and musical notation to describe features of the cry. In 1942, G. Fairbanks applied acoustic methods to analysis of the pitch of infant hunger cries. The invention of the telephone by Thomas Bell introduced the concept of separating the speech signal into different frequency components. In the late 1940s, the sound spectrograph was invented by R. K. Potter at Bell Laboratories, which is still considered to be the most important instrument in phonetics or the study of speech sounds. The sonograph is a mechanical device which produces pictures called sonograms, which are a visual tracing of various frequencies of speech. Soon after in 1951, A. Lynip reported the first spectrograms of infant vocalizations. Sonograms Sonograms were made by having pens make marks on pressure-sensitive paper. The marks represented regions of energy where sound was concentrated. The pressuresensitive paper is calibrated in Hz (cycles s1) so when you play a cry, each dark strip means a cry frequency and the length of each mark is how long the cry sound lasted. The lowest strip is the fundamental frequency or pitch. These sonograms were somewhat like inkblots: a mix of fact and fantasy and open to interpretation. At best they provided descriptive information of visual patterns. Despite limitations, the sonograms could distinguish infants with various medical complications as shown in Figure 1. The advent of high-speed computer technology has improved the science of cry analysis with enhanced quantitative methods. In the digital age, acoustical analysis is done by computer and measurement is very precise. Years ago, we developed a special computer acoustical analysis system just for infant cries. This is important because the vocal tract of an infant is shaped differently to that of an adult. In fact, the infant’s vocal tract is similar to the chimpanzee. If computer algorithms are based on the adult vocal tract, there will be errors in the calculation of the acoustical data. The acoustical analysis we conduct is computed every 250 ms to 0.25 s. So, four times a second we get a complete acoustical profile of the infant: Four times a second was chosen because that is how fast the vocal cords can change. The acoustical data are summarized and we build an overall

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(a)

(b)

(c) Figure 1 Sonograms of pain cries from newborn infants with (a) one medical complication; (b) six medical complications; and (c) the syndrome cri du chat (cry of the cat). From Zeskind PS and Lester BM (1978) Acoustic features and auditory perceptions of the cries of newborns with prenatal and perinatal complitions. Child Development 49: 580–589.

cry profile of the infant, called a criogram (Figure 2). A description of many of the measures shown in the criogram including amplitude or loudness (called energy in the criogram), phonation or voicing, dysphonation or noisy cries, hyperphonation or very high pitch, duration of cry sounds between breaths is found in Table 1.

Crying and Acoustics Crying is, of course, sound, so ultimately cry analysis amounts to analyzing sound or acoustics. Sounds are composed of sound waves that vibrate at different frequencies. The science of acoustics breaks apart sound waves into their component frequencies. For example, when we play a C note on a piano, the piano key forces the hammer to hit a string that vibrates at a specific frequency producing the C sound. The infant’s vocal cords are somewhat like piano strings; they vibrate and produce the sound that we hear as cry. But it is not just the vibration of the vocal cords that determine the sound of

the cry. A C note on a piano sounds different than a C note on a violin even though the C sound vibration is at the same frequency. These notes sound different because they, like most sounds, are not composed of single, or sine, wave but of many waves vibrating at different frequencies called complex waves. Acoustics does for sound what a prism does for light. In the same way that a prism shows us that the color we see is really composed of many colors at different frequencies of the color spectrum, acoustic analysis takes sound and shows its component frequencies. Complex sound waves are generated because the initial sound, the fundamental frequency, is affected by its surroundings. The C on the piano is produced in a different acoustical environment or resonating chamber than the C on the violin producing a complex waveform that makes these sounds unique. The resonating chamber is what changes the sound and gives it its unique qualities or richness. These are called resonance frequencies or formants and they refer to how the sound is modified, changed, and filtered by the resonating chamber.

Crying

Criogram Energy

Acoustics

Energy

Phonation

Dysphonation

Duration

Inter Utter. Interval

Nasal

Figure 2 Cry profile or criogram of an infant cry.

Nasal

Hyperphonation

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Table 1

Cry characteristics and biological mechanisms

Characteristic

Definition

Biological mechanism

Cry latency Threshold Utterances Short utterances Phonation

Time from known stimulus to onset of the first utterance (cry sound) Number of applications of stimulation to elicit a cry Number of cry sounds across cry Number of unvoiced sounds across cry

Arousal from limbic–hypothalamic system Arousal from limbic–hypothalamic system Neural control of respiratory system Unstable respiratory control

Hyperphonation Dysphonation Cry mode changes Fundamental frequency (f0) First formant (F1) Second formant (F2) Duration Duration of inspiration Amplitude

Cry mode resulting from vocal fold vibration between 350 and 750 vibrations or cycles s1 (Hz) Cry mode caused by a sudden upward shift in f0 to >1000 Hz Cry mode caused by noisy or inharmonic vibration of the vocal folds Number of times cry modes change during an utterance

Neural control of muscular tension in vocal folds and air flow through the glottis Neural constriction of the vocal tract Unstable respiratory control Instability in neural control of the vocal tract

Base frequency during vocal fold vibration, heard as the pitch of the cry Frequencies centered at first resonance of f0, approximately 1100 Hz Frequencies centered at second resonance of f0, approximately 3300 Hz Time (ms) from onset to offset of cry utterance Time (ms) between cry utterances or interutterance interval. Breath holding is evaluated by the second inspiratory period Intensity or amplitude of the cry (dB). Heard as loudness

Vagal input to larynx and lower vocal tract

Variability in f0

Changes in f0

Variability in F1, F2 Variability in amplitude

Changes in formant Changes in intensity or loudness within an utterance or averaged across utterances

Neural control of size and shape of upper vocal tract Neural control of size and shape of upper vocal tract Neural control of respiratory system Neural control of respiratory system Neural control of respiratory system and capacity Instability in neural control of the larynx and lower vocal tract Instability in neural control of upper vocal tract Instability in neural control of the respiratory system

From LaGasse LL, Neal AR, and Lester BM (2005) Assessment of infant cry: Acoustic cry analysis and parental perception. Mental Retardation and Developmental Disabilities 11: 83–93.

The infant vocal tract is a resonating chamber. Sound generated by vibration of the vocal cords in the larynx or voice box vibrates at a particular frequency. The sound is modified as it travels through the throat, upper airway, and mouth producing a distinctive cry. Each infant’s cry is acoustically unique. The fundamental frequency ( f0) is the basic pitch of the cry: the number of cycles s1 (Hz) that the vocal cords are vibrating. Most infants have an f0 around 250–450 Hz. Their vocal cords are vibrating 300–400 times s1. The sound waves become more complex as the sound travels up the airway producing concentrations of sound energy or clusters of frequencies at higher levels called formants. There are formant frequencies around 1200–1400 Hz (first formant, F1) and 3200 Hz (second formant, F2) produced in the upper airway. A description of cry characteristics is found in Table 1.

Anatomy and Physiology of Cry This section has more detail on how the vocal tract and the brain produce a cry. Infant crying comprises a rhythmic alternation of cry sounds (utterances) and inspiration. Crying is part of the expiratory phase of respiration with

sound or phonation produced by the larynx, which is identified in Figure 3(a), and contains the vocal cords or folds and the glottis (opening between vocal folds). The larynx has three functions: swallowing (a flap called the epiglottis covers the opening of your larynx to keep food out of the wind pipe), breathing (glottis is fully open), and voice production (glottis is closed). When air is forced through adducted (closed) vocal cords, the increased air speed due to passage through a constricted tube (Venturi tube effect) results in a drop in air pressure (the Bernouilli principle), causing the vocal cords to open and close rapidly (approximately 250–450 Hz in normal, healthy newborns). This vibration is the f0 and is heard as the pitch of the cry. The lower vocal tract (below the larynx and glottis), which includes the lungs and trachea (windpipe), is closely associated with the autonomic nervous system. In addition to f0, the lower vocal track produces sound characteristics such as amplitude or loudness, and the rhythm of expiratory cry sounds and inspiration (inhalation as well as breath holding). The sound from the larynx and lower vocal tract is modified by the size and contour of the upper vocal track, which consists of the nasal cavity, the mouth, and the pharynx or throat also shown in Figure 3(a). The upper

Crying

Nasal cavity

Soft palate

Mouth Epiglottis

Nasal cavity Soft palate

Pharynx Mouth

Pharynx

Larynx Trachea

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Epiglottis

Esophagus

(a) Larynx

Esophagus

Trachea (b)

Nasal cavity

Soft palate Pharynx

Mouth Epiglottis Larynx

Esophagus Trachea (c) Figure 3 Comparison of the vocal tracts of (a) human infants; (b) human adults; and (c) chimpanzees (Pan troglodytes). Reproduced from Davidson TM (2003) The great leap forward: The anatomic basis for the acquisition of speech and obstructive sleep apnea. Sleep Medicine 4: 185–194, with permission from Elsevier.

vocal tract shapes the sound to produce resonant frequencies or formants (F1 and F2), which are frequency bands above f0. These formants are similar to a sound chamber of a musical instrument, which makes it easy to distinguish, say, a C note from a piano vs. a guitar. In addition to the infant vocal tract, Figure 3 also shows the vocal tracts of adults (b) and chimpanzees (c). As seen in the figure, the infant vocal tract is smaller than the adult vocal track. Further, the shape of the newborn’s vocal tract is more like a chimpanzee than a human adult with the larynx positioned higher in the vocal tract. Subsequently the larynx drops to the adult position in the vocal track beginning at 6 months and achieving adult positioning by 2 years of age. The newborn infant’s vocal tract, like the chimpanzee, has another capacity that a human adult does not. The chance of choking on food is much greater in adults than

for infants who can easily breathe and feed at the same time. Infants can do this because of the high position of the larynx as well as a biological lock that forms between the soft palate at the back of the infant’s mouth and the epiglottis or the flap that covers the trachea or windpipe during swallowing. This lock makes the infant’s respiratory pathway (nose to lungs) completely separate from the alimentary pathway (mouth to stomach via the esophagus). The unique capacity for speech in humans is related to the lower position of the larynx. The cost for this capacity is greater vulnerability for inhaling and choking on food.

Neurological Basis of Cry Neonatal cry arises from aversive internal or external stimulation and is produced by coordination among several

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brain regions including the brainstem, midbrain, and limbic system. The lower brainstem controls the muscles of the larynx, pharynx, chest, and upper neck through the vagal complex (cranial nerves 9–12) and the phrenic and thoracic nerves. Variation in tension on the larynx muscles, cricothyroid and vocalis, and the abdominal respiratory muscle are thought to be responsible for f0. There are three identifiable cry modes of vocal fold vibration: basic cry or phonation or f0, high-pitch cry or hyperphonation (1000–2000 Hz), noisy or turbulent cry or dysphonation. Damage in the vagal cranial nerve complex is related to atypical patterns of f0. Rapid shifts or variability in f0 suggests instability in the neural control system. The brainstem also controls the contour and cross-sectional airway of the upper vocal tract, which shapes the formant frequencies. Only the first two formants are usually measures: F1 occurs at approximately 1100 Hz and F2 at approximately 3300 Hz. Other regions of the brain participate in cry initiation (limbic system, hypothalamus), configuration of the cry pattern (midbrain), and motor coordination of respiration, larynx, and articulation (reticular activating system). The extensive vagal innervation and central nervous system (CNS) coordination underlying infant cry result from modulation by the autonomic nervous system. Cry initiation, including latency to cry or threshold (amount of stimulation required), has been associated with sympathetic arousal. Respiratory modulation and temporal patterning of the cry (long or short duration of cry utterance, number of utterances, duration of inspiration, number of unvoiced sounds or short utterances) reflect parasympathetic mechanisms of homeostasis. Modulation of the overall contour of f0 as well as the amplitude of the cry reflects both faciliatory and inhibitory autonomic mechanisms. Table 1 provides a quick reference for cry characteristics currently used in infant assessment. The first four characteristics evaluate the entire cry (cry latency to short utterances); the remaining characteristics are calculated for each cry utterance and may be averaged across utterances. In addition to measuring the acoustical characteristics of the cry the amount of crying per day can also be measured. This is typically done either by placing a recorder near or attached to the infant or by asking the mother to complete cry diaries. Cry diaries divide the 24-h day into boxes that represent blocks of time such as 30 min. The mother places a check mark in each time block. The blocks are added as a measure of how much the infant cried that day.

Crying and Culture Crying is universal, all infants cry, but crying has different meanings in different cultures. Most of the studies about infant crying have been done in the western societies,

such as the US, Canada, England, and Denmark. Anthropological studies show that in some cultures, infant crying is considered to be an unusual event and an ominous sign. Among the indigenous tribes of Tierra del Fuego infants rarely cry and then only when they are sick or in pain. In fact, infant crying is so rare that adults say that hearing it is the equivalent of having a terrible earache. In the Celebes, the Torjada believe that an infant’s cry will bring a curse upon its parents. In other cultures, for example, India, colic refers to the kind of crying that indicates there is something wrong with the infant’s digestion. The word colic comes from colon. In contrast, the Kurds of Turkey and Iran say that crying is necessary to develop the voice, and leave their infants to cry. Taiwanese mothers see crying as a form of infant exercise, and even have a proverb that says, a child must cry to grow. A survey of over 180 societies showed that infants cried less when they were carried. Mothers were able to tell from the infants’ movement when their infant was starting to get upset and intervene before the infant cried. This suggests that, to some extent, crying is influenced by cultural practices. We should not be surprised that infants cry more in western societies. When infants are in a different room the culture is teaching them to cry to get attention.

Normal Development of Crying Infants have two types of cry when they are born, a basic cry and a pain cry. These cries are clearly, audibly different to the human ear and reliably distinguished by acoustical analysis. The pain cry as implied means the infant is in pain and signals an emergency. The pain cry is usually high-pitched, loud, has a sudden onset, and includes long periods of breath holding. Often the very first ‘waaaaah’ or cry burst is prolonged and followed by a long period of breath holding. The basic cry is used for everything else. It is most typically heard when the infant is hungry, and is often called the hunger cry. The basic cry has a more gradual buildup and a lower pitch. It does not have the long periods of breath holding or the frantic, emergency quality of the pain cry. The basic and pain cry of the newborn to 4–6-week-old infant has a reflexive or automatic quality to it. At about this time the infant’s nervous system matures to a point where the infant gains voluntary control of the vocal cords. This is a prerequisite for the development of speech and language. The infant also learns that he or she has this control and also learns to use the cry to summon the mother and this cry sounds less reflexive like and more intentional. The amount of crying also reaches its peak at 4–6 weeks of age when approximately 20% of infants cry as much as 3 h per day. This is also when colic is most frequently diagnosed.

Crying

Crying and Colic Colic is a special case when crying becomes problematic for the family. Colic used to be equated with excessive crying that only focuses on the amount of crying. However, this definition fails to consider other characteristics of the cry, impact of the crying on the infant’s development and on the family. Other characteristics associated with colic include high f0, high amplitude and increased duration of inspiration or breath holding suggesting pain, as well as physical signs in the infant (e.g., tight muscles, hard stomach, legs pulling up), the sudden onset, and episodic quality and inconsolability. When viewed from a psychosocial perspective, colic is diagnosed when crying at this age is problematic because it interferes with the infant’s development (e.g., causes sleep or feeding problems), the developing parent–child relationship or the family. There are probably multiple causes of colic. Gastroesophageal reflux (GER) occurs when acids from the stomach leaks into the esophagus, causes pain, and produces a pain cry. Colic can also be due to sleeping or feeding problems, or to hypersensitivity that reflects an immature nervous system. Although colic typically occurs in infants from 3 weeks to 3 months, the acoustic characteristics like high f0, high amplitude, and longer duration of inspiration may precede the onset of colic itself, suggesting greater vulnerability to stress in these infants, which may be a precipitating condition in the development of colic. Colic is not caused by bad parenting. Colic does often, however, disrupt the infant–parent relationship and psychosocial treatment addresses the parents’ issues as well as the infant’s issues.

Crying and Temperament In infancy, crying is part of the definition of temperament. Infants who cry a lot are said to have difficult temperament and there can be overlap between difficult temperaments and colic. Crying fits into the temperament constructs of reactivity and regulation that are thought to be linked to underlying autonomic processes. Infants with a short latency to cry onset are more reactive while infants who fail to cry or take a long time to cry despite aversive conditions are under-reactive. Infants who are difficult to sooth as well as have acoustic characteristics such as dysphonation, frequent cry mode changes between voicing and noise, and rapid shifts of variability in f0 have poorer regulation. The advantage of cry analysis to the measurement of temperament is that cry can be measured earlier than standard measures of temperament, which are typically evaluated no sooner than 3 or 4 months of age. Also, temperament measures are often based on parent report,

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whereas cry provides a more objective measure. In keeping with the definition of a temperamental trait as a biological disposition that is relatively stable and enduring across context and time, highly reactive or under reactive infants who are also poor regulators (as identified from neonatal cry) may be more likely to have difficulty with behavioral regulation or inhibitory control during later infancy and childhood.

Crying in Older Infants Older infants cry for additional reasons to those mentioned above. Fear, stranger anxiety, and temper tantrums are common causes of crying in older infants. The reasons why these and events like them trigger crying are varied. Crying occurs when higher (brain)-level coping strategies are no longer effective in regulating the infant’s behavior and more primitive (e.g., limbic) structures take over. As frontal areas of the brain develop, higher-level executive function abilities develop, which enable the infant to develop better coping strategies and inhibit the build up in emotion that leads to crying. This breakdown in coping can occur because the infant is frustrated. For example, receptive language develops before expressive language and infants can become frustrated because they know what they want to say, but they cannot say it. Learning new things often presents the infant with conflicts so that gains in one area are at the expense of gains in another area. Learning to walk is exhilarating and brings feelings of autonomy and mastery. But it also brings the fear of rupturing the attachment relationship to the mother. In these cases crying is often a form of coping in which there is a temporary regression, or step backward, that enables the infant to regroup and then master the new challenge.

Crying and Medical Problems Research relating cry features to medical problems are divided into three general categories: (1) significant medical problems that may be identified by standard techniques, (2) medical problems that are currently undetectable until it is too late for treatment, and (3) medical conditions that place the infant at risk for poor outcome but the prognosis is not clear. Severe Medical Problems Already Identified Much of the early interest in infant crying was based on the use of cry acoustics in the diagnosis of medical syndromes or damage to the CNS listed in Table 2. The genetic syndrome cri du chat (cry of the cat) is caused by deletion of the short arm of chromosome 5 and is virtually diagnosed

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by the distinctive high-pitched cry. In addition to other trisomy conditions (trisomys 13, 18, and 21), other conditions related to acoustic cry characteristics include asphyxia, undefined brain damage, Down syndrome, hydrocephalus, hypothyroidism, Krabbe’s disease, encephalitis, and bacterial meningitis. As seen in Table 2, the most common changes in cry characteristics associated with severe medical conditions are higher f0 and more variability in f0. In most cases with these known medical conditions there are other clinical signs. However, cry characteristics may have diagnostic value even for infants already diagnosed with CNS damage. For example, infants with severe asphyxia or bacterial meningitis with the most abnormal cries had the poorest prognosis.

Table 2 conditions

Cry characteristics associated with severe medical

Medical condition

Cry characteristic

Asphyxia Brain damage Cri du chat Down syndrome Hydrocephalus Hypothyroidism Krabbe’s disease Meningitis (bacterial) Trisomy 13, 18, and 21

Table 3

" f0, " f0 variability (biphonation), " subharmonic break, " or # duration " f0, " f0 variability (biphonation), # duration, " threshold, " latency, " short utterances " f0 # f0, " f0 variability, # amplitude " f0, " f0 variaiblity, " latency # f0 " f0 " f0, " f0 variability (biphonation), # duration # f0

Severe Medical Problems Not Yet Detectable The fact that cry changes are related to known significant medical conditions opens the door to determining if specific cry characteristics are associated with medical problems for which currently available methods of detection are inadequate. Sudden infant death syndrome (SIDS) is a common but unexplained cause of death in infants between 1 month and 1 year of age. Limited research has shown that infants with alterations in the cry that indicate vocal constriction (high F1) and poor control over the vocal tract (increased cry mode changes) are more likely to die of SIDS. However, the sensitivity of this cry test does not meet criteria for clinical application. Cry analysis has also been applied to the identification of infants with less obvious CNS damage. Medical Conditions Increasing Risk for Poor Development The category of the at-risk infant is a broad category of infants who may have poor neurodevelopmental outcome based on potential neurological insult. Factors thought to compromise the fetal brain include prematurity, intrauterine growth retardation, prenatal exposure to environmental toxins such as lead or to illegal drugs (cocaine, heroin, marijuana, methamphetamine) or legal drugs (tobacco and alcohol), and prenatal exposure to psychotropic drugs that mothers take for conditions such as depression (the class of drugs commonly refereed to as selective serotonin reuptake inhibitors (SSRIs) or serotonin-noradrenaline reuptake inhibitors (SNRIs), such as fluoxetine sold as Prozac). As shown in Table 3, studies have consistently found that these at-risk factors do alter the acoustical

Cry characteristics associated with potential neurological insults

Medical condition

Cry characteristics

Low birth weight (40 h per week) conferred

negative associations with children’s performance on a verbal test. Other research indicates that it is the time of day and days of the week in which fathers work that contribute most to their involvement in the care of children. The shift in the economy to more service-based jobs has meant more nonstandard work schedules. When fathers work evenings or weekends, they are more involved in the care of their preschoolers. Wives’ schedules, too, have an impact on father involvement. When men work different hours than their wives, they are most likely to take care of the youngest child (child under 5). Fathers also are more involved in care of their preschool children when their wives work on the weekends or nights. Work appears to ‘spillover’ to men’s family life – their parenting, their relations with their children – in both positive and negative directions. Jobs with more desirable conditions, such as higher autonomy, initiative, and support, are associated with positive parenting. Jobs that bring more strain and less satisfaction seem to compromise the quality of parenting. Economic conditions affect employment status, the availability of full-time work, work schedules, and the affordability of nonparental care, which in turn affect how families organize the care of their children. Although characteristics of fathers’ employment are receiving more attention in recent years, and the study of the work–family relations is no longer just about mothers, we still know far more about fathers’ jobs in relation to parenting than we do about the direct and mediated impact on children’s development in a variety of domains.

Moderators As can be seen from the preceding review, in general, there are few ‘direct’ associations between maternal employment and child outcomes. Instead, there are a variety of factors that moderate these relations; in other words, maternal employment is associated with infant and child outcomes only under certain conditions. Therefore, in order to understand the implications of maternal employment for child development, one needs to take into account a host of other factors. Child Gender and Socioeconomic Status As mentioned previously, a particularly important moderator appears to be child gender. One of the most consistent findings in the maternal employment literature is that of more positive consequences for girls and more negative consequences for boys. However, even this relatively wellestablished relation appears to be moderated by variables such as race and socioeconomic status. In terms of social

Maternal and Paternal Employment, Effects of

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competence, for instance, daughters (but not sons) of employed mothers are rated as better liked by their peers than are daughters of nonemployed mothers, but this association holds only for Caucasian girls. In addition, children from working-class families with mothers who return to work in the first year of their child’s life are significantly more likely to be nominated by peers for being mean and hitting than are children from workingclass families with nonemployed mothers or children from middle-class families. Another oft-cited example of the interaction between child gender and socioeconomic status is in the field of achievement: maternal employment in the middle- and upper-socioeconomic classes appears to be detrimental to the achievement of sons, but not to the achievement of their working-class counterparts or to daughters in either class. Interactions between employment, parenting behaviors, and class are also evident. In general, employed mothers appear to use parenting and discipline styles that are associated with greater competence and adjustment in their children; however, this relation is particularly evident in the working as compared to the middle-class families, regardless of family structure. The economic pathway is believed to explain these findings: maternal employment in working-class families generates invaluable financial resources and benefits that outweigh the loss of time and supervision due to the mother’s employment outside the home. In contrast, maternal employment in middle- and upper-classes is not always a financial necessity; therefore, the ‘maternal deprivation’ pathway may be operative as these children potentially suffer from decreased maternal attention, supervision, and availability, especially if the alternate-care setting is less enriched than the home environment.

employment on child outcomes, it is essential to recognize that better outcomes for children of employed mothers may reflect pre-existing differences between employed and nonemployed mothers. Employed and nonemployed women often differ on a variety of measured and unmeasured characteristics – socioeconomic, demographic, and psychological – that may contribute to what are called ‘selection effects’ or selection bias. Socio-economic and family-level factors can shape who is employed and who is not and contribute to selection effects. In addition, these differences themselves may render children more or less vulnerable to the outcomes discussed throughout this article. Mothers who are employed typically have higher levels of education, are part of families with greater income, and have fewer children than nonemployed mothers. In addition, maternal attitudes about work and mothering are different between the two groups of women in ways that likely influence parenting styles and practices and thereby child development. Unless these factors are controlled, differences in children’s development attributed to maternal employment might instead reflect selection processes that are related to mothers’ labor force participation and children’s development. A number of studies have found that when they control for a host of potentially confounding variables, the first-order significant findings are diminished. The difficulty in controlling for all likely confounding sources of influence should remind us to exercise caution before concluding that there is a cause and effect relation between maternal employment and children’s development.

Quality of Alternate Care

Despite the normative status of maternal employment in Western societies, it remains an area replete with controversy and mixed findings. Although the bulk of public opinion focuses on negative consequences of maternal employment for children, research points to both positive and negative associations and the need for more complex, ecologically sensitive models. The emphasis in this article has been on maternal employment and child development, but we also have seen that conditions of fathers’ employment are consequential for their parenting and for the development of their children. Research indicates that maternal employment may render infants slightly more vulnerable to developing insecure attachments to their mother, but that maternal attitudes about work, the timing of work in the infant’s life, and the hours a mother worked outside the home play a more important role in terms of the mother–infant attachment relationship. Often cited as a benefit of maternal employment, particularly for girls, is the association between greater independence among children with

Another essential factor that influences the associations between maternal employment and child outcomes that is being increasingly recognized by researchers is the quality of alternate-care arrangements. As discussed previously, the negative consequences of employment for children, in particular their security of attachment to mother, are more pronounced when they are placed in lower-quality childcare. Conversely, it also appears that the positive consequences of maternal employment for children are enhanced when children are in high-quality childcare. In addition, quality and number of alternatecare arrangements can interact with other factors, such as child gender, to influence outcomes for children. Selection Factors In addition to considering how various factors produce conditions that facilitate or buffer the influence of maternal

Summary

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employed mothers. Gender-of-child differences may reflect not only differential treatment of boys and girls by employed and nonemployed parents, but differences between boys and girls in how they react to the same treatment and in terms of what treatment they elicit from their parents. In terms of young children’s physical health, the timing of return to work and the hours of work can impede the breastfeeding process. Maternal employment status alone explains little variance in childhood obesity. The added income supplied by working mothers can benefit childhood nutrition, but extensive work hours that interfere with family mealtimes may contribute to poor eating behavior particularly in economically advantaged families. Having a child with a physical disability does have a negative impact on mothers’ labor force activity, and the effect is stronger for families with a female head of household. There is only weak, inconsistent evidence for an association between maternal employment and social competence with peers, although maternal attitudes about work may predict positive child behaviors with peers. Some research suggests that boys of employed mothers are better liked by their peers, but that children of employed mothers are also more likely to be rated by the teachers as acting out. There is little evidence for links between maternal employment and prosocial or cooperative behaviors. Despite public beliefs that maternal employment will lead to greater behavior problems in children, there is inconsistent evidence about work outside the home and measures of compliance and noncompliance. Personal strain and parenting behaviors mediate most of these associations. Girls and boys seem to respond differently to maternal behaviors that are consequential for children’s display of uncooperative or defiant behaviors. A consistent finding in the maternal employment literature is that children of employed mothers have fewer stereotypes and more egalitarian ideas about gender. It appears that females are especially likely to be influenced by maternal work outside the home, perhaps because of the potency of a same-sex model of egalitarian behavior. The impact of fathers’ employment on children has received less attention than has investigation of the consequences of paternal unemployment. When fathers are unemployed, negative effects accrue for the families’ economic health as well as for children’s physical health, behavior, and psychological development. Characteristics of the jobs held by employed fathers, such as autonomy and complexity, are related both to their parenting and to their children’s cognitive performance. There also is evidence that fathers’ work influences children indirectly, operating through paternal well-being and parenting values as well as through its effects on mothers.

The body of research suggests that work conditions are more relevant for children’s behavior than parental work status per se, which explains little variance. There is considerable variability across and within studies, often explained by moderators such as child gender, SES, family structure, and quality of alternate care. Particularly important mechanisms to explain associations between mothers’ and fathers’ work and children’s behavior are personal strain and parenting behaviors. Ecological variables, such as income, family structure (i.e., single parent, two-parent families), and work conditions affect the employment–child associations. Improvements over time have been apparent in the way that researchers approach the study of parental employment. Increasingly, research in this area has incorporated larger and more diverse samples as well as more ecologically based models that consider demographic selection factors and conditions of parental employment. Continuing these trends can only further our understanding of the mechanisms through which parental employment affects children’s development. See also: Attachment; Child and Day Care, Effects of; Family Influences; Independence/Dependence; Parental Leave; Parenting Styles and their Effects.

Suggested Readings Chase-Lansdale PL, Moffitt RA, Lohman BJ, et al. (2003) Mothers’ transitions from welfare to work and the well-being of preschoolers and adolescents. Science 29(5612): 1548–1552. Dye JL (2004) Fertility of American Women, Current Populations Reports P20–555. Washington, DC: US Census Bureau. Gottfried A and Gottfried AW (2006) A long term investigation of the role of maternal and dual-earner employment in children’s development. American Behavioral Scientist 49: 1310–1327. Hoffman LW and Youngblade LM (1999) Mothers at Work: Effects on Children’s Well-Being. New York: Cambridge University Press. Perry-Jenkins M, Repetti R, and Crouter AC (2000) Work and family in the 1990s. Journal of Marriage and Family 62: 981–998. Waldfogel J (2006) What Children Need. Cambridge, MA: Harvard University Press. Zaslow MJ, Brooks JL, Moore KA, Morris P, Tout K, and Redd Z (2001) Impacts on Children in Experimental Studies of Welfare-to-Work Programs. Washington, DC: Child Trends.

Relevant Websites http://wfnetwork.bc.edu – Sloan Work and Family Research Network. http://www.bls.gov – US Department of Labor, Bureau of Labor Statistics, Current Population Survey, Women in the Labor Force: A Databook.

Mental Health, Infant

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Mental Health, Infant P D Zeanah, M M Gleason, and C H Zeanah, Tulane University Health Sciences Center, New Orleans, LA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary DC:0–3R – The revised edition of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, published by Zero to Three in 2005. This document was developed by an advocacy and professional development organization to specify criteria for disorders of early childhood because of the belief that DSM-IV-TR did not adequately describe the problems seen in young children. DSM-IV-TR – The fourth edition (text revision) of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 2000. This document specifies criteria used in the diagnosis of psychiatric disorders. The criteria are developed by expert committees who review relevant research and use it to inform the criteria. Neuronal synapses – The connections between the axon of one neuron (nerve cell) and the dendrite of another in which neurotransmitters are released and taken up as electrical impulses are discharged. RDC-PA – This document, the ‘Research diagnostic criteria – preschool age’, was published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2003 and describes criteria for early childhood disorders. The purpose was to modify existing DSM-IV-TR criteria so that they could be applied to young children with a degree of specificity that would help investigators achieve uniformity in studies of early childhood disorders. Strange situation procedure – A laboratory paradigm involving a young child, a caregiver (parent), and an adult who is unfamiliar to the child (the stranger). The procedure involves a series of episodes in which the child’s behavior with the caregiver (parent) is compared with the child’s behavior with the stranger. Based on the child’s behavior, the child’s attachment to the caregiver (parent) is classified as secure, avoidant, resistant, or disorganized. Each of these types or patterns of attachment is preceded by certain patterns of interaction and predictive of

subsequent outcomes in the child. The attachment classification may vary with different caregivers (parents) and is thought to reflect a characteristic of the relationship rather than a characteristic of the child. Strengths perspective – In clinical work, the conscious attempt to discover strengths in individuals, families, and situations that may be used as the clinician attempts to reduce or eliminate problems or risks. This does not mean overlooking problems, vulnerabilities, or weaknesses, but rather, not focusing on them exclusively.

Introduction There is more interest at present in infant mental health than ever before. In part this is because enhanced infant survival in the developed world has shifted focus to quality of life issues. This interest has been bolstered by unprecedented gains in scientific advances in our understanding of early life experiences and the impact of these early experiences on later social, emotional, and cognitive development. Neuroscientific advances have begun to address how experiences affect brain development (and vice versa), increasing interest in the kinds of experiences that lead to adaptive and maladaptive outcomes.

Definitions Although there are a number of ways to think about infant mental health, it is usually considered to be essentially synonymous with healthy social and emotional development. It has been defined as the developing capacities to experience, regulate, and express emotions; to form close interpersonal relationships; to explore the environment; and to learn in the first 3 years. In this definition, infant mental health must be considered in the context of family, community, and cultural expectations for young children. This definition incorporates a broad range of risk and protective factors that impact current and future functioning and development. In addition, infant mental health is relationshipfocused; that is, the infant’s dependence on the caregiver

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means that any interventions undertaken to either enhance development or address problems must consider the caregiver’s capacity to care for the infant, as well as the psychological ‘fit’ between the infant and caregiver. Infant mental health is also intergenerational in approach. In addition to attending to both parent and infant, the parents own sense of their childhood relationships, as well as ongoing interactions with their family of origin are often central to work with infants and their families. Clinical efforts are likely to be aimed at parents or extended family members in addition to the infant. Further, infant mental health is culturally bound, with different values defined by different cultures about childrearing. Infant mental health is also prevention-oriented; activities are aimed at enhancing normal development and preventing problems from getting worse or from disrupting normal developmental trajectories. In this sense, it may be considered health promoting as well as distress alleviating. Infant mental health has traditionally been transdisciplinary – enriched by the frameworks and perspectives of numerous professional disciplines that contribute to our understanding of the early experience of children. As an integrative discipline, infant mental health involves all professionals who work toward strengthening social and emotional development of young children and their families, and it is not synonymous with any specific discipline. For some, the term infant mental health – if not the idea mental health in infancy – is objectionable. The discomfort may come from several sources: a negative association of mental health with major mental illnesses, a more general cultural issue of stigma related to mental health (e.g., many hospitals now have behavioral health units rather than mental health or psychiatric units), or a belief that the earliest years are carefree and innocent. It is likely that even those who object to the term can agree on a shared goal of fostering healthy development for our youngest and most vulnerable citizens. Nevertheless, there are those who find it difficult to imagine that infants and toddlers can have mental health problems. They discuss risk factors for later disorders rather than disorders per se, or prefer to focus on problem behaviors rather than psychiatric symptomatology. Some suggest using the term infant well-being as a strengths-based approach to describe early childhood social–emotional development. Well-being, however, does not capture the actual experience of many young children who do suffer, nor is it particularly helpful in guiding us in how to enhance early experience. Thus, this article is written from the perspective that the construct of infant mental health is both clinically useful and developmentally important. Further definition of some terms is necessary to facilitate this discussion. In infant mental health, infancy is considered the first 3 years of life or so. Typically in American culture, infancy is considered to be the first

year of life, so infant mental health requires a broadening of that view. While we recognize that influences on the child’s early development begin prior to birth, and extend through adolescence, the first 3 years represent the period of the most rapid developmental gains in the human life span. The term developing capacity refers to the enormity and rapidity of growth and development during the first 3 years of life. Finally, we emphasize that an exclusive focus on the infant alone is untenable, as the needs of parent and child in their many family, environmental, and cultural contexts are all a part of the focus of infant mental health.

Development As noted above, the developmental gains during the first three years of life are exceptional. Normal newborns are capable of recognizing their caregiver (at a sensory level), and have basic modes of communicating with their caregiver. Over the first few months of life, they begin to discriminate caregivers, express a variety of emotions, and are increasingly able to communicate needs. By age 3 years, they have developed strategies for learning, and are able to engage in complex interactions with peers, including cooperating with and showing empathy for others, and have some abilities to initiate and to resolve conflicts. Though there is a wide range of what is considered normal, there is also increasing understanding of how delays and deviations impact the pathway for normal development, and the implications for current and future mental health. For example, research shows that infants in the first few years of life who experience serious adversity (i.e., exposure to violence, trauma, or multiple medical procedures) are more likely to show abnormal patterns in the expression of emotions, unusual or deviant behaviors including increased motor activity, distractibility and inattention, disruptions in feeding and sleeping patterns, and/or developmental delays in motor and language skills. Many of these problems are not transient but herald the onset of longstanding problems.

Contexts of Infant Mental Health Context refers to all of the many factors that influence infants’ development. Intrinsic, or internal, factors include biological, genetic, and constitutional make-up. Extrinsic, or external, factors include the infants’ caregiving relationship, family, culture, and social class. These intrinsic and extrinsic characteristics are risk and protective factors that dynamically interact with each other. Risk factors increase the probability of adverse outcomes, and protective factors decrease the probability of adverse outcomes.


Biological Context The biological context includes all of the intrinsic factors that affect an infant’s development: genetic influences, temperament, constitution, physical health, and physical attributes. These factors are considered ‘within the individual’; they may or may not be modifiable. Much of primary healthcare is devoted to ensuring that the infant is off to a healthy start and addresses some of the modifiable intrinsic factors by using interventions such as nutritional education, developmental surveillance, and early intervention for various health and developmental problems. Clearly, development depends in part on biological dimensions of the individual’s experience of the world. Important contributors to the infant’s mental health are evident in the biological context. In addition to genetic dispositions, many nongenetic biological factors may be important. From the third trimester of pregnancy to the second year of life is the most rapid period of brain development in the human life cycle, though brain development begins in the first few weeks after conception and continues well into adulthood. Much of the structural development of the brain occurs prenatally, but circuitry continues to be elaborated after birth, as a result of experiences. Functional development depends on making connections between distal and local neural circuits through the formation and pruning of neuronal synapses – believed to occur in part as a result of prenatal and postnatal experiences. Thus, numerous prenatal experiences such as poor nutrition or poor maternal health may directly affect brain growth. Prenatal exposure to pharmacological agents may result in the newborns showing withdrawal symptoms at birth, and prenatal maternal stress has been associated with changes in infants’ stress-regulation abilities. Physical health impacts the type of care needed by the infant, how his caregivers respond to him, and his capacity for normal physical as well as mental growth and development. The infant’s temperament (e.g., behavioral inhibition or effortful control), as well as the infant’s physical attributes (e.g., resembling a family member or disfiguring anomalies) can powerfully impact the caregiver’s perceptions of and responses to the infant. Physical or temperamental characteristics may result in the caregiver feeling drawn to, protective of, or disconnected from the infant. Infants’ physical or behavioral attributes may facilitate positive or negative interactions and further exacerbate negative interactions. For example, a fussy infant may be off-putting for a disengaged caregiver leading the infant to cry more in an effort to elicit attention. Cultural Context Culture provides norms for parenting beliefs and behaviors, defining how to care for infants and young children,

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as well as expectations about the roles of mothers, fathers, and extended family members. Although different cultural and ethnic groups develop different child-rearing practices, there are certain values that are evident in cultures around the world: (1) ensuring the child’s safety and health, (2) ensuring the child becomes capable of economic self-maintenance, and (3) ensuring the child will be able to maximize societal values. Finally, the family exerts a strong influence on the day to day experience of the infant, particularly the type and availability of support for the parent. Culture also influences the parents’ expectations, hopes, and values regarding the infant, and in turn, how the parent cares for and experiences the infant. Social Context Social class confers access to resources. Increasing availability and use of external supports for families with young children are associated with higher social classes. Living environment impacts the needs of the infant and the family as well as the prioritization, type, and availability of resources. Rural or isolated areas, inner cities with crowded living conditions and unhealthy living spaces, and even extreme climate or physical terrain, all confer unique needs and limit families’ access to resources. Lower social class also is associated with probability of the individual encountering environmental risk factors. For example, poverty exerts a strong negative influence on the early experience of many young children because of the myriad of associated environmental and psychosocial stresses, including an increased risk of community violence and mental health issues. Relationship Context The most crucial interpersonal context for the developing infant is the small number of caregiving relationships that the child encounters. Through these relationships the infant begins to understand his world, learns how to interact with others, and begins to develop a sense of his competence and self-worth. After all, the impact of infant’s experiences of environmental risk factors, such as poverty, maternal mental illness, and partner violence is primarily via their effects on the infant–parent relationship. Further, intrinsic risk factors, such as biological difficulties, are moderated by the infant–parent relationship. For example, infants with complications of prematurity have better outcomes when their caregiving environments are supportive, and more problematic outcomes when their caregiving environments are less supportive. Also, difficult temperaments can be moderated through a responsive, nurturing, and consistent caregiving experience. The attachment relationship is a biologically based process that motivates the young child to seek comfort, support, nurturance, and protection in times of distress

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from discriminated attachment figures – providing the basis for psychological security as well as physical safety. The attachment relationship develops over the course of the first year of life through the myriad of daily interactions between the infant and the primary caregiver(s). The quality of the infant–caregiver relationship is a risk or protective factor for infants’ later development. A warm, nurturing, sensitive, responsive, and consistent pattern of interactions between the infant and caregiver leads to a ‘secure’ attachment; through these interactions, the infant learns that he is worthy of being taken care of, that he can count on his caregiver to be there when he needs her, and he develops a sense of self-competence in that his actions (i.e., signals, cues, behaviors, communications) can be understood and are effective in getting his needs met. Conversely, interactions that lack these positive qualities and are inconsistent, unpredictable, harsh, or punitive lead to insecure or disorganized attachments. Preferred attachment appears in the latter part of the first year of life, heralded by the appearance of separation protest and stranger wariness. Infants become attached to caregivers with whom they have a significant number of interactions. If more than one attachment figure is present, infants develop a hierarchy of preferred caregivers to whom they turn for comfort, support, nurturance, and protection. During these early months, the infant appears to develop a set of expectations, termed ‘working models’, of what it is like to be in an intimate relationship with another person. These models are relationship specific, so that the infant’s experiences with each caregiver determines the nature of the expectations that the infant develops for his or her relationship with each caregiver. This relationship specificity has significant implications for assessment and treatment.

Psychopathology in Infancy The idea of psychiatric diagnoses of infants and young children often makes us uncomfortable. We prefer to think of infancy as a carefree time with unlimited possibilities for the future. Faced with infants who are distressed or who have impairments in functioning, we may prefer to think about them as having risks for subsequent disorders rather than discrete psychiatric disorders. Nevertheless, in clinical practice, examples of patterns of severe psychopathology are impossible to avoid. Young children present with consistent patterns impairing symptoms which affect their functioning and development. As early as the first year of life, some infants demonstrate significant behavioral or emotional problems, including odd behaviors or unusual social or emotional responses in certain situations. Even when an infant has a mild or subclinical problem, the dynamics of the interaction between caregiver and child may be altered: the caregiver

may become more or less attentive, more nurturing or annoyed at the difficulties the infant presents. While such problems may not be disorders they do affect the relationship between the infant and caregiver, and when the relationship is altered or stressed, the infant is likely to react. Of course, real challenges exist in the psychiatric diagnosis of disorders in young children. Because infants and preschoolers develop social, emotional, communication skills at such a rapid rate, there are developmental differences in presentation of disorders across this age range. Furthermore, the major nosology-describing criteria for psychiatric diagnoses, the DSM-IV-TR, was developed without attention to young children. Many researchers and clinicians have been concerned about the usefulness of DSM-IV-TR diagnostic criteria in evaluating the symptoms of infants and toddlers because the diagnoses were primarily derived from studies of adults and used limited empirical data related to children, much less very young children. Alternative diagnostic systems have been proposed and the field continues to finetune the definition of disorders in young children. Diagnostic Classification Systems Specific symptoms or symptom clusters become problematic in children when they interfere with normal development or functioning; for example, in infants and young children, this may include disturbances in interactions between peers or with caregivers, impediments to play and learning, or negative impacts on health, growth, emotional, or behavioral development. Diagnostic classifications allow effective communication with parents and colleagues about our understanding of the problem and provide a common foundation for research to understand the validity, prognosis, intervention effects of the identified symptom constellations. An alternative to the DSM approach was first developed in 1992, when the Zero to Three organization published the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–3). DC:0–3 was revised in 2005. It uses a clinically driven set of developmentally derived criteria and a multidimensional approach to diagnostic classification to attempt to capture both developmental issues and contextual features of psychopathology. The diagnostic classifications include descriptions of relationship psychopathology as well as the infant’s functional emotional level. A third diagnostic approach was created in 2003, when a group of investigators developed the Research Diagnostic Criteria – Preschool Age (RDC-PA) to facilitate communication and additional research on the reliability and validity of early childhood disorders. Although only preliminary data exist, it appears that overall prevalence of disorders in young children is similar to rates in older children, that is, roughly 10–20%.


Disorders with prominent externalizing symptoms, such as inattention/hyperactivity, oppositional defiant disorder, and aggressive behavior disorders are common diagnoses in most referred and nonreferred populations in mental health settings. Trauma-related disorders also are prominent, though the rates of other internalizing disorders, such as depression and anxiety disorders, vary in different reports, perhaps a reflection of limited data related to their use. In primary care settings, on the other hand, regulatory problems, such as feeding and sleeping problems, are most commonly reported particularly in infants. Types of Disorders Disorders of regulation

The earliest-appearing disorders in infancy are those that disrupt basic regulatory functions such as feeding and sleep. Feeding disorders

In early infancy, feeding is a major activity involving parent and child, and feeding continues to be central in the lives of toddlers. In some diagnostic classification systems, feeding disorders are grouped under a single heading but in others they are split into many types. Most feeding disorders involve an inability to eat or food refusal, sometimes associated with an inability to maintain appropriate weight gain. Feeding disorders can present in the context of caregivers who are disengaged from the infant during feedings, or with intense conflict between infant and caregiver during feedings. Although some feeding disorders can be related to specific events (e.g., nasogastric feedings or traumatic intubations), most feeding disorders appear to have multifactorial etiologies. Sensoryprocessing abnormalities, attachment-relationship disturbances, state-regulation difficulties, and complicated medical conditions all may play a role in the development or perpetuation of feeding disorders. Regardless of the etiology, feeding disorders are generally stressful both for parents and for the parent–child relationship. These disorders often create feelings of inadequacy in parents. Of most concern is when feeding problems impair growth (failure to thrive), since malnutrition is particularly pernicious as an influence on brain development.

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some sleep problems are part of a normal developmental course. Disorders of sleep in young children can occur around sleep onset (primary insomnia or sleep refusal) or during sleep in the form of night wakenings or parasomnias (nightmares and night terrors). In toddlers and preschoolers, enlarged tonsils and adenoids can lead to obstructive sleep apnea symptoms, including night-time snoring and daytime drowsiness and sometimes irritability. Sleep disturbances may affect children’s attention and behavior, as well as impact family sleep practices and relationships. Behavioral disorders Behavioral disorders are characterized by externalizing symptoms, such as aggression, tantrums, oppositional/ defiant behavior, and inattention/hyperactivity. They are uncommon in the first 18 months of life but are commonly described in preschool children. Aggressive behavior is the most common presenting sign in children in the third year of life who are brought for mental health evaluations. It is important to distinguish true signs and symptoms of disorders from variants of normal development. The challenge of diagnosing these disorders in young children involves determining the developmental appropriateness of some of the symptoms. As children develop an enhanced sense of autonomy and they test the limits of their emotional and physical dependence, parental report of oppositional behaviors often increases. Parental reports of aggression and externalizing behaviors peak at about age 2 years and then begin to decrease to some extent. Even in the context of developmentally typical behaviors, parental distress in response to these behaviors must be acknowledged and addressed. However, there are also clearly cases in which a child’s behaviors reflect an impulsivity and dysregulation out of proportion for the normal developmental phase. The three major behavior disorders described the diagnostic classification systems include attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and, less commonly, conduct disorder (CD). These diagnoses are among the best-validated disorders in the preschool age group, and they show significant stability over time. Attention deficit hyperactivity disorder

Sleep disorders

Sleep is a central index of infant state regulation. Newborns spend up to 18 h of every 24 h sleeping. As children get older, they begin to develop a diurnal sleep pattern, sleeping in the evening and being awake during the daylight. This developmental process provides for the opportunity of a varied developmental course, and some researchers have suggested that sleep patterns be classified specifically by their frequency and duration, as

ADHD is defined as a maladaptive and developmentally inappropriate level of inattention, hyperactivity, and impulsivity. Like older children with ADHD, preschoolers with ADHD present primarily with hyperactive, impulsive symptoms or with notable inattention and disorganization, or both. Because of the diagnostic challenges of assessing young children with these symptoms, it is especially important to obtain information about the child’s behavior in multiple settings and from various

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caregivers, especially day care providers to rule out differential diagnoses like anxiety disorders, learning disorders, or relationship-based disorders. Oppositional defiant disorder

In most clinical settings, aggressive and negativisitic behavior problems are commonly seen, especially in boys. ODD is characterized by a pattern of negative, hostile, and defiant behaviors including arguing with adults, losing temper, refusing to follow directions and seeming angry, resentful, or spiteful. Children with ODD often have associated ADHD. In those cases, the outcome 2 years later is significantly less favorable than in children with ADHD only. Conduct disorder

Conduct disorder, a more extreme disorder of disruptive, aggressive, and destructive behaviors, is less common in the preschool population. Nevertheless, not only have signs and symptoms associated with conduct disorder been identified in young children (e.g., aggression, bullying, and cruelty to others), but also dispositions associated with conduct disorder symptoms at older ages, such as callous unemotional traits, also have been identified in preschoolers. Not all children who present with aggression or negativistic and defiant behaviors as their chief complaints have a disruptive behavior disorder. Assessing the biological, emotional, relationship, and environmental contexts of the symptoms can guide the diagnosis. Children presenting with externalizing behaviors may have mood or anxiety disorders, including post-traumatic stress disorder (PTSD). Emotional disorders

The category of emotional disorders includes disorders of mood, that is depressive disorders, and anxiety. Depression

Depression in young children looks similar to depression in older children and adults. In young children, irritability or sadness can be the core symptom of depression. In addition, depressed children can have notable sleep, appetite or concentration disturbances, as well as preoccupation with death or excessive guilty feelings. Unlike adults, preschoolers with depression may not demonstrate the consistent presence of daily symptoms for 2 weeks. Recent data indicate that somatic symptoms may occur, but depressive symptoms and anhedonia (lack of interest in usual activities) dominate the clinical picture. Anxiety

Anxiety symptoms normally are prominent in early childhood, with the fears peaking in the toddler years and then usually decreasing over time before entering school. It is during this time that young children can develop fears of

the dark and of monsters. However, it is also possible for children to present with impairing anxiety symptoms. Young children can present with specific phobias during this period. It is not yet clear if young children present with social phobia (though they may be extremely shy, or behaviorally inhibited), panic disorders or acute stress disorders. It is clear that young children can experience post-traumatic stress disorder (PTSD) after traumatic events such as witnessing violence, being in motor vehicle accidents, or experiencing physical or sexual abuse. Among preschoolers, trauma reactions commonly include reexperiencing symptoms such as distress in response to a reminder of the trauma and/or repetitive play related to the traumatic event; avoidance of reminders of the trauma (e.g., not wanting to go in the car); and increased arousal as evidenced by increased irritability and temper tantrums, hypervigilance (increased scanning and attention to perceived threats in the environment), and increased startle response. The context of the traumatic event is an important mediator in the development of PTSD. Children who experience a single major traumatic event are more likely to develop PTSD than those who experience chronic traumas, such as ongoing abuse or neglect, although chronic traumas increase children’s risk for other disorders. The ability of the child to feel safe and return to normal activities after a traumatic event can help to minimize the child’s reactions. A secure, supportive parent–child relationship may provide the most important way to ameliorate children’s symptoms related to a traumatic event. Relationship disorders Although psychiatry and psychology traditionally have considered disorders to be within-the-individual, the unique dependence of infants on their caregiving context have led some to suggest that disorders may exist between individuals – in this case, infant and parent. This approach is bolstered by clinical observations and research evidence of relationship specificity. What this means is that the young child may be symptomatic in the context of one relationship but not others. In young children, a relationship with a nurturing, sensitive, responsive caregiver is one of the most important contributors to healthy development. In nonreferred children, the formal attachment classifications based on the strange situation procedure provide a way to understand various relationship patterns. A secure attachment is found in children who have had warm, sensitive, responsive caregiving, and can be observed when young children are able to seek and respond to comforting in a stressful situation. Three types of insecure attachment have been described. Insecure–avoidant is seen when young children respond to stress by not seeking, or actively avoiding, help from their caregiver. Insecure–resistant attachment is characterized by the young child who can signal his distress but has great difficulty getting effective comfort from the caregiver.


The disorganized attachment classification is found in dyads in which the young child does not have coherent, reliable ways of signaling distress to the caregiver, often associated with bizarre or unusual behaviors. The insecure attachment classifications can be predictive of later psychopathology, but these classifications do not necessarily indicate current pathology. For example, children who exhibit avoidant attachment behaviors in the strange situation are at risk of developing anxiety disorders, and those children with disorganized attachments have an increased chance of developing preschool behavior problems. These characterizations of the parent– child relationship also are associated with later behavior problems and social–emotional difficulties. In some dyads, disordered patterns of behaviors as well as distortion of perceptions about the other in the relationship can impair the child or dyadic functioning at the level of a disorder. Attachment disorders are considered to reflect a significant disturbance in the relationship between the infant and his or her primary caregiver, such that it interferes with the child’s ability to develop normally in other domains, including cognitive, physical, behavioral, as well as social–emotional development. Controversy remains about how best to diagnose attachment disorders. The DSM-IV-TR contains only criteria for the diagnosis of reactive attachment disorder (RAD). The diagnosis requires a total lack of an attachment relationship and requires a known history of maltreatment to make the diagnosis. However, even in situations of profound deprivation, it is rare for a child not to develop some type of attachment with a caregiver, most likely to be a disturbed type of relationship. In contrast to DSM-IV-TR, the RDC-PA provides an alternative means of concretely operationalizing the concept by clearly describing behaviors of disordered attachment, even in the context of an attachment relationship. Unlike the DSM IV, the RDC-PA does not mandate that the child has been maltreated. DC:0–3R has similar criteria for attachment disorders as RDC-PA, but also uses Axis II for diagnosis of problematic relationship patterns which do not meet the standards for reactive attachment disorders and/or which are not focused specifically on the attachment portion of the relationship. Whatever the specific diagnostic criteria used, it is clear that clinically relevant disturbances in children’s attachment behaviors exist. A healthy attachment allows for a balance between the toddler’s developmentally appropriate exploratory drive and need for emotional reassurance and support. Children with healthy attachments to a caregiver or parent can use that person in an effective manner for comfort and are able to successfully begin to explore their environment in a safe way. Children with attachment disorders generally demonstrate two major patterns of behaviors: inhibited and disinhibited behaviors. Children with the inhibited form of RAD tend to be emotionally

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restricted, are overly cautious, and do not seek out comfort effectively, if at all. In the disinhibited type, children do not have the usual wariness of new situations and new people. They are excessively and indiscriminately friendly with unfamiliar adults and rarely check back with their parent, even in new environments where they may not know anyone. These two patterns of attachment disorders are not mutually exclusive; children can present with features of both patterns. Indiscriminate behaviors, but not inhibited behaviors, appear to persist in young children who have been raised in institutions such as orphanages, even after a child has been adopted and has developed a new attachment relationship with a committed caregiver. Although it is clear that disturbances of attachment may continue to put children at risk for other disorders, attachment disorders have not been studied in children older than 5 years, and the current descriptions of these disorders may not be helpful in the older age group. Summary of disorders While different categories of diagnosis for infants and toddlers exist, significant psychopathology can exist within children and their relationships with their primary caregivers. The field continues to move toward further validation of the disorders of early childhood. These disorders can impair children’s emotional, physiologic, and diurnal regulation as well as children’s abilities to function within the structured rules of family and school and peers. Because of the critical role of the primary caregiving relationship, recognition of disorders of this relationship – whether because of parent psychopathology, child disorders or a relationship disorder – should be evaluated and, if necessary, diagnosed to provide intervention.

Assessment of Infants and Caregivers We use the term assessment to describe the process of gathering data about an individual child and family for purposes of determining if intervention is needed and what the nature of that intervention should be. In this framework it subsumes diagnosis and includes an inventory of strengths and stressors that may affect both caregivers and child. Although we diagnose disorders, we assess individuals and families as a way of developing a comprehensive and coherent plan of intervention. Infant mental health assessments are multimodal evaluations which often take place over a number of appointments and in different settings. A thorough history, careful observations, and collateral information are critical components of the assessment. Formal assessments including structured questionnaires, observations, and interviews, developmental assessments, and relationship assessments can add additional understanding to the child and the relationships which define his or her world.

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One of the most important principles of assessment in infant mental health is that the infant–caregiver relationship is the most important focus of assessment rather than the infant as an individual. This principle derives largely from the extraordinary dependence of the human infants on their caregivers in the first several years of life and is bolstered by research demonstrating the following: (1) relationship patterns are more stable than individual characteristics of infants and they are important predictors of individual characteristics in later childhood and beyond, (2) the infant–caregiver relationship moderates the effects of intrinsic biological risk factors (e.g., complications of prematurity or adverse temperamental characteristics) on the infant, (3) the infant–caregiver relationship mediates the effects of extrinsic risk factors (e.g., poverty or partner violence) on the infant, and (4) there is often a remarkable degree of relationship specificity in signs and symptoms of disturbance in young children, suggesting that many problems in early childhood are most usefully conceptualized as relationship disorders rather than within the individual disorders. For all of these reasons, the usual assessment of the individual must be supplanted by a more comprehensive relationship assessment of young children in all of their important contexts. Conventionally, two components of the relationship are assessed. These are (1) the recurring patterns of observable interactions between infant and parent, and (2) the subjective experience of each member of the dyad with regard to the ‘other’ and the relationship. Assessment of these two components allows one to evaluate both patterns of behavior and also of the meaning of behavior for the dyad. Interactions between young children and their caregivers may be observed in unstructured, in naturalistic settings, such as during home visits or visits to child-care settings, or they may be observed in structured clinic visits during which prescribed tasks are given to the dyad. Common activities in more structured assessments are free play, problem-solving tasks, feedings, and brief separations and reunions. Most useful, even among more structured tasks, are those which do not overconstrain or prescribe parental behavior in order to allow the dyad to reveal to the evaluator how they negotiate different situations and challenges. Different paradigms of interaction have been used in clinical assessments and these are usually modified based on infants’ ages or cognitive levels. Parents’ subjective, or internal, experience of the dyad may be assessed directly but the infant’s perceptions must be inferred. Several structured interviews for assessing parents perceptions of their infants exist. Although these typically have formal coding systems for use in research, some have been used extensively in clinical settings without strict use of the formal coding system. An important contribution of these structured interviews was the demonstration that qualitative features of the parents’ narrative accounts of their infants are important predictors of their behavior

with their infants; that is, what the parent says about their infant may be important, but how they say it may be even more important. Of course, a parent’s subjective experience of their infant also may be assessed in less formal ways, such as through listening carefully to parents’ descriptions of their infant’s behavior or personality or how the baby makes them feel, during the assessment process. Domains of the parent–child relationship are the usual targets of assessment in both history taking and observations. These domains include parent characteristics that are conceptually linked with emerging infant behaviors and qualities. Thus, parents’ emotional availability is associated with infants’ patterns of emotion regulation. Parents’ nurturance and warmth are associated with infants’ sense of trust and security. Parents’ response to distress is related to infants’ learning to seek comfort for distress. Further, parents’ protection of their infants is related to the infants’ feelings of safety and the later development of the capacity for self-protection. Parents are important play partners for their infants, and play is an important domain of the infant–parent relationship. Parents also are teachers of their infants, and these efforts relate to infants’ curiosity, sense of mastery, and interest in learning. Parents provide structure, routines, and instrumental care in order that their infants develop a sense of predictability and the capacity for self-regulation. Finally, parents set limits and discipline as needed to assist young children to develop self-control and a reasonable degree of compliance and cooperation. Parents may have strengths in some areas, but difficulties in other areas of parenting; likewise, infants may experience difficulties in one or more domains, but not others. By assessing all of these domains of parent–infant relationship using both the external, observable pattern of interaction and the internal, subjective experience of who the infant, it is possible to construct an understanding of the relationship. Once the strengths and concerns of the relationship have been identified, it is important to appreciate them within contexts of caregiver functioning, and family, community, and environmental resources, including culture and class. A comprehensive infant mental health assessment includes assessment of the caregivers’ abilities to care for and understand the infant. Issues such as depression, substance abuse, a history of trauma, abuse, or significant losses, ongoing domestic violence, and isolation and/or lack of a supportive family system can all contribute to the caregiver’s ability to engage in treatment and care for the infant. Furthermore, any other environmental factors that could contribute to difficulties in the relationship or that could interfere with treatment, such as lack of stable housing, also must be identified as part of the assessment process. A comprehensive assessment must also include identification of the strengths of the infant, caregiver, and family. Including strengths in the assessment gives a fuller perspective of the infant’s experience and can help build


the treatment alliance between family and professional. Knowledge of strengths also can provide the building blocks for intervention. Finally, any interventions must be congruent with a parent’s cultural belief system. Because social class typically determines access to resources, enhancing a family’s access to needed services is a critical step toward enhancing the young child’s development. The overall goal is to design an intervention that is appropriate for whatever problems exist, uses the family’s strengths, and will be acceptable and useful for the family.

Intervention in Infant Mental Health Levels of intervention in infant mental health vary from the level of treating the individual infant/family through more comprehensive systems approaches aimed at changing policies to better address the needs of our most vulnerable citizens. They also may be arrayed along a continuum from universal, to focused, to selected (i.e., treatment). The overall goals of infant mental health services across universal, focused/targeted, and selected approaches are similar. They involve enhancing the ability of caregivers to nurture young children more effectively, expanding the ability of nonfamily caregivers to identify, address, and prevent social–emotional problems in early childhood, and minimizing or averting suffering, and ensuring that families in need of more intensive services can obtain them. Preventive Interventions Universal approaches are aimed at improving child development, parenting knowledge, and behavior. These approaches often are applied in primary healthcare settings, in early childhood education and childcare, and in family support settings. Strategies generally include health and behavioral promotion, screening and assessment, education and guidance, and referral for more intensive assessment and intervention services when needed. Focused, or targeted approaches are aimed at specifically identified groups considered at risk for developing potentially serious social or emotional problems. These approaches may be administered in any setting serving at risk infants and their families. Examples include early intervention for premature or low birthweight babies, home visiting services for first-time mothers, or preventive interventions for abused or neglected children. Family support interventions include income assistance, adult basic and secondary education, parenting education to promote positive parent– child interaction, and interventions that address other environmental risk factors associated with poverty. The nurse home visiting program developed by David Olds, for example, has shown longlasting effects on children’s emotional well being, child abuse, and even adolescent delinquent

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behaviors, even though the intervention extends only from late pregnancy to the child’s second birthday. Intensive, or selected services serve infants and caregivers experiencing current difficulties, and also attempt to prevent or lessen future problems. These services are most likely to develop from mental health programs, and may be provided for those infants currently experiencing distress, such as those who have experienced significant trauma, or for whom there are serious parent–infant relationship problems. Treatment (Selected Interventions) Treatment of infant mental health disorders may be focused primarily on changing the infant’s behavior, the parents’ behaviors, or the infant–parent relationship. Although each of these therapeutic ‘targets’ use different strategies, all are concerned with changing the infant–parent relationship as a way of changing infant behavior and ensuring that the changes are enduring. Working with parent and infant together on changing their relationship requires the establishment of a good ‘working alliance’ between parents and therapist. This is a shared commitment to work together in the best interest of the child. The relationship between the therapist and the parent becomes an important component of treatment. In the context of this relationship, therapy focuses on appreciating the parent’s emotional experience of the young child, and the young child’s experience of the parent. Examples of effective treatment strategies in infant mental health include infant–parent psychotherapy, in which patterns of intimate relationships and communication are explored using a psychodynamic approach, and interaction guidance, which uses videos of the dyad to identify and strengthen positive interactions within the dyad. All successful treatment strategies with infants require active parent participation. Furthermore, caregivers must be able to function effectively in order to care appropriately for the child. Thus, it is often the case that treatment of the caregiver for problems such as maternal depression, substance abuse, domestic violence, or other issues occurs simultaneously with dyadic treatments. Coordination of services, as well as availability of services for caregivers, can be impediments to effective infant mental health treatment. Finally, treatment of established problems aims to resolve current symptoms and distress and to prevent or minimize the detrimental effects of the symptoms on infants’ later development. For these reasons, infant mental health treatments are concerned simultaneously with present and future adaptation of the child, and treatment of infants is always concerned with prevention. Systems Intervention When considering how to support infant mental health through a comprehensive system of services, it is

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important to think strategically. One important strategy is the development of a workforce with a continuum of expertise. A growing consensus holds that infant and early childhood mental health requires specialized training and that there are far too few mental health clinicians with requisite skills given the number of young children who could benefit from provision of services. It is equally important to better equip healthcare and other nonmental health service providers, such as child-care providers and preschool teachers, to promote infant mental health and serve as efficient and effective sources of screening and referral. Tertiary providers, such as adult mental health or substance abuse services, may not be familiar with the impact of such disturbance on the parenting ability of their client, and thus, they also need education to work effectively with such clients. Another set of strategies focuses on the environmental factors that impact infant mental health. For instance, improving the financial well-being of families and communities will help to relieve the myriad of stresses associated with poverty and other environmental factors. The data are clear that the negative consequences of poverty are cumulative, pervasive, longlasting, and impact all aspects of physical, cognitive, and socioemotional development. Relief of poverty-related stressors can directly improve the health and social situations of young children and their families, ease stress on the parent–infant relationship, and directly and indirectly improve the social and emotional development of young children.

Summary of Principles of Infant Mental Health Infant mental health is considered synonymous with healthy social and emotional development. Warm, nurturing, protective, sensitive, stable, and consistent relationships provide the fundamental building blocks to infant mental health. Important indicators of infant mental health include the young child’s capacity for emotion regulation, the ability to communicate feelings and needs to caregivers, and active exploration of the environment. These behaviors lay the groundwork for later social and emotional competence, readiness to enter school, and better academic and social performance. Risk and protective factors have been clearly identified that relate to current and later function. Risk factors predispose to subsequent psychopathology, but most clinicians also believe that infants can experience psychological disorders in the first 3 years of life. Protective factors are important especially when they can be mobilized to prevent or minimize adverse outcomes in high-risk infants.

The central focus of infant mental health assessment is on the infant–parent relationship. Any factors that impact the relationship between the infant and caregiver have the potential to impact the infant’s mental health. The strengths perspective, as well as inclusion of cultural influences, provides a full picture of the infant’s experience, and can provide the foundations for intervention. For these reasons, the usual infant-focused assessment must be supplanted by a comprehensive assessment of infant and young children that examines functioning across physical, developmental, environmental, family, and relationship contexts. A continuum of services is needed to address prevention and treatment in infant mental health. Programs that address infant mental health must focus on relationships, be based in current developmental knowledge, and be supportive of the family. It is important that whenever possible, families are involved in the planning and delivery of infant mental health services. See also: Attachment; Autism Spectrum Disorders; Depression; Emotion Regulation; Risk and Resilience; Separation and Stranger Anxiety; Shyness; Social Interaction; Social-Emotional Development Assessment; Temperament.

Suggested Readings American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. – Text revision (DSM-IV-TR-TR Washington, DC: Author. Gleason MM and Zeanah CH (2006) Infant mental health. Comprehensive handbook of personality and psychopathology. In: Hersen M and Thomas JC (eds.) Child Psychopathology, vol. 3, pp. 173–191. Wiley: New York. Sameroff A, McDonough S, and Rosenblum K (eds.) (2003) Treatment of Infant–Parent Relationship Disturbances. New York: Guilford Press. Task Force on Research Diagnostic Criteria: Infancy and Preschool (2003) Research diagnostic criteria for preschool children: The process and empirical support. Journal of the American Academy of Child and Adolescent Psychiatry 42: 1504–1512. Zeanah CH (ed.) (2000) Handbook of Infant Mental Health, 2nd edn. New York: Guilford Press. Zeanah PD, Stafford B, and Zeanah CH (2005) Building State Early Childhood Comprehensive Systems Series, Vol. 13: Clinical Interventions in Infant Mental Health: A Selective Review. Los Angeles, CA: National Center for Infant and Early Childhood Health Policy. Zeanah P, Stafford B, Nagle G, and Rice T (2005) Building State Early Childhood Comprehensive Systems Series, Vol. 12: Addressing Social–Emotional Development and Infant Mental Healthin Early Childhood Systems. Los Angeles, CA: National Center for Infant and Early Childhood Health Policy. Zero to Three (2005) Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, revised edition. Washington, DC: Zero to Three.

N Nature vs. Nurture B M D’Onofrio, Indiana University, Bloomington, IN, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Allele – One variant of a gene at a particular location (or locus) on a chromosome. Behavior – The response of an individual or group of individuals to their environment. Emigration – The act of leaving one’s original country. Endophenotype – An intermediate observable trait that contributes to a phenotype. Epigenetic – The situation in which nongenetic factors influence the action of genes. Gene – A set of DNA bases that code for specific proteins. Gene–environment correlations – The situation in which one’s genetic predisposition is associated with environmental factors. Genetics – The science of heredity, which accounts for similarities and differences among organisms due to the environment and/or genes. Genotype – The genetic identity of an individual that does not show as outward characteristics. Heritability – The percent of variation in a trait that is due to genetic factors. Immigration – The act of moving into a new country. Locus – The place on a chromosome where a specific gene is located. Lod score – An estimate of whether two positions on a chromosome are near each other, suggesting they have been inherited together. Mendelian inheritance – The situation in which a particular gene is sufficient to account for a trait. Microarray – A research technique that measures the activity of many genes simultaneously. Multifactorial inheritance – The situation in which a phenotype is influenced by many genes and environmental factors (also referred to as polygenic inheritance).

Nature of nurture – A term referring to gene–environment correlations, when genetic predispositions are associated with environmental factors. Phenotype – An observable trait or behavior. Pleitropy – When one gene influences more than one phenotype. Polymorphism – A common variation in the sequence of DNA among people. Proband – The primary or first person identified in a research study. Quantitative trait loci (QTL) – One gene, among many that influence a trait is normally distributed. Transcription – The process of making of an RNA copy of the DNA sequence from the chromosome, the first step in gene expression. Translation – The process by which RNA directs the production of amino acids and polypeptides, which ultimately form proteins.

Introduction Historically, the field of psychology has generally discounted the importance of genetic factors. Early psychological theories and research were heavily influenced by environmentalism, the notion that experience accounted for all traits. Gregor Mendel’s research on inherited patterns of traits in pea plants and Charles Darwin’s theories of the importance of evolutionary influences for the selection of traits were, by and large, not incorporated into psychological research. Studies that explored genetic and environmental influences on humans were also disregarded. Francis Galton was the first person to systematically study the influence of genetic and environmental factors for a human behavior; he published a family study of genius (intelligence) in 1869. It was not until

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the mid-1900s, however, that the field of psychology as a whole began to consider the importance of genetic factors. Based on a number of influential animal studies of learning and twin and adoption studies of behavior, the field of psychology gradually accepted that genetic factors were important for psychological traits. The recognition of the role of genetics by the field of psychology can now be seen by the number of psychologists conducting research on the influence of genetic factors and the number of genetics papers that are published in psychology journals. Most psychologists, thus, currently accept the importance of both genetic and environmental factors. Yet, many researchers continue to ask whether genetic or environmental factors are more important, which is the very premise of the nature vs. nurture debate. This article provides a brief description of a number of topics related to genetics and psychology in order to facilitate a greater understanding of the nature vs. nurture debate. First, the article describes the types of psychological traits and behaviors that are studied by the field of behavior genetics, the controversial field that explores genetic and environmental influences on behavior. Second, the text will include a brief review of human genetics to provide the necessary background for the discussion of the nature vs. nurture debate. Third, it will explain the types of environmental influences that need to be considered when reviewing behavior genetic findings. Fourth, the article will go on to provide an overview of the basic behavior genetic findings that are relevant to psychological traits. Fifth, the importance of the interplay of genetic and environmental factors will be emphasized. Sixth, an overview of the research methods behavior geneticists use to simultaneously study environmental and genetic factors will be included. Finally, the text addresses some of the social concerns surrounding behavior genetic research. This article stresses the importance of moving beyond the debate over the relative importance of genetic and environmental influences. Instead, the text highlights the need to study how genetic and environmental factors act and interact to influence psychological traits.

The Study of Individual Differences in Behavior The research field that explores genetic and environmental influences is generally referred to as ‘behavior genetics’. However, it is essential to define what researchers mean by the term behavior because the term can be misleading. Behavior certainly refers to actions that an individual takes, such as dropping out of school, getting into fights, or filing for a divorce. But, there is a much broader understanding of the term. ‘Behavior’ is defined as any response to environmental stimuli, so that any traits in which people

differ are considered to be ‘behavior’. Behavior genetic research explores the variation that exists among people, which is referred to as the study of individual differences. Intellectual abilities (why are some people smarter than others?), personality traits (why are some people outgoing but others shy?), susceptibility to psychological problems (why do some people get depressed but not others?), physical health (why are some people overweight or more sensitive to pollen?), and a host of other traits are all considered to be behaviors. It is important to note that the broad definition of behavior also means that animals and plants ‘behave’. The nature vs. nurture debate, in fact, has frequently relied on animal and plant studies to provide important insights. The broad definition of behavior may seem as if it includes every characteristic of humans, animals, and plants. But, behavior genetic research solely focuses on traits or behaviors that vary among individuals and does not study characteristics that are common to all people. For example, behavior geneticists do not study characteristics that everyone shares, such as normative psychological and physical development. Additionally, many people assume that the field is primarily focused on genetic factors. That is not true. What distinguishes the field of behavior genetics from other social sciences is the use of genetically informed methods (see section titled Behavior genetic methods), which are designs that can help answer the nature vs. nurture debate.

Human Genetics To help aid the review of the nature vs. nurture debate, it is important to understand some basics of human genetics. The human genome is the complete set of human genetic material. Offspring receive a set of 23 chromosomes from each of their parents, for a total of 46 chromosomes. Chromosomes are composed of deoxyribonucleic acid (DNA), which is made of smaller units called bases. There are four bases: adenine, cytosine, thymine, and guanine. The bases are paired with each other so that DNA is in the shape of a double helix. The shape was first discovered by James Watson and Francis Crick in 1953. The human genome has approximately 3 billion base pairs. The nucleus of each cell in the body contains a copy of each chromosome. The bases are ordered along each chromosome so that a number of bases work as a unit. These units are referred to as genes, and each gene has a specific location, or locus, on a chromosome. Because humans are diploid – everyone receives two sets of chromosomes – each gene exists in two alternate forms, or two alleles. Recent estimates suggest that the human genome includes as many as 30 000 genes. Genes are important because they are the template for the building of proteins, which are essential molecules in the body. They

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are involved in every process that occurs within the cells of our body – they provide the structure, influence the function, and regulate each of the body’s cells. The order of the base pairs of a gene is copied by ribonucleic acid (RNA) in the process of transcription. RNA then specifies the synthesis of amino acids and polypeptides via the process of translation. When strings of polypeptides are linked together in three-dimensional (3D) structures they form proteins. Thus, the particular ordering of base pairs in each individual’s DNA (referred to as their genotype) provides the guidelines for the building of proteins. There are different patterns of genetic influences, but they are typically separated into two main categories: Mendelian (or single-gene) inheritance and multifactorial inheritance. Mendelian inheritance refers to the situation in which a particular set of alleles at a gene is sufficient to completely account for a trait or disorder. It is referred to as Mendelian inheritance because the one-to-one connection between an individual’s genotype and their phenotype (or observable properties of an individual) follows the pattern Gregor Mendel originally found in his plant studies. In contrast, multifactorial inheritance (also referred to as polygenic inheritance) describes the situation in which a phenotype is influenced by many genes that each have a small effect and numerous environmental influences. Traits that follow a pattern of multifactorial inheritance are referred to as complex behaviors. Genes that influence these traits are referred to as susceptibility genes or quantitative trait loci (QTLs). The influence of multiple genes could be additive, meaning that each gene influences the phenotype without the influences of other genes. An allele at one gene can also affect the expression of an allele at another gene, so that there is a gene by gene interaction. Dominance refers to the situation in which a particular allele at a gene more heavily influences the phenotype than the other allele or alleles. Although there are some instances in which psychological traits are influenced by Mendelian disorders, most traits studied by developmental psychologists are polygenic. The remainder of the article will, therefore, focus on polygenic phenotypes, traits that are influenced by multiple genetic and environmental factors. But, what does it mean to have a genetic effect on a complex behavior? How can there be genetic influences on complex behaviors, such as intellectual abilities, personality traits, conduct problems, social attitudes, etc.? Is there a gene for getting into a fight or a gene for being shy? No, genes provide the template for building proteins. Genes do not directly influence one’s behavior. When research states that there are genetic influences on complex traits, the findings suggest that individual differences for a trait (or the underlying risk for a disorder) in a given population are partially influenced by differences

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in individuals’ genotypes. Any genetic effect on behavior is mediated by biological processes in the body. Therefore, genetic influences on multifactorial traits are only probabilistic in nature; they are not deterministic. Finding susceptibility genes for disorders or QTLs for various measures of individual differences is, therefore, only informative in as much as they can help researchers understand the underlying biological and environmental process that ultimately influence the behavior. In fact, it is imprecise to describe the effects of one gene on a complex multifactorial behavior as a gene for ‘x’. For multifactorial traits, the influence of any one single gene on an individual’s phenotype will probably be quite small, meaning the gene will not be associated with much variation in the trait. Plus, the same phenotype may result from different genes or a different set of genes, a condition referred to as heterogeneity. Furthermore, a gene may influence more than one phenotype (called pleitropy). Ultimately, the effect of one’s genotype on one’s phenotype involves a complex number of processes and interactions (see section titled Gene–environment interplay). Studying genetic factors provides one a powerful research tool for analyzing the underlying causes of psychological traits, including the role of environmental factors in a person’s ‘behavior’.

What Constitutes the ‘Environment?’ Understanding what is considered to be the environment is also crucial for the nature vs. nurture debate. When referring to environmental influences, psychologists typically include factors such as parenting practices, familywide variables, and characteristics of larger communities. Researchers also frequently associate genetic effects with the influence of all biological factors. However, behavior genetic studies consider all nongenetic and biological influences to be ‘environmental’ in origin. Therefore, the availability of nutrients in the body and prenatal and postnatal insults are also considered to be environmental influences in behavior genetic studies, in addition to the traditional psychosocial factors that are more familiar to psychologists and other social scientists. Just as there are rare conditions that are completely accounted for by single-gene disorders (Mendelian disorders), there are also extreme environmental circumstances that can completely overcome genetically influenced variation in traits. Instances of severe deprivation or abuse are some examples. As highlighted by the famous case of Victor, the ‘wild boy of Averyron’, extreme environmental experiences can markedly influence psychological development. Victor had no human contact until he was 12–13 years old. Due to intensive interventions he was able to write a few words and respond to others, but he was never able to speak. The example of Victor and other

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documented cases of severe early neglect or abuse highlight the importance of the environment. But, do more normative environmental experiences play a role in the development of psychosocial traits?

Findings from Behavior Genetic Studies In addition to the major advances in our understanding of molecular genetics over the past century, researchers in the field of population genetics have also made great strides in understanding the factors that influence psychological traits. Population genetics explores the patterns of inheritance – the importance of genetic and environmental influences – in populations. Using various research designs (see section titled ‘Behavior genetic methods’) behavior genetic studies explore how much of the variation in a certain trait is due to genetic factors. The percentage of variation accounted for by genetic factors is referred to as the heritability. Heritability is an index of the extent to which individual differences in a phenotype reflect genetic differences among the people in a certain population. Behavior genetic research designs also measure the importance of environmental influences. Environmental influences are frequently separated into two types based on the impact the environment has on individuals. The first type of environmental factor is referred to as the shared environment. Shared environmental influences are environmental factors that make siblings in the same family similar. In contrast, nonshared environmental influences make siblings in a family different. Both of the estimates of environmental influences are presented as the percentage of the total variation for a trait in a population. There are a number of important caveats that must be considered when interpreting the estimates of heritability, shared environmental influences, and nonshared factors. First, the estimates of the importance of each are based on the sample from which they are drawn. The estimates from behavior genetic studies (heritability, shared environmental factors, and nonshared environmental factors) are not invariant, meaning that the influence of genetic factors for multifactorial traits can change. If environmental conditions change or differ across samples or time, the estimates of heritability are susceptible to change. Likewise, a large change in the make-up of a population (i.e., the frequency of alleles changed through immigration or emigration) could also influence the estimates of the importance of environmental factors. Second, the estimates of heritability do not state what should or could be true. Rather, the estimates of behavior genetic studies simply provide a snapshot of importance of genetic and environmental factors at the time of the study. Third, the magnitude of the heritability is not necessarily indicative of whether a trait would respond to environmental interventions. The well-known example of phenylketonuria

(PKU) supports this notion. PKU is a metabolic disorder that is caused by a Mendelian genetic mutation that makes it impossible for the body to break down dietary phenylalanine (certain amino acids). The condition results in severe mental retardation. However, genetic tests can now identify infants with the genetic mutation, and providing children with a phenalanine diet prevents the cognitive problems associated with the disorder. Finally, the estimates are population-based percentages and cannot be applied to specific individuals within the population. If the heritability of a certain trait, say delinquent behavior, is 50%, researchers cannot claim 50% of the variation in a specific individual’s delinquent behavior is due to genetic factors. Are Genetic Factors Important? One of the most surprising results from behavior genetic research is the extent to which genetic factors influence all areas of psychology. Behavior genetic research over the past 50–75 years has shown that genetic factors influence nearly every psychology trait. Behavior genetics studies have shown high heritabilities for psychological disorders such as schizophrenia, bipolar depression, and autism. But research has also shown that genetic factors influence individual variation in behaviors that were once thought to be completely influenced by social forces. Behavior genetic studies have documented heritabilities for intellectual abilities, school performance, personality traits, substance use and abuse, self-esteem, television watching, and social attitudes, just to name a few areas of research. Genetic factors are not restricted to extreme conditions, but also influence normal variation in the traits. For example, there are heritable influences in normal variation in mood and major depression. The magnitude of genetic influences on psychological traits has also shocked many researchers. Genetic factors sometimes account for as much as half of the variance in some traits, if not more. In sum, behavior genetic research has shown that genetic differences among people influence almost every area of psychology. Are There Specific Genes Associated with Psychological Traits? There have also been great advances in the design and analysis of molecular genetic studies (see section titled Behavior genetic methods). Therefore, studies reporting associations between specific genes and measures of behavior are frequently being reported. A proper understanding of the issues related to finding genes associated with psychosocial traits is important when considering the nature vs. nurture debate. First, many of the initial research articles that claimed to find a particular gene associated with

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psychosocial traits, such as intellectual abilities or homosexuality, were subsequently not replicated. Researchers and the public should, consequently, not draw conclusions about the importance of a specific genetic finding based on the results from only one study. Second, studies reporting associations between specific genes and some psychological traits have been replicated. For instance, findings for specific susceptibility genes have been replicated in studies of schizophrenia, alcohol dependence, and measures of attention/impulsivity problems. So, yes, there are specific genes associated with some psychological traits. Third, the magnitude or relative importance of the genes identified so far are not large (the genes do not account for a lot of the variation in the trait). Fourth, it is important to remember that identifying a gene is not informative about the underlying causes of a trait. Researchers can only gain a better understanding of the underlying causes by exploring the processes through which the gene influences proteinformation and biological functioning. Finally, it has been difficult to identify susceptibility genes or QTLs for psychological traits. One possible reason may be that the magnitudes of the effects of individual genes are smaller than were originally expected. This has required researchers to collect DNA from very large samples (rather than studying hundreds of people or thousands of people, new studies are including tens of thousands of individuals or more). Another complication stems from the fact that researchers frequently have difficulty assessing many psychological traits accurately. This is to say that if one wants to measure depression, is it best to have subjects in a study complete a questionnaire, be assessed by a psychologist, or complete one of the many other measures of depression? Another strategy researchers are using is to include measures of endophenotypes, which are phenotypes related to the complex behaviors (such as depression) but are measured at more biological levels. For example, researchers interested in studying psychological traits hope that measuring brain functioning may provide an outcome measure that is more directly affected by specific genes. In sum, genetic research is just beginning to identify specific genes that are associated with psychological traits but the search for specific genes represents the start of a research endeavor, not the final step.

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demonstrated that environmental factors are crucial for understanding individual differences in psychological traits. The type of environmental influences that are important, however, was largely unexpected. Environmental factors that make siblings different appear to be the most influential. Most psychological traits (with some notable exceptions, such as religiosity) are not influenced greatly by shared environmental influences. There has been great confusion concerning the meaning of the environmental estimates (shared and nonshared) that are found in behavior genetic studies. Because estimates of shared environmental influences are frequently small or nonexistent, some researchers have suggest that environmental factors that siblings share, such as parental divorce, family socioeconomic status, and neighborhood characteristics, are not important. But this is an incorrect interpretation of the results. Behavior genetic studies that show large nonshared environmental influences (and no shared influences) illustrate that environmental factors make siblings in the same family different, not more similar. To put it a different way, it appears as if environmental factors, such as parenting practices and family socioeconomic status, influence children in the same family differently. The fact that most environmental influences are nonshared also has profound implications for our understanding of why siblings in the same family are similar. Because shared environmental factors influence few psychological traits, the reason why individuals in a family are similar is mostly due to the fact that they share similar genotypes. The results of behavior genetic studies (and other research approaches) have, therefore, caused psychologists to change their theories regarding familial influences. It is, therefore, important for psychologists to study how multiple children in a family react to environmental factors. Research is also starting to focus on the importance of sibling interactions and the role of peers, which are factors that may be unique to each sibling. With respect to the nature vs. nurture debate, behavior genetic studies have highlighted the importance of the environment, but the way in which environmental factors operate appears to make children within a family different rather than similar.

Are Environmental Factors Important?

Are There Specific Environments Associated with Psychological Traits?

Although the breadth and magnitude of genetic influences on psychological traits may be somewhat surprising, behavior genetic research has also highlighted the importance of environmental influences. Estimates of heritability for many traits, including severe psychological disorders such as schizophrenia, are below 100%, meaning that environmental influences do play an important role. In fact, most estimates of heritability are around 50% or lower. Thus, behavior genetic studies have clearly

Researchers have repeatedly claimed that behavior genetics would highlight the importance of specific environmental factors. But has behavior genetic research identified specific environments that are associated with complex behaviors? Again, the answer is yes. For example, studies that compared lung cancer rates in twins who were dissimilar in the habit of smoking cigarettes (one twin smoked and one did not) provided some of the most compelling early research that tobacco smoking causes lung cancer. The comparison of

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identical twins (who share 100% of their genetic make-up) can provide a powerful study of environmental risks because the design controls for genetic risk and other risky environmental factors. Behavior genetic studies have recently highlighted the importance of divorce, prenatal alcohol exposure, and numerous other measures of the environment. In fact, more behavior genetic research that is focused on studying specific environmental risk factors is currently being conducted. What Happens When Studying Multiple Behaviors at One Time? By exploring the genetic and environmental influences on multiple traits at the same time, behavior genetic research can also study why different traits are correlated or frequently occur together. These models are referred to as multivariate models, in contrast to univariate models that only explore one variable at a time. The analyses can study the extent to which the same genetic and environmental factors influence different traits. Again, the situation in which the same genetic factors influence more than one behavior is referred to as pleiotropy. For instance, individuals with mood disorders, such as major depressive disorder, are also frequently diagnosed with an anxiety disorder. What explains why these two disorders commonly co-occur? A number of behavior genetic studies have illustrated that the same underlying genetic factors related to the personality trait of neuroticism (negative emotionality) largely explain why these disorders frequently co-occur in the same individual. Multivariate behavior genetic research can therefore help guide the psychological/psychiatric classification of diseases and our understanding of complex psychological traits. What Happens to Genetic and Environmental Influences over Time? Instead of merely documenting genetic and environment influences on psychological traits at one time point, behavior genetic studies also seek to ask questions about possible changes during development. Genes can be turned on and off (see section titled ‘Epigenetic influences’) or the same genetic factors could have different effects across the lifespan. If changes occur, maybe heritable traits are more influential during infancy than during adulthood because children have not experienced as many environmental experiences? The findings for cognitive abilities actually follow the reverse pattern. McGue and colleagues found that the importance of genetic influences increase from childhood through adolescence and into adulthood. What could account for these findings? One possibility is that genetic propensities for intellectual abilities are actually correlated with environmental experiences. Individuals

with greater intellectual abilities may also experience more environments that foster their intellectual abilities (see the explanation in the section titled Gene–environment correlation). Behavior genetic analyses can therefore explore developmental changes in the importance of genetic and environmental influences rather than only providing one snapshot at a time. Are There Genetic Influences on the Environment? Individuals greatly differ in their exposure to negative life events and harmful environments (and positive/nurturing environments). Could genetic factors influence the underlying risk for experiencing negative environments? Behavior genetic studies can analyze environments as extended phenotypes. In one of the most surprising findings of behavior genetics, numerous studies have found a heritable component for exposure to environmental risk and protective factors, such as parenting practices, divorce, stress, and social support. Genetic influences on environments are referred to as the nature of nurture. Again, the question arises – how could genetic factors influence a behavior as complex as exposure to risky environments? Simply put, there are no genes that code for the selection of dangerous environments. There are, however, psychological traits and personal characteristics that are related to risky environments. For example, individuals who exhibit high levels of the personality trait sensation-seeking are more likely to expose themselves to dangerous environments, and behavior genetic research has consistently shown that personality traits are influenced by genetic factors. Consequently, one’s exposure to many environments does not occur at random. Rather, genetically influenced individual differences (in addition to environmental factors) affect how individuals select and construct their environments. The findings of genetic influences on a range of environmental measures also highlight the important point that genetic and environmental factors may not operate independently. In fact, the field of behavior genetics is increasingly studying the interplay of genetic and environmental factors.

Gene–Environment Interplay The nature vs. nurture debate has generally relied on a view that the two types of influence are largely independent of each other, which results in the question of whether genetic or environmental factors are more important. However, research has found that genetic and environmental effects are largely intertwined. The interplay of genetic and environmental influences can be broken down into three basic phenomena: gene–environment correlation, gene–environment interaction, and epigenetic influences.

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Gene–Environment Correlation Gene–environment correlations (rGE) occur when there are genetically influenced differences in exposure to environmental risk factors (described earlier). There are three main types of rGE: passive, active, and evocative. Passive gene–environment correlation occurs when genetically influenced traits in parents constitute the environment for their children. Because parents provide the environment and pass along their genes to their offspring, genetic influences in the offspring are correlated with exposure to measures of the family environment. Take the example of maternal depression, a well-known risk factor for offspring adjustment. Depression is partially heritable and leads to poorer parenting practices. Parents could pass down risk for depression genetically to their children. The genetic factors that influence depression in the children would correlate with the greater likelihood of receiving inconsistent parenting. Active gene–environment correlation occurs when an individual selects environments based on genetically influenced traits. For example, students with greater intellectual abilities may select classes that are more challenging, which further increases their knowledge. Evocative gene– environment correlation comes about when genetically influenced traits elicit or evoke environmental responses from others. Recent research suggests that children’s oppositional behavior toward their parents, which is influenced by genetic factors, elicits parents’ use of spanking as a parenting technique. There are no genes for being spanked, but a child’s behavior may create more opportunities when parents feel the need to use corporal punishment. In both active and evocative gene–environment correlation, genetically influenced traits differentially influence the exposure to experiences/environments. The presence of gene–environment correlation creates major difficulties for research studying environmental risk and protective factors. Many studies in the social sciences have shown that various environments are correlated with psychological traits, meaning that exposure to the environment is associated with some behavior. Although measures of the environment may be correlated with psychological or behavioral outcomes, the association does not mean that experiencing the risk factor actually causes the traits. A fundamental lesson in every statistics class in the social sciences is that correlation does not mean causation. If an environment ‘x’ is correlated with outcome ‘y’ there could be a third factor that explains the correlation. The presence of gene–environment correlation suggests that genetic factors may be a third factor, or confound, that actually explains why an environmental risk factor is associated with negative outcomes. A common genetic liability between parents and offspring (reflected by passive gene–environment correlation) may account for the association between parenting practices and children’s adjustment. Genetically

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influenced behaviors may account for selection into risky environments (active or evocative gene–environment correlation). This is critical for the study of environmental influences for the reason that there could be a reciprocal effect (‘y’ could cause ‘x’). Because genetic influences on environmental experiences are so pervasive, studies that do not consider the role of gene–environment correlation cannot adequately test the consequences of most environmental risk factors. For example, every family study of parenting practices using traditional samples is confounded by gene–environment correlation. Two important cautions are in order. First, other environmental risk factors can also act as confounds. Genetic factors do not represent every third variable in the study of measured environmental risk factors. Second, just because there are genetic factors influencing exposure to an environmental risk factor does not necessitate a genetic explanation for all negative outcomes associated with the environment. For instance, risk-taking and impulsivity (personality traits that have been shown to be partially heritable) may lead an individual to drive recklessly. But, a car crash that resulted from the dangerous driving would specifically cause the bodily harm that occurred in the crash. The presence of genetic influences on exposure to environments, the ‘nature of nurture’, requires researchers to use genetically informed research designs and other approaches. The methods allow researchers to test alternative hypotheses that would explain why people who experience specific environmental risk factors have poorer functioning. Gene–Environment Interaction Gene–environment interactions occur when genetic factors affect sensitivity to environmental risk factors making some people more susceptible to environmental risks. They can also be considered environmental control of genetic expression. Gene–environment interactions occur when nature influences nurture and nurture influences nature. The same genotype may lead to different phenotypes depending on the environmental circumstances. Likewise, the importance of the same environment may also depend on one’s genotype. The role of gene–environment interaction is crucial for understanding the nature vs. nurture debate. In the presence of gene–environment interaction the study of genetic and environmental influences separately would provide inaccurate results. Researchers interested in environmental risk factors would have to also know about genetic risk to properly understand how the environment actually influences individuals. The flip side is also true; researchers interested in understanding how genetic factors operate would have to have an understanding of an individual’s environmental context. Plant and animal studies have been very informative about the gene–environment interaction because

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researchers have the power to randomly assign plants and animals with different genotypes to different environmental conditions (see section titled Behavior genetic methods). Human behavior genetics studies will be highlighted here. Researchers generally use two primary methods to explore gene–environment interaction: (1) testing whether the heritability of a condition differs in various environments and (2) investigating whether the association between a specific measured gene and a phenotype varies in different settings. Heritability by measured environment interactions

As described earlier, heritability indexes the importance of genetic factors, but estimates of heritability are not set; they can vary depending on environmental context. A study by Turkheimer and colleagues that explored the genetic and environmental influences on children’s intellectual abilities recently highlighted differences in heritability among different environmental conditions. When the researchers explored whether the family’s socioeconomic status influenced the estimates of heritability, the shared environment, and the nonshared environment, a dramatic pattern resulted. In children from poor families, genetic factors were very small or nonexistent; rather, shared environmental factors accounted for most of the variation in children’s intellectual abilities. In contrast, genetic factors accounted for an overwhelming majority of the variance in children’s intellectual abilities in richer families. The estimate of the shared environment was zero in the families who were better-off. Thus, the importance of genetic and environmental factors depended on the socioeconomic status of the children, an example of gene–environment interaction. Other studies have shown that the importance of genetic factors on alcohol problems depends on marital status and the heritability of smoking cigarettes in females has increased as smoking has become more common for women, to describe two more examples. The study of heritability by specific environment interactions supports the notion that genetic and environmental factors do not act in isolation. Measured gene by measured environment interactions

Researchers are now studying the influence of specific genes and specific measured environments to gain a better understanding of the genetic processes (and environmental influences) that influence psychosocial outcomes. Do alleles in specific genes confer greater risk for a trait under certain environmental conditions? A number of recent studies have found that the answer appears to be yes. Researchers across numerous disciplines have explored the underlying causes for behavior problems and aggression because of the societal implications of such

behaviors. Child maltreatment is a known environmental risk factor for later aggressive behavior, although there is great variability in how children respond to abuse. Neuroscience studies have also documented that numerous neurotransmitters (chemicals in the brain that help brain cells communicate with each other) are also associated with conduct problems. Caspi and colleagues studied whether a gene that influenced neurotransmitter activity in the brain would make children more vulnerable to maltreatment. In fact, the study revealed that individuals who had alleles associated with low neurotransmitter activity and experienced maltreatment exhibited many more aggressive and criminal problems than individuals who only experienced maltreatment or only had the ‘at-risk’ allele. Multiple research teams, using samples from around the world and various measures of abuse and behavior problems, have replicated the finding. The research illustrates the interdependence of specific genetic and environmental influences by identifying how genetically influenced neurotransmitter-functioning made some children more vulnerable to the risks associated with abuse. The research illustrates how the influences of genetic and environmental processes depend on each other. Epigenetic Influences The interplay between environmental and genetic factors also occurs at a more basic level. The process through which DNA sequences code for proteins is often described as a straightforward process that only goes one way (from gene to protein). However, there are many factors that influence the activity of a gene, referred to as gene expression. Proteins, growth factors, hormones, and other molecules affect the action of genes without altering the sequence of the base pairs in DNA. These factors can influence which genes gets transcribed into RNA, which RNA gets translated into amino acids, and how the amino acids combine to form proteins, to name a few possibilities. The term epigenetics refers to a myriad of factors, including environmental stimuli, that influence gene expression. What is crucial for the nature vs. nurture debate is the fact that environmental factors can influence the expression of genes. The exact mechanisms through which environmental factors influence gene expression represent an exciting new area of research that are not well understood at this time. Overall, the interplay between environmental and genetic factors is now a central focus of behavior genetics. It is not enough to claim that both genetic and environmental factors are important. Thus, current research is actively pursuing how specific environmental factors act and interact with genetic predispositions to influence behavior. What is becoming more apparent is the interrelationship among factors that were once considered to be

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separate. Because of the interplay between environmental and genetic factors, research needs to use designs and analytical techniques that can specify the influence and interactions of multiple factors from various levels of analysis (e.g., biological and societal). It is therefore important to understand the different approaches that behavior geneticists use to study nature and nurture.

Behavior Genetic Methods Unfortunately, the nature vs. nurture debate has been fueled, in part, by the fact that researchers on both sides do not understand the methods or substantive findings of research on the other side. The following review includes the primary behavior genetic methods that address the nature vs. nurture debate. Plant and Animal Studies The ability to experimentally control both genetic and environmental factors represents the greatest strength of plant and animal research. Through selected breeding, the crossing of animals or plants based on particular phenotypes over many generations, researchers can determine whether a trait is heritable. For example, cows with high milk output have been bred to produce more milk, which suggests that milk production is influenced by genetic factors. Selected breeding over many generations can also create inbred strains, populations of animals that share near-identical genotypes. Any variation in the behavior or traits within a population of inbred animals, therefore, reflects environmental influences. Animals from inbred populations can also be randomly assigned to different environmental conditions. The studies can explore the importance of environmental effects and the role of gene–environment interactions. Animal studies have also become increasingly important because researchers can study gene expression in specific areas of an animal’s brain. The procedures frequently require the postmortem evaluation of the animal’s brain. Knockout studies represent another key area of animal research. In knockout studies, researchers use newly developed laboratory techniques to deactivate a specific gene in the embryos of mice. The procedure produces a line of mice that are missing the target gene. Mice with and without the gene are then compared to study the role of the targeted gene. New techniques also provide the opportunity for researchers to ‘knock in’ particular genes. The ability to experimentally control genetic and environmental conditions in plant and animal studies has shed great light on the nature vs. nurture debate. The greatest limitation of animal and plants study, however, is the ability of researchers to generalize the findings to human populations.

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Family Studies Family studies explore whether specific behaviors or traits run in the family, for instance, alcohol problems. Family studies begin by identifying a proband, an individual who has the identifiable trait (in this case alcohol dependence). Researchers then assess the proband’s first-degree relatives (the parents, siblings, and children) and seconddegree relatives (grandparents, aunts, uncles, grandchildren, etc.). Even more distant family members can be included. If alcohol problems are more prevalent in the family members of probands than in the family members of individuals without alcohol problems, researchers can conclude that alcohol problems run in families. Family studies cannot, however, effectively determine whether genetic or environmental factors are responsible because family members share similar genotypes and environmental circumstances. Adoption Studies Adoption studies are based on families in which genetic or environmental similarity among relatives has been separated. That is, the genetic and environmental factors that co-occur in traditional families are split by the adoption process. Researchers analyze adoption studies from a number of perspectives. Three will be highlighted here. First, adopted children can be compared to their biological and/or adoptive parents. The influence of genetic factors on a phenotype would be supported if the adopted child was similar to their biological parents. The importance of environmental influences would be supported if adoptive children are similar to their adoptive parents. Second, adoptive children can be compared to the biological children of the adoptive parents. Adoptive and biological children are not genetically related, so any similarity between the siblings would be due to environmental factors. Third, adoption studies can analyze gene–environment interactions. Measures of traits in the biological parents can be used as a proxy for genetic risk in adoption studies. If children with greater genetic risk are more susceptible to the influence of environmental risk factors, the findings support the presence of gene– environment interaction. Adoption studies are difficult to conduct because of confidentiality requirements of adoption records, the difficulty obtaining information about the biological parents, and the drop in adoptions, especially within-country adoptions. Adoption studies are also based on a number of assumptions, which may partially limit the conclusions that researchers can draw. These include the limited range of environmental risk factors in adoptive homes (adoptive parents are screened for major risk factors) and the assumption that the adoptive parents are not similar to

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the biological parents. The latter is violated when children are adopted by family members, although these families are typically removed from adoption studies. Twin Studies Twin studies are based on the fact that identical or monozygotic (MZ) twins share all of their genes, while fraternal or dizygotic (DZ) twins share, on average, half of their genes. Twin studies assess the resemblance of MZ and DZ twins, measured by concordance rates (the degree to which twins share the same discrete trait) or correlation coefficients (the degree to which twins resemble each other for continuously measured phenotypes). If MZ twins are more similar than DZ twins, genetic factors are implicated because the only difference between the two types of twins (given some assumptions) is in their degree of genetic relatedness. If MZ twins are not perfectly similar or correlated, then nonshared environmental factors are important. Finally, if both MZ and DZ twins are similar and there is not much difference between the resemblance of MZ and DZ twins, shared environmental factors influence the phenotype. As described earlier, twin studies can explore whether heritability estimates differ across environments, a finding that supports gene–environment interactions. It is important to note that twin studies are based on a number of assumptions. The ‘equal environments’ assumption assumes that there are no unique environmental experiences that make MZ twins more similar than DZ twins. The design also assumes limited risks due to the process of twinning compared to being a singleton (i.e., there are no lasting problems associated with prenatal crowding in the uterus). As discussed briefly earlier in the article, the twin design can also be used to study the importance of specific environmental risk factors. The twin design is an especially useful approach for studying experiences that are unique to individuals in a family. In the co-twin control design, twins who differ in their exposure to environmental risk factors are compared (one twin smoked and the other did not, one got divorced and the other did not, etc.). The design controls for genetic factors that could confound the association between the environment and the outcome (gene–environment correlations) and environmental factors that influence both twins. Extended Family and Combined Designs Family, adoption, and twin studies can also be combined to provide more accurate estimates of genetic and environmental influences. For example, identical twins adopted into separate homes have been compared. Similarity between the separated twins provides strong evidence for the importance of genetic factors. The parents of twins, their spouses, and the children of twins can also be included in studies. Statistical model fitting with the

extended designs can provide informative tests of the genetic and environmental processes that account for similarity between parents and children. The designs can also test the importance of environmental risk factors that all siblings in a family share. Linkage Studies and Association Studies Great advances in computational ability, the processing of DNA, and the completion of the human genome project have made it possible to begin looking for specific genes associated with psychological traits. Linkage studies explore whether an area of a chromosome contains a gene for a trait. The studies explore how often a measured trait is ‘linked’ with a genetic marker, a gene whose precise loci is already known. Linkage studies provide a statistical measure, referred to as a lod score (logarithmic odds), that measures the probability that the genetic marker is closely associated with the measured trait. A high lod score suggests that the genetic marker and a gene for the trait are located close to each other on a chromosome. Linkage studies have helped identify genes associated with single-gene disorders, but, in general, the approach cannot identify the precise location of genes and are better suited to finding genes with large effects on traits. Using more genetic markers, especially in a small section of a chromosome, can help researchers better identify the location of a gene that is associated with a trait. Because of recent advancements, researchers can now complete whole genome scans with many, precise genetic markers. Association studies are another approach to finding specific genes that influence traits. In contrast to linkage studies, association studies start with one gene, which is referred to as a candidate gene. Researchers explore whether there is a statistical association between alleles at the candidate gene and the trait of interest. Candidate genes can be identified through linkage studies, the known function of the gene through biological studies, animal studies, findings from the human genome project, and other sources. Association studies have helped identify specific genes related to Parkinson’s disease and smoking behavior, to name just two of the many examples. Microarray Studies Microarray studies provide the opportunity for researchers to study the expression of thousands of genes at once. The procedure involves placing an organism’s genome on a specialized chip. The chip is then placed in a solution that has RNA extracted from one of the organism’s cells. The RNA contains a dye that becomes highlighted if the RNA binds to a gene. The stronger the dye appears on the chip for each gene, the more the particular gene is expressed. As a result, researchers can explore the expression of thousands of genes in a cell or multiple cells. Microarray studies

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provide a great deal of information that will hopefully shed light on the genetic influences related to various phenotypes, including psychological traits.

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embryos to select children with or without particular traits? Can insurance companies use the information? These are serious issues that are being addressed by a number of institutions and agencies throughout the world.

Experimental and Natural–Experimental Studies Although experimental studies and research based on natural experiments are not frequently considered to be behavior genetic studies, the designs can shed light on the nature vs. nurture debate. Because experiments arebased on random assignment to different environmental conditions, differences among the intervention groups at the end of the study are due to the environmental conditions. In natural experiments, researchers do not randomly assign people to different conditions. Rather, researchers compare individuals who randomly experienced a naturally occurring event. Again, the approach can highlight the importance of environmental factors. As the list of behavior genetic methods demonstrates, researchers can explore the etiology or causes of psychological traits from various perspectives. No one method can provide the answer; but combining the results from different research approaches gives researchers great insight into the nature vs. nurture debate.

Social and Ethical Concerns Related to Behavior Genetic Research Behavior genetic research raises a number of concerns. One concern is related to the dangers of reductionism, the belief that everything at one level can be explained by some lower level. Some researchers are concerned by an overemphasis on biological and genetic findings (biological reductionism) that ignores other levels of analysis, such as familial and societal factors. However, behavior genetic research considers the interplay of multiple factors at various levels (see the section titled Gene–environment interplay). The search for genetic influences can provide greater insights for psychology, but the research should not preclude the study of important variables at all levels of analysis and the interactions among them. Second, behavior genetics is frequently associated with eugenic practices, particularly the sterilization of Americans against their will in the 1930s and the abhorrent practices of the Nazis before and during World War II. The leaders of eugenic movements used genetic research to support their actions, and some geneticists supported the activities. However, the practices were based on a great misrepresentation of genetic findings. Discriminatory eugenic practices are not supported by behavior genetic researchers and they do not ‘naturally’ flow from research into genetic influences on behavior. There are concerns, nevertheless, associated with research looking for genes that are related to complex behaviors. What does society do with the information? Can parents screen

Summary The very title of this article (Nature vs. Nurture) is a dichotomy, which implies that one influence wins and one loses. Initial behavior genetic studies tested which side was more important, with proponents on both sides of the nature vs. nurture debate making heated (and sometimes extravagant) claims. The field of behavior genetics has moved away from trying to declare a winner or a loser. Rather, researchers are trying to study how genetic and environmental processes act and interact to better understand the underlying causal processes related to individual differences in behavior. Studies are also considering the developmental context of genetic and environmental processes to examine how the mechanisms transpire over time. Most researchers, if not all, now conclude that both genetic and environmental factors are important. However, a lot more research needs to be done to highlight the specific mechanisms. The findings will have significant implications, and society will have to grapple with important ethical decisions that result from the research. But, the debate over nature vs. nurture is not ‘either/or’. The debate is now ‘both/and/with/depending’ plus a lot more. See also: Television: Uses and Effects; Twins.

Suggested Readings Baker C (2004) Behavior Genetics: An Introduction to How Genes and Environments Interact through Development to Shape Differences in Mood, Personality, and Intelligence. Washington, DC: American Association for the Advancement of Science. Carey G (2003) Human Genetics for the Social Sciences. Thousand Oaks, CA: Sage Publications. Nuffield Council on Bioethics (2002) Genetics and Human Behavior: The Ethical Context. London: Nuffield Council on Bioethics. Plomin R, DeFries JC, McClearn GE, and McGuffin P (2001) Behavior genetics, 4th edn. New York: Worth Publishers. Rutter M (2006) Genes and Behavior: Nature–Nurture Interplay Explained. Oxford: Blackwell Publishing.

Relevant Websites http://www.apa.org – American Psychological Association, Genetics in Psychology. http://www.bga.org – Behavior Genetics Association. http://www.genome.gov – National Human Genome Research Institute, National Institutes of Health.


P Parental Chronic Mental Illness T Ostler and B Ackerson, University of Illinois at Urbana–Champaign, Urbana, IL, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Alogia – A poverty of thinking inferred from observing language behavior and speech. Anhedonia – An inability to experience pleasure. Catatonia – A motionless, apathetic state or certain types of excessive motor activity. Delusions – False beliefs based on incorrect inferences about external reality. The belief is sustained despite clear evidence or proof to the contrary. Dual diagnosis – A term used to refer to an individual who has both a psychiatric disorder and a substance abuse or addiction problem. Externalizing behaviors – A term used to refer to aggression, delinquency, and hyperactivity in children and adolescence as opposed to internalizing behaviors such as depression and anxiety. Folie a deux – A rare psychiatric condition in which a symptom of psychosis (usually a delusional or paranoid belief) is transmitted from a parent to a child. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) refers to this syndrome as shared psychotic disorder. Hallucinations – Sensory perceptions that have a compelling sense of reality of true perception but that occur internally, that is, without external stimulation of a sensory organ. Hypomania – A persistently expansive, irritable or elevated mood associated with an unequivocal change in functioning that does not cause marked impairment. It is accompanied by some of the following symptoms: grandiosity, pressure of speech, flight of ideas, inflated self-esteem, psychomotor agitation, and excessive involvement in pleasurable activities that have a high potential for painful consequences. Kindling effect – Kindling effect refers to what happens with recurring manic episodes over time.

The individual may experience manic episodes more frequently over time due to changes in the brain caused by previous episodes. It is similar to what occurs in seizure disorders. Kindling specifically refers to the repeated triggering of certain nerve cells over time. Mania – An abnormally and persistently expansive, irritable or elevated mood that lasts at least 1 week. It causes marked impairment in the individual and is accompanied by some of the following symptoms: grandiosity, pressure of speech, flight of ideas, inflated self-esteem psychomotor agitation, and excessive involvement in pleasurable activities that have a high potential for painful consequences. Negative symptoms – Symptoms that involve a diminution or loss of functioning, such as blunted affect, apathy, self-neglect, loss of motivation, difficulty with abstract thinking and social withdrawal. Negative symptoms usually occur first and may be present during periods of remission (i.e., periods when there are no symptoms) as the illness progresses. Positive symptoms – Symptoms that involve an excess or distortion of normal functions, such as hallucinatory behavior, conceptual disorganization, and delusions. Psychotic disorders – Psychiatric disorders involving severe impairment to thought and perception. Such disorders can include positive symptoms of schizophrenia such as disorganized speech, grossly disorganized or catatonic behavior. Stress-diathesis theory – A theory whereby a genetic predisposition or vulnerability (diathesis) interacts with stresses from life events in the environment (stressors) to trigger psychiatric disorders. The greater the underlying predisposition is, the less stress is needed to trigger the disorder. In cases where there is a smaller genetic contribution,

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greater levels of stress are required to produce psychiatric illness. Wrap around services – Comprehensive mental health services designed to help individuals with severe and persistent mental illness. They are often home based and include case management, psychiatric treatment, and rehabilitation services.

Introduction Individuals who are diagnosed with a mental disorder experience clinically significant distress or impairment in social, occupational, and other important areas of functioning. The individual also shows a pattern of symptoms that is characteristic of a specific psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the standard manual that is used for diagnosing disorders in the US. Mental illness symptoms vary greatly across individuals even with the same diagnosis and they may be mild or severe. Several mental illnesses have a chronic course and symptoms wax or wane over time. About one-third of women in the US and one-fifth of men show evidence of psychiatric disorder. The majority of these individuals are parents. For these individuals parenting is a central and highly valued role. However, when an individual’s illness is both chronic and severe, parenting is usually compromised to some degree. While many individuals are able to care for their children either alone or with the support of others, others struggle in the parenting role as they confront the dual challenges of dealing with a mental illness while meeting the stresses associated with raising children. In some cases, mental illness symptoms can interfere with an individual’s judgment, behavior, feelings, and energy to the point that they seriously compromise the individual’s ability to recognize risk or to provide for their child’s basic needs and safety. Children of parents with mental illness are also vulnerable and exposure to parental mental illness can compromise a child’s development and well-being in a variety of ways. Problems are likely to be more enduring if a child is exposed to parental mental illness in the early years of life, a sensitive developmental period in which a child is highly dependent on the parent for survival. During this period, early environmental stimulation and emotional responsiveness from a caregiver are essential in influencing how well an infant or young child fares in his or her development and well-being. This article provides an overview of the effects of mental illness on parenting and on infants and young children. Fathers with chronic mental illness can be and

are primary caregivers. At the same time, women with chronic mental illness are far more likely to be involved in caring for children. For this reason, focus is given to women as parents. Focus is also given to chronic mental illnesses and to parenting in the peripartum period, a time period when women are especially prone to either develop a mental illness or to experience illness exacerbations. In the sections that follow, the article describes major types of chronic mental illness, discusses the challenges that individuals with chronic and severe mental illness face in the parenting role, and outlines how different mental illnesses symptoms can affect parenting. The article then addresses factors that can increase parenting risk in individuals with mental illness and presents a model for understanding how chronic parental mental illness can affect children’s development. Literature on the outcomes of infants and young children of parents with mental illness is then synthesized followed by a description of approaches for developing effective, multifaceted interventions that can address the needs of children and their parents.

Types, Symptoms, and Course of Chronic Mental Illnesses Schizophrenia Schizophrenia and other psychotic disorders are some of the most severe mental illnesses. Schizophrenia is characterized by severe disruption in cognitive functioning and perceptions. The most pronounced symptoms, sometimes referred to as positive symptoms, are hallucinations, delusions, disorganized thought process, and grossly disorganized behavior. Hallucinations are false perceptions (e.g., hearing voices) that are not based upon any external stimulus. Persons with schizophrenia do not imagine hallucinations. They actually experience the perception (hear, see, etc.), but it is caused by abnormal activity in their brain rather than an external stimulus. Delusions are false beliefs that are not consistent with a person’s culture or religious beliefs and are caused by a disruption in reasoning abilities. Disordered thought content seen in delusions often accompanies impairment in thought processes. Examples of disorganized thought process are flight of ideas, loose associations, tangential thinking, disorganized speech, and incoherent speech. In addition to impairments in cognitive abilities and perceptions, individuals with schizophrenia may also experience disorganized behavior manifested as agitation, catatonia, or an inability to perform goal-directed behavior, such as caring for oneself. The extent that any of these symptoms are present varies according to the subtype of schizophrenia and the severity of the disorder in a particular individual. Any or all of the positive symptoms may be present during an acute phase of the illness.


Schizophrenia also consists of negative symptoms, which include flat affect, social withdrawal, ambivalence, alogia, and anhedonia. These symptoms may be present in the residual phase of the illness as well as in the active phase. Because the side effects of antipsychotic medication can also contribute to lethargy and withdrawal, it may be difficult to determine the extent to which these behaviors are due to medication or the negative symptoms of the illness. It is important to understand that withdrawal, ambivalence, and other negative symptoms are a function of the illness and not personal traits of the individual. Schizophrenia is best understood as a chronic psychiatric disability that impacts social functioning as well as cognitive abilities. Bipolar Disorders Bipolar disorders are marked by extreme mood swings, from depression on one end to mania or hypomania on the other end. Formerly called manic-depression, bipolar disorder is now categorized as having two forms. Bipolar I disorder is classic manic-depression. Individuals experience highly euphoric moods, referred to as mania, that impair their reasoning and judgment. These mood states, which may include feelings of grandiosity, flights of thought and speech, and impaired judgment, may last days, weeks, or months but eventually subside. When not in a manic state, individuals may experience normal moods for a period of time or may go directly into a major depressive episode. In bipolar II disorder individuals more often experience a depressed mood, but they still alternate between depression and elevated moods. However, their elevated mood states never escalate past hypomania, a milder form of mania that lasts for at least 4 days, but unlike mania it is not severe enough to cause impairment in functioning. In both mania and hypomania individuals may have very little sleep, talk excessively, and engage in excessive pleasure seeking behavior. At times manic states may not be easily recognized because the individual’s mood may be irritable or agitated instead of euphoric. However, they still experience a reduced need for sleep and other excessive behaviors seen in mania. Bipolar disorder is considered a chronic mental disorder and it often results in psychiatric disability. The fluctuating nature of the disorder contributes to difficulties in social and occupational functioning. Many people with bipolar disorder are able to hold jobs, engage in social relationships, and raise families. However, their ability to function in any of these roles is compromised when they experience an episode of either major depression or mania/hypomania. Rapid cycling, or the frequent shifting from one mood episode to another, may occur in more severe cases. The longer an individual has had the illness, the greater they are at risk for developing rapid cycling, similar to the kindling effect in seizure disorders.

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Major Depression Depression is the most common mental disorder. It affects about 10% of people in the US in a year and about 17% experience it during their lifetime. Individuals with major depression, also referred to as clinical depression, are at much higher risk for having another mental disorder, such as anxiety or substance abuse. Major depression is more than just feeling sad or ‘blue’. It is defined as experiencing one or more major depressive episodes. Symptoms include feeling chronically sad or depressed, anhedonia, changes in eating or sleeping, lack of energy, feeling helpless or hopeless, having problems with memory or concentration, and being socially withdrawn. Individuals with recurring major depressive episodes have a psychiatric disability that may impair their ability to work and to function socially. Major depression may begin at any developmental period. Depressive episodes typically last 6–9 months in children and adolescents. About half of the children who experience major depression will experience another episode within 2 years. Adolescent depression often continues into adulthood. Other individuals may not experience their first depressive episode until well into adulthood. For some, depressive episodes are episodic, with long periods of normal mood during which time they are able to fully engage in life. Other individuals experience a severe form of the disorder where depressive moods are more frequent and have a longer duration. Fortunately, depression has proved to be a very treatable illness. A variety of antidepressant medications have been shown to be effective, all of them working in some way on the neurotransmitters serotonin and epinephrine. Several forms of psychotherapy have also been shown to be very effective, with research showing strong support for various forms of cognitive therapy (understanding how people perceive, attribute, and interpret meaning) and interpersonal therapy. The most effective treatment strategy is a combination of psychotherapy with antidepressant medication, especially if a person has had two or more major episodes of depression. Anxiety Disorders Anxiety, a vitally important physiological response to dangerous situations, prepares an individual to evade or confront threats. In some individuals, the mechanisms that regulate anxiety break down and the individual experiences excessive anxiety. There are several anxiety disorders, all characterized by clinical levels of excessive anxiety. An individual who is diagnosed with panic disorder has repeated panic attacks, high intensive episodes of anxiety that occur without a precipitating cause. During a panic attack, an individual may experience shortness of breath, rapid heart rate, trembling, restlessness,

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lightheadedness or dizziness, perspiration, as well as cold hands and feet. An individual who is diagnosed with generalized anxiety disorder (GAD) experiences pervasive worries for at least 6 months about a variety of events or activities. It is difficult for the individual to control these worries and he or she experiences ongoing tension and restlessness. The duration, intensity, and frequency of the anxiety are out of proportion to the actual likelihood that the feared event will occur. Obsessive-compulsive disorder (OCD) is another severe anxiety disorder characterized by recurring and intrusive thoughts or images (obsessions) and repetitive behaviors or mental acts (compulsions) that an individual feels compelled to perform in response to the obsession. Some compulsive behaviors are very obvious, such as excessive hand washing, while others are more internal and not easily observed, such as mental checking or counting. These obsessions and compulsive behaviors are very time consuming, cause great personal distress and significant functional impairment. Unlike obsessive-compulsive personality disorder, these behaviors are not merely signs of an overly perfectionistic personality. Adults with OCD are aware that their behavior is abnormal and dysfunctional, but they feel as if they have little or no control over these thoughts and behaviors. OCD has a strong biological basis. It is very persistent and requires extensive treatment involving medication and psychotherapy. Individuals who are exposed to a life-threatening event or a threat of serious injury may develop a severe anxiety disorder in response to their trauma. There are two types of severe anxiety disorders that may occur as a result of trauma, acute stress disorder, and post-traumatic stress disorder (PTSD). Acute stress disorder occurs within the first month after experiencing trauma. PTSD is the more chronic of these disorders. Symptoms persist for more than 1 month and may last for many years. PTSD symptoms can be grouped in three categories: re-experiencing of the event, avoidance of stimuli associated with the trauma and numbing, and increased arousal. In adults and adolescents re-experiencing may take many forms which include recurring and intrusive images and thoughts, distressing dreams or nightmares, flashbacks, and other feelings as if the trauma were recurring. Avoidance behaviors may be related to avoiding thoughts and feelings as well as avoiding places, people, and activities and a sense of detachment may also be experienced. Arousal symptoms are both physical (autonomic nervous system) and psychological (irritability, hypervigilance). Because many of these symptoms may also be seen in depression or other anxiety disorders, PTSD may be missed or confused with another mental disorder. In addition, individuals with PTSD are at risk for developing other mental disorders and substance abuse.

Personality Disorders Personality traits are normal variations of human behavior and personal characteristics. Personality disorders reflect rigid, inflexible, and maladaptive forms of behavior that lead to personal distress or functional impairment – social and/or occupational. To be diagnosed with a personality disorder, maladaptive behavior must be seen in at least two of the following areas: cognition (how the person sees themselves and others), affect (range and intensity of moods), interpersonal functioning, and impulse control. While some inflexible traits or maladaptive behaviors may emerge during adolescence, personality disorders are not diagnosed until early adulthood. The DSM-IV lists 10 personality disorders that are categorized into three clusters. Cluster A consists of paranoid, schizotypal, and schizoid personality disorders. These three disorders share the common trait of odd and eccentric behavior, social aloofness, and milder forms of symptoms that are associated with schizophrenia. Cluster B consists of antisocial, borderline, histrionic, and narcissistic personality disorders. These disorders are all characterized by dramatic, emotional, and erratic behavior. They also have a high comorbidity with mood disorders and substance use disorders. Cluster C consists of avoidant, dependent, and obsessive-compulsive personality disorders. Individuals with these disorders all exhibit anxious or fearful behaviors and the disorders appear to be closely associated with anxiety disorders. In recent years there has been special attention given to borderline personality disorder, which is diagnosed more frequently in women. Once considered extremely difficult to treat, dialectical behavior therapy, a psychosocial treatment that combines behavioral theory with components of cognitive therapy, and other forms of cognitive therapy have been shown to be effective.

Mental Illness and Parenting: Dual Challenges Mothers with severe and persistent mental illnesses (e.g., schizophrenia, bipolar disorder, depression) face a dual challenge. They have to manage a chronic illness that causes impairments in judgment and social functioning while also dealing with the stress and complex demands of parenting. However, even the severe and persistent mental disorders are typically episodic in nature. The symptoms and behaviors that pose risk for a mother’s children, then, fluctuate over time and are amenable to a variety of treatment interventions. The special challenge these mothers face is that while most of them express a strong desire to be good mothers, the stress of parenting can exacerbate their symptoms. Therefore, these mothers need help both with learning


how to manage their psychiatric disability as well as with learning effective parenting techniques. They require special interventions that address the interaction between the demands and stress of being a parent and the symptoms of their particular illness. Mothers with depression, bipolar disorder, and schizophrenia experience negative or depressed mood symptoms. In depression and bipolar disorder these occur as major depressive episodes, which may be of limited duration or may extend for months or years. In schizophrenia these negative moods are part of the negative symptoms of the disorder. These negative symptoms may exist even when other symptoms such as delusions and hallucinations are not prominent. When a parent experiences depressive moods they may be emotionally unavailable or exhibit maternal insensitivity to their children. They may also withdraw and exhibit lower levels of energy which may impair their ability to provide for their children’s basic needs. Discipline of their children may also be erratic or ineffective during these periods of negative moods. It is important to note that these mood symptoms are typically episodic and are often amenable to treatment with medication. Mothers can be trained to recognize when these symptoms occur and to seek treatment and social support for their family. Services for these parents and their families should address emotional and social support needs. Another common symptom of severe and persistent mental illnesses is lack of sustained motivation. This can result in inadequate care of children’s hygiene, failure to provide appropriate clothes and adequate nutrition, and inconsistent child discipline. This apathy and amotivation may be misunderstood as a lack of desire to engage in the parenting roles. When mothers with a chronic mental illness have been interviewed about their roles as parents, they report a strong desire to be effective parents and they derive a great deal of pride and self-esteem from being parents. Several studies have found that many of these mothers are aware of their difficulties in performing the parenting role. Therefore, it is important to distinguish between the symptoms of their illness and a lack of desire to function as parents. Similar to episodes of negative moods, they need to learn effective coping strategies for dealing with periods of lower motivation and how to appropriately seek assistance during these times. Mothers with psychiatric disabilities may also experience cognitive deficits that impair their ability to accurately interpret or understand their children’s behavior. In fact, unrealistic expectations of children’s behavior along with impaired problem-solving abilities are more reliable indicators of risk for child maltreatment than psychiatric diagnosis. Cognitive deficits are a key symptom of schizophrenia and other psychotic disorders. Severe deficits are easily recognized in the form of delusions and problems with

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forming coherent thoughts. Fortunately, these symptoms can be managed with appropriate medication. More subtle deficits may not be as easily recognized. In these cases the parent may misinterpret a child’s behavior and overreact. Mothers with severe mood and anxiety disorders may also have unrealistic expectations of their children. This is caused both by their illness and by a tendency at times to rely on older children to help care for the house and younger siblings. For these reasons, parent skills training is an important component of treatment for many parents with chronic mental disorders. Education regarding developmentally appropriate behavior and parental expectations should be an important component of this training for these parents.

Parenting and Chronic Mental Illness in the Peripartum Period Women are especially vulnerable to developing a psychiatric illness and to experiencing symptom exacerbations during the childbearing years, that is, in the time when they conceive, carry, and give birth to children. This section examines how parenting is affected by different chronic mental disorders and their symptoms in the period during pregnancy and after birth. Depression About 10% of women develop clinical depression during pregnancy. New mothers (10–20%) develop depression after giving birth to their babies. These rates double in low-income mothers and in adolescent mothers. Although the symptoms of depression in pregnancy are the same as the symptoms that occur in depression at other phases in life, they often go unrecognized because normal pregnancy changes cause similar symptoms such as difficulties in sleeping, tiredness, changes in body weight, and strong, emotional reactions. Clinical depression in pregnancy can pose formidable problems for the mother and baby to be. A mother who becomes depressed during pregnancy may fail to seek out prenatal care. In addition, she may not eat properly, lose weight, and increase her use of addictive substances, particularly smoking and alcohol use. If a mother develops suicidal thoughts as part of her depression, there is a risk that she may overdose on medications, posing a substantial risk for herself and her fetus. There is growing evidence that depression in pregnancy can negatively affect fetal and infant well-being. Untreated maternal depression in pregnancy has been associated with premature labor and with low infant birth weight. Maternal smoking and substance abuse can all exert a negative effect on fetal and infant development. Pregnant mothers who are depressed also experience high levels of stress. Their

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babies, in turn, show high levels of activity during pregnancy and high stress hormone levels after birth. Recognizing factors that increase the chances that a pregnant woman will develop depression can help in preventing depression in this critical phase of life. Table 1 lists several factors that increase the risk that a pregnant mother will develop depression. Postpartum depression is not the same as the postpartum ‘blues’, which is a normal experience for many women in the immediate postpartum period. Women experience the blues within the first 10 days after birth. They alternate between feeling irritable, having an elated mood, and having increased crying spells. Women who develop postpartum depression, by contrast, experience sleep and appetite disturbances, impaired concentration, feelings of inadequacy, and a sad mood. These symptoms occur within 6 months after a woman has given birth to her child. Postpartum depression can greatly affect how a mother feels about herself as a parent and how she perceives and responds to her newborn baby. A mother who becomes clinically depressed after giving birth may develop a negative attitude toward her baby or harbor negative feelings and thoughts about her ability and desire to parent. She may be emotionally unavailable to her baby and have difficulties in responding to her baby’s cues. Some mothers feel that their baby hates them. Most women with postpartum depression feel guilty about these thoughts and are anxious about their ability to parent. The exact etiology of postpartum depression is unknown, but the lack of sleep, stress, and new responsibilities that are part of having a baby can contribute to its development. Table 2 summarizes factors that increase the risk that a woman will develop depression in the postpartum period. Depression in the postpartum period often remains unrecognized by mothers, family members, and mental Table 1 Factors that increase risk of clinical depression during pregnancy A past history of depression or substance abuse A family history of mental illness Anxiety about the unborn baby Problems with a past pregnancy or birth Young age Marital or financial problems Little social support

Table 2 depression

Factors that increase the risk for postpartum

A previous history of depression A family history of mood disorder Little social support Anticipating a separation from the unborn baby after birth Prior custody loss of a child

health professionals alike. In about 50% of cases, however, episodes of postpartum depression are continuations of a depressive episode from pregnancy. Mothers may be reluctant to acknowledge that they are depressed after giving birth to their child because it may seem incongruous with the happiness they feel they should experience in the mothering role. Given the negative repercussions that it can have on parenting, recognizing symptoms of depression in the postpartum period as early as possible and helping mothers to seek treatment is essential. There is some evidence that prolonged interventions may be needed to achieve positive outcomes for parenting. A significant proportion of women who are vulnerable to postnatal depression, however, refuse to engage in treatment. Understanding the barriers to engaging in services is therefore essential for achieving better outreach and care for these women and their babies.

Bipolar Disorder and Schizophrenia Bipolar disorder and schizophrenia can pose risks to parenting at any time in the life span, but there are specific risks that can be recognized during the prenatal period. Impaired judgment and hypersexuality, both symptoms of mania, can contribute to high rates of unplanned pregnancies and HIV infection in women with bipolar disorder. High rates of substance use, including nicotine, that are characteristic of individuals with both bipolar disorder and schizophrenia, can increase the risk to the fetus in the first trimester of pregnancy. In addition, women with schizophrenia are more prone to have higher rates of unplanned or unwanted pregnancies and to recognize their pregnancy later than nonmentally ill mothers. Psychotic denial of pregnancy is a complication that can co-occur with some chronic psychiatric disorders and, though rare, can lead to a high level of risk to the mother and unborn baby. A woman who psychotically denies pregnancy is unaware that she is pregnant. She may misinterpret or ignore symptoms of pregnancy. She may attribute fetal movements to gas or interpret labor as signs of menstruation. As delivery approaches, she may not seek out help or go to a hospital, placing both the women at risk for precipitous delivery of the baby, and, in some cases, for fetal abuse or neonaticide. Psychotic denial of pregnancy is more common in women with schizophrenia than in women with bipolar disorder or severe personality disorders. Treatment involves integrating comprehensive obstetrical and psychiatric care, medication, and supportive psychotherapy with an evaluation of a mother’s parenting skills. Postpartum psychosis is a rare condition that typically starts within the first few days to 2–3 weeks postpartum. It has a rapid onset and is characterized by hallucinations and/or delusions. Having bipolar disorder or severe


postpartum depression are major risk factors for postpartum psychosis. If untreated, postpartum psychosis can greatly affect a mother’s ability to parent her baby. Some mothers with postpartum psychosis experience a loss of love for their babies, a feeling which they often experience as painful. Others may develop bizarre beliefs about their babies, thinking, for instance, that the baby is still in the uterus, or that the baby is deformed or dead. Some mothers with postpartum psychosis try to harm their infants. The shortterm prognosis for parenting is usually good if a mother responds to medication and is in treatment. Anxiety Disorders Little is known about how anxiety affects parenting during pregnancy. However, mothers with GAD apparently experience higher levels of distress when their young child is engaged in routine activities and in structured play tasks than nonanxious mothers. Obsessional rituals associated with OCD, another anxiety disorder, can interfere with childrearing responsibilities. A parent with OCD, for instance, may be overmeticulous and demand too much from a young child. Similarly, obsessive self-doubting can contribute to a young child doubting his or her abilities. In some cases, obsessive symptoms may lead to repetitive checking to ensure a young child is safe. Clearly, to the extent that they are communicated to a child, obsessive worries and compulsions can burden the child emotionally and increase his or her anxiety level. There is little systematic research on the parenting capabilities of individuals with PTSD. Parental PTSD has, however, been found to be a salient risk factor for PTSD in offspring. Clinical evidence suggests that parents with PTSD may have difficulty in expressing emotions and in recognizing a young child’s cues, especially if the child is distressed. There is evidence for interactive effects between child and parent. Studies, for instance, show that if a child is traumatized, the child’s trauma symptoms may reactivate PTSD symptoms in a parent. Personality Disorders Mothers with personality disorders have serious problems in social and occupational functioning which can make it difficult for them to sustain a safe, predictable environment for their babies. Since many are victims of childhood abuse and neglect, they are often vulnerable in intimate relationships, including those with their young children. This vulnerability may make it difficult for a mother with a personality disorder to distinguish her own needs from those of her baby and for her to tolerate her baby’s distress. A mother with a personality disorder may also project feelings she canot tolerate in herself onto her young child. Change can occur for individuals with this

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diagnosis, but it usually takes considerable time to engage a parent in the treatment process which the parent may perceive as threatening.

Assessing Parenting Risk in Individuals with Chronic Mental Illness Many individuals with mental illness raise their children to adulthood, either alone or with the support of others. Some protective factors that ameliorate risk and are associated with good enough parenting are listed in Table 3. Risk for serious parenting problems is especially high in individuals whose illness is chronic and severe. As many as 60–80% of women with chronic and severe mental illness may relinquish or lose custody of their children at some point in their lives. There is some evidence that custody loss may occur more frequently right after birth or in the early years of parenting, probably because women are at high risk in these periods for developing a major mental illness or for experiencing illness exacerbations. Some factors that can signal risk for serious parenting problems during pregnancy for mothers with a chronic mental illness include: a marked ambivalence about wanting a baby, delusions about the pregnancy or baby, a denial of pregnancy, significant family tension prior to delivery, refusal of prenatal care, thoughts of harming the baby to be, a suicide attempt during pregnancy, poor support, and lack of compliance with treatment. Only two mental disorders, depression and substance abuse, have been specifically linked to child maltreatment and their overall contribution is small. Overall, illness dimensions and symptoms appear to be more important predictors of parenting risk than psychiatric diagnoses. Table 4 provides an overview of illness dimensions and symptoms that increase parenting risk in individuals whose illness is chronic and severe. While mental illness symptoms can increase risk, maltreatment is multiply determined. It results from a broad range of environmental and familial factors that interact with each other to compromise a parent’s ability to nurture and provide adequate care and protection for a child. Table 5 summarizes factors, beyond the parent’s psychiatric symptoms, that can contribute to parenting risk. Table 3 Protective factors for parenting in individuals with psychiatric disorders Good coping skills A supportive network of friends and relatives Compliance with treatment Responsiveness to treatment Good insight into illness symptoms and the need for treatment Will power and motivation to change

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Parental Chronic Mental Illness Psychiatric factors that can increase parenting risk

Dual diagnosis A comorbid substance abuse problem Active psychotic symptoms Aggressive or violent behavior Poor insight into the mental illness Including a child in delusions Parent has command hallucinations Lack of response to treatment Noncompliance with treatment Low level of adaptive functioning

Table 5 risk

Nonpsychiatric factors that can increase parenting

Neglect of the baby’s basic needs Apathy or hostility toward the baby A projection of feelings onto the baby (e.g., ‘he hates me’) A refusal to hold and engage the baby Parent has an intrusive or hostile interactive style Parent has expectations that the child should provide the parent with comfort and support Parent lacks basic knowledge about the child or holds unrealistic expectations about child Parent has difficulties in meeting their own basic needs Parent utilizes extreme disciplinary measures Parent has a small or unviable support network Parent has difficulties in establishing and maintaining supportive relationships Parent denies he or she has problems Domestic violence Marital disharmony and conflict

How Parental Mental Illness Affects Infants and Young Children Young children who experience parental mental illness are often characterized as a high-risk group of youngsters. Some of the risk to children is due to biological and genetic factors, but risk also results from environmental influences, including poor parenting, marital discord, socioeconomic disadvantage, and the increased stresses that result from living with a parent with mental illness. Child factors, including temperament, intelligence, and gender can also contribute to risk. Parental mental illness may affect children’s well-being and development in different ways. Risk may be transmitted genetically to a child. There can also be a direct impact on the child’s development and well-being through exposure to the parent’s illness. Parental mental illness can also impact a child’s development indirectly via poor parenting or through its impact on the parent’s interpersonal behavior. The effect on children’s development may also occur through factors that are associated with chronic mental illness such as poverty, social adversity, and disadvantage. Marital discord, for instance, can result in part from living

with an individual who has a chronic mental illness and can impact children’s development and well-being. Genetic factors can also interact with environmental factors to affect child outcome. Child factors can interact with parenting in an individual with chronic mental illness, thereby affecting child outcome. In early development, for instance, perinatal and medical complications, prematurity, or a low birth weight, conditions more common in infants of mothers with chronic mental illness, may contribute to severity of postpartum depression in a mother, and thereby influence how she cares for her baby and how the baby fares developmentally. A young child’s temperament is another factor that can contribute to parenting, thereby affecting a child’s developmental pathway. A baby with a difficult temperament, for instance, may elicit different responses from a parent with a chronic mental illness than a baby with an easy temperament, thereby contributing to a more difficult parenting pathway and to a less favorable outcome for the child. Having a child with disabilities or a chronic illness can also contribute to the overall stress that a parent experiences in the caregiving role. Supporting the view that child factors interact with parenting to influence child outcome is the finding that children with is behavioral disorders or disabilities are more likely than other children to experience maltreatment by a caregiver. The stress-diathesis theory helps to explain how risk develops. In this theory, child vulnerability due to genetic or to early environmental stresses interacts with later stresses to precipitate risk or the onset of illness symptoms in the child. For instance, if the child’s parent has a heritable psychiatric disorder, the child may have an elevated genetic vulnerability for developing a disorder under adverse environmental conditions. This child may be particularly susceptible to poor parenting. Under adverse conditions, including stress and poor parenting, the child’s disorder may be expressed. Whether risk in a vulnerable child is actualized, however, will turn on the degree to which the child is vulnerable biologically to begin with, how the mother fared during pregnancy, how the child has been parented and cared for after birth, and by the larger environment in which he or she lives including the stresses the child experiences. Effects on Children’s Development and Well-Being Studies have documented that parental mental illness can affect various aspects of young children’s well-being and development. Studies show increased rates of externalizing problems, delays in cognitive development, particularly in boys, and interpersonal difficulties, including attachment insecurity and feelings of guilt.


Children of parents with mental illness are also at increased risk for developing a psychiatric disorder over the course of their life. By age 10 years, over 20% of children born to a mother who has major depression are likely to develop a major episode of depression or dysthymia, a low-grade form of chronic depression, twice the amount of children born to mothers who had never been depressed. A child with a parent with major depression has a 40% chance of developing an episode of depression by age 20 years. This rate increases to 60% by age 25 years. If a parent has a dual diagnosis, risk is increased further. Problems are more enduring if the child is exposed to parental mental illness in the early years of development, a period when vulnerability emerges and is maintained. The next section reviews recent findings on the outcomes of infants and young children of parents with mental illness. Since much research attention has been given to major depression in mothers, this work is emphasized. However, when available, findings on the effects of other disorders are discussed. Emphasis is also given to identifying areas and sources of strength in children, an area that has, until recently, been neglected. Infancy

Maternal depression in the postpartum period affects mothers’ ability to respond in a sensitive and contingent manner to a baby’s cues and to show delight in the baby’s presence. Their babies in turn show limited engagement, poor eye contact, and muted affective expressions. They are also more prone than babies whose mothers are not depressed to develop insecure attachment patterns to their mothers as assessed in the Ainsworth Strange Situation procedure, a standard observation that is used to classify mother–infant attachment quality when the baby is 12 months of age. Babies of mothers with postpartum depression are most prone to develop an insecure-disorganized attachment pattern, a pattern which has been linked to frightened or frightening maternal behavior. This pattern is viewed as an at-risk pattern and is associated with high levels of insecurity in the mother–child relationship. Several studies show effects of postpartum depression on early cognitive development. Infants of mothers who have postpartum depression, for instance, have been found to be significantly delayed in their language development and on the development of object permanence, a key measure of early representational capacities in infants when compared to infants of nondepressed mothers. Object permanence is constructed over the first 18 months of life and involves the child coming to grasp that what is out of sight is not out of mind. Infants of mothers who develop depression in the postpartum period are also disadvantaged in their behavior and in their social and emotional development. They show more negative responses with other adults, less

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sharing, and less concentration than infants whose mothers are not depressed in the postpartum period. They are also more prone to act out in order to obtain a response from an adult, and have more eating and sleeping problems, more temper tantrums and more difficulties with separations. Studies on the attachment quality and cognitive development in infants of mothers who are depressed in the postpartum period have found that development is more compromised when the mother has a severe rather than mild episode of depression and if her illness is chronic and occurs in the context of other adversities. Poor outcomes in behavior and cognitive development may persist even after the mother’s depression has abated. In the early years of life, the mother is the baby’s primary environment. Small wonder, then, that the adverse effects of maternal depression on infant development are mediated through the quality of the mother–child attachment bond. Young boys of mothers with postpartum depression may be at particular high risk for adverse effects in attachment, behavior, and cognitive functioning. One explanation for this difference is that girls appear to hold a maturational advance which may protect them more than boys from the experience of postpartum depression. Another explanation is that mothers who are depressed may treat their sons and daughters differentially. Less is known about the effects of chronic psychotic disorders in a parent on infant well-being and development. Interactions between mothers with psychosis and their babies have been found to be more deviant and negative than those of mothers and infants in a control group. Mothers with schizophrenia show greater deficits while interacting with their babies than mothers with mood disorders. They are more insensitive to their babies’ cues, more remote, intrusive, and self-absorbed. Their babies in turn are more avoidant and have poorer interaction quality than babies of mothers with mood disorders. Babies of mothers with psychotic disorders lag in their cognitive functioning, including the development of object permanence and show more anxiety in exploring objects. One study found that at age 12 months, babies of mothers with postpartum psychoses showed no fear of strangers, a development which appears on the average at about age 8 months and is observable in almost all infants by age 12 months. The findings suggested aberrance or delays in the infants’ social development. Early childhood Maternal depression can exert a strong negative effect on the self-system of young children and on their social and emotional development during toddlerhood and the preschool years. For instance, young children of depressed mothers are more prone than children of nondepressed mothers to express negative views about their own worth and performance.

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According to John Bowlby, the father of attachment theory, young children construct so-called ‘internal working models’ of self and other based on their day-to-day experiences with their primary caregiver. These internal or representational working models include children’s notions of self and others – how worthy and able the self is and how caregivers are likely to respond if the child is in need. With increasing development, children’s internal working models are generalized to other important relationships. If the primary caregiver is experiencing chronic severe depression, she may not focus on the child’s needs, grow irritated at the child’s bids for attention, or tell the child her behavior is ‘too much’ or is making the parent ‘ill’. A young child may conclude from these experiences that she is not lovable and that she is responsible for the parent’s illness. The child may also have a working model that expects others to respond to the child’s needs with irritation or lack of concentration. Postpartum depression is linked to behavior problems in toddlers and to distractibility and antisocial behavior in the preschool years. The risk of a child developing behavior problems is increased if there is marital conflict and if the family is economically disadvantaged. Choice of play can also be affected, with children of depressed mothers being more prone to avoid more personally challenging creative play and to engage in simple physical play than children of mothers who are not depressed. A substantial number of young children with depressed caregivers do not evidence dysfunction. Such findings point to the need to look at protective factors in the broader social context in which young children develop and are raised. If a mother is not experiencing current difficulties or conflict with the child’s father, for instance, the child may fare better in his development. Separation and custody loss

Between 60% and 80% of mothers with chronic mental illness may lose temporary or permanent custody of their children at some point in their lives. Some studies suggest that custody loss may occur early on, either at birth or in the first years of life. If a parent with a chronic mental illness is hospitalized, the child may stay with the nonmentally ill parent, or with relatives or friends until she stabilizes and recovers. Others may be placed in foster care. Infants and young children who experience a separation are at higher risk in all areas of development as they experience not only the loss of a healthy mother and loss of a normal family life, but a loss of stability and confidence that the mother is available. How well they fare will turn not only on their own vulnerabilities and constitution, but on the care they receive from their mother and from alternate caregivers. If a child has already established an attachment bond to the biological mother who is

mentally ill, he or she may experience profound changes in their feelings toward the mother during and after the separation. Long-term effects The impact of chronic parental mental illness on family members is referred to as a ‘burden’. Children are confronted not only with the objective burden of coping with the parent’s symptoms, the stigma of the illness, and with additional caregiving responsibilities, they may also grieve for a lost childhood, or for a parent they knew and loved before the illness set in. This burden is stressful and contributes to the sense of isolation and loneliness that many of the children experience. Several long-term patterns can be identified in children who grow up with a parent with a chronic mental illness. Many children, for instance, experience difficulties in deciphering which of their family experiences are normal and which are not. Some children may feel guilty that they are healthy or feel embarrassed at the odd behaviors their parent may engage in. Many do not have someone with whom to talk to about what they are going through. Children who experience these feelings need advice and help from adults so that they can come to terms with the illness, and understand and acknowledge how the illness affects themselves and their family. Role reversal and intensified self-sufficiency are other patterns that may be evidenced in children of parents with chronic mental illness as they grow older. Children who evidence these patterns have adapted their behavior to make things work within a family which is under considerable strain. Even very young children may show these patterns. Role reversal and intensified self-sufficiency often build on a child’s need to control situations to obtain some outward security about what she can expect. While sometimes viewed as mature, if extreme, these patterns can come at a high emotional cost to a child. Children who are parentified or highly self-sufficient, for instance, have great difficulties in relying on others for help or support. In addition, they may miss out on being a child and their own capacity to feel and to learn may be constricted. Family members may fail to acknowledge a mental illness or minimize or distort its effects on the individual and family. As a result, children may learn to keep the illness secret as they grow older. Secretive and distorted communication patterns in turn can contribute to a child feeling a need to hide her own feelings and needs from others. In extreme cases, children who hide their own feelings and thoughts develop a false sense of self. Such children try to do or be what they think is right for others in the family. Underlying this outward appearance of perfection, however, is a fundamental fear that the child is not good enough. If a child lives alone with a parent who has a chronic mental illness, the child may become enmeshed in the

Parental Chronic Mental Illness Table 6

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Heritability of major mental illnesses: Child’s lifetime risk of becoming ill

Schizophrenia Major depression Bipolar disorder

General population rates if neither parent is ill (%)

Risk if one parent is ill (%)

Risk if two parents are ill (%)

Risk for other monozygotic twin if one twin is ill (%)

Risk for dizygotic twin if one twin is ill (%)

1.5 10 1

10 20–25 5–10

40 30–50

18–60 50–60 40–70

15 20 10–20

Reproduced from Brunette M and Jacobsen T (2006) Children of parents with mental illness. In: Hendrick V (ed.) Psychiatric Disorders in Pregnancy and the Postpartum: Principles and Treatment, p. 200. Totowa, NJ: Humana Press, with permission from Humana Press.

parent’s symptoms. Children in this situation may become the parent’s confidant and be burdened with too much information to the detriment of their own development. Children in this circumstance often experience high levels of anxiety and keep their worries to themselves. Some children enter their parent’s psychotic world and accept their beliefs as their own so as to feel close to a parent who is hard to reach, a condition that is called a ‘folie a deux’. Risk for psychiatric disorders

While environmental context is important in the etiology of mental illness in a child, genetic factors also contribute to risk and interact with environmental factors in the expression of vulnerability. The genetic risks for children of parents with schizophrenia, major depression, and bipolar disorder are summarized in Table 6. Recent work on anxiety disorders also shows both genetic and environmental contributions. There are higher rates of anxiety disorders among children of anxious parents, but only when the child’s mother has the disorder. A maternal history of anxiety disorder doubles the risk that a child will develop an anxiety disorder. If a mother has both an anxiety and a depressive disorder, the risk that her child will develop an anxiety disorder is tripled. This high risk of transmission is thought to be linked to genetic factors, but also to the higher levels of general pathology that mothers with dual diagnoses are likely to exhibit. Studies on transmission from fathers to children need further study. Fathers may be less likely than mothers to report symptoms of anxiety. Factors that ameliorate risk

Risk to children is cumulative. The more risk factors present, the greater the likelihood that the child will fare poorly in his or her development, especially if the risks occur in the early years of development. Some important protective factors that can ameliorate risk and influence young children’s outcomes favorably include help and understanding from family members and relatives, a stable living environment, feeling loved by parents, including the parent who has a mental illness, and psychotherapy, either individual or within the family. Understanding that they

have not caused the illness and that they are not to blame for the parents’ symptoms is also essential.

Conclusions Parents with mental illness face the dual and challenging demands of managing their disability while meeting the many stresses associated with raising children. When the illness is chronic and severe, parenting is usually compromised to some degree. How well an individual fares as a parent, however, will turn on many factors, including the parent’s responsiveness and compliance with treatment and the social support he or she receives in the parenting role. To ensure positive outcomes, parents with chronic mental illness need a comprehensive range of multifaceted interventions. In designing such interventions, individual strengths should be considered as well as the needs of the children. Interventions should be closely informed by an assessment of parenting and children’s needs. They may include medication management, pregnancy decision making, trauma and abuse therapy, substance abuse treatment, marital and family counseling, comprehensive case management, self-help, parenting mentoring, assistance with housing, and independent living. Assessment of the home environment and the parent’s social support system is crucial. Building support networks for the parenting role and meeting the needs of affected children are other essential aspects of such interventions. Community mental health services targeted specifically for parents with chronic mental disorders and their families may include: intensive case management, psychiatric rehabilitation day programs that include parent skills training and day care for preschool children, psychoeducation classes that include information about child development and parenting skills along with information about mental disorders and symptom management, and crisis nurseries and other types of respite care for young children when the mother’s symptoms become acute. Because children of mothers with chronic mental disorders are at risk, they need interventions that provide wrap-around services and linkage with schools and healthcare providers. These children may also benefit from education about their parent’s mental illness along with community support services.

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See also: Abuse, Neglect, and Maltreatment of Infants; Attachment; Depression; Emotion Regulation; Mental Health, Infant; Postpartum Depression, Effects on Infant; Risk and Resilience; Separation and Stranger Anxiety.

Suggested Readings Ackerson B (2003) Coping with the dual demands of severe mental illness and parenting: The parents’ perspective. Families in Society 84: 109–118. Ackerson BJ (2003) Parents with serious and persistent mental illness: Issues in assessment and services. Social Work 48: 187–194. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision). Washington, DC: Author. Brunette M and Jacobsen T (2006) Children of parents with mental illness: Outcomes and interventions. In: Hendrick V (ed.) Treatment of Psychiatric Disorders in Pregnancy and the Postpartum, pp. 197–227. Totowa, NJ: Humana Press. Cleaver H, Unell I, and Aldgate J (1999) Children’s Needs – Parenting Capacity. The Impact of Parental Mental Illness, Problem Alcohol and Drug Use, and Domestic Violence on Children’s Development. London: TSO.

Go¨pfert M, Webster J, and Seeman MV (eds.) (2004) Parental Psychiatric Disorder: Distressed Parents and their Families, 2nd edn. Cambridge: Cambridge University Press. Holley TE and Holley J (1997) My Mother’s Keeper: A Daughter’s Memoir of Growing Up in the Shadow of Schizophrenia. New York: Morrow. Murray L and Cooper PJ (eds.) (1997) Postpartum Depression and Child Development. New York: The Guilford Press. Nicholson J, Biebel K, Hinden B, Henry A, and Stier L (2001) Critical Issues for Parents with Mental Illness and Their Families (KEN01–0109). Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Ostler T (2007) Assessing Parenting Competency in Individuals with Mental Illness. Baltimore, MD: Paul H. Brookes Publishing Co.

Relevant Websites http://www.aacap.org – American Academy of Child Adolescent Psychiatry. http://www.nmha.org – Mental Health America. http://www.nami.org – National Alliance on Mental Illness. http://www.niaaa.nih.gov – National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health. http://mentalhealth.samhsa.gov – National Mental Health Information Center, Center for mental health services. http://www.nida.nih.gov – The National Institute on Drug Abuse, National Institutes of Health. http://www.lookingglass.org – Through the Looking Glass.

Parental Leave J S Hyde and J L Petersen, University of Wisconsin, Madison, WI, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Buffer effect – A protective factor that reduces the risk of a potentially harmful situation. California Paid Family Leave Act – The first paid parental leave legislation in the US that allows both men and women in the state of California 6 weeks of leave at 55% pay to care for a newborn or ill family member. Family and Medical Leave Act (FMLA) – Federal legislation for family leave that requires employers with more than 50 employees to provide a minimum of 12 weeks unpaid, job-guaranteed leave for parents to take care of an infant or for an elderly or sick family member. Family leave – Leave from work for purposes of caring for an infant or for an elderly or sick family member. Family salience – The importance of family. Maternity leave – A women’s leave from work at the time of a birth to recover from childbirth and care for a newborn.

Parental leave – A mother’s or father’s leave from work at the time of birth or adoption of a child. Work salience – The importance of work.

Introduction Although the transition to parenthood is an exciting and joyous time for many parents, the addition of a newborn or adopted child may also add stress to an already hectic lifestyle. Particularly in a dual-earner household, parents may worry about finances and job security in addition to caring for a new life. As more women enter the labor force and more households become dual earners, a need for a paid parental leave policy becomes ever more apparent. ‘Parental leave’ refers to a mother’s or father’s leave from work at the time of birth or adoption of a child. ‘Maternity leave’ is a more specific concept referring to a mother’s (not a father’s) leave from work at the time of a birth to

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recover from childbirth and care for a newborn. ‘Family leave’ is a more general term encompassing both parental and maternity leave and refers to leave from work for purposes of caring for an infant or for an elderly or sick family member. This article will focus primarily on parental leave during the transition to parenthood.

Policy Review Before 1993 the US was the only industrialized nation without a federal parental leave policy. Even with the inception of the Family and Medical Leave Act (FMLA) in February 1993 the US still lags behind many European nations in the generosity of federal parental leave policy. The FMLA requires that employers with more than 50 employees provide a minimum of 12 weeks unpaid, job-guaranteed leave. Both mothers and fathers are covered equally under the FMLA and they may accumulate paid vacation or personal days to use for parental leave. Employers must continue to provide health benefits but are not required to extend other benefits during parental leave. Despite the benefits of the FMLA, parental leave policy in the US can still be improved. Women work disproportionately for small businesses with fewer than 50 employees, leaving a large number of women uncovered by the legislation. For those women who are covered by their employers, a leave of 12 weeks is often too short, leading to physical and mental health implications for the mother as well as reduced marital satisfaction and less time to develop a secure relationship with the infant. Finally, an unpaid leave gives many parents no option but to cut their leaves short due to financial concerns. Taking 3 months off work without pay can be detrimental to many people’s finances but especially for parents with the financial burden of caring for a new life. In 2004, California became the first state in the US to enact a paid parental leave policy. The California Paid Family Leave Act allows both men and women 6 weeks of leave at 55% pay to care for a newborn or ill family member. During its first year, over 150 000 parents took advantage of the paid parental leave program. Since then, 28 other states including Massachusetts, New York, and New Jersey have introduced paid parental leave bills into their legislature. This is a promising avenue of policy reform as states take responsibility for providing a paid parental leave policy. It may be helpful to put US parental leave policy in the context of other nations’ policies. Many countries including Sweden, Italy, and China offer a paid parental leave policy. Sweden in particular is known for the most generous parental leave policy. In an effort to restore population following a severe loss in World War II as well as an effort to increase gender equality, Sweden offers

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15 months of paid, job-guaranteed leave for both mothers and fathers. For the first 12 months pay is approximately 90% of the normal wages; for the last 3 months it is reduced further. Mothers also have a right to work at 75% time until the child is 8 years of age. Italy offers a maternity leave of 2 months paid leave prior to the birth of a child and 3 months after birth with a pay of 70% of normal wages. Italian mothers also have the option of an additional 6 months leave at 30% pay. In China mothers are offered 3 months paid leave and fathers are provided with 15 days. Opportunities are also made available for mothers to nurse while they are at work. These cases illustrate how culture affects parental leave policy and the generosity of paid leave policies in other nations.

Wisconsin Maternity Leave and Health Project Before reviewing the data on the effects of parental leave we will briefly describe the Wisconsin Maternity Leave and Health (WMLH) project, the source of many of the results discussed below. The WMLH project is a longitudinal study of over 500 women, their partners, and their infants in the Wisconsin area. Women were interviewed in their homes during (1) the first trimester of pregnancy (2) 1 month postpartum, (3) 4 months postpartum, and (4) 12 months after birth. Almost 82% of the women were employed when the study began. This project was the first large-scale study of psychological aspects of parental leave and continues to be one of the best sources of data on the topic. The participants in this study are representative of the US population in household income and education; therefore, this study may be generalized to other men and women in the US.

Parental Leave and Health Mental Health There is evidence to suggest that overall, women’s employment is associated with improved mental health. These conclusions are based, however, on studies of women at various times in the life span, and may include single and married women, and women with or without children. The year after child birth may be a time of particular stress including physical recovery from childbirth, postpartum depression, caring for an infant with around-the-clock needs, and associated sleep deprivation for the mother. Depression Rates of depression in women after childbirth (8–20% of postpartum women) are higher than rates in the general population of women (3–4% of women). Levels of depression following childbirth are dependent upon a number of

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factors including employment status following the birth of a child. According to data from the WMLH project, length of parental leave interacts with several variables to affect levels of depression. Marital concern is one such factor that interacts with length of maternity leave to predict rates of depression. Women who took a short parental leave (6 weeks or less) and who were high in marital concern showed elevated risks of depression compared to women who took longer leaves (12 weeks or more) and women who took a short leave but were not high on marital concern. It seems that concern for the marriage adds an addition stress, that when combined with a short maternity leave, increases maternal depression. Length of leave also interacts with work vs. family salience in predicting depression. Women who were higher on work salience than family salience and took a long leave were more likely to show increased levels of depression than women high on work salience who took a shorter leave. Many women are highly involved with their work prior to pregnancy and may find staying at home with an infant to be a difficult transition. They may be eager to return to work and resent the time that they feel they must spend at home to care for an infant. A long leave may not always be beneficial, especially when the mother is eager to return to work. Therefore, the effects of varying lengths of leave on depression are dependent upon individual characteristics of the woman. Policy should reflect these individual needs by allowing women the opportunity to take long leaves but recognizing that long leave is not beneficial to all women. Women who were high on family salience relative to work salience were low in depression regardless of when they returned to work. These women may feel that they are providing for their families regardless of their length of leave. Working mothers are providing for their children financially whereas mothers at home are providing care for their infant. Because these women are more concerned about family life than work, they are less affected by taking time off work and concerns with their job. The association of length of maternity leave with depression is dependent upon a number of factors including work rewards and marital concern. Women play multiple roles as wife, mother, and employee. These roles logically interact to provide a complex influence on maternal mental health. Length of maternity leave may provide a buffer effect from this role conflict by allowing women an opportunity to provide care for an infant while having a sense of job security. It is well known that maternal depression has consequences for infant development. Mothers with depression are less responsive to their infant and are at greater risk of developing an insecure maternal attachment. Clearly, it is in the best interest of the families and society as a whole to promote mothers’ mental health in the postpartum period.

Anxiety Although anxiety may not be related to length of maternity leave per se, it is associated with hours worked per week and full-time employment during the first year after birth. The WMLH project found that higher levels of anxiety were reported for women working full time 4 months postpartum compared to women working part time or as homemakers. These women who work full time may feel overloaded with the stress of both work and caring for an infant who, at 4 months, may not yet sleep through the night. Difficult infant temperament and work concerns also predicted maternal anxiety. A difficult infant temperament may exacerbate the stress of working long hours and caring for an infant. Difficulty at work may also increase anxiety as it adds another role-related concern of being a good employee as well as a good mother.

Physical Health Maternal recovery Time off work may be essential for women to recover from the physical labor of pregnancy and the rapid physiological changes following pregnancy. Childbirth is a physically taxing experience that reduces energy and vitality and creates health problems for some women. Women need time to physically recover from the process of giving birth. Postpartum physical symptoms include breast tenderness, constipation, uterine cramps, and respiratory symptoms. Women reported worse health at 1 and 4 months postpartum than either during pregnancy or at 12 months postpartum. Typically, recovery from childbirth has been said to take an average of 6 weeks, but this actually refers to the time it takes for the uterus to return to its size before pregnancy. Recent studies find that complete recovery may take up to 6 months for women to return to their typical level of health and activity. Recovery from childbirth usually takes longer with Cesarean delivery than vaginal birth. This form of delivery is more common in the US than in many other countries. Therefore, recovery for American women is expected to be longer on average than that of women in other nations. In a 1997 study, Patricia McGovern and colleagues found that length of maternity leave contributed to women’s physical health although the direction was not linear. Women who took leaves between 3 and 5 months long reported more vitality and fewer limitations to their daily role than women who took leaves shorter than 3 months or longer than 5 months. This suggests that a leave of 3–5 months is optimal for recovery from childbirth and better maternal health. Women who take a short leave may not have recovered fully from pregnancy and

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childbirth, whereas women who take a long leave may be more susceptible to infection from their infant. Reduced sleep in association with caring for a newborn is a likely contributor to poor postpartum health. Data from the WMLH project show that the greatest loss of sleep occurs 1 month postpartum, but even after 4 months women are still getting less sleep, on average, than before pregnancy. Reduced sleep may aggravate already existing health problems and weaken the immune system allowing other health problems to be introduced. Women who work throughout the day do not have an opportunity to catch up on sleep lost the night before. Working long hours and being concerned about that work is likely to affect nightly sleep as well. Unfortunately, women’s parental length of leave is rarely determined by their physical health. A number of factors, most commonly economic concerns, may reduce the length of maternity leave regardless of physical health, forcing a woman with poor physical health to return to work. Providing a longer paid maternity leave is arguably a cost-effective strategy for employers to minimize employees’ sick leave. Infant health

Mothers who took a leave longer than 3 months also reported better health of their infants. This may be because working women whose children are in childcare have an increased risk of infection from other children in the care facility. Women taking parental leave also have more time to attend to their infant’s needs and devote more attention to their child who is vulnerable to infection. This higher level of care is likely to ward off infection by providing a healthy immune system. For example, mothers who were not employed during the first 12 weeks of their infant’s life were more likely to have their infant immunized than mothers who worked. In 2000 Christopher Ruhm found that European countries with a generous paid parental leave policy had a lower infant mortality rate than countries with unpaid leave. A 1-year parental leave was associated with a decrease in infant mortality of about 20%. This is a staggering finding suggesting the importance of paid parental leave on infant mortality. Paid parental leave allows more parents, especially fathers, to take time off work to care for an infant. This individualized care reduces infant disease and infection and has a significant effect on infant mortality. In addition, infant health was associated with more maternal vitality. Infant health may be related to parental health as infectious diseases spread throughout the family. Waking in the middle of the night to care for an ill infant likely drains a mother’s energy and leads to increased sleep deprivation. In light of this evidence, longer parental leave may be a cost-effective means of reducing health problems in both the mother and the infant.

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Breastfeeding A number of studies suggest that there are many benefits to breastfeeding including increased health of the infant and enhanced cognitive development. Infants who are breastfed develop a temporary immunity to some diseases and have a reduced risk of obesity in childhood. The World Health Organization recommends at least 6 months of exclusive breastfeeding for improved infant health. Breastfeeding is very time-intensive, requiring the mother to devote several hours a day to feeding her infant. A short maternity leave (less than 6 months) does not allow women to devote the time necessary to feeding their infant exclusively on breast milk. Length of maternity leave is associated with increased frequency of breastfeeding. At 6 months postpartum only 10% of women employed full-time breastfed their infant in comparison to 24% of women who were not employed. Frequency of breastfeeding is also related to milk production. If a woman is unable to breastfeed or pump regularly, her milk supply will diminish. Private places to breastfeed or pump at places of employment are rarely available in the US. In China women are provided with breaks for nursing and pumping in private locations on the jobsite. This allows women to return to work while continuing to provide the nutrition needed for their child’s health.

Fathers’ Parental Leave Paternal leave may have beneficial effects for both the father–infant and marital relationship. Fathers who take at least some leave are more likely to have a secure relationship to their child and be more involved with their child later in life. The father–infant bonding early in the child’s life seems to affect the relationship later in life. Parental leave provides fathers the opportunity to grow close and remain close with their children. Fathers who took a longer leave were more likely to be high in both family salience and gender equality suggesting that fathers who are eager to be involved with their children and share in the responsibility of caring for them take longer parental leaves. Parental leave also provides increased support for the mother. By sharing household and childcare responsibility, the father is able to relieve the mother’s stress and enhance the marital relationship. Fathers may wish to take parental leave at the same time as the mother in order to take responsibility for childcare while the mother recovers from birth, or they may opt to take leave at different times so that both parents may return to work quickly while knowing their infant is being cared for by a parent. Despite the positive effects of paternal leave, few fathers take an extended leave to care for an infant. Although about 90% of fathers in the WMLH project took some time off work following the birth of their child,

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the average leave was only 5 days in comparison to 9 weeks for mothers. A short leave may be due to a number of factors including negative attitudes from coworkers and supervisors and, more commonly, financial considerations. Many fathers consider themselves to be the breadwinner and may take a shorter leave not because they are unsupportive, but rather because they are expected to provide financially for their new family. In the WMLH project fathers were more likely to take paid vacation or sick leave off work than unpaid parental leave following the birth of a child. Therefore, although the FMLA provides equal job protection for mothers and fathers, fathers are much less likely to make use of the legislation as long as the leave is unpaid. Data from the Families and Work Institute support this assertion citing that 70% of fathers took leave before legislation and only 75% took leave after the FMLA was passed. In Sweden, where fathers are provided with 12 months of parental leave at 90% pay, the average paternal leave is 53 days. Of American fathers 92% said they would drop to at least part time work for a year to care for a newborn if they were guaranteed 100% pay. This suggests that fathers are willing to take parental leave to care for an infant or mother but are less likely to take leave if the leave is paid. Father’s parental leave also has implications for gender equality. Discrimination against women in the work force is commonly excused with the assumption that women take longer parental leave than men or quit their jobs after birth and are therefore temporary employees. If men took longer parental leaves, this assumption would be called into question. In addition, fathers who take equal responsibility for infant and childcare allow mothers to return to work sooner providing more gender equity in both the home and the work force.

Parental Leave and Relationship Quality Marital Relationship Researchers generally agree that marital quality typically declines after the birth of a child. This is especially true for women and may last for 18 months or more following a birth. Many factors may contribute to this decline including reduction in time spent together as a couple, the husband’s worry about supporting a family, the wife’s worry about returning to work, and the quality of the sexual relationship. The hectic time of caring for a newborn and worrying about job security adds additional stress to a marriage that may lead to decreased satisfaction. According to data from the WMLH project, length of leave and number of hours worked interacts with a number of variables to predict marital satisfaction for the wife. In regard to length of leave, women who took shorter leaves and were dissatisfied with their childcare had the greatest marital incompatibility. Women who take a short leave may

not have the financial resources to place their children in adequate childcare and their worry over childcare may spill over to the marital relationship. In regard to work hours there were two profiles of women with high levels of marital dissatisfaction: (1) women who worked long hours and were satisfied with their work status and (2) women who worked shorter hours and were dissatisfied with their work status. Those in the first group are likely to be women who are very involved in their work and have less time to cultivate, or perhaps are not interested in, a close marriage. The second group is comprised mainly of women who work part time but would prefer to be home full time. Financial necessity is the driving force behind their employment, and they may resent their husbands for not being better providers, creating a sense of marital incompatibility. Parental leave provides both parents with the opportunity to spend more time caring for the marital relationship rather than worrying about balancing work and family demands. In particular, a paid parental leave would allow new parents to spend time with the newborn without resenting their partner for neglecting financial responsibilities. Father–Infant Relationship Not only does parental leave permit the formation of a strong father–infant relationship, but according to the WMLH project maternal employment during the child’s first year of life may also affect the father–infant relationship. When mothers either did not work or worked part time during the child’s infancy, fathers were more involved in care giving and were more sensitive and responsive to the infant than when wives worked full time. When fathers were satisfied with their marital quality and their wives did not work outside the home they were more positive in their interactions with the infant, whereas when wives work full and part time, the relationship between father’s marital satisfaction and infant interactions was negative. Fathers may feel forced to care for their child when the mother is working and thus resent the time they spend with their infant. In contrast, fathers whose wives are not working may be more willing to voluntarily interact with their infant and therefore enjoy the relationship they share with their children more. This suggests that maternal employment during the first year of an infant’s life may indirectly affect the father–infant relationship. Mother–Infant Relationship Another benefit of parental leave is increased opportunity to bond with the infant and develop a secure attachment. A number of studies have examined the effect of maternal employment on mother–infant attachment. Researchers such as John Bowlby and Mary Ainsworth suggest that maternal interaction with an infant is correlated with a

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more secure relationship. They suggest that the first year of life is a particularly sensitive time for mother–infant bonding. Quality of maternal interaction may also be more important that quantity of time spent together. Therefore, working mothers who value the time spent with their infant outside of work may have rewarding mother–infant relationships. The WMLH project found results consistent with attachment theory. Results indicate that shorter leaves were associated with more negative maternal affect and behavior toward the infant. Length of leave also interacted with other risk factors such as maternal depression, mother’s health symptoms, and infant’s temperament to predict the quality of the mother–infant relationship. Among mothers experiencing depressive symptoms, poor physical health, or those dealing with an infant with difficult temperament, a longer leave provided a buffer effect for a more rewarding mother–infant relationship. Quality of the mother–infant relationship is likely due to a number of factors in addition to maternal employment. Recent research suggests that parent–child bonding is a lifelong process rather than a ‘sensitive period’ during the first year of life. Warmth and responsiveness from both parents is an evolving process present throughout the child rearing process.

Parental Leave and Infant Development The National Institute of Child Health and Human Development (NICHD) study of Early Child Care and Youth Development is the largest study of early child care to date. They found that amount of time spent in childcare was a significant predictor of behavioral problems and cognitive deficiencies in children in grade school. Children who spent more time in childcare, rather than being cared for by their parents, were more likely to have more behavioral problems and less cognitive ability. In addition, those children were more likely to have poor work habits and more mother–child conflict through third grade. However, a stronger predictor of cognitive ability and academic skill was quality of childcare. Children who experienced higher-quality childcare performed better on tests of cognition, language, and other academic skills such as math and reading, than children in poor-quality day care. Maternal employment during the first year of life has negative effects on infant development when childcare is poor. Women who take a short parental leave because of financial concerns may not be able to afford good-quality childcare. A paid parental leave would provide low-income parents with an opportunity to care for their child themselves without worrying about poor childcare. A paid leave may also allow parents to save money for good childcare when they return to work.

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Employer Benefits Although the most vocal argument against paid parental leave is the burden on the employer, many employers are beginning to see paid parental leave as a benefit to their business. With the growing research documenting the health and psychological effects of maternal employment soon after giving birth, businesses are becoming concerned about issues of work productivity. Workers who take a short parental leave are likely to be absent from work more often due to health problems of the worker and infant. In addition, employees with an infant at home may be more distracted at work. They are likely to be sleep deprived, worry about the well-being of their infant, and stressed about balancing work with family. All of these are likely contributors to reduced work productivity. More employers are also becoming concerned about the message that they send to their employees. Employers have a duty beyond profit that includes worker care. By providing a paid parental leave, businesses send a message to their employees that they are concerned and supportive of family life. Employees who work for a company that is supportive of their personal decisions are likely to be more diligent workers because they are motivated to support a company that is supportive of them. In contrast, workers who resent their employer for their parental leave policy are less likely to give back to their company in terms of productivity. In addition, businesses with generous benefits such as paid parental leave attract more workers providing competitive applicants for employment. Overall, paid parental leave helps most employers by providing diligent workers and cost-effective benefits.

Conclusion The available evidence suggests that the US is in need of a paid parental leave policy providing adequate time to care for a newborn infant. Short parental leave adversely affects mental health, physical health, and relationship quality of both parents and the infant. However, negative effects such as depression are also reported for long leave when the parent is eager to return to work. Parental leave should reflect the individual considerations of the parents and infant allowing parents the opportunity to take efficient time off work to provide for their infant. Countries such as Sweden have provided an example of a superior parental leave policy providing parents with adequate payment and time to make the transition into parenthood smoothly. This Swedish legislation has increased quality of work as well as quality of family life for those who take advantage of it. In addition, egalitarian gender roles in the work place are becoming more

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accepted as fathers increasingly take advantage of parental leave and responsibility for childcare. Although a short maternity leave may have negative effects during the infant’s first year of life, maternal employment after the infant’s first year may have many beneficial effects. Women who work provide an extra income to alleviate the family’s financial concerns. They are also a positive role model for their children, especially daughters, by showing that women are as smart and capable as men in the work force. Working mothers may add goals and aspirations increasing their quality of life, and as the number of women in the work force increases gender equality is becoming more of a reality. Parental leave provides women with the opportunity to spend time with their infants and maintain the job security that produces these benefits for them and for society. Women should not have to choose between caring for their infant and job security. The job security provided by parental leave policies is crucial for women to avoid this dilemma and gain equality in the work force. A paid policy would provide the financial support for mothers and fathers to enjoy the pleasure and excitement of welcoming a new life into a growing family without the burden of worrying about job security and financial concerns. See also: Attachment; Child and Day Care, Effects of; Marital Relationship; Maternal and Paternal Employment, Effects of; Postpartum Depression, Effects on Infant.

Suggested Readings Galtry J and Callister P (2005) Assessing the optimal length of parental leave for child and parental well-being: How can research inform policy. Journal of Family Issues 26: 219–246. Haas L (1992) Equal Parenthood and Social Policy: A Study of Parental Leave in Sweden. Albany: State University of New York Press. Hyde JS, Essex MJ, Clark R, and Klein MH (2001) Maternity leave, women’s employment and marital incompatibility. Journal of Family Psychology 15: 476–491. Hyde JS, Essex MJ, Clark R, Klein MH, and Byrd JE (1996) Parental leave: Policy and research. Journal of Social Issues 52: 91–109. Klein MH, Hyde JS, Essex MJ, and Clark R (1998) Maternity leave, role quality, work involvement, and mental health one year after delivery. Psychology of Women Quarterly 22: 239–256. McGovern P, Dowd B, Gjerdingen D, Moscovice I, Kochevar L, and Lohman W (1997) Time off work and the postpartum health of employed women. Medical Care 35: 507–521. NICHD Early Child Care Research Network (2005) Early child care and children’s development in primary grades: Follow-up results from the NICHD study of early child care. American Educational Research Journal 42: 537–570. Ruhm C (2000) Parental leave and child health. Journal of Health Economics 19: 931–960. Waldfogel J (2001) International policies toward parental leave and child care. The Future of Children 11: 99–111.

Relevant Websites http://www.paidfamilyleave.org – California Paid Family Leave. http://www.dol.gov – Family and Medical Leave Act. http://www.ilo.org – International Labor Organization. http://www.sweden.gov.se/sb/d/2025/a/19953 – Sweden’s Parental Leave Act. http://www.dol.gov – U.S. Department of Labor: Women’s Bureau.

Parenting Styles and their Effects M H Bornstein and D Zlotnik, National Institutes of Health, Bethesda, MD, USA ã Published by Elsevier Inc.

Glossary Authoritarian parents – Parents who use punitive, absolute, and forceful disciplinary tactics and who place a high level of importance on obedience and conformity. Authoritative parents – Parents who expect their child to comply to a reasonable set of rules and are responsive to the child’s needs and are respectful and supportive of the child’s autonomy and individuality. Avoidant attachment – An infant–caregiver relationship characterized by indifference on the part of the infant toward the caregiver.

Cronbach’s coefficient alpha – A statistical measure used to assess internal consistency reliability of items in a scale. If there is little correlation and items are independent, the Cronbach coefficient alpha will be low and close to zero; however, if items are well correlated the Cronbach coefficient alpha will be higher and approximate one. Demandingness – One of two important dimensions of parenting; referring to the degree to which the parent expects and demands maturity and responsibility from the child.


Externalizing behaviors – Psychosocial problems that are manifested in turning symptoms outward such as aggression or delinquency. Familismo – A Latino concept for thinking of the family as an extension of the self in addition to feelings of loyalty, reciprocity, and family cohesion. Indifferent parents – Parents who are not dedicated to their parenting roles and are uninvolved in helping foster the optimal development for their child. Internalizing behaviors – Psychosocial problems that are manifested in turning symptoms inward, for example, depression or anxiety. Marlowe–Crowne social desirability scale – A measure to assess social desirability bias. Parental Authority Questionnaire (PAQ) – A parenting styles assessment instrument consisting of three 10-item scales that correspond with Baumrind’s authoritative, authoritarian, and permissive parenting styles. Parenting practice – Specific parental behaviors, such as spanking, making sure children are doing their homework, and demonstrating an interest in children’s activities. Parenting style – Several elements that combine to create the emotional climate in which parents communicate their attitudes about their child. Style is conveyed through body language, temper, tone of voice, emotional displays, and quality of attention. Permissive parents – Parents who are highly responsive to their child’s needs but exert little control over the child’s behavior, allowing the child the freedom to act and choose activities as he or she pleases. Resistant attachment – An infant–caregiver relationship characterized by ambivalence toward the caregiver. Respeto – A unique quality of Latino families that emphasizes the importance of being respectful and obedient. Responsiveness – One of two important dimensions of parenting referring to the degree to which the parent responds to the child’s needs in an accepting and supportive manner. Secure attachment – An infant–caregiver relationship characterized by trust. Temperament – Constitutionally based individual differences in behavioral characteristics that are relatively consistent across situations and over time.

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Introduction The type of parenting style a parent exhibits greatly affects child development. Diana Baumrind, Eleanor Maccoby, and John Martin were integral in identifying four main types of parenting styles: authoritative, authoritarian, permissive, and indifferent. We explain how parenting style is manifested in infancy through early childhood. Additionally, we examine the characteristics of each parenting style and how each style affects children’s temperament, attachment relationships, academic success, and psychological development. The effects of parenting styles are embedded in class, cultural, and historical contexts. The typical definitions used for each parenting style may not accurately represent all cultures; therefore, we examine the effects of parenting styles for European, Asian, African, and Latin American cultures. Furthermore, we explain how various factors such as family socioeconomic status (SES), maternal employment status, parental education level, parental stress, marital problems, and parental depression affect the parenting style a parent is likely to exhibit.

Parenting Styles A parenting style consists of several elements that combine to create the emotional climate in which parents communicate their attitudes and practices about childrearing with their child. Within the context of their style, parents express their attitudes toward children’s responsibilities and engage in a variety of specific parenting practices such as spanking, ensuring children are doing their homework, and involvement in children’s activities. Parenting styles convey parents’ overall feelings about the child through body language, tone of voice, emotional displays, and quality of attention. Parenting styles are often considered as traits due to their consistency across time and context, this consistancy in interaction patterns are apparent as early as the first year of a child’s life. Virtually all aspects of parenting are informed by culture, and each culture prescribes unique socialization patterns and traditions to achieve its childrearing goals. Therefore, it is important to be aware that there is no optimal parenting style for all cultures and the implications of one parenting style may vary for children from different cultural and socioeconomic contexts. Research generally takes a typological approach to parenting styles. The most prominent contributor to parenting style research is Diana Baumrind, who conducted innovative research with predominantly well-educated, middle-SES, North American families. Baumrind’s typologies are compilations of ranges of parenting behaviors that reflect the level of control, clarity of communication,

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maturity demands, and nurturance exhibited by parents. Baumrind combined these dimensions to define three distinct styles of parenting: authoritative, authoritarian, and permissive. Each parenting style has a unique set of behaviors and characteristics associated with it. The first parenting style is authoritative. Authoritative parenting is characterized by a parent who demands that the child comply with a reasonable set of rules and is simultaneously responsive to the child’s needs and respectful and supportive of the child’s autonomy and individuality. The second style, authoritarian, characterizes a parent who is controlling and thus discouraging of the child’s autonomy, values obedience and limits the child’s emotional expression. The third style, permissive, characterizes a parent who fails to set restraints on the child and does not believe in punishment regardless of the child’s actions. These typologies are further elaborated below. Building on Baumrind’s typologies, Eleanor Maccoby in collaboration with John Martin tested the generalizability of Baumrind’s typologies on more diverse sets of populations. They conceptualized parenting styles as being assessable along two separate dimensions, responsiveness and demandingness. These dimensions combined to produce four parenting styles similar to Baumrind’s typology: authoritative, authoritarian, permissive, and (a newly added type) indifferent. The first dimension, demandingness, refers to parental control and the degree to which the parent expects the child to exhibit maturity and responsibility. For example, demandingness is expressed in terms of parental supervision, disciplinary efforts, and willingness to respond to the child if he or she disobeys. The second dimension, responsiveness, refers to how child-centered and warm the parent is. Responsiveness promotes the child’s individuality and is exhibited in behaviors that are receptive, supportive, and compliant to the child’s individual needs and demands. Having analyzed parents along these dimensions, Maccoby and Martin found that authoritative parents score high in demandingness and responsiveness, authoritarian parents are high in demandingness but low in responsiveness, permissive parents score high in responsiveness but low in demandingness, and indifferent parents score low in responsiveness and demandingness (see Figure 1).

Demandingness

Responsiveness

High

Low

High

Authoritative

Permissive

Low

Authoritarian

Indifferent

Figure 1 A scheme for classifying parenting styles based on dimensions of demandingness and responsiveness.

Parenting Style Typology Different parenting styles construct different emotional climates in the home. We now explore the type of emotional climate each of Baumrind’s parenting styles creates, the styles of behaviors and characteristics parents exhibit, and the outcomes each parenting style likely facilitates. The Authoritative Parenting Style An authoritative parent exerts firm control over the child, expects maturity, and establishes reasonable guidelines for the child to abide. Simultaneously, authoritative parents make disciplinary decisions by integrating the point of view of the child as long as the parent perceives it to be reasonable. Authoritative parents utilize reason and control when disciplining the child. Authoritative parents, however, are careful not to use harsh forms of punishment or restrict their child’s autonomy. Authoritative parents also show warmth, love, and acceptance for their child, encouraging the child to be independent, autonomous, and assert individuality. Another important characteristic of authoritative parenting is parent–child verbal give-andtake which helps facilitate open communication between children and their parents. This reciprocal dialogue consists of parents being open to the opinions of the child but at the same time not failing to express their own perspectives. Authoritative parenting is like a democracy in which the feelings and ideas of both the parents and the children are recognized and supported. The Authoritarian Parenting Style An authoritarian parent stresses the importance of compliance, conformity, parental control, respect for authority, and maintaining order. Such parents exercise high degrees of control on and maturity demands from their children; however, this is coupled with low amounts of nurturance and clarity of communication. Complete obedience is expected from children, and authoritarian parents will put a stop to any action the child takes to defy them. When children deviate from the strict standards set for them, the authoritarian parent favors the use of harsher forms of punishment than are used by authoritative parents. The authoritarian parent often discourages the child’s autonomy and instead attempts to shape the child to exhibit behaviors and attitudes the parent deems to be desirable. This strategy could hinder the child’s maturation by not allowing the child adequate experience making decisions and taking responsibility for his or her own actions. Unlike authoritative parenting, where open discussion is encouraged, in authoritarian parenting, reciprocal dialog and verbal give-and-take between parent and child is discouraged. Authoritarian parents do not discuss thought


processes behind their absolute childrearing rules. Instead, the authoritarian parent holds the belief that the parent’s word is considered final. The Permissive Parenting Style A permissive parent is described as having a high level of nurturance and clarity of communication, paired with low levels of control or maturity demands. They have little expectation of mature behavior from the child, allowing the child the freedom to act and choose activities as he or she pleases. Furthermore, the permissive parent rarely governs the child’s time schedule and allows children to determine their own bedtime, mealtime, and time spent watching television. The permissive parent makes few demands of the child and rarely requires the child to do chores around the house or use appropriate manners. Additionally, the permissive parent tends to be extremely accepting and supportive of all the child’s behavior and actions including sexual and aggressive impulses. The permissive parent also often holds the belief that restricting the child’s actions in any way might infringe on the child’s autonomy, in turn hindering normative child development. As a result of this philosophy, the permissive parent rarely implements rules or guidelines for the child’s behavior. Furthermore, the permissive parent often sees her or himself as a resource for the child only if the child decides to utilize the parents as such. Additionally, the permissive parent may care more about being the child’s friend than an authority figure. The permissive parent tends to refrain from sharing true sentiments with the child, while allowing the child to freely express negative feelings and behaviors. Permissive parents take a passive approach to disciplining children. They avoid using punishment, asserting authority, or imposing restrictions on the child, whenever possible. The only disciplinary tactic used is reasoning, and parents look to the child for his or her opinion when deciding to implement any type of structure or rule. The Indifferent Parenting Style An indifferent parent is characterized as being neither demanding nor responsive to the child. The indifferent parent is not dedicated to parenting roles and is disinterested in helping foster optimal development of the child. The indifferent parent limits time and energy dedicated to the child. Moreover, the indifferent parent is characterized by having little knowledge or involvement in the child’s personal life, seldom shows concern for what goes on at school or with the child’s friends, and rarely factors the child’s opinion in decision making processes. Additionally, indifferent parents fail to implement guidelines or rules to control the child. Indifferent parents have a parent-centered lifestyle and put their personal

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needs and interests first rather than concerning themselves with what is best for the child. Indifferent parenting differs from the other three types of parents who all rear their children according to a set of beliefs about what is optimal for the child’s development. Indifferent parents fail to set regulations for their children, not because they have the philosophy that it will hinder the child’s development, but instead because they are too preoccupied with their own life to concern themselves with implementing rules for their children. In extreme cases, indifferent parents could be considered negligent.

Measurement of Parenting Styles Parenting styles have been measured using direct observational techniques, but more commonly data are obtained through interviews and questionnaires of parents and children. However, the accuracy of reports is debatable because parent and child responses tend to differ. Some researchers suggest that reports from children may be more accurate because children are less influenced by social desirability biases (the desire on the part of the person answering to ‘look good’ to the interviewer). Moreover, parenting style in the eyes of children may have more significance. Additionally, SES may affect the accuracy of parenting style reports because some argue that parents of different SES tend to be more or less prone to social desirability biases which could undermine the validity of these assessments. The Parental Authority Questionnaire (PAQ) developed by John Buri is a commonly used instrument to categorize parenting styles. The PAQ is a 30-item assessment consisting of three 10-item scales that correspond with authoritative, authoritarian, and permissive parenting style. The PAQ assesses children’ perceptions of their parent’s parenting style and is completed by children about each parent independently. On the questionnaire, the children indicate how well each statement describes a parent based on a 5-point scale, 1 indicating ‘‘I strongly disagree that this statement relates to my mother or father’’ and 5 indicating ‘‘I strongly agree that this statement applies to my mother or father.’’ An example of an item that corresponds with authoritative parenting is: ‘‘As I was growing up, once family policy had been established my mother discussed the reasoning behind the policy with the children in the family.’’ An example of a statement corresponding with authoritarian parenting is: ‘‘Whenever my mother told me to do something as I was growing up, she expected me to do it immediately without asking questions.’’ An example of a statement corresponding with permissive parenting is: ‘‘My mother has always felt that what children need is to be free to make up their own minds and to do what they want to do, even if this does not agree with what their parents might want.’’

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The PAQ has proved to be a reliable and valid measure of Baumrind’s parenting style typologies. In a test–retest reliability study in which participants completed the PAQ twice over a 2-week period, high reliabilities were found for mother’s authoritativeness, authoritarianism, permissiveness, and father’s authoritativeness, authoritarianism, and permissiveness. Cronbach coefficient alphas were used to calculate internal consistency reliability for the measure, and high values were obtained for each of the PAQ scales. A third study that measured the discriminant validity of the PAQ indicated that mother’s authoritarianism was inversely related to mother’s permissiveness and authoritativeness, and father’s authoritarianism was inversely related to father’s permissiveness, and authoritativeness. Also, mother’s permissiveness was not related to mother’s authoritativeness. A fourth study assessed criterion validity to examine whether parental nurturance is correlated with authoritative, authoritarian, and permissive parenting styles. Authoritative parents (mother and father) were found to be highest in parental nurturance; authoritarian parenting was inversely related to nurturance for both mothers and fathers; and parental permissiveness was unrelated to nurturance for both mothers and fathers. A final study examined if the PAQ is influenced by social desirability biases by looking at correlations with the Marlowe–Crowne Social Desirability Scale. For example, it would be problematic if people agreed with more authoritative and with fewer authoritarian statements because they wished to appear more socially desirable. PAQ scores did not correlate with the Marlowe–Crowne Social Desirability Scale; therefore, the PAQ does not appear to be vulnerable to social desirability response biases. These studies show that the PAQ is a reliable and valid measure for categorizing parenting styles according to Baumrind’s typologies.

Approaches to Parenting Infants and Young Children Infants Although the majority of parenting styles research has focused on developmental outcomes in adolescence, parenting styles influence the child’s development during the infancy and toddler periods as well. Parenting styles and behaviors must appropriately coincide with the differential tasks and demands of the infancy and toddler periods. Parents play an extremely influential role in early development, and parents are unambiguously responsible for their child’s initial adaptation to the world. Parents influence their infants directly by means of their genes, beliefs, styles, and behaviors as well as indirectly by means of their influences on one another and the multiple contexts in which they live. During infancy, the majority of babies’ experiences stem from interactions they have

within the family. However, postinfancy, their social context expands as children are old enough to enter other social situations, like play groups and school. Researchers have established a taxonomy identifying four categories of parental caregiving during infancy; these include: nurturant, social, didactic, and material. Together, these modes are perhaps universal, even if their emphasis, frequencies, and durations vary across cultures. Nurturant caregiving meets the physical needs of the infant. Infant mortality is a perpetual parenting concern, and from the moment of conception parents are predominantly responsible for promoting infants’ wellness and preventing their illness. Parents nurture offspring by providing sustenance, protection, supervision, and grooming to their infants, in addition to shielding infants from risks and stressors. Social caregiving includes various visual, verbal, affective, and physical behaviors parents use in engaging infants in interpersonal exchanges (kissing, tactile comforting, smiling, socializing, and playful face-to-face contact). Parental displays of warmth and physical expressions of affection toward their offspring peak during infancy. Furthermore, social caregiving influences the regulation of infant affect as well as managing infant social relationships with others, including relatives, nonfamilial caregivers, and peers. Didactic caregiving consists of parental efforts used to stimulate infant’s engagement and understanding of the environment outside the dyad. Didactics include focusing the baby’s attention on properties, objects, or events in the baby’s surrounding; introducing, mediating, and interpreting the external world; describing and demonstrating; as well as provoking or providing opportunities to observe, to imitate, and to learn. Normally, didactics increase over the course of infancy. Material caregiving includes the ways in which parents provision and organize their infant’s physical world. Adults are responsible for the number and variety of inanimate objects (toys, books) available to the infant, the level of stimulation, the limits on physical freedom, and the overall physical dimension of babies’ experiences. An indifferent parent would fail to provide adequately for these parenting tasks for their infants, which could lead to developmental problems in their child. Adults differ considerably in their caregiving behaviors and styles, even when they come from the same culture and from similar socioeconomic backgrounds. However, individual parents do not vary much in their activities from day to day even if parenting activities change over longer periods and in response to children’s development. Authoritative parents are likely to be sensitive to their infants’ developmental progress and tailor their caregiving to match their infants’ developmental needs. For example, as infants age, parents provide more didactic experiences for their child. Additionally, responsiveness is a major component of parenting infants. Authoritarian parents differ from authoritative parents in


their level of responsiveness with their infant. For example, authoritarian parents tend to be less responsive to their child’s crying to try to keep the child under control. Parents who respond promptly, reliably, and appropriately to their babies’ signals give infants a good message from the start. For example, when a baby cries and a mother comes, the baby already feels she or he has an effect on the world. An infant whose parents are indifferent or permissive, may be frequently angry because they may find their parent’s inaccessibility and unresponsiveness painful and frustrating. Furthermore, babies uncertain about the parent’s responsiveness may grow apprehensive and become easily upset by stressful situations. It is commonly assumed that the overall level of parental involvement or stimulation affects the infant’s overall level of development. However, increasing evidence shows that characteristics of individuals shape their experiences and reciprocally those experiences shape the characteristics of individuals through time. Therefore, through infants’ interactions with their parents they actively contribute toward their own development by virtue of their unique characteristics, expressivity, and temperament. Thus, infant temperament and maternal sensitivity operate in tandem to affect child development and the parent–child relationship. Additionally, parents’ attitudes about their infants and the activities they engage them in are each meaningful to the development of infants. Parental personality affects a person’s abilities as a parent. Features of a personality favorable to good parenting might include empathic awareness, predictability, nonintrusiveness, and emotional availability. Additionally, adult adaptability can be critical in the first few months when infants are less ‘readable’, for example, their activities are more erratic and disorganized, and their cues less distinct and well differentiated. Being a self-centered parent can cause difficulties when parents put their own needs first and are not sensitive toward their infants’ needs. Toddlers Parenting styles, parental support, guidance, and structure play a pivotal role in navigating the toddler period. During this period, parents are vital in mediating toddlers’ entry into a wider social realm and influencing the affective responses, communicative styles, and social repertories that their children bring to forming meaningful and sustainable relationships and associations. During the toddler period the quality of responsiveness in parent–child relationships is established. Children prone to engage in power struggles with caregivers elicit more negative perceptions. Similarly, mothers of toddlers rated high in ‘negative reactivity’ tend to have more authoritarian characteristics, for example, they are often more controlling and less guiding in style, and their children are less compliant. Children who are unruly

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despite their parents’ attempts at guidance contribute to a potentially devastating ‘cycle of coercion’ in parent–child relationships. Researchers indicate that to establish a toddler’s willing compliance it may be necessary to have well-coordinated interaction behaviors with the child, in the sense that parents’ behaviors scaffold the child’s effort and parents set the stage for what the child might do next. An additional developmental challenge of toddlers is for them to develop empathy and organize their emotional sensitivity. It is important for toddlers to learn this through maternal modeling, as maternal sensitivity and reasoning have been found to relate positively to empathic, prosocial response during the child’s second year of life. As children age parenting strategies may involve different disciplinary practices than those of earlier childhood, more extensive shared regulation of children’s behavior, and altered patterns for effective control.

Child Temperament Beginning shortly after birth, a child’s individuality is manifested primarily in temperament, constitutionally based individual differences in behavioral characteristics that are relatively consistent across situations and over time. That is, individual differences in temperamental characteristics are somewhat stable; however, temperamental characteristics are not expected to be rigidly stable as a child develops. Child temperament can greatly affect the type of parenting style a parent exhibits. Researchers agree that parenting styles are evident during infancy; however, the particular style a parent exhibits is subject to change as a consequence of a changing child temperament. A child’s dominant mood, adaptability, activity level, persistence, threshold for distress (or happiness), and other characteristics are important because of the influence they have on others, and because they constitute the foundations of personality. For example, parents who start out with an authoritative style, being warm, affectionate, and sensitive when the child is an infant could alter their parenting style as the child ages and becomes more of a challenge for the parents as a result of an increasing behavioral repertoire or striving for autonomy. Children’s individual temperaments may require differing parental behaviors and styles to lead to optimal developmental paths. For example, some children are receptive to a parent’s disproval, and an authoritative approach to socialization is effective. However, this type of parental behavior may not be effective with an imperturbable child, and as a result a more effortful method of discipline may be necessary, and parents may take a more authoritarian approach to disciplining their children. As a result of having a more problematic child, parents may find it necessary to escalate to using greater amounts of anger and harsher disciplinary measures to control their

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child. Parents who respond to a problematic child with high levels of punitive behavior sets into motion a negative cycle of coercive behavior that could result in the development of a child who is aggressive and difficult to control.

Parent–Child Attachment Child attachment is an issue that also interacts with parenting styles in affecting child development. Child attachment to their mother is assessed using the Strange Situation paradigm and children are divided into four categories: avoidant, resistant, secure, or disorganized attachment. Secure attachment between infant and caregiver is characterized by trust; avoidant attachment is characterized by indifference on the part of the infant toward the caregiver; resistant attachment is characterized by ambivalence toward the caregiver; and disorganized attachment is characterized by inconsistency in attachment toward the caregiver. The secure behavior pattern has been seen as an indicator of healthy mother–infant interaction and emotional growth. Intrusive, overstimulating, and rejecting parenting is associated with insecureavoidant attachment in infants, whereas insecure-resistant attachments are linked to inconsistent, unresponsive parenting, very characteristic of the indifferent parenting style. Secure attachment has additionally been shown to lead to the development of psychologically and socially skilled children. It has been proposed that mothers of future avoidant babies express anger and rejection of their babies, mothers of groups of resistant babies are insensitive and inept, and mothers of secure babies are more affectionate and effective in soothing their babies.

Variation in Approaches to Parenting Cultural Effects Parenting styles and practices are not universal and are often moderated by social and cultural contexts. Virtually all aspects of parenting are informed by culture. Culture influences parenting behaviors and child development from early in infancy through such factors as when and how parents care for infants, the extent to which parents permit infants freedom to explore, how nurturant or restrictive parents are, which behaviors parents emphasize, and so forth. It is important to be aware that each culture has unique socialization patterns and traditions to achieve the childrearing goals of that society. For example, some cultures uphold the use of physical punishment whereas other cultures morally object to that practice. Generally, authoritative parenting seems to contribute to the most positive outcomes for all youth regardless of SES, ethnicity, or culture. However, authoritative parenting is less common among African American, Asian

American, or Latin American families than European American ones. Instead, among ethnic minority families, the authoritarian parenting style is more prevalent than it is among European American families. What makes authoritarian parenting more prevalent in certain cultures than others? Perhaps one reason is that authoritarian parenting does not always have the same adverse effects on children of ethnic minority backgrounds, particularly in the case of low-income families. The more restrictive parental practices associated with authoritarian parenting are often considered overly controlling or harsh in middle-class European American communities. However, in neighborhoods that are less safe, have higher levels of poverty, and more frequent levels of antisocial activities, more restrictive parenting may serve an adaptive strategy by providing a high level of supervision and support. Another consideration is that the discrepancies between authoritative and authoritarian parenting for European Americans may not be relevant in other cultural contexts. The same definitions for authoritative parenting may not make sense when applied to other cultures. For example, in many ethnic minority families a high level of control may be combined with warmth. This does not fit the European American definition of authoritarian or authoritative parenting. If researchers look solely at the parent’s use of control, families of different cultures may be mislabeled as authoritarian when in fact they do not possess other negative aspects of authoritarian parenting besides high levels of control. We now turn to explore in more depth how parenting styles appear in Asian, African, and Latin American cultures. Cultural effects: Asian. Parenting styles may have different effects in Asian families because of their differing values, attitudes, and traditions from those of Western families. For example, equality, self-determination, individualism, and competition are ideals associated with Western culture. This differs dramatically from Eastern ideals of collectivism, harmony, and purity. These disparities lead to different approaches to parenting that each culture considers appropriate and desirable. Although one cannot generalize how all Asians parent, some particular themes unite them. For example, research shows that Asian families stress the importance of parental control and restrictiveness. In turn, Asian parents are less likely to express affection or show reciprocity, and parent–child relationships are less close compared to Western families. Additionally, Asian parents are often more concerned with their child’s academic success than are European American parents. Many Asian parenting beliefs stem from traditional Confucian and Buddhist thought that stresses the importance of respect for authority. It is common for Asian parents to change their parenting style as their child ages. For example, Asian parents generally have few expectations and indulge every need of their child in the first few years of life. However, when the


child reaches ‘the age of understanding’ (around age 6), parents shift to harsher and stricter styles of parenting. At this age children learn discipline and obedience and the importance of respecting authority and promoting family coherence. With modernization, this pattern of lax parenting style at younger ages is beginning to change as parents realize children are capable of understanding earlier in life. Some researchers argue that Baumrind’s parenting style typology is not culturally relevant for Asian families because of the different meanings Asians place on responsiveness and parental control. Generally, researchers assess parental responsiveness from parents’ emotional and physical expressions and affections toward their children. However, most Asian parents exhibit responsiveness in a manner different from most European Americans. For example, in Asian cultures responsiveness is expressed in a parent’s involvement, support, and prioritizing the caregiving and education of their children rather than emotional and physical demonstrativeness. Therefore, responsiveness cannot be measured accurately given the strict European American definition. Additionally, parental control also holds different meanings for Asian vs. European American cultures. For Asian families, strict control over the child generally occurs in conjunction with positive characteristics such as parental care, concern, and involvement. Asian children perceive this control as a reflection of their parent’s dedication and concern for them as long as the control is not excessively domineering or harsh. Furthermore, parental control is linked to traditionally desirable traits for children in Asian cultures – for instance, self-control, tolerance of frustration, diligence, self-confidence, positive attitudes toward others – and it can be beneficial to gaining high levels of achievement. Parents who fail to exhibit characteristics of control and restrictiveness are often seen as negligent and uncaring by others within Asian culture. However, from the viewpoint of someone from another culture, these restrictive and controlling parental practices may appear authoritarian and be considered undesirable. Therefore, research categorizing Asian parents based strictly on Baumrind’s typology may be problematic because it may not accurately represent the manner that responsiveness, control, and warmth are expressed and interpreted by Asian families. Studies of Asian families in both the US and Hong Kong demonstrate that authoritative parenting does not always lead to the same beneficial outcomes for Asian children as it does for children of European decent. Authoritative parenting style is correlated with higher academic achievement and better grades for Americans and Australians of European decent, but this does not hold true for children in Hong Kong of Chinese decent. In turn, studies of Hong Kong Chinese indicate that, instead, authoritarian parenting styles actually benefit children’s academic performance and leads to higher grades among Chinese children.

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Not only do parenting styles have different effects on European Americans vs. Asians, but the effects also differ within Asian populations based on generation level of immigration. Research shows that authoritative parenting is predictive of academic outcomes for European Americans, but this does not hold true for either first- or second-generation Chinese. This pattern of findings shows that first-generation Chinese do not benefit from authoritative parenting styles. The effects of parenting style on second-generation Chinese show somewhat inconsistent effects on children lying somewhere in between how parenting styles affect European Americans and how they affect first-generation immigrants. This suggests that some effects of authoritative parenting are beneficial to second-generation Chinese but others are not. Second-generation Chinese are more similar to European Americans than first-generation, but there are still many cultural differences. First-generation immigrants are more familiar with traditional Chinese society and culture, unlike second-generation immigrants who were born in the US and tend to be more assimilated to American culture and tradition. Cultural effects: African American. Cultural differences also account for the differing effects of parenting styles in African Americans families. Research indicates that having authoritarian parents may not adversely affect African American children as is thought to be true for European American children. Conversely, the benefits of authoritative parenting as seen with European American populations may not have the same positive effects on African American children. Authoritative parenting is not predictive of success for African American children; instead, authoritarian parenting actually leads to greater academic success and higher intelligence quotient (IQ) scores for African American children, especially in the case of high-risk families. Researchers speculate that for children growing up in low-income and unsafe neighborhoods, authoritarian parenting could actually play an adaptive and protective role. Different cultures attribute disparate meaning to the same parenting behavior. For example, strict parental control and discipline have different meanings for African American compared to European American children. In African American families, firm control and discipline are not perceived negatively, but instead as signs of love, concern, and affection from the parents. Additionally, African American communities often endorse parental practices that may not be upheld in European American culture. One example is the use of physical punishment. Middle- and low-income African Americans tend to use physical punishment without reservation more often than European Americans. Research indicates that around 66% of middle-income and lower-income African American mothers endorse spanking as a form of punishment compared to just 25% of middle-income European American

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mothers. This does not indicate that African Americans are more likely to endorse child abuse and maltreatment. Punitive punishment is correlated with children exhibiting more externalizing behaviors for European Americans, but this does not hold true for African Americans. The effects of harsh disciplinary practices vary depending on how a particular community perceives those practices. For example, if parents in a community have normative views and feel justified using a practice such as spanking, then children will react normally and will not be adversely affected by the practice. The context surrounding a parent’s action is important in determining how it will affect the child. In African American communities, a unique kind of parenting exists called, ‘no nonsense’ parenting. This type of parenting is characterized by high levels of control and physical restraint, in the context of maternal warmth. This type of parenting appears to combine authoritarian and authoritative parenting styles. ‘No nonsense’ parenting has been shown to result in greater cognitive and social competencies and fewer internalizing behaviors in African American children. Cultural effects: Latinos. For Latino communities, there has been less research indicating differences in the effects of parenting styles compared to African American and Asian families. However, there are some unique characteristics to take note of for Latino families. One distinctive characteristic of Latino families is the concept of ‘respeto’ which means proper demeanor. Latino families emphasize the importance of being respectful and obedient and exercise greater levels of control over children’s’ behavior than European American families. Another consistent theme in Latino communities is that they are generally more family oriented than European Americans. The term familismo refers to thinking of the family as an extension of the self in addition to feelings of loyalty, reciprocity, and family cohesion. Research indicates that Latino youth tend to seek advice from family members, have positive attitudes toward parents, feel more satisfied by family life, and feel more obligated to respect and help their parents than European American children. Research indicates that ‘familismo’ leads to positive effects for Latino youth such as highquality parenting and favorable academic and social outcomes. Furthermore, in times of trouble or transition, Latino families tend to rely on their extended family and to utilize family resources to resolve the problem at hand and cope with stress. However, there is also within group variation. For example, first-generation Latin Americans tend to have more positive attitudes toward their parents in comparison to children of later-generations. Perhaps, this finding reflects assimilation to the culture of the US. Latinos have an increased likelihood to drop out of high school. Therefore, researchers debate whether Latino families place less emphasis on educational achievement.

One study showed that Latina mothers are very willing to assist with their child’s school work, however, Latina mothers often hold the belief that their assistance has little effect on the child’s academic success. In general, researchers feel that issues confronting Latin Americans academically are not related to culture or parental socialization, but instead have to do with the poverty, segregation, and discrimination that are negative consequences of immigration, resettlement, and resulting minority status.

Socioeconomic Status and Maternal Employment Biology, personality, and perceptions of role responsibilities constitute factors that influence parenting from the start. However, societal factors condition and channel beliefs and behaviors of parents as well. Family situation, social status, and culture for example encourage diverse patterns of parenting perceptions, styles, and practices. Parenting is influenced by family configuration, level of parental stress, marital relationships, and parents’ social networks, among other social-situational factors. SES affects many aspects of parenting styles and behavior. Mothers in different SES groups behave similarly in certain ways; however, there is considerable evidence to support the claim that parenting styles vary with SES. Parent–child relationships in middle-class families are characterized as being child centered, accepting, and egalitarian. Higher-SES mothers tend to exhibit warmth, are more involved in their child’s life, and value the child’s self-direction. Lower-SES families tend to be parent centered and focus on maintaining control, order, and obedience from children. Why does economic status have an effect on parenting styles? One prominent explanation is that low-income families, which lack economic resources, limit the quality and quantity of goods the family can provide their children. For example, low-income families have less money to buy cognitively stimulating educational toys and books that are beneficial to a child’s cognitive development. Moreover, poverty and economic insecurity negatively affect a parent’s mental health which may relate to unsupportive parenting sometimes exhibited by low-income parents. Having low SES is considered a risk factor in children’s development also on account of its detrimental effects on the quality of mother–infant interaction. Low-SES adversely affects mothers’ psychological functioning and promotes harsh or inconsistent disciplinary practices. Research shows that low-income parents are more likely to adhere to authoritarian and punitive parenting styles compared to middle-class parents. Additionally, as previously mentioned low-income parents are less likely to provide their children with cognitively stimulating educational activities at home. Lower-SES mothers


often think that it is a bad idea to spoil children and consequently are less warm and supportive toward them. Furthermore, low-income parents tend to be less receptive to their child’s needs and less likely to reward their child’s positive behavior. In extreme cases the lack of child-centered behavior could develop into child abuse or neglect, phenomena that are more prevalent in lowincome families. A related issue of interest is the effect a parent’s employment status has on parenting styles. Studies indicate a link between a mother’s employment status, the type of parenting style exhibited, and the child’s developmental outcomes. For example, having a mother with a job outside of the home is linked to a more authoritative style parenting. Furthermore, maternal mood has been found to be correlated with maternal employment status. Studies show that working mothers are less likely to suffer depression. In turn, this results in more successful academic and social outcomes for children, especially in the case of low-SES families.

Parental Education Another external factor that seems to affect parenting style is parental education level. Families with higher levels of parental education tend to be more authoritative and lower in authoritarian and permissive parenting. This finding is further supported in a study of exclusively African Americans that indicated that maternal education is correlated with child-centered parenting. Studies conducted in both Egypt and China replicated the finding that mothers with less education were less likely to exhibit authoritative parenting than mothers with more education. Additionally, mothers with low levels of education are more likely to use physical punishment to discipline their children, and they place more emphasis on conformity. However, mothers with higher levels of education have been linked to more supportive, child-centered parenting.

Parental Stress, Marital Problems, and Divorce Parental stress can have potentially damaging effects on parents’ attitudes and behaviors toward children. Parental stress can come in many forms such as financial troubles, lack of social support, or it can stem from problems within the marriage. Stressors adversely affect the general wellbeing and health of parents and demand attention and emotional energy from them. Parental stress can reduce parental participation, attentiveness, patience, and tolerance toward children and increase the use of punitive practices. This disruption in family functioning can negatively impact children’s social competence. Social support

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can improve parenting satisfaction, affecting the availability of mothers to their infants as well as the quality of mother–infant interactions. Well-supported mothers are less restrictive and punitive with their infants than are less well-supported mothers, and frequency of contacts with significant others improves the quality of parent–infant relationships as well as parents’ sense of their own effectance and competence. Marital problems affect more than just the individual’s own relationship; they can also compromise a person’s ability to be a good parent. For example, parents in unhappy marriages can become preoccupied with their marital problems leading them to detach emotionally from their children and become less engaged in their upbringing. Due to this preoccupation, parents may act overly lax and permissive, engendering a sense of rejection in children. Mothers and fathers who are dissatisfied with their marriages are more likely to exhibit authoritarian parenting styles. Also, parents who are depressed are more prone to have marital problems, and as a result, are less likely to be authoritative. The negative consequences of parental stress influence a parents’ well-being in addition to the wellbeing of a marriage and the parent–child relationship. Divorce changes a family dynamic in many ways including effects on parenting styles. Studies show that divorced parents are similar in parenting style based on their SES and level of education. For example, a divorced mother or father is more likely to be authoritative if she or he has higher levels of education and is middle-class. In many families of divorce, a child usually resides with only one parent. Having a noncustodial father can be difficult for children. However, research shows that the amount of time noncustodial fathers spend with their children is generally unrelated to child adjustment. Instead, the important factor is the quality of the father–child relationship. Having a close relationship with an authoritative nonresident father leads to better outcomes for the child than having a distant relationship with a nonauthoritative nonresident father. For example, children who have a close relationship with a nonresidential authoritative father have greater academic success and exhibit fewer externalizing and internalizing behaviors. However, having a father who is intermittently involved or infrequently visits the child can lead to a different type of father–child relationship. These fathers are often more permissive and take on a role as a recreational companion instead of that of teacher or disciplinarian.

Parental Depression Parental depression not only has detrimental effects on the parent’s own mental health but often negatively affects parenting as well. Depressed mothers demonstrate a style of interaction marked by intrusiveness, anger, irritation,

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and rough handling of their infants. Infants tend to respond to this style of parenting with gaze aversion and avoidance. Such feelings surely diminish responsiveness or discoordinate interactions, and so depressed parenting may have short- as well as long-term consequences for infants. Mothers with depression are more likely to exhibit authoritarian or indifferent parenting styles. Depressed mothers display limited amounts of nurturing and are less responsive to their child’s needs. Instead, depressed mothers tend to exhibit anger, retaliation, and ineffectively deal with problems. Often, parenting of depressed mothers is characterized by high levels of control, hostility, and punishment. Depressed parents often alternate coercive parenting tactics with lax attitudes sometimes to the point of indifference, anxiety, and guilt-induction. This inconsistent array of parenting behaviors can be confusing and difficult for a child to process. Depression is often characterized by increased negative social cognitions and negative attributions. For example, depressed mothers tend to say critical and unsupportive things to their children, and are more likely to admit to feeling disappointed in them. Research indicates that mothers with depression have an increased likelihood to label their preschool aged children’s problem behavior as internal and stable characteristics particular to the child instead of normative developmental issues for children of a given age. Depressed mothers are likely to endorse statements such as: ‘‘It’s my fault; I am responsible for all bad things that happen, it will always be that way.’’ Some research suggests that depressed parents’ negative attributions about their children’s behavior are associated with harsh parenting practices which potentially result in the development of psychological problems for the children. Through various socialization mechanisms, children’s mental health can be compromised by exposure to a depressed parent’s negative behavior and cognitions. Over the course of time, symptoms of depression, such as negative affect, self-criticism, and negative attributional style may develop in the child. Having a depressed parent can lead to problems in children’s cognitive, social, and emotional development. One possible reason for the child’s developmental problems is that depressed parents inadequately model social skills and productive coping strategies.

Effects of Parenting Styles/Behaviors on Infants and Children Each parenting style has a more or less unique set of effects on a child’s development. Research indicates, however, that the effects of parenting styles on child outcomes are not always consistent. The effect of parents on children cannot be examined in isolation; instead, it is important to recognize the influences of factors such as

culture, neighborhood, and SES have on parenting behaviors and childrearing. One issue that has become a major focus of parenting styles research is whether the positive effects of authoritative parenting are universal and transcend the boundaries of ethnicity, SES, and household composition. With some exceptions, the majority of research indicates that authoritative parenting leads to favorable child outcomes. This strong connection has been replicated in numerous studies taking into consideration factors such as geographical location, social stratum, and family structure. However, as previously discussed, more recent culturally sensitive research has shown that parenting styles may have different meanings in different cultures and the same definitions of parenting styles may not hold true in different cultures. We now turn to elaborate on the typical child outcomes associated with each parenting style.

Effects of Authoritative Parenting Style Experts contend that rearing a child in an authoritative home leads to favorable outcomes for European American children. Authoritative parents tend to rear children who are socially responsible, competent, self-assured, adaptive, creative, curious, independent, assertive, successful in school, friendly, cooperative with peers and parents, and generally happy. Furthermore, the authoritative parenting style leads to the development of mature moral reasoning, prosocial behavior, and high self-esteem. Children of authoritative parents exhibit low amounts of internalizing behaviors such as depression and anxiety and externalizing behaviors such as antisocial behavior and substance use. Another positive aspect of authoritative parenting is that over time these positive effects on adjustment continue to build. What about authoritative parenting leads to such positive outcomes for children? First, authoritative parents help the child to develop self-reliance by providing necessary controls that a developing child needs while still granting the child appropriate amounts of autonomy. Children of authoritative parents are better equipped to cope with life stresses and less likely to succumb to peer pressure, due to the competencies authoritative parents have instilled. Second, the reciprocal give-and-take dialog between authoritative parents and their children helps to promote intellectual development which is integral to the child gaining competence. In addition, reciprocal dialog fosters the development of social and cognitive skills that help children function successfully in environments outside the home. Another important aspect of authoritative families is that they incorporate the opinions of both children and parents during family discussions. Authoritative parents explain decisions, rules, or expectations they have to the child, enhancing the child’s understanding of social systems and social relationships. Furthermore, this knowledge facilitates development of the child’s


reasoning skills, moral judgment, and empathy. Also, the warmth, nurturance, and parental involvement authoritative parents provide create an environment in which a child identifies with and even admires the parents. This strong bond can render children more open to parental influence because they look up to the parents and respect their opinions. Additionally, as a result of sharing a warm and close mutually respectful relationship with their family, children tend to endorse similar attitudes and values to their parents. This has positive effects on socialization and friendship formation for the child. For example, children of authoritative parents tend to form bonds with others who have attitudes and values similar to those endorsed by their parents. Therefore, children of authoritative parents are more likely to have friends their parents approve of and are less likely to be involved in antisocial behavior compared to children reared in nonauthoritative homes. Authoritative parenting has proved to be the most advantageous for European American children’s academic achievement. More specifically, European American children reared in authoritative homes perform better in school, attend classes more regularly, are more engaged in the classroom, have higher expectations, and profess more positive academic self-concepts. Authoritative parents are successful at helping to improve their children’s academic performance even if children initially struggle academically. One reason authoritative parenting benefits academic achievement is that authoritative parents emphasize a healthy achievement orientation and intrinsic motivation toward learning. Children who learn because of intrinsic motivation gain pleasure from learning and mastering new material and concepts rather than being motivated by external rewards or punishment. Moreover, authoritative parents promote the development of the child’s work ethic by being less controlling and having more positive thoughts regarding the child’s academic achievement. Authoritative parents are often more engaged in their child’s other activities and have a better grasp of what goes on in their child’s life outside the family. Additionally, some common traits of authoritative parents also may affect a child’s achievement. For example, authoritative parents tend to be of higher SES, which alone correlates with higher achievement. Furthermore, they are likely to promote educational activities in the home environment, have higher academic achievement themselves, and tend to be brought up in families where their parents had higher levels of income and education than nonauthoritative parents. One can easily understand too why the reciprocal relations characteristic of authoritative parenting is ideal for a child’s transition across life’s stages. Gradual changes in family structure that are appropriate to the child’s developmental transitions give youngsters more age-appropriate independence and autonomy. Furthermore, later adjustments are smoother for an authoritative family because

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change is gradual and adapted to the child’s developmental needs throughout the child’s life. Additionally, the child’s own behavior may be a factor in fostering authoritative parenting styles. Children who exhibit favorable characteristics such as being responsible, confident, independent, curious, and open to sharing details of their life with parents will in turn draw out favorable responses from parents such as warm and authoritative parenting. For their part, children who exhibit less favorable characteristics such as aggression, dependence, or immaturity will tend to elicit more negative responses from their parents such as harsh or indifferent treatment. A reciprocal cycle is in motion in which an agreeable and mature child naturally elicits more authoritative parenting which results in the development of greater maturity and other positive qualities in the child.

Effects of the Authoritarian Parenting Style The effects of authoritarian parenting are less positive than an authoritative upbringing for European American youth. Children reared by authoritarian families tend to depend on their parents (especially girls), be more submissive, less socially adept, less confident, less intellectually curious, and less committed to achievement in comparison with children reared in authoritative homes. Furthermore, children reared by authoritarian parents often exhibit hostility and shyness toward peers and show higher levels of aggression. One positive effect of authoritarian parenting is that children often score reasonably well on school achievement and low on deviance measures. Later life transitions are often more difficult for children from authoritarian families whose parents interpret their child’s growing need for independence and autonomy as disobedient and disrespectful. As a result of having punitive and cold parents, children may rebel against their parents’ standards explicitly trying to exert greater autonomy and individuality. This rebellion does not indicate genuine emotional autonomy but instead attempts to express aggravation with authoritarian parents’ strictness, control, and lack of understanding. Additionally, it is important to note that there can be advantages of authoritarian parenting styles in some cultural and socioeconomic contexts. For example, authoritarian parenting can play an adaptive and protective role for children growing up in low-income and unsafe neighborhoods, as more restrictive parenting can keep children safe and away from harm. Also, in African American families, authoritarian parenting characteristics such as firm control and discipline (so called ‘no nonsense parenting’) are not perceived negatively, instead they are seen as signs of love, concern, and affection from caregivers. Advantages to

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authoritarian parenting are also seen in Asian American families. For example, strict control is thought of as a reflection of a parent’s dedication and concern for children and leads to traditionally desirable traits for children such as self-control, diligence, and self-confidence.

Effects of the Permissive Parenting Style The developmental outcomes for children reared in permissive homes are also more negative compared to those reared in authoritative homes for European American youth. These effects are somewhat universal and similarly affect children from various socioeconomic backgrounds and cultures. Children of permissive parents generally experience less academic success and have higher levels of drug and alcohol use. Children of permissive parents display a number of similar traits to children reared by authoritarian parents, for example, lack of assertiveness, greater dependency on parents, and lower levels of self-control. Despite the appearance that permissive and authoritarian parenting styles are opposites to each other, in actuality they share the common bond of minimizing opportunities for children to learn to cope with stress effectively. Authoritarian parents accomplish this by limiting autonomous decisions made by their child. Permissive parents do this by failing to implement standards for appropriate behavior, thereby granting their children freedom to behave in any manner they please. Consequently, children of permissive parents tend to be limited in their capacity to deal with difficult circumstances and may be unprepared to cope successfully with problems that arise normally in life. Additionally, children reared in permissive families are often immature, fail to control their impulses, and lack self-reliance. Studies show that parental permissiveness, indulgence, and lax supervision are associated with aggression in children. Such permissive behavior and attitudes on the part of parents could in fact legitimize the child’s aggressive behavior. As a result, aggressive children may continue to act out if their behavior seems to be accepted by their parents. Furthermore, high levels of parental punitiveness can further exacerbate externalizing problems and render a child more prone to aggression. A child from a permissive home reared in an environment lacking rules and guidelines may consequently find it difficult to adjust to societal rules during adulthood. With the lack of guidance from parents, children reared in permissive homes tend to rely on their peers (instead of parents) for guidance and emotional support. This is potentially problematic because the people they are turning to for advice and support are usually just as naive as the child seeking the advice. Without adequate guidance, children from permissive homes often become distanced from parents, and in turn become emotionally and

psychologically dependent on peers. Children from permissive families are increasingly likely to be influenced by peer pressure. Additionally, children reared in permissive homes are more likely to bully classmates. This phenomenon is most likely due to the fact that permissive parents fail to discourage their children from expressing negative and disrespectful behavior. The effects of permissive parenting tend to be stronger for boys than for girls. Some think that the increased impact on sons is due to society’s tendency to place fewer limits on boys’ behavior. Furthermore, boys who are highly impulsive and aggressive may wear out their parents and make their parents’ disciplinary efforts seem futile leading them to take a more lax and permissive approach to parenting.

Effects of the Indifferent Parenting Style A consistent finding is that indifferent parenting has the most detrimental long-term outcomes on children especially in the case of neglect and abuse. Research shows that by the age of 2 years, children of indifferent mothers already show clear signs of problematic attachment relationships and overall deficiencies in psychological, cognitive, and social development. Children reared by indifferent parents tend to be immature, irresponsible, impulsive, ineffective leaders, and also susceptible to peer pressure. Furthermore, they are more prone to exhibit internalizing and externalizing problems, and additionally may have sex and use alcohol and drugs at younger ages. Additionally, these children have difficulty achieving academically and fail to demonstrate social responsibility and social assertiveness. Indifferent parents do not provide children with adequate guidance; consequently, children fail to acquire knowledge about appropriate ways to behave. The detrimental effects of indifferent parenting continue to accumulate throughout life and are evident all the way through young adulthood. For example, young adults from indifferent families are more likely to be hedonistic, lack tolerance to frustration, and poorly control their emotions. Additionally, these young adults lack long-term goals, drink excessively, and are more likely to have criminal records. Other factors that could lead to indifferent parenting include poverty, mental illness, unemployment, marital distress, or other such factors causing parents to be too overwhelmed to be invested in parentina.

Parents in the Same Family Who Differ in Parenting Style In some families, the two parents may differ in their approach and attitudes toward parenting. What effect do two differing parenting styles have on the child’s

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development? Having parents with the same parenting style matters only in the case that the type of parenting exhibited is authoritative. If parents agree on the same style but are authoritarian, permissive, or indifferent, the child’s developmental outcomes tend to be less positive than they would be if at least one parent favors an authoritative style. Part of the problem of having parents differ in parenting style is that it leads to difficulty in coordination and cooperation in the childrearing process. For example, one parent could actively undermine and disparage the other parent. Also, one parent could become overly involved in the child’s life causing the other parent to withdraw and feel disconnected from the child. All of these conditions can engender disharmony and stress in a child’s life potentially leading to developmental problems. In contrast, if both parents display authoritative parenting styles, cooperation, and warmth, child outcomes are generally more positive and children show more prosocial behavior and peer competence.

Summary Authoritative, authoritarian, permissive, and indifferent parenting styles have varying effects on child development. The majority of research indicates that authoritative parenting leads to the most beneficial child outcomes for European Americans. In addition, an abundance of culturally sensitive research shows that parenting practices and behaviors carry different meanings in different cultures. Therefore, care must be exercised in drawing implications of different parenting styles based on narrow typological definitions. Parenting style research continues to expand as researchers study more in depth

parenting styles, differing effects on gender, and different cultural, economical, and geographical contexts.

Acknowledgments Preparation for this article was supported by the Intramural Research Program of the NIH, NICHD. See also: Attachment; Discipline and Compliance; Family Influences; Marital Relationship; Postpartum Depression, Effects on Infant; Routines; Social Interaction; Temperament.

Suggested Readings Baumrind D (1978) Parental disciplinary patterns and social competence in children. Youth and Society 9: 239–276. Baumrind D (1991) The influence of parenting style on adolescent competence and substance use. Journal of Early Adolescence 11(1): 56–95. Bornstein MH (2002) Handbook of Parenting, 2nd edn., vol. 1–5. Mahwah, NJ: Lawrence Erlbaum Associates, Inc. Darling N and Steinberg L (1993) Parenting style as context: An integrative model. Psychological Bulletin 113(3): 487–496. Maccoby EE and Martin JA (1983) Socialization in the context of the family: Parent–child interaction. In: Mussen PH (ed.) and Hetherington EM (vol. ed.) Handbook of Child Psychology: Vol. 4. Socialization, Personality, and Social Development, 4th edn., pp. 1–101. New York: Wiley.

Relevant Websites http://www.cfr.nichd.nih.gov – Child and Family Research. http://www.parentingscienceandpractice.com – Parenting: Science and Practice.

Play M Sumaroka and M H Bornstein, National Institutes of Health, Bethesda, MD, USA ã Published by Elsevier Inc.

Glossary Exploratory play – Play that is directed toward the tangible properties and functions of objects. Imaginary companion – Invisible vividly imagined characters that children play and talk with, while recognizing their unreality.

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Individual differences – Variability in development and behavior as the result of different biological, cognitive, social, and environmental factors. Interpersonal play – Direct, interactive social involvement with other participants in play with the purpose of entertainment. Object play – Play that focuses on objects and events.

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Primary circular reactions – Activities repeated for their own sake. Security of attachment – A relationship between caregiver and child characterized by mutual trust. Symbolic (pretend) play – Make-believe activities, in which children create symbolic uses of objects, pretend roles, and scenes.

Introduction Play is important to children’s lives and stimulates their development in many ways. There are two main categories of play: interpersonal and object play. Interpersonal play implies participation in social interactions, such as face-to-face routines, social games, and physical play. Object play involves exploration and concentration on a toy, its functions and properties. Each kind of play contributes to psychological growth (e.g., children learn to control and express emotions); cognitive maturation (e.g., they develop creative abilities); mastery (e.g., they learn to concentrate and elongate attention span); social (e.g., they understand behaviors and feelings of others), communicative (e.g., they acquire social skills), and cultural (e.g., they rehearse traditional roles and behaviors) development. Particular types of play depend on many factors, among which are developmental capabilities of the child, play partners, and context. Children’s abilities change through the course of development, allowing parents to initiate more complex games. For example, 2–3-month-old infants are mostly entertained by repeating simple body activities, such as repeatedly kicking their legs. By 4 months of age, infants are capable of manipulating and exploring objects. When infants reach 1 year, they become interested in physical characteristics of objects (e.g., color, texture, and shape). In the second year of life, children develop symbolism and pretense in play. They start to substitute objects for one another and imitate actions and situations, at first centering pretense on themselves and, later, involving others and objects. Children’s evolving sophistication of play reflects their progression in cognitive functions, such as representation, perception, language, and attention. Many psychologists and philosophers have studied play and its influence on the development of children. Among the main theories of play are: surplus energy theory, relaxation and recreation theory, practice theory, and recapitulation theory. Psychologist have also suggested that play helps children to rehearse certain survival skills, has anxietyrelieving qualities, and fosters psychosexual development. Researchers have related play to social, cognitive, therapeutic, and emotional functions in the child.

Development of play is often stimulated by parents and other partners who initiate and participate in child play. Play partners differ in many aspects. For example, mothers usually focus on object play, developing children’s visual, language, and representational abilities, whereas fathers are prone to initiate physical play, stimulating motor and communication skills; peers and siblings tend to involve children in pretend play and stimulate social competence. Along with play partners, children’s gender also influences their types and kinds of play. From birth, children are traditionally offered different toys, infants’ rooms are often decorated in ‘gender appropriate’ colors, and parents are more permissive during play with boys and more directive in playing with girls. Around 4–5 years of age children start to choose certain gender-segregated types of play and toys and prefer playmates of their own gender, which can be explained by biological, cognitive, and social-learning theories. Societies around the world have different understandings of the role of play and play partners. Many cultures regard play as an exclusively children’s activity and parents do not participate in play. In other cultures parents may by the first and main play partners for their infants and, usually, initiate play and direct it as participants. Through play, cultures rehearse social role behaviors, introducing expected duties and responsibilities.

Types and Functions of Play Play is practically synonymous with childhood. Play seems to be children’s primary and most enjoyable activity, and it is a prevalent form of children’s interactions with parents, siblings, and peers. It is usually associated with joyful and fun pastimes for children of all ages, yet play is also a very important force in child development, because it incorporates cognitive, social, emotional, and motivational skills. Therefore, play is a broadly beneficial activity that transcends simple enjoyment. There are no specific activities ascribed to play because it can take numerous forms, and any activity might be identified as ‘play’ when it meets the criteria of certain types and functions. Play is acknowledged to be complex and resists definition by any single characteristic or set of actions. Types of Play There are two main types of play that are evident from infancy: interpersonal (dyadic) forms of play and objectfocused (extradyadic) engagements. These types of play are distinguished according to identifiable characteristics. Each type of play demonstrates patterned developmental change, serves unique functions, and is meaningful in child development. Throughout development, many changes occur in types of play as well as in their frequency of occurrence.

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Interpersonal play

Interpersonal play is a social activity that appears to be prevalent during the first few years of life and has the goal of having fun. It requires direct interaction of the participants and is normally characterized by high degrees of pleasure derived by both parties. Interpersonal play involves various dyadic exchanges, such as face-to-face interactions, social games or routines, and physical play. Face-to-face interactions balance repetitive bouts and creative variations of shared affect; they are framed as playful through specific vocalizations or gestures within the stream of ongoing parent–child communication. This type of play has mainly affective characteristics, and parents seem to engage in it with the goal of teaching infants to enjoy interpersonal interactions. Imitation is a typical component of face-to-face play interactions. Face-to-face play often occurs at home during other task-oriented activities (e.g., mothers engage into face-to-face interactions while feeding or changing the baby). Face-to-face play is typical of early infancy and decreases in frequency and duration as infants reach their first birthday. Although face-to-face play is common in early infancy, interpersonal play is not confined to this period. When faceto face interactions decrease in occurrence, parents and children begin to get involved in social games and routines, such as peek-a-boo and pat-a-cake. The unstated goal of these social routines is to teach the child set formats of social exchange and their variations, as well as to try on different roles and take progressively greater responsibility. The role of parents is usually to facilitate the game, and the child’s role often involves motor behaviors that are meaningful within the context of a particular game. Physical play is another prevalent form of interpersonal play which occurs most frequently between 1 and 4 years of age. Research distinguishes among three types of physical play: rhythmic stereotypies, exercise, and rough-and-tumble play. Rhythmic stereotypies are usually a solitary form of play that emerges during the first year of life and includes gross motor movements. Onset of exercise play starts at the end of the first year and includes motor behaviors in the context of play. Exercise play can be solitary or interpersonal. Roughand-tumble play peaks in the preschool years. It includes kicking, wrestling, and pushing in the friendly context of play. Rough-and-tumble play can escalate in levels of aggression; thus, parents must teach children the acceptable limits of rough-and-tumble physical play and explain how to maintain friendly interactions to control their behaviors. Object play

At the age when children begin to notice objects, mothers adjust their playful interactions from interpersonal to extradyadic, focusing attention outwards from the dyad toward objects in the environment. Thus, strictly interpersonal interactions moderate in complexity to match newly developing skills in the child.

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Parental direct involvement in child object play is usually less active, and characterized by less mutual engagement than interpersonal play, because the child is often preoccupied with toys. At the time children begin to focus on objects, parents actively promote and encourage such attention by showing new objects and demonstrating the functions and properties of objects, thus encouraging children to explore and learn about their surroundings. Functions of Play Play serves various adaptive functions. It also contributes to several different developmental areas: psychological, cognitive, mastery, social, communication, and cultural. Through the psychological functions of play, children learn to control their state of arousal, develop self-regulation capacities, resolve conflicts, and address traumas. Appropriate stimulation also helps children to develop self-regulation capacities. Play enables children to experience a broad range of feelings and emotions, from fun and enjoyment to anger and sadness. Parents are the best play partners for children in terms of intensifying and prolonging their pleasure in the first few months of life. From the beginning of life, parents support babies’ experience of joy by playing with facial expressions, vocalizations, and touch, and evoking gaze, smiles, and laughter from their infants. During the course of typical face-to-face interaction games, mothers build and repeat predictable sequences of actions and vary them based on their infant’s response. The infant’s growing awareness of contingency in these interactions adds to feelings of mastery, in addition to enabling greater tolerance for higher arousal states. Parental selective imitation of infant behavior also enables infants to mark important acts as meaningful, thereby reinforcing certain behaviors to and facilitating mutual understanding. Object play gives parents and children an opportunity to share their joys and frustrations while exploring objects, and struggling to accomplish goal-directed activities. During object play, parents devote much more time to talking about children’s inner states and emotional expressions. These activities later help children verbally label their emotions as well as correctly link their inner states to emotional expressions. Children experience and express a wide range of emotions such as joy and sadness, fear and excitement, or pleasure and anger. Play can be a unique platform for experiencing certain emotions, for example, aggression and anger that are caused by behaviors that might not be safe or appropriate to display otherwise. During interpersonal play, children also have an opportunity to ‘practice’ particular life events in a playful nonthreatening manner. A well-known example is the peek-a-boo game that gives the infant a chance to experience and control emotions related to separation and reunion. By representing traumas and conflicts symbolically through play,

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children can release forbidden impulses and also test alternative outcomes and solutions in conflict resolution. The cognitive functions of play are to receive and exchange information, develop skills and representational abilities, and engage in creative and divergent thinking. In infancy, caregivers use play to foster speech-like sounds and babbling, thus stimulating child language development. Joint play advances communication between child and caregiver, and parent–child object play adds opportunities for children to expand their lexicon, learning new names for objects, their qualities, and effects they can produce. Language use in child–parent play depends on the toys presented and settings of play, however; parents’ speech toward children varies if they are playing with dolls, vehicles, or shape-sorters. When playing with dolls, parents tend to talk more and use a greater variety of words, ask questions, and name and label objects and contexts. By contrast, when play involves shape-sorters, parents tend to give directions and use attention-stimulating techniques. Play with vehicles produces the least amount of parent–child communication; parental vocalizations involve mostly pretend noises and imaginative sounds. Different play contexts also provide children with different opportunities for language acquisition. Caregivers direct children’s attention to objects in the environment, encouraging them to explore, and later practice new skills. Both exploratory and pretend types of play promote flexibility, creativity, and divergent thinking in children. New behaviors and skills help children to combine actions and objects in novel ways, promoting mental flexibility. For example, imaginary play is linked to creative performance and problem solving. It stimulates the development of representational thinking by allowing children to reflect on the past and anticipate the future using language and gestures. Joint play with caregivers brings the quality of children’s play to a new level. During play with a caregiver, children are expected to (and often do) exhibit higher levels of play (more sophisticated pretense and symbolism) than when playing alone. Empirical evidence shows that children’s play with parents is more sophisticated, complex, diverse, frequent, and sustained than is their solitary play. Higher complexity of parent–child play is believed to advance children’s abilities. The functions of play that enhance mastery cultivate a sense of self-efficacy, motivation, and persistence toward goal achievement. Over the course of the first 2 years of life, children practice new skills and engage in multipart tasks in playing with objects. During this time parents offer essential support – first, by focusing children’s attention; next, by sustaining children’s attention; and finally, by fostering mastery motivation on structured tasks. Mothers who encourage their 2-month-olds to orient and explore objects in the environment have infants who explore objects more at 5 months. Additionally, parents’ stimulation and responsiveness to infants at 6 months is

associated with infant persistence on problem-solving tasks at 13 months. Parents’ achievements in supporting persistence and efficacy in children’s goal-directed behaviors are attributable to their responsiveness to children’s initiatives, accuracy in assessing children’s need for help, and effectiveness in assistance. Mothers who encourage and physically aid or coach their 18-month-olds when playing, have children who persist on structured tasks. Through joint play, parents can help children find different, innovative uses of objects thus helping children to think ‘outside the box’ and develop their imagination. For example, while engaged in symbolic play, parents often make objects and toys perform different roles, shifting among different imagined or real scenarios and situations. When parents give children opportunities to play freely with materials, they enhance innovative uses of objects, flexible approaches to problem-solving tasks, and more divergent thinking on tasks. Development of attachment between children and parents also affects children’s mastery capacities. Research links security of attachment to exploration. Security allows children to explore more, while in turn, exploration promotes competence. Play sophistication is associated with a longer attention span and greater persistence in problem-solving. Curiosity motivates children to explore the world, and pretend play enables them to master novel and complex environments in small scale. The social functions of play create a base for future successful interactions and relationships by fostering children’s understanding of others’ feelings, intentions, and perspectives. During play, children practice reciprocal patterns of communication. Positive emotional exchanges in game rituals with parents, and later, with siblings and peers, allow children to achieve greater levels of joy than they might on their own. Role-playing, in particular, is associated with the ability to accept multiple points of view. Shifting between pretense and reality enhances children’s ability to compare and contrast various perspectives, which is positively associated with social competence. In the social domain, play supports the development of mutual accordance and adjustment, or attunement, and it provides a foundation for more advanced forms of social understanding. Parent–child object play has been linked to the later quality of childrens’ relationships with peers. For example, mothers’ involvement in symbolic play with children between 2 and 4 years predicts their peer competence at 5 years. Children’s play with their parents serves as a foundation for enhanced competence with peers, once peer interactions become prevalent in children’s lives. Some forms of interpersonal play serve as a medium through which children learn norms, rules, and limits that are acceptable in society. Through games and rituals, children learn the limitations and boundaries of their behavior, first, within the family and, later, with

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peers. Games like peek-a-boo and pat-a-cake translate culturally appropriate elements of social interaction and set the stage for learning rule-bound conventional behaviors. Play helps children to develop their communication skills. Through playful interactions, children learn key elements of social exchange, such as engaging a partner’s attention, turn-taking, terminating social encounters, and role-reciprocity. Through face-to-face play, children learn to frame certain social exchanges as playful as well as to discern meaningful acts, and read certain expectations within a particular social interaction. Sometimes face-toface interactions do not go smoothly; sometimes a mother may vary her vocalizations or movements too quickly and thus lose the child’s attention. It is important that both partners remain attuned to each other. Through mutual involvement, face-to-face play allows parents and children to establish, maintain, and construct their relationship on the basis of common expectations, and vocalizations in play allow creative variation in interpersonal exchanges. Play serves a variety of cultural functions, by embodying accepted social roles and values. Through cultureappropriate play, children learn local norms of behavior and are exposed to cultural traditions. Expectations about the roles of different individuals within a society start with the notion of who is an appropriate play partner. In some cultures, it is considered inappropriate for parents to play with children. Thus, Mexican, Guatemalan, and Indonesian parents typically avoid participating in play with their children. In other cultures, such as Turkish and American, parents think of themselves as good play partners for their children. The cultural functions of play begin early in life. For example, when playing with their infants, Japanese mothers more often direct attention to themselves, whereas American mothers encourage attention to objects in the environment. When the child gets older, Japanese mothers more often involve their toddlers in ‘other-directed’ interpersonal pretense play, whereas American mothers more often encourage their toddlers to engage in independent object play. In this way, Japanese mothers foster generally allocentric collectivist values in play which are typical of their culture, whereas American mothers foster generally idiocentric individualist values which are typical of theirs. Toys are cultural objects that children learn to play with in particular and culturally appropriate ways. Through participating in complex play, caregivers demonstrate traditional ways of object use. For example, when a mother models a telephone conversation during pretend play, she first dials the number, waits for a response, and only then begins to talk. If, while imitating the telephone conversation, the child forgets to dial the number, or mistakes the order of action, the mother may adjust child’s actions, thus teaching the correct way of play. Parent–child object play is also a medium through which children practice real-life scenarios (e.g., doctor–patient, mother–baby). Children’s

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knowledge of cultural activities also contributes to the structure of parent–child play. When children play with familiar toys, they are more likely to facilitate pretend play, while parents serve as an audience. In contrast, when novel toys are used in the course of parent–child play, parents are more likely to start and organize the pretense.

The Developmental Progression of Play Play develops with the child. It begins as inspection and manipulation and moves gradually to symbolism and pretense. For the first 2–3 months of the child’s life, objects in the environment are not very important for play purposes. According to Jean Piaget, during this time infants engage in ‘primary circular reactions’ – activities repeated for their own sake. For example, infants may coo repeatedly or open and close their fingers repetitively, suck their thumbs, or blow bubbles; while lying awake, they may arch their backs and drop their bodies onto the mattress over and over again. Around 4 months of age, infants develop skills to manipulate objects, but even then, they are more interested in the actions they can perform than in any object characteristics. Thus, babies may look at a toy in their field of vision, but when holding an object in their hands they bring it to their mouth rather than visually study it. Even when two objects appear related to one another – a cup and a spoon, for instance – the infant often still focuses on actions, banging the spoon in the cup rather than on the objects. Remove the spoon, and the infant is likely to continue the action. A major change in complexity and quality of play occurs when infants approach the end of the first year. At about this time, infants engage in three different types of exploratory play: functional, relational, and functional–relational. When infants are involved in functional play, they play with toys in the way the toys were designed to be played with, like rolling a car on its wheels. In the course of relational play, infants bring together two unrelated toys (e.g., a car and a cup) with no signs of pretense. In functional–relational play, children bring two objects together and use them in the meaningful way (e.g., load a container with blocks). Thus, first-year play is predominantly characterized by sensorimotor manipulation. In their play infants explore the environment around them, deriving information about objects: their properties, physical characteristics, functions, and effects. Because children’s activities are tied to the physical properties of objects, rather than being representational, this type of play is called exploratory or nonsymbolic. In the course of development of exploratory play, infants first direct their actions and attention toward a single object and later incorporate several objects in

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their play. Initially these objects may be treated inappropriately with respect to function, and only later children learn to treat them appropriately. For example, during the first months children may mouth a cup, but when they get a little older they may bang a spoon and a cup. Only later with age does the child use a cup and spoon appropriately, by stirring the spoon inside the cup. Until the second year of life there are few signs of pretense or symbolism in children’s play. Pretense requires representational skills. Because representational skills only slowly emerge, pretend play does likewise. Additionally, object substitution emerges as a clear indicator of more advanced symbolic play. When the young child builds a tower out of blocks, the tower now means more to the child than the characteristics of the blocks themselves. This suggests that there are two distinct kinds of representations reflected in object substitutions: primary representations and metarepresentations. Primary representations reflect tangible properties of objects (their shape, color, substance). Thus, objects can be used for different purposes. Younger children tend to restrict object substitutions according to perceptual features, such as shape and color. The child can talk on the toy telephone, utilize a cloth as a toy blanket, or pretend a red ball is an apple. Older children are able to use metarepresentations – representations of objects in unusual ways, independent of their physical characteristics. Thus a banana can be a telephone, and blocks can be served as pastries. When pretend play first emerges, children tend to engage into self-directed pretense, centering pretense on their own bodies and actions. Children may pretend to be asleep, to eat from toy tableware, to read a book, or to talk on a toy telephone. Older children ‘decenter’ pretense by involving not only themselves but surrounding objects in pretend actions. They can make a doll read a book or make a set of buttons to go for a walk as if they were people. Even after the advent of decentration, play becomes more elaborate, when children combine sequences of pretend actions into a coherent scenario and make pretend plans for the future, such as hosting tea parties, cooking dinners, taking dolls to school, and going to work. Thus, in the second year, children’s play actions take on more of a nonliteral quality. The goal of play now appears to be symbolic or representational. Play becomes increasingly generative, as children enact activities performed by self, others, and objects in simple pretense scenarios, pretending to drive toy cars, eat from empty plates, or talk on toy telephones. Symbolic or pretend play also follows a sequence in development. At first symbolic play is selfdirected, later it begins to include pretense schemes that apply to others. In the same way, single-scheme pretense appears before multischeme pretense. Finally, pretense with substitution objects develops. This developmental progression of play is a generalized version of the sequential changes in representation that

take place in early childhood. The majority of children follow this developmental pattern, although there are also wide individual differences in the rates of children achieving each level of development and in the quality of each level of achievement.

Play and Other Related Functions Engaging in play requires the activation of different cognitive factors such as attention focus and mental representation. Thus, play, especially solitary play with objects, often serves as a mirror of cognition. Infants’ perceptual exploration of objects facilitates the development of representation. While playing with an object, rotating, banging, mouthing, or squeezing it, a child receives different perceptual experiences that relate to the same object. As the central nervous system develops, cognitive processing grows, and children are exposed to novel situations that allow them to experience the presence and absence of objects. Children express their interest in the temporary absence and presence of objects or others by engaging in peek-a-boo games or intentionally dropping objects. These experiences extend perceptions in the developing child gradually promoting the distinction between perceptual experiences that rely on focal sensorimotor attention and representational experiences that transcend the here and now. Children’s representational play is a platform for this distinction. In parallel with their growing play sophistication, infants exhibit tremendous development in related areas of cognition. Thus, the growth of language and engaging in pretend-play scenarios during the second year of life, both reflect the development and increasing sophistication of children’s representational capacities. In the domain of language, for example, children begin to understand and produce sound sequences that function as true naming as they shift away from the context – ‘restricted’ use of words and phrases to more ‘flexible’ uses across contexts. At the same time, their attention span becomes longer and more controlled. Children can coordinate and focus their attention, disregarding extraneous distractions. Pretense play appears to have least two independent components – play that is associated with language as well as play that is associated with attention. The two reflect different underlying mental capacities. Advances in play and language go together. Children who perform well in one domain of development usually do well in the other. Apparently, language and pretense play share a representational nature. In language, as in pretend play, objects, people, and actions are represented symbolically. In contrast to this association between language and play, children’s play competence is separately associated with their attention span. The mastery motivation side of play provides an explanation of the association between play and attention. Motivation to master the environment often results in

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sustained periods of object exploration, or attention focus, and thereby increased competence. Some theories suggest that ability to stay on task is necessary to bring play to higher levels of sophistication. Over the first 2 years, children regulate their visual attention and gradually move from nonsymbolic to symbolic play.

A Short History of Research on Play Play is a part of the child’s daily life in every society. Many philosophers and psychologists have been interested in child play, tried to define it, explain the reasons that motivate children to engage in play, and discuss the benefits and outcomes of play for children. Early theories of play tended to divide into four groupings based on function: 1. Surplus energy theory. Charles D. Spencer argued that there is a universal need for people to engage in mental and physical activities. Because young children do not have responsibilities, they expend their surplus energy through play. 2. Relaxation and recreation theory. Moritz Lazarus suggested that work exhausts people mentally and physically, and sleep and rest are insufficient to recover. To achieve full recreation (‘re-creation’), people need to engage in actions unrelated to real life and released from the constraints of work. 3. Practice theory. Karl Groos opined that a period of immaturity is specifically designed for complex organisms to practice skills that are necessary for survival during adulthood. 4. Recapitulation theory. Luther Gulick and Granville Stanley Hall considered play to be a cathartic factor in child development. Play constitutes an outlet for certain instincts and, by weakening them, enables children to acquire more complex behaviors of adults in society. Many theorists have addressed other specific aspects of the development of play. For example, William Stern suggested that gender-specific games, such as girls playing with dolls and boys play-fighting, foster maternal instincts in women and aggressive instincts in men, respectively. Lili Peller linked the evolution of child play to progression in psychosexual development. Sigmund Freud suggested that the purpose of play is wish-fulfillment released from the constraints of reality. Karl A. Menninger emphasized the anxiety-reducing benefits of play. Among the most influential child psychologists of play are Erik Erikson, Lev Vygotsky, and Jean Piaget. Erikson thought of play as a way children work through tensions; he advanced the use of play for therapeutic purposes. Piaget viewed play as a tool for cognitive assimilation. Vygotsky argued that caregivers serve as important play partners who help to shape child play in its social context.

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Contemporary theorists consider play to have more than instinctual and psychoanalytic functions, but also include normative emotional, cognitive, communicative, social, and cultural functions.

Play in Relation to Play Partners, Gender, and Culture Children’s growth and development are shaped by various biological, cognitive, and social factors. Play, among other developmental processes, is strongly influenced by these aspects. It varies across families, genders, and cultures. To understand child play, it is often crucial to determine the child’s playmates, the gender of the child, and where the play occurs. Play and Play Partners Early theorists tended to focus on children’s solitary play. Vygotsky changed the way the child’s playmates were viewed, by introducing the notion that child play is shaped by the context of social interactions. Although play emerges from the child, adults provide the play environment and objects used in play, inducing and stimulating play. Children often initiate pretend play, but they also complete play scenarios begun by others as well as imitate the play they see. Collaborative play interactions are believed to advance play sophistication in children, bringing the child to higher levels of development. Various play partners stimulate the development of play, and they do so in different ways. It is difficult to underestimate parental contributions to children’s cognitive development through play. At all ages, mothers are more effective than other play partners in controlling and regulating emotional arousal in play and by providing appropriate stimulation. Mothers who are more knowledgeable about play are likely to prompt their children to play at more sophisticated levels than mothers who are less knowledgeable. Generally, mothers are more likely to initiate symbolic play than nonsymbolic play with their toddlers and remain involved until the pretend scenario is completed. Depending on their children’s capabilities and age, mothers take different roles in pretend scenes, sometimes facilitating the game and sometimes participating as audience. Children actively seek maternal involvement in pretend play, thus indicating their understanding of symbolic play as a joint activity. In addition, maternal initiation of symbolic play predicts the quantity of children’s engagement in symbolic play and maternal responsiveness to child play predicts the quality of later child play. Child’s gender influences the style of maternal play. Thus, mothers of girls tend to direct their daughters’ behavior during the course of play, more than do mothers of boys, who direct them less and let

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them explore more. As play partners, mothers and children seem to adjust to one another, each bringing the play level of one close to the play level of the other. Multiple studies have shown the importance of father’s involvement as a playmate in infancy and childhood. While in general, fathers participate in caregiving less than mothers do, fathers tend to spend more of ‘together time’ playing with their infant. The ways in which fathers play with their children during the course of development differ consistently from the ways that mothers do. Different styles of play encourage development of various skills and abilities in infants and children. For example, fathers usually engage in physical games, such as lifting and bouncing, while mothers prefer educational, visual games, most of the time involving toys. During object play, mothers follow infants’ gaze, notice changes of attention from one object to another, and let infants explore and choose objects of interest; fathers, in contrast, change infants’ attention by initiating physical play. Fathers’ engagement in physical play is most frequent in toddlerhood and gradually declines after that. Even with the decreased engagement in physical play, father’s participation is significantly higher than mother’s participation in physical games. Through late childhood fathers remain frequent partners in outdoor activities, trips, and the like. Both mothers and fathers respond appropriately to the changes in their children’s abilities, by switching to more complex play patterns. Parental knowledge about play development is an important factor in fostering interactions with children. Aside from parents, siblings and peers are also effective play partners for children and impact social and gendertyped roles of the society by engaging in culturally appropriate, and eschewing inappropriate, play behaviors. After the first year, play interactions with siblings and peers increase in prevalence and may be more intense than those with parents. Parents and siblings stimulate cognitive skills differently through play, often with different outcomes. Parents use play as a tool for learning and communicating knowledge about the real world, whereas siblings and peers often ‘play for play’s sake’. Like adults, older siblings have more competence and are capable of bringing child play to more sophisticated levels. Peers share similar developmental achievements; therefore, they relate to each other more as equals, without necessarily creating an intellectual hierarchy. Aside from peers and siblings, older children often have imaginary companions – invisible individuals that are invented and vividly imagined. Even though children pretend to talk or play with imaginary companions, they usually acknowledge that imaginary companions are not real. More girls than boys are known to have experiences with imaginary companions. In the beginning of the last century, these experiences were thought to indicate

mental and developmental deviations and were strongly discouraged. In the middle and at the end of the last century, scientists assumed that children with experiences of imaginary companions grow to be more creative than children without such experiences. Recent findings disprove that notion, suggesting that there is no difference in creativity in children who have an imaginary companion compared to those who do not have such experiences. Gender Segregation of Play Around their fourth or fifth birthday, children’s play becomes remarkably gender-segregated in terms of preferred toys, playmates, and play styles. Girls prefer to play with girls; they are less interested in rough, outdoor play, but are more interested in playing with dolls. Boys play with other boys, prefer cars and constructors, and enjoy rough, outdoor games. If one looks at toys that boys and girls choose and ask to buy, children tend to ask for more gender-stereotyped toys than their parents tend to choose. While they both may request clothing, sports equipment, and educational toys, boys usually desire action figures and toy vehicles, and girls ask for dolls and toy household items. Biological, cognitive, and social-learning theories have been marshaled to explain this phenomenon. The biological perspective includes hormonal theories. It holds that sex-typed behaviors develop due to the influence of hormones (especially androgens), during critical stages of development. Because of hormonal changes in the brain, sex-typed behaviors are altered. Differences in levels of prenatal androgens contribute to observed sex-typed behaviors such as toy choices. For example, androgenized girls (girls exposed to high prenatal levels of male hormones) prefer typical boys’ toys over girls’ toys. The cognitive perspective invokes gender constancy and the gender schema concept to explain gender-specific play. Gender constancy refers to children’s understanding of belonging to a certain gender identity group and this identity does not change with time, social settings, or appearance. When children achieve gender constancy, they develop skills to categorize behaviors in terms of being male or female (gender schema). These schemas influence subsequent sex-typed behaviors. For example, when a girl categorizes cooking as an example of female behavior, she will more likely play with kitchen-sets than with a tool kit. According to the social-learning perspective, children’s gender play behaviors develop as a result of social–environmental influences. Traditional views on childrearing cause different treatment of children based on their gender, thus different sex-typed behaviors are reinforced. Adults fill infants’ cribs with toys that are considered to be gender-appropriate to the child. Older children imitate sex-typed behaviors of caregivers and other adults; appropriate sex-type behaviors are later

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encouraged by parents and peers through positive and negative responses. Same-sex play is supported by peers who see it as appropriate, while crossgender play does not usually elicit positive responses. Observational learning contributes the development of gender-segregated play as well. While playing ‘house’, for example, girls pretend to do dishes imitating mothers, and boys emulate fathers by pretending to fix appliances. When they play with different toys, children acquire different play experiences and thereby develop different skills and abilities. Traditional boys’ toys, such as constructors and action figures, stimulate sustained attention, creative thinking, and fantasy play that is centered on constructiveness, social pretense, and competitiveness. Because many of boys’ toys, such as electric trains and radio-controlled cars, can move on their own, they may stimulate visual tracking and spatial skills. Girls’ toys, such as dolls, dolls’ accessory packs, and tea sets, stimulate nurturance and fantasy play that centers on domestic life. Girls’ toys are usually more colorful and appealing than boys’ toys, but often are less mobile. In general, instructions and accessories for dolls point to what can be done to the doll (e.g., groom it, put on make-up, dress up), whereas directions and accessories for action figures advise what can be done with the toy (e.g., fight with weapon). Certain categories of toys are played with equally by both boys and girls. Gender-neutral toys, such as play-doh, slinkies, and doctor kits, promote artistic and creative abilities. Gender-neutral toys change across time and culture. Contemporary girls play with sports equipment as much as boys do, but several decades ago most sports toys were considered to be boy toys only. In the countries of the former USSR, most physicians were women; thus, doctor kits were considered a strongly feminine toy, whereas in the US they are seen as masculine or gender-neutral. When toys are rated from strongly gender-stereotyped to gender-neutral, violence emerges as a feature associated with masculine toys (e.g., weapons, toy soldiers, and certain video games); use of such toys is also associated with aggressiveness in pretense play. Toys and accessories, such as perfumes and make-up, are believed to focus girls on the value of physical attractiveness. Moderately gender-stereotyped and gender-neutral toys (e.g., books, puzzles) tend to have higher educational value and to stimulate development of cognitive skills. Play and Culture The vast majority of research on developmental milestones, individual variation, and parent–child interactions in play has been conducted by Western researchers among families in the West. This monocultural tradition imposes limitations on the findings and extant theories of play. Characteristics of growth and development that appear universal can turn out to be culturally specific and vice versa.

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Even though virtually all children around the world may engage in prevalent types of play, parental involvement in play differs across cultures. In some cultures, especially in hunting-and-gathering and agricultural village ones, play is regarded as mainly an amusing child activity. Children tend to find play partners among their peers rather than among adult caregivers (e.g., Mayan and the native peoples of the Americas). Parents do not practice direct teaching through play, rather they assist and direct children in group play with their siblings or peers. In contrast, other cultures view parental participation in play as an important developmental activity. In these cultures (e.g., North America), parents are the first and main play partners of children during the first years of life. This is often due to the widespread belief that children learn through play, and that play helps to develop cognitive, social, motor, and affective skills. Parents in different countries hold different attitudes toward stimulating children’s play. European and North American cultures traditionally encourage independence and autonomy, whereas Asian, South American, and African societies tend to emphasize interdependence and obedience to elders. For example, during mother–child pretend object play, US American children engage in more complex play, when mothers encourage their children’s independent activity and praise them. By contrast, Japanese children respond with more complex pretend play when their mothers lead and direct joint activities. In many cultures, interpersonal play is viewed as an activity through which parents and children strengthen their attachment and learn to exchange emotions in shared experiences. In these cultures, interpersonal play is a usual daily interaction. Interpersonal play can be also affected by child-care arrangements and everyday cultural practices. For example, in many traditional cultures, mothers use devices such as slings to carry infants and free their hands for work; this practice eventuates in less opportunity for face-to-face interpersonal play. Rather than engaging in face-to-face play interactions, these mothers structure interpersonal games that involve a third person; their own role is to direct the infant’s gaze toward others. These examples show that even though interpersonal games between parents and children are rare in some cultures, infants still engage in games with partners other than parents. Those interactions enable children to master modes of communication appropriate to their culture. For example, the Gusii of southwestern Kenya avoid eye-to-eye contact during social interactions. This behavior derives from cultural superstitions about the possible dangers of visual contact. Even though mothers provide children with sufficient physical contact, they tend to restrain playful interactions and avoid eye-to-eye gaze. Gusii infants are viewed as incapable of interpersonal interactions; although mothers respond to infants’ needs and demands, they do not engage them in play nor do they

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facilitate interactions. However, when specifically asked to perform face-to-face interactions, Gusii mothers and infants resemble Western dyads in many ways. Nonetheless, the dynamics of their interactions differ. Their duration of playful interchanges is shorter, and their interactions do not revolve around peaks of stimulation and affect arousal. This dynamic might be the result of different cultural beliefs. Gusii parents might view their role as protecting the child from overexcitement and distress rather than as being a source or partner of playful stimulation. In play, cultural settings cannot be underestimated: they constitute means of play forms and organize children’s experiences, provide rules and information to construct knowledge about the society, and teach appropriate roles and behaviors.

Summary Play is a complex activity that is described best according to its types and functions. Different types of play, such as interpersonal play and object play, contribute to psychological, cognitive, and mastery in addition to social, communication, and cultural development. Types of play develop gradually with the growth of child. The infant first engages in exploratory play and progresses to symbolic play. This progression serves as an indicator of cognitive development of the child: advances in play are correlated with progress in mental representations, attention, and language acquisition. Play develops in the context of gender and culture. Toy preferences of boys and girls differ due to biological, cognitive, and social factors; play partners vary by culture due to different cultural attitudes toward play and appropriate play partners.

Acknowledgment Preparation of this article was supported by the Intramural Research Program of the NIH, NICHD. See also: Attachment; Friends and Peers; Gender: Awareness, Identity, and Stereotyping; Imitation and Modeling; Social and Emotional Development Theories; Social Interaction; Vygotsky’s Sociocultural Theory.

Suggested Readings Blakemore Owen JE and Centers RE (2005) Characteristics of boys’ and girls’ toys. Sex Roles 53: 619–633. Bornstein MH (2007) On the significance of social relationships in the development of children’s earliest symbolic play: An ecological perspective. In: Go¨nçu¨ A and Gaskins S (eds.) Play and Development: Evolutionary, Sociocultural, and Functional Perspectives, pp. 101–129. Mahwah, NJ: Lawrence Erlbaum Associates. Bornstein MH and O’Reilly AW (eds.) (1993) The Role of Play in the Development of Thought. San Francisco: Jossey-Bass. Pasterski VL, Geffner ME, Brain C, Hindmarsh P, Brook C, and Hines M (2005) Prenatal hormones and postnatal socialization by parents as determinants of male-typical toy play in girls with congenital adrenal hyperplasia. Child Development 76: 265–278. Pellegrini AD and Smith PK (1998) Physical activity play: The nature and function of a neglected aspect of playing. Child Development 69: 577–598. Piaget J (1983) Piaget’s Theory. In: Kessen W and Mussen PH (eds.) Handbook of Child Psychology: Vol. 1. History, Theory, and Methods, 4th edn., vol. 1, pp. 103–128. New York: Wiley. Rubin KH, Fein GG, and Vandenberg B (1983) Play. In: Mussen PH and Hetherington EM (eds.) Handbook of Child Psychology: Vol. 1. Socialization, Personality, and Social Development, 4th edn., vol. 1, pp. 752–833. New York: Wiley. Tamis-LeMonda CS, Uzˇgiris ICˇ, and Bornstein MH (2002) Play in parent–child interactions. In: Bornstein MH (ed.) Handbook of Parenting, 2nd edn., vol. 5, pp. 221–241. Mahwah, NJ: Lawrence Erlbaum Associates.

Postpartum Depression, Effects on Infant D M Teti and N Towe-Goodman, The Pennsylvania State University, University Park, PA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Comorbid – Term used by diagnosticians to describe an illness or condition that coexists with another illness or condition (e.g., depression is frequently comorbid with anxiety). Depressogenic – A term describing an event or process that may be causal in the development of depression.

Goodness-of-fit – The quality of the ‘match’ or ‘fit’ between the characteristics of an individual and the environment. This term is frequently used to describe the quality of fit between infant characteristics (e.g., temperament, gender) and personality attributes of a parent. Theoretically, the better the fit, the better the adaptation of the parent and infant to each other and, in turn, the child’s adaptation to the wider world.


Infant–mother attachment classifications – Infant–parent attachments are based on a scoring system developed by Mary Ainsworth and Mary Main for infants between 12 and 18 months, with particular attention to infant behavior during infant–mother reunions in the Strange Situation. Secure infants typically greet the parent, approach the parent to achieve contact, soothe quickly after contact is achieved, and are eventually able to resume toy play. Insecure-avoidant infants do not greet and conspicuously avoid the parent following reunion and appear to prefer toy play to achieving contact with or interacting with the parent. Insecure ambivalent/ resistant infants overtly express anger toward the parent during reunions and have great difficulty soothing and returning to toy play. Insecuredisorganized infants appear to lack a coherent strategy in gaining access to the parent and show fear and/or confusion in response to the parent’s during reunions. Major depressive disorder (MDD) – As defined by the American Psychiatric Association’s Diagnostic and Statistical Manual – 4th edition (DSM-IV), a diagnosis given for a single major depressive episode (nonrecurrent), or for multiple episodes (recurrent). MDD should be distinguished from other mood disorders that have depressive features but whose cause can be traced to a medical condition, substance use, dementia, or psychosocial stressor, or whose patterning of depressive symptoms cannot be clearly linked to the postpartum period (e.g., bipolar disorder or dysthymia). Major depressive episode – A period of at least two consecutive weeks of depressed mood or loss of interest or enjoyment in most activities, accompanied by at least four of the following symptoms lasting 2 weeks or longer: loss of energy; difficulties in concentrating, thinking, or making decisions; a change in weight, appetite, psychomotor activity, or sleep; feelings of worthlessness or guilt; and recurrent thoughts of death or suicide, or suicide plans or attempts. Maternal self-efficacy – Mother’s beliefs or judgments about their competency in the parental role. Depressed mothers commonly report feeling less efficacious in the parenting role than do nondepressed mothers. Negative affective bias – The tendency of depressed individuals to view oneself, others, or events in a negative or pessimistic light. Depressed women tend to hold negative cognitions about their children and themselves, which may impact their behavior in the parenting role.

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Postpartum – Of, or pertaining to, the period of time, typically the first year, following an infant’s birth. Still face paradigm – An observational procedure composed of three 2 min phases: (1) free play phase – the caregiver engages the child in face-to-face play, talking and engaging the infant in a playful manner; (2) still face phase – the caregiver is instructed to maintain a flat or emotionally neutral facial expression (a ‘still face’) and does not respond to the infant in any way; (3) free play ‘reunion’ phase – the caregiver re-engages the infant in face-to-face play. Strange situation procedure – A 21 min procedure, conducted in a laboratory playroom with toys, developed by Mary Ainsworth to assess quality of infant–parent attachment. The procedure enables one to observe infant behavior in the presence of the parent and a (typically) female stranger during a series of separations from and reunions with each. The pattern of infant behavior is then classified into one of four attachment categories (see above). Transactional perspective – A conceptualization of development in which individual development is viewed as a dynamic process in which individual and environment mutually and reciprocally influence each other over time.

Introduction Depression is particularly common among women of childbearing age, and approximately 13% of women can be expected to experience at least one bout of significant depression during the early postpartum period. Postpartum depression is similar in symptom profile to depressions that occur at other points in life. It is characterized by sadness or an inability to experience pleasure, accompanied by several additional symptoms, including negative cognitions (poor self-worth, perceptions of failure, guilt, and/or suicidal thoughts), somatic dysfunction (loss of appetite, sleep disturbance, fatigue), and impairment in daily functioning (e.g., inability to make decisions and to work effectively). The American Psychiatric Association’s Diagnostic and Statistical Manual – 4th edition (DSM-IV) identifies a major depressive episode in terms of the symptom profile outlined above, which persists for at least a 2-week period. A DSM-IV diagnosis of major depressive disorder (MDD) may be given for a single major depressive episode, or for multiple, recurring episodes, and should not be confused with other mood disorders

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that have depressive features but whose etiology can be traced to a medical condition, substance use, dementia, or psychosocial stressor, or whose patterning of depressive symptoms cannot be clearly linked to the postpartum period (e.g., bipolar disorder or dysthymia). Postpartum depression is also not to be confused with the ‘postpartum blues’, a mild depressive condition that occurs early in the postpartum period, is not associated with significant impairment, and resolves quickly. Some postpartum depressions can also be accompanied by psychotic symptoms, such as hallucinations, delusions, and excessive psychomotor disturbances. Psychotic postpartum depressions are rare, however, and most discussions of postpartum depression are with reference to nonpsychotic depression. Postpartum depression can have insidious effects on the mother and her family. Because of its high prevalence rate, it has become a major public health concern. Prevalence estimates vary as a function of the nature of the assessment and the window of time during which assessment takes place. Depressive symptoms can be assessed either through self-report questionnaire assessments, or by more formal clinical interviews. Self-report assessments include such well-known measures as the Beck Depression Inventory, the Center for Epidemiological Studies – Depression Scale, and the Hamilton Rating Scale for Depression, each of which taps the frequency and severity of such symptoms and provides overall score cut points that, when exceeded, identify individuals with clinical levels of symptom severity. Clinical interviews, by contrast, use a more comprehensive interview format to inquire about current and past symptoms of depression that can be used to diagnose a depressive disorder, past or present. Not surprisingly, prevalence rates of postpartum depression are somewhat lower when comprehensive clinical interview assessments are used than when mothers are asked to complete self-report questionnaires. The effects of postpartum depression are broad-based, with consequences not only for individual functioning but also for the quality of the mother’s relationships with other family members. Marital discord in families with depressed mothers is common, as are troubled relationships between the depressed mother and her children. Indeed, children of depressed mothers are at significant risk for maladjustment and cognitive delays. Infants of depressed mothers are more likely than are infants of nondepressed mothers to be fussy, irritable, or withdrawn, to deploy attention ineffectively and manifest developmental delays in significant cognitive milestones such as object permanence, and are at risk to become insecurely attached to their mothers. Among older children of depressed mothers, rates of psychiatric disorder are as much as four to five times those among their same-aged counterparts of nondepressed mothers. Although maternal depression appears to predispose children to become

depressed, these children are also at elevated risk for the full spectrum of externalizing disorders, including oppositional-defiant disorder and conduct disorder. Not surprisingly, these children are also at risk for poor academic performance, and for difficulties in interpersonal relationships, depressive and anxiety disorders, substance abuse, and delinquency over the long term. Mechanisms for the transmission of psychopathology from depressed parent to child are poorly understood. Depression appears to be at least partially heritable, which may account in part for the elevated psychiatric risk status among children of depressed women. Other biologically based influences may also be at work. Recurrent bouts of significant depression among women are common. It is not unusual that women suffering from postpartum depression have experienced depressive episodes during pregnancy and pre-pregnancy. Interestingly, infants born to mothers suffering prepartum depression manifest a biochemical profile (i.e., levels of cortisol, catecholamines, and serotonin) that is similar to that of their mothers, but different from infants born to nondepressed mothers. The potential impact of genetically and biologically based factors on the psychiatric risk status of children of depressed women has been given relatively short shrift among researchers who study parental depression and its effects. We will return to this point later. Most research examining mechanisms of transmission of psychopathology from depressed parent to child has focused on the kinds of environments depressed parents create for their children, and the impact such environments have on the developing child’s interpersonal, cognitive, and emotional life. Depressed mothers indeed create pathogenic child-rearing environments to which even very young (3–4 months old) infants are reactive. Importantly, the degree to which maternal depression singly influences child outcomes, however, depends on the chronicity and severity of the mothers’ illness. A single, isolated, nonrecurrent bout of major depression, albeit debilitating to the mother while it occurs, is much less likely to affect children’s adjustment over the long term than is chronic, severe depression, involving multiple, recurrent bouts of depression during the early postpartum period and beyond. Unfortunately, a woman who experiences postpartum depression is likely to experience at least one additional depressive episode sometime during her child’s first 5 years of life. Also important to note is that depression is more likely to occur under adverse environmental circumstances, such as poverty and single parenthood, and it may also be but one feature of a broader spectrum of psychiatric symptoms. It is common to find, for example, that depression is comorbid with anxiety, and that depression, broadly speaking, is a salient feature of a variety of other psychiatric disorders. Interestingly, recent research


suggests that depression that is chronic and severe may be comorbid with some personality disorders, as outlined in DSM-IV, axis II diagnoses. Indeed, some have proposed that chronic, severe depression is almost always comorbid with personality disorder, and that the depression is a by-product of the significantly impaired interpersonal relationships, problems in living, and emotional volatility that characterize personality disorders. This has raised significant concerns about whether chronic, severe depression without features of personality disorder can be distinguished from the effects of personality disorder alone. The ability to address these concerns rests on whether mothers with recurrent MDD that is not comorbid with an axis II disorder can be identified and compared, in terms of features of the mother–child relationship and child developmental outcomes, with mothers whose recurrent depression is paired with personality disorder. Most research to date has not systematically addressed the effects of maternal depression with vs. without comorbidity with other psychiatric problems.

Depressed Women as Parents Depressed Mothers’ Cognitions Because cognitive distortions feature so saliently in depression, we begin a discussion of depressed mothering with a focus on what is known about depressed mothers’ thoughts about themselves as parents and their thoughts about their children. Put simply, depressed women hold decidedly negative cognitions about their children and themselves. Depressed mothers are more likely than are nondepressed mothers to perceive themselves as inadequate parents, and to enjoy parenting less. Depressed mothers are also more likely to view their children negatively, in terms of their overall social competence and adjustment. Because children of depressed mothers are indeed at risk for maladjustment, it is unclear if depressed mothers’ negative views of their children are accurate, or if they represent depression-induced cognitive distortions. Some studies suggest that the difference between depressed and nondepressed mothers’ perceptions of their children is not based on the negative affective bias associated with depression, but on the tendency of nondepressed mothers to be more positive about their children than is actually warranted (i.e., a ‘positive affective bias’). Indeed, when depressed and nondepressed women’s perceptions of their children were compared with perceptions obtained from nonfamilial sources such as teachers, there is some evidence of greater concordance between depressed mothers’ perceptions and teacher perceptions of the same children than between nondepressed mothers’ and teachers’ perceptions. However, because of depressed women’s tendency to dwell on and exaggerate problems of all types, it is likely that depressed

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mothers’ negative perceptions of their children are in part driven by a negative affective bias, the strength of which is probably directly proportional to the severity of their depressive symptoms. It is reasonable to expect that a depressed mother’s tendency to dwell on the negative, or to perceive a perfectly normal, developmentally appropriate behavior or accomplishment as problematic, may have its own impact on a developing child’s emotional well-being. A child whose mother repeatedly labels her/him in negative terms is likely, at the least, to be at risk for low self-esteem, and possibly for a host of internalizing and externalizing problems. The negative affect and negative cognitions that define depression, however, are intimately tied to action tendencies. It is thus not surprising that depression takes a toll on the quality of mother–child interactions. The symptoms associated with depression challenge the ability of mothers to interact with their children in a developmentally supportive manner, and many studies now available describe depressed mothering as noncontingent and unresponsive, irritable and intrusive, insensitive, asynchronous, and incompetent. Difficulties observed in depressed mothering may stem from deficiencies in the depressed mother’s awareness and interpretation of her child’s behavior (i.e., a ‘signal detection’ deficiency). For example, a depressed mother’s rumination and selfabsorption can influence her attention to and awareness of her children’s needs and social signals, and can also interfere with her ability to process social information efficiently and accurately. Her negative affective bias may create tendencies to misinterpret child behavior, and depressed mothers may be inclined to attribute negative intentions and motives to their children’s behavior. Further, a depressed mothers’ own need for support and comfort may lead her to expect more support and comfort from her child than the child is able to provide. Parenting difficulties among depressed mothers may also stem from the general slowing effect depressed affect has upon one’s capability and motivation to act. Lack of energy and indecisiveness are hallmark features of depression, which in turn would be expected to influence a mother’s motivation to respond promptly and contingently to child signals that she does comprehend. Thus, the problems observed in depressed parenting may arise from the debilitating effect depression has on mothers’ capacities for processing social information (awareness and interpretation of child cues), and from the dampening effect of depression on a mother’s capacity and motivation to respond contingently. Depressed Mother–Infant Interactions In infancy, the emotional climate of parent–child interactions may be particularly important for the development of self-regulation, secure attachments, and the promotion of

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other social and emotional competencies. Unfortunately, the disturbances associated with depression have a clear impact on the emotional quality of early mother–child interactions. Depressed mothers interact less with their infants, are less aware of their infants’ signals, and are less contingently responsive to their infants’ bids for attention. The joint attention, shared positive affect, and appropriate scaffolding that characterizes warm, nurturant parent–child relationships are often missing in depressed mother– infant dyads. Further, depressed mothers show less emotional availability and affection toward their infants, display less pleasure and positive emotion during interactions, and express more negative affect overall. Some depressed mothers may alternate between being disengaged and then overly stimulating, the latter of which can be so intrusive that they appear disorganizing to the infant. In turn, their infants’ behavior is conspicuously devoid of positive affect, and is also characteristically high in distress or protest, unresponsiveness to maternal bids, avoidance, and withdrawal, and this behavior sometimes generalizes to other, nondepressed adults. The infant’s distress and unresponsiveness in turn may increase the mother’s feelings of inadequacy or rejection, thus creating a vicious cycle of negative, dysregulated affect in the mother–infant relationship. Experimental evidence underscores the premise that depressed mothers’ emotional unavailability and lack of responsiveness is emotionally dysregulating to infants. In 1978, Edward Tronick and colleagues developed the still face paradigm, a procedure that requires mothers to mimic the flat affect and unresponsive behavior commonly seen in depressed mothers. The procedure is composed of three very brief episodes: In the first episode, the mother engages the child in face-to-face play, talking and engaging the infant in a playful manner; in the second episode, the mother is instructed to maintain a flat or emotionally neutral facial expression (a ‘still face’) and does not respond to the infant in any way; and in the final ‘reunion’ episode, the mother re-engages the infant in face-to-face play. Infants of nondepressed mothers are typically very positive and engaged during the face-toface play, but show a heightened level of arousal and distress to their mothers’ sudden emotional unavailability and unresponsiveness during the still face. Typical reactions on the part of the child include attempts to re-engage the mother through smiling, vocalizations, or fussing, and distressed facial expressions such as frowns or grimaces. Infants may use a variety of methods to try to regulate their discomfort during the still face, such as turning their head away from the mother and averting their gaze, or engaging in self-soothing behaviors such as sucking on their thumb. The effects of the still face often linger even when the mother re-engages the infant, with infants often continuing to show distress afterwards. Research with the

still face paradigm demonstrates that even very young infants (i.e., as young as 3 months of age) are emotionally attuned to maternal affect and can become emotionally dysregulated when mothers’ normally positive affect is withdrawn. Interestingly, when the still face procedure is conducted with depressed mothers and their infants, clear differences emerge between these dyads and nondepressed mother–infant dyads. First, when the mother is depressed, there is less distinction in the behavior of both the child and the mother across the three episodes. There are often less shared positive emotions during faceto-face play, with more neutral affect and withdrawn behavior in both the mother and infant. Second, during the still face phase, infants of depressed mothers show less active attempts at regaining their mothers’ attention than do infants of nondepressed mothers. Instead, infants of depressed mothers become more quiet and withdrawn, and devote more energy toward self-comforting or distraction. Such behavior has led some to suggest that the still face episode is similar to the normative behavior of the depressed mother, and that infants of depressed mothers are more likely to make attempts at managing their distress without maternal assistance. The inability of infants to gain comfort and support from their mothers when distressed may have serious consequences for the formation of secure attachments, as well as in the development of healthy strategies for regulating emotions. Tronick’s work with the still face paradigm prompted the development of his ‘mutual regulation model’ as an integrative framework for understanding how mother and infant affective states become mutually and reciprocally regulatory. Among typical, nondepressed mothers with very young infants, mothers’ use of contingently responsive, positive affect during interactions with their infants significantly exceeds their use of negative affect. Maternal positive affect in turn elicits similarly positive affective responses (smiles, coos, laughs) from the infant, and both mothers and infants find each others’ positive affective signals to be mutually rewarding and reinforcing. Over time, mutually reciprocal positive affect predominates in interactions between nondepressed mothers, which carries developmental benefits for the infant’s socioemotional development over the long term. By contrast, mutually reciprocal, negative affect predominates in interactions between depressed mothers and their infants. Depressed mothers may be unresponsive to or critical of their infants’ behavior and social cues, leading their infants in turn to withdraw and become distressed. Depressed mothers’ lack of sufficient use of contingently responsive positive affect may render them less capable than nondepressed mothers to soothe their infants when distressed (indeed, depressed mothers’ negative affect may be, in many instances, the cause of their infants’


distress). The infants in turn may become dysphoric and overly reliant on self-soothing and self-stimulatory behaviors to regulate their negative emotions, placing them at risk for psychopathology. Depressed Mothering and Infant–Mother Attachments Attachment theory would predict that depressed mothers’ interactional difficulties with their infants, if prolonged, will predispose infants to become insecurely attached. Indeed, maternal sensitivity during infancy, which can be defined as an empathic awareness of and appropriate responsiveness to infant needs and social cues, is taken by attachment theory as the single most important predictor of attachment security in infancy. Research that has examined linkages between maternal depression and infant–mother attachment security typically employs the Ainsworth Strange Situation procedure, a brief, 21–24 min seven-episode procedure used for infants between 12 and 18 months of age. The procedure, which almost always takes place in a small room that is novel to the infant, puts the infant through a series of 3 min episodes of separations and reunions with the mother, a (typically) female stranger, and one episode in which the infant is alone. Specific attention is given to the infant’s behavior during the two Strange Situation reunion episodes with the mother. Secure infants typically greet the mother during infant–mother reunions, approach the mother and seek her out for comfort (if the infant experiences separation distress), and are ultimately able to return to toy play and exploring their environment in the mothers’ presence. Sensitive mothering during the infant’s first year would be expected to promote secure infant–mother attachments, which, as many studies now attest, predicts healthy adjustment in the preschool years and beyond in terms of empathic awareness, child compliance, and peer relations. Insecure-avoidant infants, by contrast, typically do not greet the mother during reunions. They do not approach the mother except in the context of toy play, and it is not uncommon for insecure-avoidant infants to prefer to play with toys rather than interact with their mothers. Maternal insensitivity characterized by intrusiveness and rejection would be expected to predict insecure-avoidant infant– mother attachments, which some attachment theorists propose is developed as a defense against maternal rejection. Insecure-ambivalent/resistant infants direct overt expressions of anger toward their mothers during reunions and typically do not soothe in response to maternal attempts to do so. Mothering characterized by unresponsiveness and/or inconsistency in responsiveness would be expected to predict insecure-ambivalent (resistant) infant–mother attachments. Both insecure-avoidant and insecure-ambivalent/resistant attachments, albeit not

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adaptive to the infant over the long term, are viewed as ‘strategies’ the child has developed to maintain access to the attachment figure (the mother) in times of stress. Insecure-avoidant infants learn not to seek out their mothers because doing so in the past has led to rejection. Thus, they employ a ‘close, but not too close’ strategy to maintain some degree of proximity to the mother. Insecure-ambivalent/resistant infants have learned that overt expressions of anger and prolonged distress is ‘what works’ to keep their mothers focused on them. This strategy, although maladaptive to their development over the long run, is functional in the short term to maintain access to their mothers. Both insecure-avoidance and insecureresistant/ambivalent infants are at risk for difficulties in later mother–child relationships and peer relationships, compared to secure infants. Elevations in insecure infant–mother attachments (i.e., insecure-avoidant and insecure-ambivalent resistant attachments) have been reported in several studies of depressed mother–infant dyads. Further, when mothers’ depression is chronic and severe over the infant’s first year, infants are at risk for developing insecure-disorganized attachment to their mothers, which some attachment theorists cite as the most insecure of all of the insecure attachment classifications. Unlike the insecure-avoidant and insecure ambivalent attachment patterns, which appear to be governed by clear-cut strategies (albeit not ideal) for accessing the attachment figure, insecure-disorganized attachment is identified by conspicuous absence of a clear-cut strategy. Disorganized attachment is instead hallmarked by fear and confusion about how to access the attachment figure (the mother) at times when it is in the infant’s best interests to do so. In the Strange Situation, insecure-disorganized infants are identified by any of a variety of behavior patterns signifying fear and/or confusion during the infant–mother reunion episodes. For example, disorganization is identified when the infant manifests clear-cut expressions of fear (e.g., infant brings hand to mouth and has a fearful expression) of the mother when she enters the room to begin the reunion episode. It is also identified when the infant freezes or stills in the mother’s presence for a substantial period of time, or when the infant, upon approaching the mother, repeatedly veers away from her. These are but a few of a variety of indicators of disorganized attachment, all of which reflect a state of fear or confusion about how to access the attachment figure in times of stress. Rates of disorganized infant–mother attachment are found to be elevated among infants of alcoholic parents, substance abusing parents, and parents with significant psychopathology. Of the three insecure infant–parent attachment classifications, children identified as insecure-disorganized are at highest risk for the development of behavior problems in the preschool years.

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Attachment theory proposes that, over time, children develop working models of relationships that spawn from their early attachments with their caregivers, models that are carried forward and applied in subsequent relationships. Such models can be thought of as a set of affectively laden cognitions or expectations about relationships that develop as a result of repeated interactions with attachment figures and that guide behavior and the processing of social information. Attachment theory predicts that children with secure working models develop expectations that their caregivers will be appropriately responsive to them when needed, and such children in turn come to believe that they are worthy of love and support. Such expectations are consistent with a history of sensitive, responsive caregiving. Children who develop insecure working models, by contrast, do not expect their caregivers to be appropriately responsive, and insecure working models may serve as a foundation for low selfworth. Importantly, attachment theory also proposes that children internalize not just the child’s role in their early attachment relationships, but the role of the parent as well, and that they are likely to carry forward and enact the parent’s side in subsequent relationships with others. Indeed, it is the development of these working models that provides the theoretical link between the insecure attachment patterns infants develop to their depressed mothers and the adjustment problems these children present later in development. It is important to emphasize, however, that the link between maternal depression and insecure infant–mother attachment is most clear when mothers’ depression during the infants’ first year is prolonged. A single maternal depressive episode during the postpartum period that resolves and does not recur is unlikely to have long-term negative effects on security of infant–mother attachment, nor on other aspects of infant and preschool-child functioning. Depressed Mother–Toddler Relationships Emergent social, emotional, and cognitive capabilities in the toddler years create new opportunities for change and growth, but may also place new demands on the depressed mother. Although the affective connection between the toddler and mother is clearly still important, the inability to appropriately structure and build upon the child’s activities may be especially damaging during this developmental period. Depressed mothers are less able to follow the child’s interests or facilitate joint attention, making mutual engagement in activities challenging. Further, depressed mothers’ lack of verbal communication and reduced responsiveness in interactions with their toddlers may impact the acquisition of linguistic and cognitive skills, important developmental tasks during this time. Similar to the difficulties seen in infancy, depressed

mothers often display sad, anxious, or irritable affect with their toddlers, and their interactions lack the shared positive affect and coordination of their nondepressed counterparts. In turn, their children appear to have difficulty regulating negative emotions, showing less positive emotions and more frequent depressed, anxious, or angry behavior. Toddlers’ growing desire to assert their independence often increases parent–child conflict during this period, and depressed mothers may be less able to provide the gentle guidance and limit setting necessary to successfully negotiate these conflicts. Some mothers experiencing depression are more likely to avoid confrontation with their toddlers, expressing fears over their child’s willful behavior and their inability to assert appropriate authority. Conversely, some mothers experiencing depression resort to harsh discipline, showing greater hostility toward their children and utilizing more physical punishment than their nondepressed counterparts. Maternal feelings of helplessness and lack of control over their children’s behavior increases the likelihood that they will employ coercive or punitive tactics in disciplinary encounters. In fact, maternal depression may be considered a risk factor for physical abuse and maltreatment of young children. In either case, these ineffective socialization techniques employed by depressed mothers are often met with dysfunctional behavior on the part of the toddler. In some cases, children of depressed mothers show more frequent defiance, hostility, aggression, and externalizing behavior. Alternatively, the toddlers of depressed mothers may show more depressed affect and withdrawal themselves, as well as helplessness in the face of challenges. Notably, the behavior of these toddlers often matches that of their mother, such that the affect and symptoms of the mother are mirrored in her child’s actions. Interestingly, disorganized attachment in infancy is predictive of two rather sophisticated yet very maladaptive preschool behavior patterns directed toward the mother, and both of these patterns have been linked to chronic maternal depression. One of these patterns is characterized by the child’s repeated attempts to take care of and nurture the mother (i.e., a role-reversing ‘caregiving’ pattern). Such a pattern, on the surface, does not present with any outward signs of trouble or hostility between the child and mother. However, a role-reversed caregiving pattern that develops in a child at such an early developmental stage has been identified by some as representing attempts on the part of the child to repair a damaged relationship, with consequences for the child’s emotional well-being. Insecure-disorganized infant–mother attachment is also associated with a second maladaptive preschool behavior pattern, characterized by repeated, overt attempts by the child to embarrass and


punish the mother. These ‘coercive’ child behavior patterns are thought to develop in response to a caregiving history characterized by unresponsiveness and inconsistency, perhaps particularly in the area of appropriate limit-setting. The coercive and caregiving preschool patterns may be different manifestations of an overarching ‘controlling’ strategy of accessing mothers in times of stress. Not surprisingly, these caregiving and coercive patterns have straightforward links to child behavior problems.

Maternal Depression and Child Outcomes in Middle Childhood and Adolescence There tend to be fewer studies of the effects of maternal depression on developmental outcomes of school-aged children and adolescents, but the data that are available indicate that such children are at high risk for depression, anxiety disorder, conduct disorder, delinquency, attention deficits, and academic failure. Similar to younger children with depressed mothers, interactional difficulties are common between children of depressed mothers and their parents, with withdrawal, poor limit setting, and criticism being central features of depressed mothering for children in this age range. School-aged children and adolescents develop stable representations of themselves in relation to others, and they are more likely than are children of nondepressed mothers to develop negative attributional styles and low self-worth. Peer relations may also suffer, with children of depressed mothers being more likely to suffer peer isolation, loneliness, and rejection. It is not uncommon for teachers of children of depressed mothers to rate them as being more aggressive and disruptive, in comparison to children of nondepressed mothers.

Individual Differences in Depressed Mother–Child Relationships and Child Outcomes Despite the well-documented associations between postpartum depression and difficulties within the mother–child relationship, it is important to emphasize that problematic interactions are not seen in all cases in which the mother is experiencing depression. Further, the association between maternal depression and relationship disturbances is less clear in samples that are not also considered ‘at risk’ due to factors such as poverty or high interparental conflict. Some mothers experiencing depression appear quite normative in their interactions with their infants, and environmental

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sources of stress or support may play a large role in altering the effects of depression on the mother–child relationship. Although postpartum depression is clearly a risk factor, the numerous individual differences in the way postpartum depression may impact parent–child interactions should not be overlooked. The Role of Maternal Self-Efficacy One important source of individual differences in depressed mothering may be variations encountered in maternal self-efficacy, or a mother’s beliefs in her own competencies as a parent. Maternal self-efficacy is a construct that has grown out of Albert Bandura’s socialcognitive theory. Bandura defines self-efficacy as a set of beliefs or judgments about one’s competency at a particular task or setting. Self-efficacy beliefs are viewed as the final common pathway in predicting the degree of effort one expends to succeed at a particular task. Selfefficacious individuals are strongly motivated to marshal whatever resources (personal, social, economic, etc.) that are available to them to succeed at a given task. Selfinefficacious individuals, by contrast, are likely to give up prematurely, despite the fact that success may be within reach. Whereas the strongest predictor of self-efficacy is the degree of prior success at that task, self-efficacy beliefs are also sensitive to social persuasion, vicarious experiences (e.g., modeling), and affective state. Given the link between self-efficacy and affect, it is not surprising that depressed mothers feel less efficacious in the parenting role than do nondepressed mothers. At the same time, social-cognitive theory would predict that maternal self-efficacy should also be sensitive to support for their mothering provided by intimate support figures (social persuasion), by previous learning experiences about mothering by watching other competent mothers (modeling), and by mothers’ perceptions of how ‘easy’ or ‘difficult’ their infants are to care for (perceptions of infant temperament, which should be linked with mothers’ histories of prior successes and failures with the infant). Thus, variation in maternal self-efficacy is not a simple, direct function of variations in maternal depression, but also of variations in other social influences in the environment. Self-efficacy theory would also predict, however, that any influences of mothers’ affective state, social persuasion, or prior experiences with their infants on parenting should be mediated by maternal self-efficacy, which is the final common pathway in the prediction of behavioral competence. Douglas Teti and Donna Gelfand tested this hypothesis in 1991 in a study of 86 mothers (48 with clinical depression, and 38 nondepressed) of first-year infants. Maternal self-efficacy was assessed with a scale developed by the authors that tapped mothers’ self-efficacy beliefs in

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nine parental domains relevant to mothering an infant in the first year of life (e.g., soothing, maintaining infant attention, diapering, feeding, changing), with a tenth item asking mothers to report on their overall feelings of competence in the mothering role. Ratings of mothers’ behavioral competence (e.g., sensitivity, warmth, disengagement) with their infants were conducted from observations of feeding and free play by ‘blind’, highly reliable observers. Standard, well-established measures were used to assess severity of maternal depressive symptoms, social marital supports, and infant temperament. As predicted, mothers’ parenting efficacy beliefs were negatively associated with maternal depressive symptoms and perceptions of infant temperament, such that mothers felt less efficacious in the maternal role when they were more depressed and when they perceived their infants as more difficult. Mothers’ self-efficacy beliefs, by contrast, were positively associated with perceived quality of social-marital supports and with observer judgments of maternal behavioral competence with their infants. In addition, as expected, mothers’ behavioral competence was significantly related to perceptions of infant temperamental difficulty (negatively) and with social–marital supports (positively). Importantly, maternal self-efficacy beliefs continued to predict maternal behavioral competence even after maternal depressive symptoms, social–marital supports, and infant temperamental difficulty were statistically controlled. Further, when maternal self-efficacy was statistically controlled, the linkages between maternal behavioral competence and maternal depression, infant temperament, and social–marital supports were substantially reduced in magnitude. Taken together, these findings identified maternal self-efficacy beliefs as a central mediator of relations between mothers’ behavioral competence with their infants and the severity of maternal depressive symptoms, perceptions of infant temperamental difficulty, and social–marital supports. These findings indicate that depression is more likely to debilitate parenting quality when maternal self-efficacy is also compromised. This is likely to be the case in many depressed mothers because of the strong linkage between affective state and self-efficacy beliefs. However, maternal self-efficacy is also sensitive to infant temperament and social–marital supports, and thus it is possible for depressed mothers to have more positive self-efficacy beliefs about parenting, and in turn to parent more effectively, when their infants are temperamentally easy and when they receive consistent encouragement from intimate support figures. Conversely, the combination of significant depression and difficult infant temperament and/ or inadequate social–marital supports may be particularly devastating in their joint effects on maternal self-efficacy beliefs. In their 1991 study, Teti and Gelfand found this to be the case when examining the single vs. joint

impact of maternal depression and infant temperamental difficulty on mothers’ parenting efficacy beliefs. Maternal self-efficacy was much more compromised among mothers who had high levels of depressive symptoms and who also perceived their infants to be difficult. Further, the joint ‘impact’ of severe maternal depression and infant temperamental difficulty on maternal self-efficacy was significantly greater than what would have been expected from an additive model of effects. Maternal Depression in Transactional Perspective Interestingly, studies that examine the impact of maternal depression in the context of other risk and resilience factors are not common. The dearth of such research is surprising, given that developmental scientists now embrace the spirit of the Transactional Model of development, articulated by Arnold Sameroff over 30 years ago. This model posits that development is a complex function of ongoing, mutually occurring influences between the child and the environment, such that, at any given point in time, one must take into account the impact of the environment on the child as well as the impact of the child on the environment in order to understand individual differences in developmental trajectories. The Transactional Model is a vast conceptual improvement over the more static ‘main effects’ models, which purport to predict development on the basis of knowledge of a single environmental event or child characteristic measured at a specific point in time, and over ‘interactional models’, which improves upon main effects models by taking into joint consideration single environmental events and single child characteristics, again measured from a single time point. Although we feel that a fair test of the Transactional Model, in terms of predicting development across several years, may not be possible, it should govern our thinking about how individual differences in depressed motherchild relationships and in child outcomes can be explained by examining how maternal depression’s effects are moderated by specific child characteristics and by features of the maternal environment. We believe such an emphasis is long overdue, because the links between maternal depression, parenting, and child outcomes are far from uniform. Such a perspective was represented in some ongoing work by the first author, who examined predictive relations between postpartum maternal depression and maternal sensitivity during interactions with infants, maternal self-efficacy, and infant behavior problems, assessed at different points during the infants’ first year in a sample of approximately 120 African American, premature infants (56% female) and their mothers. Interestingly, maternal depressive symptoms, assessed prior to


infant hospital discharge, did not predict maternal sensitivity toward the infant in the home when infants were 4 months and 12 months of age (corrected for prematurity), nor were they predictive of maternal self-efficacy at 4 months infant corrected age. They were, however, predictive of mother reports of infant behavior problems at 12 months, but only modestly. When specific child characteristics, assessed either prior to infant discharge or at 4 months of infant corrected age, were taken into account, more specific linkages between early postpartum depression and later mother–infant outcomes emerged. For example, depressed mothers who perceived their infants to have unsettled, irregular states of arousal prior to discharge were observed, by raters who were blind to all other data, to be less sensitive during interactions with their infants at 4 and 12 months of infant corrected age than were mothers without postpartum depression but who also saw their infants as unsettled and irregular. No link between postpartum depression and maternal sensitivity at either age point was observed among mothers who did not perceive their infants as having problems in state regulation. In a separate analysis examining the role of infant gender in linkages between maternal postpartum depression and mother-reported child behavior problems at 12 months, significant longitudinal linkages were only observed for male infants, but not female infants. Thus, the main effect of maternal postpartum depression on 12 month infant behavior problems, reported above, appeared to be accounted for in mother–male infant dyads, but not mother–female infant dyads. This finding is consistent with a large literature documenting that male children tend to be more vulnerable to environmental stressors, including parental psychopathology, than are female children. Very few of these studies, however, document such vulnerability in male children during the first year of life. What this work emphasizes is that the impact of maternal depression on child outcomes is at least in part dependent on the quality of fit between the mother’s illness and characteristics of the children themselves. Goodness-of-fit, of course, is a construct that is wellunderstood among child temperament theorists, who argue that fit between parental and child characteristics, and not each individual’s characteristics alone, is ultimately the driving force that underlies the quality of the relationship that develops between parent and child and, in turn, individual differences in children’s outcome. We do not mean to imply that there are certain circumstances under which the effects of maternal depression on child development are nonexistent or not worth pursuing. Indeed, even in cases of a better fit between a depressed mother and a specific child, the mother’s depression may be influencing the child in ways that may not be evident at a particular time or in terms of the measures used to assess

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such effects. The construct of fit, however, has not been systematically employed to understand individual differences in depressed mother–child relationships and maternal depression’s effects on child outcomes. We believe such an emphasis is long overdue. The role of partner involvement in families with depressed mothers, both in terms of the quality of support provided to mothers, and as a potential buffering or exacerbating influence on child development, is also poorly understood. What little work that has been done examining fathers in depressed mother households suggests that these fathers are also likely to be distressed, although it is unclear to what degree such distress is a product of coping with a spouse with an affective illness. Of course, children growing up in households with two parents with affective disorders would likely be at even greater risk for maladjustment than would children with only one affectively disturbed parent, but there is little prior work that documents how much greater this risk might be. It does appear, however, that the quality of support fathers provide to depressed mothers may be an important buffering influence on the effects of maternal depression. It is quite common for mothers to report high levels of marital distress. Marital distress, in turn, has well-known deleterious effects on child adjustment, and some have speculated that the marital distress that is so common in depressed mother households may actually mediate the effects of maternal depression on child development. Indeed, Robert Emery and colleagues, in a paper published in 1982, found that the degree to which fathers adjusted to their depressed wives disorder was a significant predictor of children’s rates of psychiatric symptoms. Specifically, Emery found that the negative effects of mothers’ depression on children’s adjustment were practically negligible after controlling for marital distress, suggesting that maternal depression’s effects may operate via its impact on the larger family system. Low levels of marital distress in depressed mother households is rare; however, when fathers have some insight into their partners’ illness, they may be better able to provide appropriate emotional support, which in turn may help mothers parent more effectively and, in turn, the quality of children’s attachments to their mothers. In addition, fathers who adapt better to their wives’ depression are likely to be better, more engaged parents with their children, which may buffer any direct negative effects of mothers’ depression on children. We believe that an important goal in intervening in families with depressed mothers is not simply to work to alleviate mothers’ depression and (if needed) promote competent parenting skills, but also to help other family members cope with the mother’s illness more effectively by promoting a better understand and appreciation of the nature of the mothers’ illness. Indeed, research on the impact of maternal

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depressed on children as filtered through the larger family system is sorely needed and may foster a better understanding of why some children, in the face of maternal depression, fare better than others.

Conclusions Maternal depression can have serious consequences for children in social, emotional, and cognitive developmental domains, and children of depressed parents are four to five times as likely as children of nondepressed mothers to be at risk for behavior problems. Children’s risk for behavioral disturbances appears to be directly proportional to the chronicity and severity of mothers’ depression. Even very short bouts of maternal depression appear to have an emotionally dysregulating effect on infants as young as three months of age, and postpartum depression that is recurrent places infants at risk for insecure attachment. Children who grow up in depressed mother households are at risk for elevated psychiatric symptoms, both internalizing and externalizing, and to develop psychiatric disorders along a broad spectrum, including depressive and anxiety disorders, oppositional defiant disorder, and conduct disorder. Mechanisms of parent-to-child transmission have focused primarily on the impact of depressogenic mothering, although there is also evidence that depression is partially heritable. Importantly, depression’s effects on mothering, and on children’s development, are heterogeneous and may be buffered or exacerbated by a variety of additional parent, child, and environmental influences. Understanding the effects of maternal depression in the context of other risk and protective factors is a worthy goal for the field. Fortunately, depression ranks as one of the more treatable psychiatric disorders. Women who suffer from postpartum depression can avail themselves of a variety of treatment approaches, including pharmacological, psychotherapeutic (e.g., cognitive-behavioral, psychodynamic, and support-based ‘talking’ therapies), or some combination. In addition, approaches that target mother–child interactions have also been successful, in particular when maternal depression co-occurs with skill deficits in mothering. All of these treatment approaches have been effective, to varying degrees, in reducing symptom severity and improving quality of mothering. Pediatricians are likely to be the first health professionals to identify postpartum depression. It is thus important to equip pediatricians with the training and assessment tools to screen for postpartum depression, and to refer mothers to the appropriate mental health facilities for further evaluation and treatment. Mothers who suffer from depression clearly need help, not just for themselves but for their children. Continued

research is needed to understand more clearly the heterogeneous nature of maternal depression and its effects, what role maternal, child, spousal, and family characteristics play in this regard, and to develop effective interventions. Efforts to increase public awareness of postpartum depression and its effects on children are also critically important, if only because such awareness could lead to more mothers seeking treatment. See also: Attachment; Depression; Emotion Regulation; Marital Relationship; Mental Health, Infant; Parental Chronic Mental Illnesses; Parental Leave; Parenting Styles and their Effects; Risk and Resilience; Social and Emotional Development Theories; Socialization; Temperament.

Suggested Readings Elgar FJ, McGrath PJ, Waschbusch DA, Stewart SH, and Curtis LJ (2004) Mutual influences on maternal depression and child adjustment problems. Clinical Psychology Review 24: 441–459. Embry L and Dawson G (2002) Disruptions in parenting behavior related to maternal depression: Influences on children’s behavioral and psychobiological development. In: Borkowski JG Ramey SL,, and Bristol-Power M (eds.) Parenting and the Child’s World: Influences on Academic, Intellectual, and Social–Emotional Development. Monographs in Parenting, pp. 203–213. Mahwah, NJ: Erlbaum. Gelfand DM and Teti DM (1990) The effects of maternal depression on children. Clinical Psychology Review 10: 329–353. Goodman SH and Gotlib IH (1999) Risk for psychopathology in the children of depressed mothers: A developmental model for understanding mechanisms of transmission. Psychological Review 106: 458–490. Nylen KJ, Moran TE, Franklin CL, and O’Hara MW (2006) Maternal depression: A review of relevant treatment approaches for mothers and infants. Infant Mental Health Journal 27: 327–343. O’Hara MW (1997) The nature of postpartum depressive disorders. In: Murray L and Cooper PJ (eds.) Postpartum Depression and Child Development, pp. 3–31. New York: Guilford. Radke-Yarrow M (1998) Children of Depressed Mothers: From Early Childhood to Maturity. Cambridge, UK: Cambridge University Press. Speranza AM, Ammaniti M, and Trentini C (2006) An Overview of maternal depression, infant reactions, and intervention programs. Clinical Neuropsychiatry: Journal of Treatment Evaluation 3(1): 57–68. Teti DM and Gelfand DM (1991) Behavioral competence among mothers of infants in the first year: The mediational role of maternal self-efficacy. Child Development 62: 918–929.

Relevant Websites http://www.aafp.org – American Academy of Family Physicians. http://healthyminds.org – Healthy Minds. Healthy Lives. http://www.nimh.nih.gov – National Institute of Mental Health, National Institutes of Health. http://www.4woman.gov – National Women’s Health Information Center. http://www.nlm.nih.gov – United States National Library of Medicine, National Institutes of Health.

Pragmatic Development

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Pragmatic Development N Akhtar and K Herold, University of California, Santa Cruz, Santa Cruz, CA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Communication – The exchange of ideas and/or feelings, often via speech, but also via gestures, eye contact, etc. Comprehension – Understanding of words, gestures, etc. Conventional symbols – Usually words, but also sometimes arbitrary gestures, that are understood by the community to have a particular meaning. Deictic gestures – Gestures such as pointing that refer to something in the nonlinguistic context. Ellipsis – The omission of certain words or phrases from a sentence, especially when that information can be retrieved from the preceding linguistic context. Joint attention – A state achieved when two (or more) individuals attend to the same thing at the same time and are mutually aware of the other’s focus of attention. Morphology – The branch of linguistics concerned with word structure. Narratives – Telling of a sequence of events in a particular order. Pragmatic bootstrapping – Using one’s understanding of communicative intentions to learn language. Pragmatics – The branch of linguistics concerned with the uses of language for the purpose of communication. Production – Expression or use of words, gestures, etc. Proto-words – Phonetic forms used by very young children with a consistent meaning, but that are not considered conventional words in the adult language. Scaffolding – The graduated assistance provided by adults to infants and young children to aid them in their cognitive or linguistic development. Social referencing – Checking in (usually via gaze) with a social partner to judge his/her reaction to something. Still-face paradigm – A method used in infant social development research whereby a parent interacting with his/her infant is asked to stop interacting verbally and to provide no facial expressions. Symbolic gestures – Gestures (e.g., a thumbs-up) that stand for or represent something else. Syntax – The branch of linguistics concerned with sentence structure.

Introduction Pragmatics is the branch of linguistics concerned with the use of language for the purpose of communication; it is concerned with the use of language in context. Pragmatic approaches to language acquisition focus on the fact that children’s primary motivation in acquiring language is to communicate with others, and they learn language in the context of conversational interactions (i.e., in communicative contexts). Since the emphasis is on communication, pragmatic development begins in the prelinguistic period, as infants begin to communicate before they start using any linguistic forms. Babies can be said to communicate from birth in that their reflexive cries tell their caregivers that they need food or comfort. Researchers make an important distinction, however, between unintended acts that communicate information (e.g., shivering communicates that an individual is probably feeling cold) and acts that are intended to communicate. In a classic paper published in 1975, Elizabeth Bates and her colleagues distinguished between the perlocutionary (pre-intentional) stage in which babies behave in ways that have communicative effects and may be interpreted by adults as communicative (e.g., crying, smiling, vocalizing) and the illocutionary (intentional) stage in which infants demonstrate increasing control over their (nonverbal) communicative behaviors, and can establish and maintain attention on a shared ‘topic’. Most researchers agree that intentional communication begins in earnest around 9–10 months. This is widely recognized as the period in which both the ability to produce intentionally communicative acts and the ability to comprehend the communicative intentions of others really takes off. In this article, we provide a description of the most notable developments in infants’ and children’s communicative abilities, beginning with a brief description of some of the pre-intentional behaviors in early infancy that are interpreted as communicative by infants’ caregivers. We then describe some of the intentionally communicative acts of late infancy, focusing on gestures. Finally, we examine toddlers’ learning and use of conventional symbols (words), their subsequent production of phrases and sentences, and the development of the ability to engage in extended discourse in the preschool years. In each section, we describe the major communicative milestones of the period and discuss the abilities that are hypothesized to underlie attainment of these milestones.

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In particular, it is infants’ ability to read the intentions of others that is considered to play a very important role in their communicative development. Quite contrary to the Piagetian view of the egocentric child, the emphasis now is on infants’ and toddlers’ skills of perspectivetaking. With new methods of assessing infants’ comprehension, huge strides have been made recently in establishing that infants are sensitive to the goal-directedness (intentionality) of others’ behavior from a relatively early age. Indeed, it is around the same age (9–10 months) as they themselves begin to engage in intentional behavior that they also show evidence of understanding the intentions of others. Initially, however, babies do not communicate intentionally. Their behavior communicates information to their caregivers, but they lack the motor, cognitive, and social skills necessary to engage in intentional acts of communication.

Early to Mid-Infancy Newborns cannot behave intentionally, but they are born with certain visual and auditory preferences that enable them to enter into social interactions. For example, they prefer human voices to other types of sounds, and will sometimes even stop crying in order to attend to someone talking softly to them. On the basis of prenatal auditory experience, they also prefer to listen to their own mother’s voice rather than another woman’s voice. These preferences for speech ensure that babies will get plenty of exposure to the language they are going to be learning. In terms of visual preferences, newborns like to explore complex stimuli – stimuli with lots of contrast and contours; in particular, they like to look at human faces. A preference for faces means babies will spend a great deal of time looking at the faces of their caregivers, and often caregivers will interpret the resulting eye contact as an intention to interact. Among adults, mutual gaze generally signals an intention to communicate. Even if a baby doesn’t have this intention when it gazes at its caregiver’s face, the caregiver (at least in Western middle-class cultures) will tend to interpret the baby’s behavior as intentionally communicative. Caregivers sometimes interpret clearly noncommunicative sounds (like burps) as communicative signals by acknowledging them and responding to them in some way. This contingent responsiveness of caregivers may play an important role in showing infants that their behaviors have a predictable impact on people. Then, eventually, when they are cognitively mature enough, infants will start to intentionally act to get reactions from their caregivers. Early on, however, it is the caregiver who takes most of the responsibility for social interactions. In some sense, caregivers create the illusion of a communicative interaction with a newborn. In early infancy, babies are not themselves very good at turn-taking. What looks like turn-taking behavior seems more a function of what the

caregiver is doing than what the infant might be doing. For example, during nursing, infants produce sucking bursts and they pause in between them. Often the mother will do or say something during these pauses. Initially newborn babies do not really initiate or maintain turntaking interactions but their pauses give mothers the opportunity to turn feeding sessions into social interactions. The same is probably true of what are known as ‘proto-conversations’. In these face-to-face interactions the caregiver and infant seem to be engaging in a conversation in that the caregiver says or does something, the infant appears to respond by smiling or vocalizing, and they go back and forth in this manner. It may be that early on what looks like turn-taking is actually the caregiver skillfully inserting behaviors into pauses in the baby’s ongoing behavior. Gradually, however, as infants get older and enter the mid-infancy period, they start to take a more active role in these kinds of interactions. In the mid-infancy period, infants start to show more awareness of social interactions. The evidence for increased awareness comes from studies of infants’ participation in routine games and from what is known as the ‘still-face procedure’. Games such as peek-a-boo have a predictable sequence and over time infants develop an anticipation of ‘what happens next’ (also known as script knowledge or event knowledge). Thus, when parents or researchers interrupt the regular sequence by not doing what they normally do, the infants respond by trying to get the adult to continue, sometimes even taking the adult’s turn in the game themselves. Similarly, in the still-face paradigm, researchers ask parents to engage their infant in a face-to-face interaction and then at a signal from the experimenter, they are asked to adopt a still face and stop interacting with their infant. What usually happens is that the infant will first attempt to reengage the parent and when those attempts fail, become distressed. Both sets of results are interpreted as the baby being sensitive to the normal structure of a social interaction. It is interesting that allowing the parent to continue to touch the baby during the still-face can attenuate the effect, indicating that a sense we often neglect in the realm of communication – touch – also serves to communicate to young infants. Around 4–6 months there is a noticeable change in social interactions as infants start to become more interested in objects out in the environment. Their interactions with their caregivers start to be centered on objects and they don’t spend as much time in face-to-face interactions. Adults tend to follow the infant’s interests and talk about what the infant is looking at or playing with, leading to episodes of what is known as joint attention. These episodes – when adult and infant are focused on same thing – set the stage for more complex social and linguistic achievements, but at this early stage they are achieved mainly through the adult’s efforts to follow what the infant seems to be interested in.


Over this period of time, babies also gain control over their muscles and therefore develop control over a wider range of behaviors – including communicative behaviors such as smiling, gazing, and vocalizing. Developing motor skills thus plays a role in how well and quickly infants can respond to their social partner’s communicative behaviors, and probably also in the next big step in the infant’s communicative repertoire: the production of gestures. Gestures play a very important role in early communication and they provide one way of assessing whether a given child is on track in terms of early language development. One of the difficulties in assessing language delays or problems in young children is that there is such a wide range of what is normal in terms of when a child utters their first word, so it is difficult to know whether a given child is simply a late bloomer or truly delayed. Researchers have found that these two groups of children can be differentiated by their comprehension of words and their use of gestures; those with poor comprehension of words and low use of gestures are the ones who continue to show signs of delay 1 year later. The infants with high comprehension of words and use of gestures tend to catch up to their age level 1 year later. Early use of gestures is therefore an important predictor of subsequent language development. Summary In early infancy babies engage in several social behaviors that enable them to interact with others and have communicative effects. Adults are primarily responsible for initiating and maintaining these early interactions. In midinfancy, infants’ interests shift to objects; caregivers tend to follow their infants’ interests and initiate and maintain episodes of joint attention with them. It is not until the last part of the first year that infants begin to clearly initiate episodes of joint attention themselves by, as we discuss in the next section, pointing to something and then checking to see if the caregiver has followed the point.

Late Infancy Around 9–12 months, infants begin to take a more active role in establishing periods of joint attention. For example, they will follow an adult’s gaze to determine what the adult is looking at, and they start using points to actively manipulate their caregiver’s focus of attention. It seems that at this age they are starting to understand that another’s focus of attention can be different from their own, and that one needs to ensure that one’s social partner is focused on the same thing to communicate about that thing. This is also the age at which social referencing first appears. Social referencing involves infants checking their caregiver’s expression when they’re in an uncertain situation – essentially

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trying to get information from their caregiver about a new situation or object. So, it is around the end of the first year, when babies start to use communicative gestures, that there is strong evidence for truly intentional communication. Initially, infants primarily use deictic gestures (sometimes accompanied by vocalizations) such as pointing, showing, and giving. A variety of behaviors have been used to establish the intentional nature of infants’ early gestures. First, babies tend to use them only or primarily when they have an attentive audience. Second, they tend to alternate gaze between their addressee and the event or object of interest, suggesting they are checking to see if their message has been received. And third, they make attempts to repair failed messages by repeating and/or elaborating the message when there are signs that their social partner has not attended to the message or has misunderstood it. Repairing failed messages is a particularly good indication that preverbal infants can communicate intentionally as it shows that babies recognize when their communicative goals have not been achieved, and they are able to (and motivated to) adjust their behavior to achieve their goals. For example, when parents misunderstand or ignore their 1-year-old infant’s communicative signals, the infant is likely to repeat the original signal, to augment it in some way (with additional vocal emphasis or the addition of a gesture, for example), or to substitute another signal for the original one. Infants will produce repairs of failed messages when they have failed to achieve some desired object (e.g., a special toy), but will also do so when their goal is simply to share their interest in something. Some experimental studies show that somewhat older toddlers will repair failed messages even when they have achieved their instrumental goal, suggesting even more strongly that the ultimate goal is to communicate, not just to get what they want. This and other findings like it have been used to argue that, in addition to using language as an instrument to get things done, infants and toddlers are also motivated from very early on to acquire language to express themselves and share their interests. Pointing Language is used, by children and adults, for both instrumental and sharing functions, and so are early gestures. Perhaps the most studied deictic gesture is the point – the extension of the index finger to an object or event. Early studies described two distinct functions of 1-yearold infants’ points: imperative (instrumental pointing to request the object pointed at) and declarative (pointing to share interest in the object or event pointed to). Subsequent studies have confirmed this distinction that imperative points involve using a person as means to obtain an object (the goal), whereas declarative points involve using an object as a means to obtain adult attention. Declarative pointing is therefore seen as involving a

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deeper understanding of others as having attentional states that can be manipulated. Indeed, the claim is that the use of declarative pointing implies an attribution of an internal psychological state (as opposed to mere agency) to the addressee. While some studies have shown a nearly simultaneous emergence of the two types of points, others suggest that declarative points may develop a few months later than imperative points. Later emergence of the declarative point and the fact that use of it (and not of the imperative point) correlates with an independent measure of intention understanding, supports the view that declarative points rely on a more complex social–cognitive understanding. Michael Tomasello has argued quite strongly that the infant’s use of declarative points means that she has in some sense an understanding of others as intentional agents with mental states such as attention. The claim is that when babies use imperative points they may simply be using their social partner as a tool; that is, imperative points may rely on understanding of adults as causal agents but not necessarily as mental agents. Declarative points, on the other hand, are not used to obtain material goals, but simply to direct attention and to share an experience; thus, they appear to be more purely communicative, as they do not involve any instrumental goals. While some researchers argue for attributing less sophistication to 1-year-old infants, and intentional understanding certainly develops in complexity over the first few years of life, there is considerable evidence to support the view that intentional understanding is present in nascent form at the end of the first year. In this regard, it is interesting that autistic children show a dissociation between the two types of points – they have difficulty with declarative pointing (both comprehension and production) but not with imperative pointing. The same dissociation is seen in humanreared apes. This dissociation provides additional support for the conclusion that declarative points may index a deeper understanding of others’ minds than imperative points. While this is one possible interpretation, it is also possible that the dissociation is due to motivational differences rather than an inability to detect others’ mental states; that is, not using declarative points may be related to less interest in sharing sights and sounds with others. We know of no studies that have attempted to tease apart the motivational versus sociocognitive explanations, but recent studies may lead in that direction. These studies describe a third function of prelinguistic pointing: to provide information. In these studies, 12- and 18-month-olds spontaneously pointed to an object they inferred the experimenter needed to complete a task. This type of point is particularly interesting because it appears to involve both the cognitive ability to understand the experimenter’s need for information and the motivation to cooperate with and help the experimenter. It would be interesting to conduct a similar study with autistic children

to see if they are motivated to engage in this type of pointing. Finding that these children do not point to inform would not be very instructive on its own. However, if they, for example, looked to the object the experimenter needed but did not point to it, that might provide evidence that they possess the sociocognitive capacity to determine what the experimenter needs, but lack the motivation to provide that information. For present purposes, however, it is sufficient to note that all three types of pointing that toddlers engage in – imperative, declarative, and informative– are examples of intentional communication that involve directing the attention and/or behavior of others. It is widely agreed that 1-year-old infants use intentional vocalizations and gestures to communicate, but there is less consensus on the number and variety of specific meanings or communicative intentions their vocalizations and gestures express. As discussed previously, pointing is used for imperative (instrumental) as well as declarative (sharing, commenting) and informative purposes, but prelinguistic infants also make use of varied intonation patterns to produce requests for actions, to greet their social partners, to protest or reject the actions of others, and so on. Eventually they begin to use words for these and other communicative functions. Symbolic Gestures Before they start using words, however, many infants and toddlers produce symbolic gestures in interactions with their caregivers; for example, sniffing to label a flower. These gestures appear to be used for the same communicative functions as early words; that is, to request, comment on, and label objects, and to describe children’s experiences. Some of these gestures are learned within interactive routines, but some seem to be spontaneously generated by children themselves. Regardless of how they originate, these gestures seem to be generalized and used in a contextually flexible way (i.e., in different contexts for different communicative functions), much as early words are, and so their acquisition probably relies on the same social and cognitive skills that word learning does (see the next section). The production of symbolic gestures emerges earlier than word production probably because infants and toddlers have better control over the large muscles used in forming a gesture than they do over the many tiny muscles used to articulate words. One interesting finding is that children who are trained to use multiple symbolic gestures may have an advantage (compared to children with no training) in subsequent verbal comprehension and production. With or without training, it is possible that children’s early use of symbolic gestures can facilitate or bootstrap their subsequent communicative development in several ways. One possibility is that once babies start producing some symbolic gestures, adults around them start to treat them


differently – they may talk to them more because there is more to communicate about. So, infants who produce more symbolic gestures may receive more verbal input overall than, for example, a baby who only points. A related possibility is that once babies start producing gestures, it is easier to read their minds and figure out what they are focused on – so that makes it easier to establish joint attention with them and determine their specific communicative intentions. If the baby makes the sign for ‘Hungry’, for example, the parent might respond with ‘‘Oh, you’re hungry,’’ thereby providing a verbal label for what the child is feeling at the time. In this way the children might receive more relevant verbal input. Finally, another possibility is that by using symbolic gestures and being understood children might become even more motivated to talk and be even better understood. These are all hypotheses at this point and remain to be tested systematically. It is important to note that almost all of the developments in preverbal intentional communication we have described have also been demonstrated by captive apes: for example, pointing, gaze following, gaze alternation, and even communicative repairs. There are a few important differences, however. One is that the apes tend to use their communicative gestures for imperative purposes only. Second, to our knowledge, they do not invent novel symbolic gestures as young human infants do. Finally, the apes in these studies do not appear to use their human-like communicative behaviors in communication with conspecifics, suggesting that these are behaviors that they learn only through training and that the learning does not transfer to their interactions with one another. These differences between apes and children suggest that apes’ understanding of communicative signals may be qualitatively different from the understanding of human toddlers; that is, the apes may only appreciate the impact of their gestures on the overt behaviors of the humans who interact with them, and not any impact on their mental states. An alternative hypothesis is that human-reared apes may have the same cognitive level of understanding of internal states as young children but they may, in sharp contrast to human infants, lack the motivation to share these states with others. Summary Near the end of the first year of life, a variety of preverbal behaviors (gaze following, gaze alternation, communicative repairs, pointing, vocalizations, and symbolic gestures) demonstrate not only that infants have the ability to communicate intentionally, but also that they have come to understand others as intentional beings like them. Although nonhuman primates in captivity also engage in some of these behaviors, they seem to do so in qualitatively different ways from human infants, for example, using pointing only for instrumental purposes, and not using it to communicate with other apes.

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Early Word Learning and Use Before beginning to use conventional symbols (words), some children produce transitional communicative forms known as phonetically consistent forms or proto-words. These forms function as words in that they are used intentionally for consistent communicative functions but are unlike words in that they are not fully conventional symbols in the adult linguistic system, for example, saying ‘‘baba’’ to request one’s bottle. Use of proto-words is a significant development because it indicates very clearly that toddlers understand that specific sound patterns can be used for specific communicative intentions, a necessary precursor for word-learning. On average, infants demonstrate the first signs of word comprehension at approximately 9 months of age, but don’t start to spontaneously produce words until around 12 months. While there are huge individual differences in the age of onset of word comprehension and production, the lag between comprehension and production is a very robust finding. This lag is probably due, in large part, to the difficulties associated with coordinating the many nerves and muscles involved in speech production. Indeed, early difficulties with articulation may also explain why toddlers’ first words tend to include the same phonemes they used most frequently in earlier babbling. Toddlers’ earliest words also tend to be used for similar communicative intentions as their preverbal gestures, but as children acquire more words, they learn to use those words in new ways; that is, the variety of communicative intents expressed increases, as does the intelligibility of children’s productions. Children also gradually develop the capacity to take into account multiple aspects of the interaction context in producing different speech acts. Finally, as in the prelinguistic stage, they continue to negotiate communicative breakdowns with their caregivers but they are more adept at tailoring the reformulations of their initial utterances to the type of feedback provided by their social partner. For example, they respond differently to specific versus general queries of their utterances (‘‘What does he need?’’ vs. ‘‘What?’’) and they are able to monitor their own speech for errors and respond appropriately when queried. Many researchers now view children’s ability to discern others’ communicative intentions as playing a critical role in early word-learning. In brief, the view is that words are used primarily to direct the attentional states of addressees, and that children match the sound patterns they hear to their interpretations of what the speaker is trying to get them to attend to. If words are used by speakers to direct the attentional states of their listeners, then the child listener’s goal in communicative contexts is to try to understand what a speaker is directing their attention to with a given word. Indeed, Bruner has argued that an act of reference is actually an intention to invite the listener to engage in joint attention.

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Many experimental studies have shown that 18- and 24-month-old toddlers can use a variety of pragmatic cues to establish joint focus with their interlocutors, and thereby determine their communicative intentions. These include gaze direction, facial expressions, event or script knowledge as well as sensitivity to the prior discourse topic. Children’s use of these cues enables them to attend to the appropriate referents and learn the words their caregivers use, but it also indexes a motivation to establish joint attention with others. In all of these studies, the onus is on the child participant to establish joint attention with the adult in order to learn the word the adult used. Clearly, young children are very motivated to do so. It is also important to note, however, that in all of these studies the children were engaged in a dyadic interaction with the experimenter. One interesting question is whether toddlers are also able to determine the communicative intentions of a person who is not interacting with them. This is an important question because anthropologists suggest that in many communities, young children do not experience as many one-on-one interactions with adults as the children we typically study, yet they do not appear to be greatly delayed in language-learning. Children growing up in these contexts seem to be quite good at monitoring others’ interactions, which leads to the hypothesis that they may learn a great deal of language by listening in on the conversations of others. Indeed, children in all cultural contexts probably learn a great deal of language in this way. For this reason, researchers have begun to examine young children’s ability to learn new words through overhearing – that is, through monitoring third-party interactions. The main findings so far are that 2-year-old children are equally good at learning a new object label through overhearing as when they are directly addressed. Older 2-year-olds are able to learn a verb through overhearing as well. Eighteen-month-old infants are also able to learn a new object label through overhearing but it is not as easy for them as it is for 2-year-olds. Another recent study has shown that 18-month-old children can monitor and comprehend communicative gestures that are not directed to them. These are interesting findings, but it is not clear to what extent the experimental contexts used in these studies are similar to the everyday contexts in which children overhear new words. In these studies, the children in the overhearing condition were seated as onlookers to the adults’ interaction but there was nothing to really distract them from that interaction. There was nothing else that was particularly interesting going on; certainly, the most interesting thing in the room was the interaction between the two adults who were playing with fun toys. But in real life, children don’t just sit down and pay attention to others’ conversations. There are generally other things going on that compete for their attention. If children are

truly motivated to attend to others’ communicative intentions, they should do so even when they are engaged in an interesting activity themselves. More recent studies have shown that 2-year-olds can also learn new words through overhearing when they are engaged in another distracting activity. These experimental studies of word-learning through overhearing along with naturalistic observations of children’s attention to third-party conversations demonstrate that toddlers are motivated to monitor the communicative intentions of people who are not even interacting with them, giving them multiple sources from whom to learn words. It is probably true that many (if not most) children spend a significant amount of time in multispeaker environments in which they are not always directly addressed; therefore, overhearing contexts may represent a vital part of young children’s early language learning experiences. The vast majority of studies of early language learning focus on dyadic contexts; only a few relatively recent studies have systematically examined children’s word-learning through overhearing. Future studies will need to explore the cognitive skills that underlie children’s ability to learn through overhearing, and whether children who grow up in societies where they are expected to learn through observation are actually better at learning through overhearing than children growing up in communities that emphasize direct teaching. Summary Children first use nonconventional forms (proto-words) to communicate, and at around 12 months begin producing more traditional words, with varying success. While their intent is quite often to highlight their own wants and needs, they also use words to communicate their perspectives in attempts to share those perspectives with others. They repair misunderstood utterances, and use words to direct the attention of the person they are communicating with. Young children are quite skilled at learning new words, even when those words are not being directed to them. These findings indicate that children can monitor others’ interactions, and can learn words from overheard conversations as well as from conversations in which they are directly involved.

Multiword Speech Before toddlers begin to combine words, they first combine gestures with words, for example, pointing to a book and saying ‘‘mommy’’ to indicate something like ‘‘That book belongs to my mom’’. These gesture-plus-word combinations are said to ‘pave the way’ for two-word combinations as children who are first to produce gesture-plusword combinations are also first to produce word–word


combinations. One way in which gesture–word combinations may facilitate the production of word–word combinations is that they may lead parents to ‘translate’ the communicative intents children express with gesture–word combinations into word–word combinations, providing an appropriate models for children on how to verbally express their communicative intents. Early word combinations allow the child to begin to rely somewhat less on the nonlinguistic context to get their communicative intentions across. In the one-word stage, their holophrastic (one-word) utterances can only be interpreted with heavy reliance on context and even then the child’s intent may be ambiguous. Although two-word utterances can also be ambiguous, they provide a bit more information about what the child has in mind. Across the languages that have been studied in detail, children’s early word combinations tend to be used for a similar range of communicative functions. For instance, toddlers make requests, reject and negate others’ assertions, describe and comment on actions and locations, talk about possessions, etc. They also ask questions, often yes/ no questions that are marked with rising intonation, but ‘where’ questions are also frequent. In their two-word utterances. toddlers tend to mark new information with stress, suggesting that they take the context (and perhaps the listener’s perspective) into account when formulating their early multiword utterances. There is not as much known about the communicative intentions of children in the later stages of linguistic development when they start producing full-length sentences. This is likely because the emphasis (of most researchers) appears to shift to matters of form (morphology and syntax) rather than function (pragmatics) when children start speaking in longer sentences. Formalists define language as a system of abstract rules for combining various parts of speech, independent of the contexts of use of those rules. Functionalists, on the other hand, define language as the use of symbols and rules for combining those symbols for the purpose of communication. While the differences between formal and functional approaches to language may appear to be merely differences in emphasis – after all, both form (structural rules) and function (communication) are crucial aspects of human language – because of their focus on communication, functionalist approaches tend to be more developmentally friendly. However, most of the research on children’s developing syntactic abilities is not framed in terms of communicative intentions because grammar has been considered by many theorists and researchers to be a completely autonomous linguistic module. More recent functional approaches to grammatical development are promising, but it remains true that most of the research on the early development of syntax and morphology does not explicitly examine the communicative functions of the various constructions children are learning to comprehend and produce.

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It is noteworthy, however, that some longitudinal studies have found positive correlations between measures of pragmatic development and grammatical development, and some researchers believe that joint attention may play an important role in grammatical development. This is consonant with Tomasello’s view that ‘‘learning words and learning grammatical constructions are both part of the same overall process,’’ the process being reading the communicative intentions of the people speaking those words and constructions. The process is slightly different in the case of grammatical constructions because the child has to pay attention to (and abstract) a pattern of symbols and link that pattern to the speaker’s communicative intent. In this view, sentence-level constructions are, like words, essentially pairings of form and function (communicative intent). It is certainly the case that different syntactic constructions can provide different perspectives on the same scene or event (e.g., the passive vs. active transitive construction in English), and children and adults do use different syntactic constructions to convey different communicative intentions. We know of no empirical research, however, that has directly addressed the question of whether children learn syntactic constructions in the same way as they learn words; that is, through ‘‘pragmatic bootstrapping’’ or attention to speakers’ intentions. The fact that autistic children sometimes show a dissociation between pragmatic and syntactic abilities – producing grammatically correct utterances that are often pragmatically odd – suggests that pragmatic development alone cannot account for the development of syntax. Ochs and Schieffelin’s description of the language socialization of Kaluli children, however, provides illustrations of the role of pragmatics in some aspects of grammatical development. They found that there are several grammatical forms that are frequent in input to Kaluli children but the children themselves do not use them because it is not culturally appropriate for them to do so, for example, command forms of a verb that the society’s rules dictate can only be used by adults to children and not vice versa. The children show comprehension of these verb forms at a young age (by 19 months) but they do not use them themselves. Similarly, there are grammatical forms that are relatively infrequent in the input that the children do pick up and use. The main point is that children do not just learn the words and constructions that they hear frequently – they are paying attention to the pragmatic contexts in which those words and constructions are used, and they use the ones that best fit their communicative goals within the constraints of the cultural context. Indeed, Ochs and Schieffelin conclude that ‘‘children’s use of particular grammatical forms at particular moments of their language development is profoundly linked to social and cultural norms, expectations, and preferences which may not be explicit and are not easily counted or detected.’’

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Summary Children’s early ability to combine gestures with words facilitates their ability to combine words with each other. As children move from two-word combinations to multiword utterances, they rely somewhat less on the extralinguistic context and more on linguistic means for expressing their communicative intentions, although context remains vital to communication throughout development. The new linguistic skills that allow children to produce complex constructions also allow young toddlers to engage in extended discourse, the topic of our final section.

Extended Discourse In the preschool years, children begin to engage in extended discourse on various topics; that is, they become better conversationalists and tell better stories. To do these things effectively, they need to adapt to their audience and use linguistic devices such as ellipsis pronouns, and various causal connectives to maintain coherence and cohesion across utterances. They have to monitor their listener’s comprehension and, in general, they need to use social perspective-taking and their developing linguistic skills to ensure this comprehension. In addition, children learn to use mental state terms such as ‘think’, ‘want’, and ‘believe’ to convey their own feelings and perspectives as well as those of story protagonists. Although conversations often contain narrative sequences, we discuss these two types of extended discourse – conversational development and narrative development – separately. Conversational Development Becoming a skilled conversationalist is important because it plays a role in peer relationships; children who are good at conversation are more effective at interacting with their peers and better liked by them. But becoming an effective conversationalist is a difficult task because it involves coordinating many different skills, both linguistic and nonlinguistic. For example, one has to plan what one is going to say, monitor and comprehend one’s partner’s responses, time one’s turns appropriately, maintain relevance to the topic at hand, maintain an appropriate distance, use eye contact appropriately, and so on. There are also a number of conversational rules (some of which vary by culture and subculture) that children must learn, including of course the famous Gricean maxims of Quantity (say enough, not too much or too little), Quality (be sincere or truthful), Relation (be relevant), and Manner (be clear). As young preschoolers are generally more egocentric than older children their contributions to conversations are not always relevant, and may not provide enough information in a clear manner to their conversational

partners. Young children sometimes appear to assume that their listeners have access to the same information as they do. Motivation seems to play an important role in conversational competence, however; when engaged in referential communication tasks in a laboratory, preschoolers appear less competent than when engaged in more meaningful situations in which they are highly motivated to get their message across. In real-life situations, children will try various ways of repairing or reformulating their initial utterance when it is clear that their partner has misunderstood them. Some studies have shown that children will adjust the type of repair they use in different communicative situations. For example, toddlers are more likely to simply repeat their initial utterance (or say it louder) when queried by their mother and more likely to reformulate it when queried by an adult stranger, suggesting that they may be sensitive to the fact that strangers are less likely to understand them whereas their mother may not have heard what they said. Similarly, toddlers also respond differently to different types of requests for clarification. They tend to repeat all of what they had said when asked ‘‘What?’’ but they give only the requested information when asked a more specific question (‘‘You want what?’’). In general, these studies of communicative breakdowns show that even young children have some rudimentary knowledge of appropriate conversational behavior: they recognize when communication fails and have a variety of means for repairing breakdowns. They are also clearly motivated to achieve communicative success, as they engage in repairs even when they get what they want but their conversational partner has indicated a misunderstanding verbally. There are individual differences in how successful young children are at turn-taking; some do not wait for their partner to stop speaking (although it must be noted that in some communities, this type of overlapping speech is the norm), while others wait too long before taking their turn. In general though, young children appear to be relatively good at conversational turn-taking. Other aspects of conversational exchange, however, seem to undergo more protracted development. These include the abilities to smoothly initiate, maintain, and end conversations. Young children are generally not very skilled at initiating conversations, but they are more likely to do so with family members than strangers. When interacting with peers, young children are less likely to maintain a topic over several conversational turns than they are when interacting with adults. This is most likely due to the responsive scaffolding of the adults children typically interact with. Through their interactions with parents, siblings, peers, and teachers, children learn that they should speak differently (use different speech registers) in different social settings. For example, in school they typically speak differently to teachers than to their peers, and are more likely to use politeness markers such as ‘please’ and


‘thank you’ with adults than with other children. Language socialization studies have shown that in many cultures parents actively teach children when to say what; however, politeness consists of far more than simply knowing when to use the appropriate words. It also involves understanding various social roles and how they relate to the use of different linguistic forms. In some communities, children are required to use different lexical and grammatical forms with different individuals. Children in these communities attend to how males and females speak differently, and to the various relationships among individuals, and who speaks how to whom, in order to learn with whom to use different grammatical forms. They are generally not directly instructed in these understandings but come to them through keen observation of others’ interactions. As with all pragmatic developments, the development of politeness relies heavily on children’s social understanding. Narrative Development Narratives are similar to conversations in that both involve perspective-taking and a certain degree of linguistic skill. In both it is important to provide relevant information in a clear and unambiguous way. But conversations and narratives differ in one significant way. Whereas conversations are dialogues between two or more participants who essentially build on and provide a context for each other’s contributions, narratives involve, for the most part, decontextualized monologues. There is in some sense necessarily less scaffolding because a narrative usually involves a longer stretch of speaking, and children therefore have to rely more on their linguistic skills in getting the message across. This may explain why narrative skill has been linked to literacy development. Children who are good at producing coherent narratives appear to have an advantage in learning to read, perhaps because experience with decontextualized language plays an important role in literacy. Children’s earliest narratives occur in the context of conversations so they have lots of responsive support initially, but as they get older they depend less on adults’ scaffolding, and their contributions become longer, more coherent, and more complex. They often begin by recounting stories with adult encouragement, and typically construct their stories in response to prompts or other adult scaffolding behaviors. Very young children also learn to tell stories by narrating ongoing events. This is especially prevalent in pretend play, when children will often narrate their constructed imaginary situations to one another. By 4–5 years of age, children have typically learned a ‘story grammar’, or a set of rules that provide the structure for a good story. These rules vary by culture, and children tend to adopt the storytelling structures of their parents, and others in their community.

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A ‘good’ narrative often has a specific organizational pattern. The speaker presents an explicit topic, and discusses it in a way that clearly states the relations among a sequence of events. For many narratives the grammar consists of an introduction that orients the listener followed by an organized sequence of events that leads to some type of conclusion. The setting or introduction includes the place and the characters involved. This is generally followed by a sequence of events or episodes and then some kind of ending or resolution. Older children’s narratives are more sophisticated in several ways – they include mention of the characters’ motivations and internal states, they describe multiple events and, in general, there are more explicit connections made between the events so that the story actually ‘flows’. Good narratives make use of various linguistic devices to achieve coherence and cohesion. These include conjunctions (and, but, or), causal connectives (because, so), temporal connectives (then), the appropriate use of pronouns, definite and indefinite articles, etc. These devices bridge different parts of the narrative in appropriate ways and, in some cases, are essential to maintain coherence of the narrative as a whole. Summary In early childhood, children begin to engage in extended discourse. They learn culturally specific rules of conversation and politeness, and become sensitive to the need to use different speech registers in different settings. Their emerging linguistic skills as well as their increasing ability to take others’ perspectives enable them to produce more coherent and cohesive narratives. Early interactions within the family set the stage for these developments and while some parents actively socialize these skills, children also learn a great deal through observation of ‘how things are done’ in their communities.

Concluding Remarks Intentional communication begins with infants’ use of gestures to request and comment on objects and events. Toddlers progress to using words for these and other communicative functions, then combine gestures with words, and then combine words with words. There appears to be some continuity between these stages of communicative development in that infants’ use of symbolic gestures predicts their use of words and their use of gesture–word combinations predicts their use of word–word combinations. The ability to produce effective narrative sequences is positively correlated with subsequent literacy skills, but there is little evidence on the relations between earlier communicative developments and the ability to engage in extended discourse.

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We have noted throughout our review that social– cognitive abilities (e.g., understanding of others as intentional/mental agents, perspective-taking) provide the foundation for pragmatic development. Pragmatic development is also inextricably linked to children’s motivation – evident at a very early age – to communicate with others and to interpret others’ communicative intentions. While intention-reading skills have been demonstrated in some nonhuman primates, the motivation to connect with others and share experiences is postulated to be unique to humans. It is perhaps this distinctive combination of social–cognitive skills and motivation to communicate that sets human children apart and enables them to progress as rapidly as they do through the various stages of pragmatic development. See also: Autism Spectrum Disorders; Social Interaction; Theory of Mind.

Suggested Readings Adamson LB (1996) Communication Development During Infancy. Boulder, CO: Westview Press. Akhtar N and Tomasello M (2000) The social nature of words and word learning. In: Golinkoff RM and Hirsh-Pasek K (eds.) Becoming a Word Learner: A Debate on Lexical Acquisition, pp. 114–135. Oxford: Oxford University Press. Baldwin DA (2000) Interpersonal understanding fuels knowledge acquisition. Current Directions in Psychological Science 9: 40–45. Bloom L (1998) Language acquisition in its developmental context. In: Kuhn D and Siegler RS (eds.) Handbook of Child Psychology, Volume 2: Cognition, Perception, and Language, pp. 309–370. New York: Wiley. Bruner JS (1983) Child’s Talk: Learning to use Language. New York: Norton. Ninio A and Snow CE (1996) Pragmatic Development. Boulder, CO: Westview Press. Tomasello M (2003) Constructing a Language: A Usage-Based Theory of Language Acquisition. Cambridge, MA: Harvard University Press.

Preschool and Nursery School H H Raikes, C Edwards and J Jones-Branch, University of Nebraska–Lincoln, Lincoln, NE, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Asili nido – ‘Safe nests’, the Italian term for infant–toddler centers. Barnehage – ‘Children’s gardens’, care and education programs for children aged 0–3 years, in Norway. Early childhood programs for children of age 3 years and under – Federal and state-supported center-based programs, private nursery schools, home visiting programs with a child development emphasis, out-of home-enrichment programs for children, and 0–3 programs that originated in countries other than the US. Early Head Start – A variation of the federal Head Start program for children in poverty under the age 3 in over 700 US communities. Ecole Maternelle Française (EMF) – Publicly supported French nursery schools serving about a third of French 2-year-olds. Educare – High-quality 0–3 programs for children in poverty that blend funding from Head Start and other federal sources, states, localities and philanthropy, coordinated by the Bounce Learning Network. Even Start – Parent–child literacy program.

Home visiting programs – Regular home visitor services offered in children’s homes to parents and children for purposes of enhancing children’s development. Examples of four programs are provided in this section. Out-of-home enrichment programs – Educational programs for children under age 3 years that may also include instruction for parents. Several examples are included here. Part C of the Individuals with Disabilities Education Act – A program that provides services for children under age 3 years with identified disabilities.

Introduction This article provides descriptions of nursery education for children under the age of 3 years, including an overview of quality features for such programs, and descriptions of center-based, home visiting, out-of-home enrichment programs, programs for 0–3 year olds that are identified


with other countries. It concludes with an overview of extant research on the effects of early childhood programs for 0–3 year olds.

Overview of Early Childhood Programs Early Childhood Education (ECE) programs are highly prevalent in the US and in European countries, and are growing in emphasis in other parts of the world today. Children under age 3 years participate in group or formal educational experiences for a variety of reasons: (1) social and cognitive preparedness for preschool or formal schooling or enrichment; (2) remediation or intervention; (3) to learn specific skills deemed important by parents; or (4) for childcare in order for parents to work or pursue training. ECE for children age 3 years and under (sometimes referred to as nursery, cre`che, or infant–toddler programs) is somewhat challenging to define as can be seen in Figure 1. Programs appear to array along a horizontal continuum with those more focused on education at one end and those more focused on care on the other. Many European countries provide systems of publicly supported services for children under three explicitly integrate functions of support for working families and childhood education and socialization, for example, the barnehage (‘children’s gardens’) of Norway and asili nido (‘safe nests’) of Italy. In the US, increasingly, education and care functions are becoming blurred. This blurring seems to be occurring for a number of reasons. First, many mothers of infants and toddlers from all educational and income groups are now in the US labor force (US Department of Labor reported that 61% of mothers with children under age 3 years were in the labor force in 2000). Closely related, states are responding to the need for full-day childcare and market demands with efforts to promote higher standards in caregiving settings for all children. Second, there is increasing recognition of the importance of infant development, particularly infant brain development. The widespread awareness of the importance of stimulation, nutrition, and emotional footings during the Center-based

Education-oriented

Care-oriented

Home-based Figure 1 Care and education for children aged 0–3 years in the US – education and care, center-based and home-based.

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age 0–3 years time period has led to increasingly more intentional approaches to care and education, particularly on the part of parents purchasing care and education for their infants, as well as to a renewed dedication to intensity and quality in early intervention settings for infants and toddlers, among policy and programmatic leaders. Thus, along a vertical axis, programs with the child’s education as target (as opposed to those explicitly aiming at parents or parental self-sufficiency) range from those providing part or full-time (20–40 h per week) centerbased services to children (on top) to those providing out-of-home shorter-term education-oriented programs (middle) to those providing in-home, child-oriented education. In this article we address the full range of both axes but minimize the caregiving functions of childcare that are addressed elsewhere in this encyclopedia. It is important to consider this full range of educational opportunities for children under age 3 years in the US, organized as it is to a large extent by the developmental needs of very young children; for children over 3 years of age, formal educational opportunities are more consistently concentrated in center-based settings and are also more consistently accessible to children. We also include information about the most formal educational settings in several European countries. This article is intended for early childhood professionals and potential infant–toddler professionals in the US as information that will help them examine and understand the various professional niches for working with this important age group. It is also intended to be useful to parents of infants seeking a statement about the state of the art in the US and in European countries of programs for infants and toddlers; it also outlines availability of educational programs for parents and children. In some states most of these programs are for infants whose parental circumstances put them at risk, but in other states, many educational programs are offered to all children, either for free or for a fee. The article begins with an overview of characteristics associated with quality in early childhood programs for children under 3 years of age. We then turn to a review of center-based ECE programs that have an educational or intervention emphasis. These may include centerbased Early Head Start programs, State Pre-Kindergarten programs that may include infants and toddlers, other intervention programs for disadvantaged children under age 3 years, Part C programs for 0–3-year-olds, and private nursery schools. Next, we reference out-of-home educational programs for infants and toddlers that are briefer in nature and, then, home visiting programs that are designed to provide educational opportunities for the child. Finally, we include reference to center-based programs in a number of European countries for children aged 0–3 years. For the most part, we do not include discussion of childcare, as that is the topic of another

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article in this series, and we do not reference home visiting programs that focus more explicitly on the parent or on self-sufficiency, more completely discussed elsewhere in this encyclopedia. We conclude with a section reporting research on programs for at-risk children aged 0–3 years.

Participation in Early Childhood 0–3 Programs in the US It is difficult to know how many children under the age of 3 years participate in the types of nursery education programs we have identified, given the wide-ranging types of programs that have been included. Some 61% of mothers of infants and toddlers are in the labor force in the US and a majority of their children are cared for in out-of-home settings. The focus of this article is on educational settings for infants and toddlers, some of which overlap with child care. There were 63 000 children attending Early Head Start in 2004; 200 000 children under age 3 years enrolled in Part C programs in 2004; and an estimated 400 000 participate in home visiting programs annually. The number of children in enrichment nursery education and special programs is not known. Certainly, substantial numbers of infants and toddlers in the US are involved in formal educational settings, although more 3- and 4-yearolds are in such settings, as reported in the National Household Survey.

Features of Quality Early Childhood Programs for Children 0–3 A number of features have been identified as important within infant–toddler early education settings because they associate with positive outcomes for children: responsive relationships; low group sizes and ratios; emphasis on health, safety, and hygiene; developmental appropriateness of the educational program; and physical environment. These criteria apply to center-based settings but they are useful guides in other settings as well. We address each in turn. The ‘quality of interaction and relationship’ between teachers/caregivers and children is critically important in ECE settings for children under age 3 years. Very young children are comforted and learn in the context of sensitive interaction and secure relationships; therefore, it is critical that teachers of infants and toddlers are sensitively and contingently responsive to children in group care. When an infant cries, a teacher should be there to meet the need; infants in a group setting should be rocked and held and responded to when they coo, babble, and say their first words. Many programs for infants and toddlers are organized so that children always have the same primary caregiver and, in some cases, so children keep the same

teacher over the infant–toddler years. These practices enable the child to feel secure while away from home and to use the teacher as secure base for exploration and comfort while in the out-of-home setting. Studies have demonstrated that children under age 3 years form relationships with teachers/caregivers that are regarded as attachment relationships, that these relationships manifest in ways parallel to attachment relationships with parents – some secure and some avoidant or anxious – and that secure relationships with teachers and caregivers are associated with favorable social–emotional outcomes for children in the early childhood setting. Small group sizes and low teacher–child ratios are important given the importance of responsive caregiving. Small groups – no more than six or eight children – enable the child to relate to a primary caregiver. Similarly, small groups of children per teacher (1:3 or 1:4) enable primary caregiving and intimate, responsive relations to form between teachers and children. Small, stable groups of children also promote children’s early peer friendships and their learning prosocial behaviors in ways that can be positively guided. Group sizes and ratios in center-based care and education programs and in licensed family child care are typically regulated. Emphasis on health, hygiene, and safety is an important value in settings for infants and toddlers, and observers should note the presence of critical hygienic practices around diapering, feeding, napping, and illness. Teachers should follow strict cleaning and hand washing for themselves and children after diapering, before eating, and when using tissues. Rules for responses to illness within the program should be carefully proscribed and dutifully followed in order to minimize the transmission of illnesses in a group setting, a situation for which infants and toddlers are vulnerable, as they still may lack natural immunities to many diseases. Infants and toddlers in group settings have been found to have more upper respiratory infections than children cared for in home settings so health and hygiene practices are important for minimizing illness. Additionally, small group sizes, low ratios, and consistent teachers who have relationships with infants and toddlers contribute to safety practices that must be monitored carefully in settings with children so young. Studies of quality in group settings for infants and toddlers in the US frequently report that health, hygiene, and safety practices are suboptimal, so it is of great importance that these practices are monitored. Using developmentally appropriate practices that stimulate children’s learning in appropriate ways is also critical in group settings for children under age 3 years. Infants and toddlers learn in ways that are different from how older preschool age children learn. For example, for children under 12 months of age, learning is frequently in the sensory and motor mode and occurs in small ‘bites’ and at ‘teachable moments’ in the course of caregiving and


play routines. For toddlers who are beginning to incorporate representation through language and play into their learning, it is important that environments be rich in language and opportunities for symbolic play. Studies of quality in group settings frequently find lower scores observed for the quality of the learning environment than for more interactive aspects of group settings (the teacher–child relationship), so it is important that the learning environment be given attention. Several curricula for organizing learning experiences for infants and toddlers in group settings have been developed, which we describe in the section on ‘Private or specialized nursery schools for children aged 0–3 years’. Finally, the physical environment for group settings for infants and toddlers is important. In order to facilitate developmentally appropriate exploration for children in this age range, the environment must be completely child proof (safe to an exploring infant or toddler in all aspects), incorporating features that both protect and stimulate children (e.g., low sectionals that partition older and younger children from one another, as appropriate, yet allow teachers to see all the children; ramps and high/low spaces for children to explore; low sinks, toilets, tables, and other surfaces accessible to small children; shelves that enable teachers to make available but also control use of materials and manipulatives; and opportunities for inside and outside play with an abundance of opportunities to explore natural materials such as sand and water). Furthermore, young children need extensive time in the out of doors to develop a love of nature, habits of vigorous activity, and the self-regulation that are promoted by outdoor play. In the US, Louis Torrelli, James Greenman, and Deb Curtis and Margie Carter offer expertise in designing spaces for groups of very young children. A very good measure of the quality of infant–toddler center-based settings is the Infant Toddler Environment Rating Scale-Revised, developed at the well-known Frank Porter Graham Child Development Institute at the University of North Carolina – Chapel Hill. This measure assesses most of the items listed above and other features. A score of 5 or above on this measure is a good indicator that an environment is good quality; increasingly infant– toddler center-based programs participate in state Quality Rating Systems that give star or levels of ratings of program quality, often publicly available to consumers via state department web sites.

Center-Based Programs Providing Early Childhood Education to Children under 3 Years of Age We focus here on the nursery/ECE settings of a more formal nature where some children are cared for or whose

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parents chose them for enrichment or remediation. These categories include (1) federal Early Head Start and federal/state Even Start programs; (2) state-sponsored PreKindergarten programs; (3) Part C of the Individuals with Disabilities Education Act programs; (4) programs that blend Head Start, state and local funds such as Educare programs; and (5) private nursery schools for children aged 0–3 years in the US. Again, we do not discuss child care here; nor do we discuss a myriad of programs for ‘parents’ of children under age 3 years, such as teen parent programs, as our focus is on programs that directly target infants and toddlers, although many of the programs we reference here have substantial parenting components. Thus, this section does not include the numerous parent education programs and family support programs. Early Head Start Early Head Start programs offer federal Head Start services to children under age 3 years and their families. Head Start was authorized in 1965 but Early Head Start came into being through the 1994 authorization of the Head Start Act. The blueprint for Early Head Start was created by the national Advisory Committee on Services to Families with Infants and Toddlers as national experts sought to infuse Early Head Start with best practices in prenatal to age 3 years services. Early Head Start programs are two-generation in nature (have services for both children and parents); 90% of all participations have incomes at the poverty level or lower. Services begin for the mother prenatally in order to promote health and psychological outcomes for the child. As noted, programs in the US today served about 63 000 low-income children ages 0–3 years in 2005 in over 700 US communities. The program is estimated to serve about 3% of the children who would be eligible for services. Early Head Start programs are organized around the Head Start Performance Standards and studies have documented that infant–toddler group programs are typically of high quality. Early Head Start programs may be center based (offering part-day or, more typically, full-day center services for children with a minimum of two home visits a year for parents), home based (weekly home visits and monthly group socializations with groups of children) or a mixture (children receive a combination of center- and homebased services and/or children and parents may receive home visiting for a period of time, often the first year of life, and the children attend centers while parents continue to receive home visits). The child development component in home visiting programs is emphasized; children as well as parents are expected to benefit from the services when they are delivered in the homes. Home visitors typically set goals with parents focused on children’s development; toys and materials may be left for the child to use during the

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ensuing week, and child as well as parent service needs are discussed and planned for. Each Early Head Start program serves about 75 children on average. The majority of programs are affiliated with three to five Head Start programs that typically serve much larger numbers of children. These programs are in urban as well as in rural areas, with rural areas somewhat more likely to deliver services through home visiting and urban areas through center-based services. In 2004, the race/ethnicity of children in the Early Head Start program was slightly under a third African American, under a third Hispanic, about a quarter white, with smaller proportions from other minority groups. Some Early Head Start programs are also offered on Native American reservations and in migrant communities. Even Start Federal Even Start Family Literacy was authorized in 1988 as the Improving America’s Schools Act. Since 1992 it has been administered at the state level with authority to award subgrants delegated to states. The program’s purposes as defined in the Improving America’s Schools Act are ‘‘to help break the cycle of poverty and illiteracy by improving the educational opportunities of the nation’s low-income families with children 0–7 by integrating early childhood education, adult illiteracy or adult basic education, and parenting education into a unified family literacy program.’’ These programs may supplement or stand alone with other 0–3 programs serving low-income families. State Sponsored Pre-Kindergarten Programs While most state-sponsored pre-kindergarten programs serve children 3 years of age and even more typically 4-year-olds, a few offer center-based services to children aged 0–3 years (e.g., Nebraska). These programs typically supplement Early Head Start services by serving more children or by adding hours or days. Nebraska is one state that includes services for infants and toddlers among its pre-kindergarten, state-funded programs. About 18% of Nebraska children attending state-supported prekindergarten programs in 2004 were under age 3 years. In this state, priorities are given to children of teen parents, those of low birth weight, those in low-income families, and those not speaking English. Some of the infants and toddlers are served in center-based and some in homebased programs. Illinois sets aside 11% of its state prekindergarten funds for serving infants and toddlers. Part C Programs Families of young children with disabilities are eligible for early intervention services as mandated by Part C of the

Individuals with Disabilities Education Act. As reported in a nationally representative sample commissioned by the US Department of Education, conducted by SRI, International of Menlo Park, CA, and referred to as the NEILS study, about 200 000 children (or 1.8% of all children aged 0–3 years) were enrolled in Part C programs. Higher percentages of children at later ages have identified disabilities. These children have individualized family service plans (IFSPs). Some are enrolled in center-based services, others receive home-based services and others, individualized referrals. In all cases, the service plan is designed to address the educational and other needs of the young child and his/her family. The NEILS study, commissioned by the US Department of Education, reported that the average age at which families reported a concern about their child was 7.4 months. A diagnosis was made, on average, 1.4 months later, and the child was referred for early intervention an average of 5.2 months after the diagnosis, with the IFSP being developed 1.7 months later or at an average age of 15.7 months. This study reported that most families were very positive about their entry into early intervention programs. They reported discussing their concerns with a medical professional and finding that person helpful. Families reported relative ease in accessing services, felt that services were related to their perceived needs, rated positively the professionals working in early intervention, and felt that they had a role in making key decisions about child and family goals. A small percentage of families experienced significant delays in getting services, wanted more involvement in service planning, or felt that services were inadequate. Minority families, families with limited income, and families with less-educated mothers were more likely to report negative experiences. Educare Programs, Bounce Learning Network Educare programs blend Head Start, other federal, state, local and private philanthropy funds to offer center-based services that begin before children’s first birthday (in some sites, doula services begin before birth). These programs offer highest-quality 0–5 services for children to families at greatest risk. The Bounce Learning Network, operated by the Ounce of Prevention of Chicago, IL, is the organizational framework for Educare programs for underserved, low-income infants and toddlers in a number of cities; including Omaha, NE, Milwaukee, WI, Chicago, IL, Tulsa, OK, Kansas City, KS, and Denver, CO. New programs are being added to this network. The programs offer intensive high, quality full-day, full-year, center-based programs in outstanding facilities designed to optimize environmental opportunities. The Educare high bar for quality is maintained by emphasizing core features – employing teachers with bachelor’s degrees, employing master teachers, emphasizing children’s literacy, social–emotional


development and opportunities for expression through the arts, and using evidence-based practices. Facilities are linked to public schools in each community. Private or Specialized Nursery Schools for Children aged 0–3 years, Including Montessori A number of private schools offer education experiences for children under age 3 years, usually a somewhat small group and often in connection with a larger program offered for older children. These may or may not be indistinguishable from childcare programs; many are full-day programs. These may include private church-related programs, privately or collectively owned programs, laboratory schools on university campuses, and specialized programs such as Montessori schools. Many offer services for children aged 0–3 years but may also include a 3–5 (or beyond) emphasis. Montessori schools, following the philosophy of the Italian educator, Dr. Maria Montessori, typically include older children but may begin serving children below a year of age. Some begin when children are able to walk, around 15 months; when children are 18 months of age or at age 2 or 2.5 years. These programs share their founder’s view of children as competent beings and emphasize the importance of observation of the child interacting with his environment as the basis for ongoing curriculum development, highlight sensitive periods of development during which a child’s mind is particularly open to learning specific skills or knowledge, and a belief in the ‘absorbent mind’, the limitless motivation of the young child to achieve competence over his or her environment and to perfect his or her skills and understandings as they occur within each sensitive period, and self-correcting ‘auto-didactic’ materials. Parents may notice that the environments and materials in an infant/toddler Montessori program differ from what they see in other centerbased programs for infants and toddlers. For example, children may sleep on futons vs. cribs, and engage in practical life and sensory experiences, and the environment is organized to be organizing and supportive of autonomy, yet calm and not overstimulating. Many are surprised at the purposeful and independent work that even very young children are able to accomplish in Montessori settings. Curricula and Specialized Programs that Can be Embedded into Child Care, Nursery Programs or in the Home A number of specialized approaches and curricula exist that may be imbedded within nursery, childcare, or intervention programs. Some of these curricula may be purchased or subscribed to by parents as well. While the total number of infant curricula is truly extensive and covers a wide range of

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quality and developmental appropriateness, we present several here that may be useful for professionals and, in some cases, parents to access. While the curricula and approaches represent some of the most frequently used by programs and parents, others are available. The ‘Active Learning’ Series from the Frank Porter Graham Child Development Institute, published by the Pearson Learning Group, devotes a volume to each specific age group – infants, ones, twos, threes (and older). Each volume contains over 300 clearly formatted activities intended for use in home visiting programs or centerbased early care and education programs. ‘Beautiful Beginnings’ offers a curriculum of developmental experiences for children ages 0 through 36 months of age. This easy to use curriculum, built around children’s strengths in multiple areas of development, is used in centers, family childcare, home visiting programs, and by parents. ‘The Creative Curriculum’ series, developed by Teaching Strategies, Inc., includes specific resources for curriculum development for infants and toddlers (as well as for preschool-age children, school-age children, and children in family childcare). This curriculum focuses on how children learn, what children learn, the parent’s role, the teacher’s or provider’s role, and the physical environment. ‘Hawaii Early Learning Profile HELP’ (0–3 year olds) is a center-based curriculum for children from birth through age 3. It is a curriculum-based assessment that provides play-based activities and intervention strategies for skills in six developmental domains. It can be used by physical, speech, and occupational therapists; early childhood educators; infant specialists; psychologists; social workers; and nurses. ‘High/Scope’–the High/Scope educational approach is a set of guiding principles and practices that adults follow as they work with and care for infants/toddlers (as well as for preschoolers, and elementary, and adolescent students). Children in High/Scope settings are engaged in a consistent routine that includes time for children to plan, carry out, and reflect on their own learning activities as well as time to engage in small- and large-group activities. ‘Transdisciplinary play-based assessment and transdisciplinary play-based intervention’ was designed by Toni Linder offers a practical way to assess children’s learning styles, interaction patterns in four areas of development. This system for children infancy through age 6 years is particularly helpful for developing intervention plans in a parent and teacher team.

Home Visiting Programs Home visiting programs predominantly serve families with children aged 0–3 years, with some beginning during

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pregnancy and a few continuing services until children are age 5 years. According to Deanna Gomby, who has written periodic reviews of home visiting in the US, approximately 400 000 families with young children participate in the six largest home visiting programs in the US. These programs share the intention of maximizing outcomes for young children, although the role of the home visitor may vary. For example, the home visitor may focus more on the parent in some programs, on the parent–child relationship in others or work directly with the child in still others. Home visiting programs vary also by the qualifications of the home visitor; some employ professional nurses while others build the program around paraprofessionals, frequently from the neighborhoods of families being visited. Four of the five largest home visiting programs in the US that include services to parents with infants and toddlers are briefly described. (The fifth of these largest programs is Early Head Start which was described above.) (1) Healthy Families America; (2) The Nurse–Family Partnership; (3) Parents as Teachers, and (4) The Parent–Child Home Program. Other home visiting programs with a child development emphasis may be sponsored specifically by local communities, states, or organizations. Healthy Families America Healthy Families America home visiting programs exist in 430 communities within the US with the specific purpose to promote positive parenting and prevent child abuse among families at risk who have children under the age of 5. Families receive weekly home visits initially, diminishing to once a quarter for older children. Home visitors include both paraprofessionals and those with bachelors’ degrees. Nurse–Family Partnership The Nurse–Family Partnership serves 250 communities nationally. Public health nurse visitations begin before birth and continue through the child’s second birthday, initially weekly and fading to monthly. This program serves low-income, first time mothers and seeks to enhance child development by improving pregnancy outcomes, health and economic self-sufficiency. Parents as Teachers Parents as Teachers is the largest home visiting program serving 3000 sites nationally as well as providing services in at least six other countries. Parents as Teachers visits begin before birth and continue through the child’s third birthday, but some may continue longer. This program seeks to give children a firm foundation for school success by empowering parents, increasing parent competence

and confidence, and by developing home–school community partnerships. Parents as Teachers programs may be targeted for children at risk, but in some communities it is universally available to all parents (http://www.parentsasteachers.org). Parent–Child Home Parent–Child Home programs serves 137 sites nationally as well as in the Netherlands and Bermuda, with two visits a week beginning when children are 2 years of age and continuing until they are 4 years old. Families targeted are low-income, as well as parents of low education, teen parents, homeless parents, and parents who do not speak the native language. This program emphasizes the development of language and literacy skills and parents’ ability to promote these. Books and materials are provided for the parents to use with their children (http:// www.parent-child.org).

Out-Of-Home Enrichment Programs There are many out-of-home enrichment experiences available for young children and their families. An outof-home enrichment experience will refer to any experience that occurs outside of the home setting and is targeted for children ages 0–3. Formal experiences refer to any program that has an organized curriculum and is being offered outside of the child’s home environment by a professional trained in the content area. A fee may be required along with parent participation for the age category of 0–3. Informal experiences refer to opportunities available to children and families who do not have a curriculum, but still offer benefits to the child’s development. There may be fees associated with some of these experiences (Table 1).

Center-Based Programs for Children 0–3 in European Countries We now leave the US and consider formal care and education available in selected European countries. Here we focus on full-time and part-time education and care. The early education picture for children under 3 looks very different in Europe vs. the US, for two key reasons. First, in the European nations – indeed in most industrial nations other than the US – new mothers (and sometimes even new fathers) are entitled to paid parental leave for at least several months and sometimes up to a full year or more. In the Organization for Economic Cooperation and Development (OECD), for example, the average period of paid parental leave for the 30 members (excluding the US) is 10 months, with the pay

Preschool and Nursery School Table 1

Examples of out-of-home enrichment experiences for infants and toddles

Formal experiences

Program

Music

Kindermusik Begin in the 1970s in the US from Germany. It is international, with over 5000 licensed educators. The curriculum is research based. Gymboree Began in 1976. Currently the program has over 500 franchises in 26 countries. The curriculum is research based. YMCA/YWCA American Red Cross

Swimming*

Club Swim Private schools that specialize in infant/toddler swimming lessons Informal experiences Play dates/groups

Storytelling/reading

Children’s museums

Parks

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Offerings

Website

Through shared experiences, parents learn more about music and their children’s abilities as the children learn how to integrate fun with musical play.

http://www.kindermusik.com

Play-based developmentally appropriate learning experiences for parents and children. Swimming lessons from birth with certified educators.

http://www.gymboreeclasses. com

Comprehensive website for aquatic enthusiasts.

http://www.clubswim.com

http://ymca.com http://ywca.com http://www.redcross.org

Where to find local information

Offerings Children and parents who gather on a regular basis. Parents either taketurns leading the play session or the group of parents will hire a person to provide activities. A main goal of these gatherings is for children and parents to socialize with one another. Children and parents meet with a storyteller or reader on a regular basis. The stories told and books read are developmentally targeted for children within the age range to which they are offered.

Displays are interactive and are designed to provoke and stimulate children’s development in the areas of social, physical, language, and cognitive development. Parks offer children the opportunity to play with peers similar in age while challenging them with their cognitive and physical abilities through problem-solving and climbing or walking on structures.

Local Chamber of Commerce

Local libraries or bookstores such as: Borders (www.borders.com) or Barnes and Noble (www.barnesandnoble.com) Local Chamber of Commerce

Local Chamber of Commerce or The City Parks and Recreation Department

A cautionary note: The American Academy of Pediatrics (http://aap.org) recommends that children not be expected to have formalized swimming training before the age of 4 years, stating that developmentally children are not ready to swim alone before this time and should always have a parent within ‘touch’ length (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/4/868). Any training prior to age of 4 years should be thought of as water safety and not as swimming readiness courses. The leading cause of death in children ages 1–2 years is accidental drowning.

ranging from a basic daily stipend to 90% of regular salary. Thus, infants with working parents in Western Europe tend to be cared for at home by a parent for the first year of life. During the second year, however, many of the infants are placed in care as the mothers go back to work. Second, in Europe, many nations (often the very same ones with the most generous parental leaves) provide a government-subsidized system of education and care for children under 3. In some cases, these infant–toddler services are separated off into a more care-oriented stratum of services running parallel to a more educationally oriented system for children aged 3–5. Yet, across Europe, trends are seen toward expanding the supply and quality of infant–toddler services as part of an integration of care and education under education auspice. These trends are especially strong in France, Italy, and the Scandinavian

countries. According to Michael Lamb and colleagues, in France, for example, about 20% of children aged 0–2 years old attend publicly supported centers, and this percentage rises to 100% for children aged 3. By age 3, almost 100% children not only in France but also in Italy and Belgium participate in educationally oriented center-based programs (both public and private), as do at least two-thirds of 0–2-year-olds in Iceland, Spain, Denmark, Norway, Hungary, and Sweden. A sketch of the educational policies and national guidelines of the European countries with the highest percentages of 0–2s in publicly supported care suggests that a strong educational mission is coming to prevail. For example, parents in France have a range of different kinds of programs for their children under 6, with the most educationally oriented being the Ecole Maternelle Francaise

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(EMF) (French nursery school system). The EMF is a publicly supported system that in 1995 served about 34% of 2-year-olds and 100% of children aged 3–5, with the goals of compensating for cultural disadvantages, preventing developmental delays, preventing later school failure, and equalizing educational opportunities. The children, aged 2–6, are typically grouped by age in classes that are somewhat large by American standards but with consistent quality supported by trained professional teachers who have the same status, salary, duties, and training as primary school teachers. The French terms for child care outside the home are programmes d’accueil (‘programs of welcoming’) and programmes d’eveil (‘programs of awakening’). Thus, the mission of the public system is to invite children into French society and arouse their capacities for learning and development. A Child Care Study Panel of the French American Foundation suggested that seven principles animate the French childcare system. Most of the principles (e.g., integrated focus on care and education, skilled staff, preventive healthcare, quality incentives, maternity leave, and parental choice) overlap with American values and approaches, but one (beauty) seems quite distinctive from the perspective of the US, where esthetics are less emphasized. As authors Richardson and Marx, from the French-American connection have noted, ‘‘The resources and beauty invested in buildings and equipment for children celebrate and express children’s value to society. Well-designed space and furnishings are integral to program quality.’’ In Italy, likewise, certain regions and localities have become recognized worldwide for their high-quality public early childhood systems serving children under age 3 years and their families, including children with disabilities. The asili nido (‘safe nests’, the Italian term for infant–toddler centers) developed as a result of a national law passed in 1971 and are intended to set up a system for children under 3 years of age parallel in some ways to the Italian publicly-supported scuole del infanzia for children aged 3–6 years. The asili nido are full-day programs that are open 10–11 months a year, usually serving 30–60 children divided into three age groups with two or more teachers for each age group. Their mission blends family service and education, resulting in a strong trend away from a custodial approach to infant–toddler care to a developmental orientation, and this has created a rising trend in Italian parents across all social classes to appreciate the programs as a developmental benefit and source of pleasure for children, not primarily as a convenience or service for working parents. Certain cities, particularly in Northern and Central Italy, such as Reggio Emilia, Pistoia, Milan, and San Miniato, have become known for their leadership in innovating and implementing strategies that lead to excellent education. All of these strategies place a focus on process rather than products or outcomes.

. System-wide and center-wide goals are decided upon through discussion and dialog among stakeholder groups of parents, teachers, and administrators. . Professional development and teacher education are based on activities of ongoing observation and reflection. . Families are brought in and involved in multiple ways that are particular to each city and region. Families are regarded as partners rather than consumers. . Sense of group belonging life is the focus of the infant–toddler center experience for children and parents and the impetus for learning, well-being, and lasting relationships. . Continuity and closeness of social relationships is promoted by strategies such as the inserimento (delicate process of transition into the center), diario (memory book given at the end), pedagogical documentation; teacher–child continuity over several years; and welcoming, soft, and beautiful physical environments. Each of the Scandinavian countries, finally, has its own unique array of programs – public and private, part-day and full-day, home and center based – serving its children under age 3 years, yet certain generalizations seem to hold true across this whole region which shares the Nordic history, culture, and languages. The Scandinavian nations in general feature generous social welfare provisions that support and promote women’s political and economic labor force participation. Programs serving infants and toddlers usually favor a mixed-age or ‘family’ grouping in order to promote the child’s emotional security and continuity with the same adults and peers over time. Furthermore, education and care are part of an integrated philosophy that traces back to the progressive philosophies of Froebel, Pestalozzi, and Montessori but that has been adapted to the Nordic emphasis on free play, homelike environments, and active daily engagement with nature and the outdoors. Self-initiated free play is considered essential for children’s development and vital for the child’s well-being and development. Children are dressed in warm snuggly clothes and sent outside to play avidly for hours in challenging, exciting playgrounds or to enjoy regular excursions to forests and parks. Children’s rights are anchored in legislation to a greater extent in the Scandinavian countries than in many other places; for example, corporal punishment (even by parents) is prohibited in Sweden and Norway, and children of divorce must be allowed access to both parents in Finland.

Findings from Research: Intervention Program Effects on Disadvantaged Infants and Toddlers Societies differ somewhat in their reasons for supporting infant–toddler nursery education. As noted above, many


European countries may offer 0–3 programs for both care and educational purposes. In the US, as Figure 1 shows, programs may be more educational or more care oriented in their purpose. As noted, in the US, a number of programs are designed to create opportunities for children at risk. These programs often have the explicit purpose to improve developmental outcomes and some have conducted rigorous research, comparing children who received the 0–3 service with eligible children who did not receive the service. In the next section, we provide findings from some of the best known of these studies to illustrate the positive advantage that has been attributed to educational opportunities for infants and toddlers among children at risk. There are three types of programs providing evidence about program practices and infants and toddlers: (1) Evidence of positive program effects from programs that are no longer in service; for example, demonstration programs designed to determine if positive outcomes were possible or likely under specific intervention conditions. (2) Other programs contributing to the evidence base (such as Nurse Family Partnerships, Early Head Start that have already been described) that are in operation today. (3) Finally, newer programs (e.g., national home visiting programs, Educare programs) are incorporating data into their regular practices using findings for continuous program improvement. Findings from the first two groups are presented; the work represented by the third group is more recent, typically generated for internal and local use and thus is not widely available. The Carolina Abecedarian Program Among the demonstration center-based programs for infants and toddlers, the best known is the Abecedarian project, which was carried out in North Carolina beginning in the early 1970s. The first-born children of African American single teen mothers were randomly assigned to receive the experimental Abecedarian full-day, full-year, high-quality center-based services from before they were a year old until they entered kindergarten. A group of 111 children were enrolled into the study. Children in the control group who did not receive the educational Abecedarian program did receive health, nutrition and supportive social services that Abecedarian children received. When children were 3 years of age, program children had intelligence quotient (IQ) scores a full standard deviation larger than those of the control group (101 vs. 84 for the control group). Abecedarian children were followed into adulthood and at each assessment point, they were developing significantly better than the control group. Although Abecedarian was an expensive program to implement (5 years of full-time care and education), cost–benefit analyses show $4 returned for every dollar invested because Abecedarian children were less likely to need special education, were more likely to graduate from high school and to have greater adult earnings.

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Infant Health and Development Program Another well-known study assessing intervention effects and beginning in infancywas the Infant Health and Development project (known as IHDP), carried out in eight communities. It was designed to test whether an Abededarian-like Program could be effective for children at risk due to low birth weight. This program featured home visits to mothers and children until children were 12 months of age and then full-time center-based care until children were 36 months of age. Like Abecedarian, IHDP showed positive impacts on program children when children were still toddlers that were apparent in subsequent follow-up periods. The children were followed up at age 18 and among the heaviest low-birth weight group, positive program effects were still detectable. Early Head Start Research and Evaluation Project The Early Head Start Research and Evaluation project (the Early Head Start program was described earlier) randomly assigned 3001 children and families to program and control group within 17 of the program communities around the country. When the program ended, program children had significantly better cognitive, language, and social emotional development than control group children. Effect sizes were particularly large for African American children and children who had enrolled during pregnancy, those in families at a medium level of demographic risk, and those enrolled in mixed approach programs featuring center-based and home visiting services. Children were followed up at age 5 years and a number of the positive effects were sustained particularly social emotional and approaches toward learning outcomes, as well as outcomes showing that parents were offering children more stimulation for learning and demonstrated fewer depressive symptoms. Nurse Home Visiting Multiple studies (carried out in Elmira, NY, Memphis, TN, and Denver, CO) have found that children and parents who participated in Nurse Home Visiting programs (Nurse Home Visiting serves families beginning before birth and continuing until 2 years of age) demonstrated positive outcomes attributed to the program. In this program a public health nurse visits enrolled monthly during the prenatal period and continues to meet with them until children are age 2 years. During this period the nurses provide health, development and parenting information and support for the parents. Across most programs, parents had fewer child abuse infractions (Elmira) and children had

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fewer childhood injuries (Elmira, Memphis) and other positive outcomes. Today, several states in the US have adopted the Nurse Home Visiting model. Summary These studies taken together illustrate that intensive programs for infants and toddlers who are at risk due to poverty and for other reasons are beneficial to the children, with benefits lasting into school and beyond.

Conclusions In all, many children in the US (and in European countries as well) under the age of 3 years are enrolled in early nursery education. These programs array along continua from center-based to home-based and whether primarily for purposes of care or for purposes of enrichment. Programs may be primarily full-time, around 40 h a week or only be for an hour or so a week (e.g., enrichment programs and home visiting programs with a child emphasis). In the US, many of these programs target children in low-income households because intervention is believed to be of compensatory value for the ill effects of poverty and other risk factors, although only a small percentage of children who qualify for such programs are actually served. In all, many children at all income levels are likely to encounter 0–3 programs. Despite model programs, rates of participation are much lower than for children at age 3 and 4 years because of substantially lower investments in 0–3 programs by state and federal government. See also: Child and Day Care, Effects of; Friends and Peers; Head Start; Maternal and Paternal Employment, Effects of.

Suggested Readings Bailey DB, Hebbeler K, Scarborough A, and Spiker D (2004) First experiences with early intervention: A national perspective. Pediatrics 113–114: 882–896.

Cochran M (1993) International Handbook of Child Care Policies and Programs. Westport, CT: Greenwood Press. Committee on Sports Medicine and Fitness and Committee on Injury and Poison Prevention (2000) Swimming Programs for Infants and Toddlers. Pediatrics 105(4): 868–870. Edwards CP and Raikes H (2002) Extending the dance: Relationshipbased approaches to infant–toddler care and education. Young Children 57(4): 10–17. Gandini L and Edwards CP (2001) Bambini: The Italian Approach to Infant/Toddler Care. New York: Teachers College Press. Kamerman, SB (2001) Early childhood education and care: International perspectives. Testimony prepared for the United States Senate Committee on Health, Labor, and Pensions, March 27, 2001. Lamb ME and Ahnert L (2006) Nonparental child care: Context, concepts, correlates, and consequences. In: Renninger KA and Lerner RM (eds.) Handbook of Child Psychology, Vol. 4: Child Psychology in Practice, pp. 950–1016. New York: Wiley. Richardson G and Marx E (1989) A Welcome for Every Children: How France Achieves Quality in Child Care: Practical Ideas for the United States. New York: French-American Foundation. Watt N, Ayoub C, Bradley RH, Puma JE, and LeBoeuf WA (2006) The Crisis in Youth Mental Health: Early Intervention Programs and Policies. Westport, CN: Praeger.

Relevant Websites http://www.fpg.unc.edu – Active Learning Series, FPG Child Development Institute, The University of North Carolina at Chapel Hill. http://www2.acf.dhhs.gov – Administration for Children and Families, Department of Health and Human Services. http://aap.org – American Academy of Pediatrics. http://www.amshq.org – American Montessori Society. http://www.redcross.org – American Red Cross. http://www.brookespublishing.com – Brookes Publishing, Co. http://www.clubswim.com – Club Swim, Inc. http://www.gymboreeclasses.com – Gymboree, Gym-Mark, Inc. http://www.healthyfamiliesamerica.org – Healthy Families America, PCA America. http://www.highscope.org – High/Scope Educational Research Foundation. http://www.kindermusik.com – Kindermusik International, Inc. http://www.nextdoormil.org – Next Door Foundation. http://www.nursefamilypartnership.org – Nurse-Family Partnership Program. http://www.ounceofprevention.org – Ounce of Prevention Fund. http://www.parentsasteachers.org – Parents as Teachers National Center, Inc. http://www.teachingstrategies.com – Teaching Strategies, Inc. http://www.educareomaha.com – The Educare Center of Omaha. http://www.parent-child.org – The Parent-Child Home Program, Inc. http://www.vort.com – VORT Corporation. http://ymca.com – YMCA, Young Men’s Christian Association. http://ywca.com – YWCA, Young Women’s Christian Association.

R Risk and Resilience L M Gutman, University of London, London, UK ã 2008 Elsevier Inc. All rights reserved.

Glossary Competence – Successful achievement of critical developmental tasks that vary according to the particular age of the child. Intervention – Effort designed to change the course of children’s lives toward a more positive direction. Within the framework of resilience, programs focus on both fostering competence and preventing future problems. Protective factors – Attributes of persons, environments, situations, and events that relate to positive adaptation for children under conditions of adversity. Resilience – Developmental process wherein children demonstrate positive adaptation despite experiencing significant adversity. Risk factors – Stressors that have proven or presumed effects in increasing the likelihood of maladjustment in children. Vulnerability factors – Attributes of persons, environments, situations, and events that relate to maladjustment for children under conditions of adversity, that is, the opposite of protective factors.

Introduction For more than three decades, researchers have been interested in the study of resilience in which children demonstrate positive adaptation despite experiencing significant risk in their lives. Risk factors – such as war, maltreatment, and poverty – increase the likelihood of maladjustment in children. Protective factors – such as children’s psychological and personality characteristics, their families, and the availability of external support systems – buffer the effects of risk factors leading to positive development.

Resilience is not indefinite, instead it is a developmental process that can be modified as new risks and/or protective factors emerge with changing life circumstances. Why do some children develop well despite facing severe life adversities such as war, natural disasters, maltreatment, and poverty? For more than three decades, researchers have been interested in the study of resilience in which children demonstrate positive adaptation despite experiencing significant risk in their lives. To infer resilience, a child must have two coexisting conditions: (1) exposure to threat or severe adversity and (2) achievement of positive adaptation. Resilience is not necessarily an attribute or personality trait that some children possess and others do not, but rather a developmental process. Resilience is not indefinite: children who meet the criteria for resilience may not necessarily be doing well continually, in every possible circumstance, and in totality. Children may experience resilience yet still suffer from the residual effects of trauma. Resilience does not mean unharmed or invulnerable. Rather, resilience is demonstrated by adaptive behaviors and life patterns. In this sense, resilience is a process that can be modified as new risks and/or strengths emerge with changing life circumstances. The historical roots of resilience can be traced to research on individuals with psychopathology. The work of Norman Garmezy and his colleagues was particularly important in this regard. During the 1940s and 1950s, Garmezy examined the history and prognosis of patients with serious mental disorders including schizophrenia. In the 1960s, Garmezy was interested in understanding the antecedents of mental illness and thus began to focus on the children of mentally ill parents due to their elevated risk of developing disorders. He was surprised to discover that many of these children were doing well. By the early 1970s, Garmezy and his research team shifted their focus to the study of competence in children who were at risk due to parental mental illness, poverty, and stressful life experiences. In 1976, Ann Masten joined the research

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team which was renamed Project Competence. Their research represents one of the earliest efforts to define the positive factors that compensate for the presence of risk in children’s lives. Another landmark study was conducted by Emmy Werner and Ruth Smith. This longitudinal study spanning more than four decades followed the development of nearly 700 children born on the Hawaiian island of Kauai in 1955. The children were followed from birth to adulthood. Although most of the children experienced some level of risk such as poverty and low parental education, one-third experienced multiple risks. Despite these risks, one-third of the children with more than four risks developed well in terms of getting along with their parents and peers, doing well in school, and having good mental health. This resilient group had more resources such as good temperaments and positive parenting in their lives. Most of these children have grown up to be successful adults – in stable marriages and jobs and satisfied with their relationships and life circumstances. These findings indicate that positive factors can make more of a profound impact on the life course of children who grow up in adverse conditions than specific events or risk factors. These early efforts have played a crucial role in the recognition of childhood resilience as a major theoretical and empirical field of study. These endeavors have enhanced our understanding of the pathways to psychopathology and the processes that lead to normal development. More importantly, this body of work has challenged deficit models that characterized the developmental course of disadvantaged children as deterministic, with an inevitable trajectory leading to maladjustment and pathology. This early work has inspired others to focus on how resilience research may inform social policy and shape prevention and intervention programs to improve the lives of vulnerable children and families. Following this earlier research, scholarly interest in the study of resilience burgeoned. More contemporary researchers, however, have criticized some of the conceptualizations and methods used by resilience researchers. One of the main criticisms concerns the absence of a unifying conceptual framework across disciplines and specialized areas. A scientific basis for intervention research necessitates precise terminology to build upon earlier classifications and to ensure its continued vitality. A consistent and systematic framework is essential to facilitate the work of researchers and practitioners who pursue work in this area, to integrate findings across diverse fields, as well as to provide guidance for the identification and implementation of age-appropriate, optimal targets for preventive interventions. For these reasons, it is essential to delineate the main concepts involving the study of resilience including risk factors and protective/vulnerability factors as well as to describe

its models of risk and resilience and definitions of successful developmental outcomes.

Risk Factors Defining Risk Factors Risk factors have been defined as stressors that have proved or presumed effects in increasing the likelihood of maladjustment in children. Risk factors include catastrophic events such as war and natural disasters, family adversities such as bereavement and divorce, economic conditions such as poverty, and exposure to negative environments such as community violence. Risk factors pose a pervasive threat through the deprivation of children’s basic needs such as physical sustenance and protection, emotional security and attachment, and social interaction. As a result, exposure to risk factors predicts a variety of difficulties in adjustment and adaptation across the lifespan. Children’s exposure to risk varies according to age. Children in the first few years of life have not established any independent functioning and therefore are highly dependent on their families. As a result, young children are particularly vulnerable to adversities involving their parents and caregivers. However, infants are less likely to suffer from the atrocities of war or the significance of major disasters by their lack of understanding of what is happening. Adolescents, in contrast, have larger and more varied social communities and therefore may have access to supportive environments other than their family. Yet, adolescents are more influenced by the loss and devastation involved in war and natural disasters. They have a greater understanding of what these events signify for their future, a realization that extends beyond the mental capabilities of young children (Table 1). One of the most immediately traumatizing events for children and adolescents is the death of a parent. Parental bereavement represents a permanent loss and separation from the primary caregiver. The process of bereavement can be aggravated by additional stressors such as family restructuring, new expectations of children’s behavior, parental grief and distress, and death reminders. Family dissolution from parental divorce also increases children’s risk for psychological, behavioral, social, and academic problems in comparison to two-parent nondivorced families. Risk is greatest for children of divorced parents who experience high interparental conflict, loss of contact with one parent, problems with the mental health of parents, less economic stability, and multiple marital transitions. Although the intensity diminishes across time, offspring of divorced and remarried families experience difficulties that extend into adolescence and young adulthood. Nevertheless, resilience is the normative outcome for children who are faced with their parents’

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Table 1

Examples of risk factors for children

Domain

Factor

Family processes

Bereavement Family dissolution Maltreatment Harsh parenting Poor mental health Substance abuse Low education Single parenthood Numerous stressful life events Household crowding Poverty Peer rejection Delinquent peers Lower qualified teachers Lack of school resources Violence Poverty Crime Victimization Discrimination Racism Prejudice War Catastrophic natural events

Parent characteristics

Family structure

Peers Schools Community

Societal

Environment

marital transitions and, in the absence of additional adversities, the vast majority of children of divorced parents develop into reasonably competent well-adjusted adults. Child abuse and maltreatment also pose a severe threat to children’s development. Child abuse involves a significant deviation from the normative environment required for children’s successful development and, as a result, few maltreated children experience resilience. Despite this, there are maltreated children who achieve higher levels of adaptation than others. This is likely due to the heterogeneity of maltreatment experiences. Children who are older at the age of onset of maltreatment and who are exposed to shorter, less severe, and pervasive experiences of abuse are more likely to experience resilience. Parental psychological disturbances such as mental health problems and drug/alcohol use have also been linked to a variety of behavioral, socioemotional, and cognitive problems in children. Many of these disorders coexist and therefore it is often difficult to disentangle their effects on children. For instance, drug-abusing parents also tend to report a higher degree of psychological disturbances. Parental psychological disturbances interfere with interpersonal relationships within the family as well as compromise family functioning in which daily tasks are not accomplished. These aspects of impaired functioning may be the pathways through which problems persist into adulthood. Childhood poverty – defined by living in a family whose income falls below a specified level necessary for minimum

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coverage of basic expenses – has been shown to increase the risk of negative child outcomes. Poverty has more detrimental effects for those children who are under the age of 5 and who live in extreme or enduring impoverished conditions. Such negative effects include poor physical health; lower academic and school performance and attainment; and increased likelihood of social, emotional, and behavioral difficulties. Other factors associated with economic circumstances exact their toll on children. Low parental education is also a risk factor for children’s cognitive and social development. Parental education influences the educational advantages of the family and their access to key educational resources and opportunities. A larger family size, or greater number of children living in the home, also increases the risk of negative outcomes for children. This is most likely due to the fact that a greater number of family members decreases the amount of resources that is available per person. Another risk factor concerns the number of stressful life events encountered by the child and/or family. These life events can range from the trivial to severe and from the desirable to undesirable. For example, moving home may be stressful even if it is to a more desirable location. Daily hassles – or the irritating, frustrating experiences that happen nearly every single day – can also exacerbate stress. Although stressful life events may have more of an impact on parents, evidence suggests that both major and minor events contribute to variation in children’s development. In children’s larger environment, peers, schools, and neighborhoods can also pose a risk to children’s development. Children living in impoverished urban areas are particularly at risk for experiencing a variety of difficult circumstances. Children living in inner-city environments more likely to live in inadequate housing, have less access to good-quality schools and other social resources, and more likely to be exposed to negative peers and multiple violent events. Recent attention has particularly been focused on community violence. Community violence includes many forms such as victimization, witnessing violence, and listening to violence experienced by friends and family members. A growing body of research links this exposure to both psychological and behavioral problems and school underachievement. In a larger context, societal mechanisms of discrimination, racism, and prejudice have been shown to negatively influence the lives of ethnic minority children. Racial and ethnic discrimination has been linked to a number of psychological symptoms such as low perceived control, anxiety, and frustration. Many children experience discrimination in everyday exchanges and these greatly undermine their mental health. Racism and discrimination also influence other resources in children’s lives. For example, research indicates that teachers have lower expectations for, and respond less positively to, ethnic-minority students. Ethnic-minority students are also more likely to be placed

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in lower academic tracks than their counterparts. These experiences undoubtedly play a role in the underachievement of many ethnic minority children. On a broader scale, catastrophic events such as war, extreme privation, and natural disasters clearly disrupt children’s development. In such severe trauma, children experience devastation on an extreme and massive scale. Children are often less capable of coping with the consequences of such catastrophes – including the lack of basic necessities for existence. These children experience loss of their loved ones and witness unimaginable atrocities. The experience of resilience is defined by their very survival. Yet, studies of children who have experienced such catastrophes suggest that most, when placed in new environments, lead normal, competent lives. Assessing Risk Factors Early studies of risk often focused attention on a single risk factor such as child poverty or maltreatment. Many investigators soon realized that the examination of a single risk factor does not address the reality of most children’s lives. Children rarely experience risk in isolation, rather risk tends to cluster, usually encompassing a sequence of stressful experiences instead of a single event. For example, children living in poverty are often exposed to other chronic stressors such as family disruption, inadequate housing, and community violence. Child maltreatment tends to co-occur with other environmental threats to children’s development such as parental mental illness, parental substance abuse, poverty, parental conflict, and community violence. Evidence also suggests that the effects of an isolated risk factor tend to be rather modest. The exposure to a specific risk factor does not necessarily cause difficulties, but rather it is a life history characterized by the accumulation of family disadvantages, social and economic life events, and adverse conditions that predict maladjustment. For these reasons, many investigators have taken broader perspective when examining the risk factors that impact children’s development. Given the importance of studying multiple influences simultaneously, the next question would be to identify the best analytic strategy. Although regression analyses with a large set of variables might be considered optimal, the relatively small sample sizes of most developmental studies militate against the use of an approach. In situations where many risk indices are considered, it is often impractical to have a large number of predictor variables included in a single regression analysis particularly when sample sizes are limited. Therefore, a number of researchers have employed a cumulative risk model that incorporates a large set of risk factors created by aggregating information about stressful life experiences or risk indices. In both instances, the cumulative risk score is calculated by dichotomizing each condition into two

groups, representing the presence (1) or absence (0) of an event or risk, and then adding all of the resultant scores. In general, cumulative risk models indicate that the more the risks children experience, the worse their developmental outcomes. In his sample of 10-year-old children of mothers with a psychiatric disorder, Michael Rutter computed a cumulative risk score based on six factors including severe marital distress, low socioeconomic status, large family size or overcrowding, paternal criminality, maternal psychiatric disorder, and placement of the child in foster care. Rutter found that it was not any particular risk factor but the number of risk factors in a child’s background that led to the diagnosis of a disorder. Psychiatric risk rose from 2% for children in families with zero or one risk factors to 20% for children in families with four or more risk factors. Similar findings were evident in research conducted by Arnold Sameroff and his colleagues in the Rochester Longitudinal Study (RLS). The RLS followed a sample of children from birth to young adulthood from families with a high level of maternal psychopathology. Ten environmental risk factors were examined: (1) a history of maternal mental illness; (2) high maternal anxiety; (3) parental perspectives that reflected rigidity in the attitudes, beliefs, and values that mothers had in regard to their child’s development; (4) few positive maternal interactions with the child observed during infancy; (5) head of the household in an unskilled occupation; (6) minimal maternal education; (7) disadvantaged minority status; (8) single parenthood; (9) stressful life events; and (10) large family size. When there was no clear definition of risk, 25% of the sample with the worst scores was labeled as high risk. Each of these risk factors was associated with lower preschool competence. Once the risk score was computed, the researchers found that the greater number of risks, the worse cognitive and mental health outcomes for children. Moreover, most children with only a single risk factor did not have a major developmental problem. Another question regarding the cumulative risk model is whether quality or quantity matters in terms of the negative effects of risk on developmental outcomes. Using the 4-year data in the RLS, Arnold Sameroff and colleagues examined families that experienced a moderate number of risks (3–5 out of 10) to determine whether specific combinations of risk factors had worse effects than others. The families fell into five groups with different combinations of high-risk conditions. Despite these differences, the children had similar developmental outcomes across the five groups. Therefore, it was the number of risk factors, not the combination, which was most important in predicting children’s outcomes. This suggests that is it unlikely that the same intervention will be successful for all families. For each family, a unique combination of risk factors will require a specific set of intervention strategies to address the specific risks facing that family.

Risk and Resilience

Recent studies also indicate that there is a universality of risk factors. The same risk factors have been found to influence multiple outcomes such as depression, delinquency, and substance abuse, and each disorder has multiple risk factors. Studies of single risk factors and single outcomes neglect the contribution and congruence of multiple risk and multiple outcomes. The comprehensiveness and the unity of the developmental process require a broader perspective in order to avoid a distorted view of the importance of any single factor.

Table 2

Personal Characteristics Personal attributes found to operate as protective factors include both genetic and constitutional factors such as gender, intelligence, temperament, and personality characteristics. Although personal characteristics are always active in a child’s life, they influence the way children react when negative situations do occur. A similar situation event will elicit different reactions and responses from children depending on these characteristics. Some children may be more upset than others even when experiencing exactly the same event and these responses will influence the way they can handle such stress.

Examples of protective factors for children

Domain

Factor

Personal

Gender Intelligence Temperament Sociability Perceived control Self-esteem Coping style Attachment style Parent–child interactions Parenting style Family cohesion Family routines Family support Family resources Friendships Teacher support School resources Organized activities Neighborhood cohesion

Family

Protective and Vulnerability Factors The examination of children who experience developmental success despite adversity has led to an investigation of the mechanisms that either support or undermine resilience. For children who succeed despite less than optimal conditions, the presence of protective factors may compensate for the risks that exist in their lives and environments. Protective factors are those attributes of persons, environments, situations, and events that relate to positive adaptation for children under conditions of adversity. Vulnerability factors, on the other hand, are those attributes that relate to maladjustment for children experiencing adversity. Protective or vulnerability factors are considered the opposite dimension of the same concept, not a different one. In this sense, vulnerability factors are considered the negative pole, whereas protective factors are considered the positive pole of the same variable, for example, parental warmth defined as positive and parental abuse defined as negative. On the basis of his review of research in the area, Garmezy identified three broad sets of variables that have been found to operate as protective factors including: (1) personal characteristics of the child such as gender, intelligence, and personality characteristics; (2) family characteristics such as warmth, cohesion, and structure; and (3) the availability of external support systems such as peers and schools (Table 2).

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External

There have been a number of suggestions in the literature that gender may also modify or influence children’s responses to adversity. Specifically, evidence indicates that females are less susceptible to emotional and behavioral disturbances than boys when exposed to family stress. This finding is interactive indicating that boys do not simply have a higher rate of disturbances in general but rather their risk is much greater when exposed to family discord compared to girls. Michael Rutter has noted that there are several reasons why boys may be more vulnerable than girls. First, males may have more direct experiences of family discord, for example, parents may argue in front of boys more than girls. Second, when families break up, sons are more likely to be placed in institutional care than daughters. Third, boys are more likely to react with disruptive oppositional behavior rather than emotional distress. Fourth, parents may react more negatively to aggression in boys compared to girls. For these reasons, the protection afforded to girls may be the result of a reduced exposure to risk factors rather than a biological component due to gender itself. However, the protective effects may lessen with age. In their study of Hawaiian youth, for example, Werner and Smith found that males in their sample showed greater vulnerability than females during the first decade of life, but this lessened during the second and third decades. One of the most widely investigated variables in resilience research is children’s intellectual ability. Although there is less support that intelligence is a protective factor for children’s social success and mental health, there has been some evidence indicating its protective effects on academic achievement. Studies of younger children have found that high-risk children with

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higher intelligence perform better in school than their high-risk peers with lower intelligence. However, several studies have found counterintuitive results indicating that intelligence may sometimes operate as a vulnerability factor. These studies indicate that higher intelligence may be positively related to school achievement at low levels of risk, whereas children with higher intelligence lose their advantage at high levels of risk. It has been suggested that age may be the contributing factor for this difference. Intelligence may serve a protective function for younger children, yet as children mature into adolescents, they may be more likely to use their talents in areas other than educational achievement. Several studies have suggested that temperament and personality characteristics operate as protective factors for children. Children who have a positive constellation of characteristics such as easy temperament, social responsiveness, and humor are more likely to elicit positive responses and support from other people. Child temperament – measured by characteristics such as mood, activity level, attention span or distractibility, adaptability or malleability, and emotion reactivity – has received much attention as a protective factor. Evidence suggests that children with an easier temperament are less likely to be the target of negative parenting during stressful situations. Children’s negative temperaments may also influence the amount of family discord and increase the likelihood that children will experience its adverse effects. In this sense, parents who are experiencing more distress may be more likely to release their negativity on children with difficult temperaments. Several researchers have also suggested that psychological characteristics such as perceived locus of control, self-esteem, and coping style are key protective factors. Perceived locus of control refers to beliefs about the sources of one’s successes and failures. Children with high levels of perceived internal locus of control believe that their successes and failures are due to their own attributes or actions, whereas children who have high levels of external locus of control believe that other people or unknown causes account for such outcomes. Highrisk children who perceive more internal locus of control over their lives tend to have better mental health and higher functioning than their high-risk peers with a more external locus of control. Self-esteem has also been shown to operate as a protective factor for children exposed to risk. A positive sense of self has been shown to have a positive impact on children experiencing stress and may facilitate the development of other characteristics such as perceived internal control which mitigate the effects of risk. Coping strategies also influence children’s response to negative life situations. Children who have more active coping skills such as problem-solving and social support seeking are better apt at handling difficult situations. Children who do not learn to cope with

stress and use ineffective skills such as distraction and avoidance are more likely to be overwhelmed by adverse circumstances. Family Characteristics A number of studies have examined the protective effects of family characteristics including more proximal factors such as parent–child interactions and more distal factors such as parents’ financial and educational status. For proximal factors, one of the most important protective factors is a secure parent–child attachment particularly during infancy and early childhood. Research consistently demonstrates that a secure attachment defined by a responsive, supportive, structured, and affectively stimulating relationship between parent and child contributes to children’s positive development. A secure attachment has also been shown to be particularly important for children exposed to adversity. For example, the security of attachment between child and mother has been shown to differentiate positive versus negative outcomes in those children experiencing risk. A sensitive, securely attached caregiver relationship also fosters the development of children’s sense of self worth and their capabilities to adapt to changing circumstances with positive coping strategies, problem-solving skills, and social competence. In this way, a secure parent–child attachment not only operates as a protective factor for recent exposure to risk, but also enables children to develop the capacity for resilience in the future. The quality of parenting plays an essential role in children’s response to stressful situations. Parenting may either protect children from life circumstances or make them more vulnerable to adversities. Research suggests that authoritative parenting provides the most beneficial environment for children’s development. Authoritative parents create a warm and supportive environment for their children with the appropriate amount of structure and consistent discipline. Although authoritative parenting is optimal for most children, it may serve a protective function particularly for children who are experiencing stressful events and situations. Children who are exposed to adversities such as family dissolution are more likely to need additional emotional support and structure that authoritative parents provide. However, there is some evidence to suggest that optimal parenting strategies may vary depending on the specific risks to which children are exposed. Although research has found that poor families tend to engage in more controlling, harsh parenting, some have suggested that these types of strategies may be more adaptive for children living in impoverished environments. For children living in inner-city neighborhoods, more controlling parenting behaviors may protect them from exposure to danger and violence leading to more positive outcomes.

Risk and Resilience

Family-level resources such as cohesion, positive interactions, and support may also operate as protective factors. Adversity makes it difficult for families to maintain their normal family-level interactions and routines. For example, parental divorce disrupts family events such as outings and decreases interaction with the noncustodial parent. However, children exposed to stressful events such as family disruption may have a greater need for these family-level resources in order to maintain a sense of normality and structure. These family-level resources may also exert their protective effects by influencing children’s psychological adjustment and parent–child interactions. For instance, family cohesion may enhance children’s perceived internal control and their coping strategies. Alternatively, family routines such as eating meals together create a context where warm, supportive parenting can occur. More distal characteristics of families may also operate as protective factors. For example, some researchers have demonstrated the protective effects of household income for specific adverse conditions. For example, children of divorced parents benefit when their fathers provide more financial support. Research indicates that children in mother-custody families who receive child-support payments from their fathers tend to have better relationships with their fathers and experience more positive outcomes. Parents’ level of education may also serve as a protective factor for children through the increased access to resources and advantages that higher education affords. External Support Systems As children mature, external support systems play an increasingly significant role in children’s development. Children’s friendships are particularly important for children experiencing adverse life circumstances. Reciprocal, positive friendships may provide additional avenues of selfesteem and emotional support for children whose families offer less positive engagement and interaction. For example, studies suggest that friendships may be particularly important for maltreated children as they often have fewer opportunities to learn and practice social skills in their family setting. On the other hand, peer rejection has been shown to exacerbate the deleterious consequences of many life stresses such as divorce. Another vulnerability factor regarding peer relationships is the association with negative friends. When children disengage from their family relationships and spend more time with negative friends, they are at greater risk for the development of antisocial behavior and academic problems. However, a supportive relationship even with a single friend may act as a protective factor from the negative effects of both peer rejection and other adverse circumstances. Teachers and school environments have also been shown to be beneficial for children experiencing risk.

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In early childhood, child-care attendance and quality are protective factors particularly for those children living in low-income environments. Evidence suggests that children living in impoverished conditions including shelters or poverty-level housing may benefit more from higher quality child-care than children from more optimal home environments. Supportive teachers and school environments are also consequential for children’s development. Teachers can play a crucial role as caring adults or mentors for those students who need additional support. School environments characterized by defined schedules and rules, high expectations, and the use of warm yet consistent discipline have been associated with social and academic achievement for children exposed to risk. These protective effects may be especially salient for those children with no supportive and authoritative parent or caregiver at home. School attendance and achievement also appear to be protective factors for children exposed to adverse circumstances. Evidence indicates that school attendance and academic achievement are associated with fewer behavioral problems and antisocial outcomes among children in high-risk families. There is also increasing evidence that communities play a protective role for high-risk children. Social processes within a neighborhood are particularly important. Social processes within a neighborhood refer to the perceived social support and cohesion among neighbors, supervision of children and adolescents by other adults in the community, participation in voluntary organizations, and a general sense of belonging to the community by its members. These neighborhood social processes have been shown to help protect against structural disadvantages (e.g., poverty and violence) even in more impoverished communities. Youth-serving community organizations and participation in organized after-school activities may also provide some protection from the structural disadvantages of a neighborhood. Unfortunately, youth-serving programs are less likely to exist in those neighborhoods with the greatest need for such organizations. Participation in organized after-school activities is also lower for low-income families compared to their more advantaged peers due to the overall unavailability of such activities in poorer areas.

Theoretical Models of Risk and Resilience Considering models of resilience, it is essential to distinguish between risk factors and those factors which either support or undermine children facing multiple risks. Researchers have employed a number of models to describe the relations among risk and protective/vulnerability factors. These include interactive effects, main effects, and mediating effects models (Table 3).

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Table 3

Models of risk and resilience

Model

Terms

Relation with risk

Interactive effects

Protective/vulnerability

Main effects

Compensatory/promotive

Mediating effects

Deterioration/mobilization

Interactive relationship with risk thereby either having no effect in low-risk populations or its effect being magnified in the presence of risk Direct relationship with risk thereby having an equally beneficial effect on high-risk and low-risk children Mediational relationship linking risk to developmental outcomes

Interactive Effects Models The earliest models of resilience used the term ‘protective factor’ only for those effects involving adversity. The concept was first systematically defined by Rutter who argued that to be meaningful, protective/vulnerability factors must be evident only in combination with a risk factor. In this framework, the essential question of resilience research is: what factors explain positive development in the face of adversity but have little or no positive impact on development in the absence of adversity? To address this question, protective/vulnerability effects are required to have an interactive relationship with the risk factor(s) thereby either having no effect in low-risk populations or its effect being magnified in the presence of risk. Whether the variable itself is considered a protective or vulnerability factor lies in its connection with the risk variable, not in terms of whether it has positive or negative qualities. Protective factors decrease the effect of risk, whereas vulnerability factors increase the effect of risk. A protective factor may not necessarily be a socially desirable characteristic of the individual or a positive event. Therefore, protection for a high-risk child may even come from a factor that itself is a risk to the mental health or social functioning of a low-risk child. On the other hand, a vulnerability factor for high-risk children may be related to positive development for low-risk children. In a hypothetical example of an interactive effects model, a researcher may compare the effects of high versus low child-care quality on the cognitive development of young children with varying degrees of risk: (1) high risk, low quality; (2) low risk, low quality; (3) high risk, high quality; and (4) low risk, high quality. Quality of childcare would be a protective factor only if high-risk children in a high quality child-care environment had significantly higher cognitive development than high-risk children in a low quality child-care environment and there were no differences in the cognitive development of low-risk students regardless of the quality of child-care. According to Rutter, this interactive process must be determined empirically, in order to differentiate risk from vulnerability factors. Main Effects Models Although interactive effects models provide a distinction between vulnerability and risk factors, not all factors may

conform to the interactive requirement. Consider, for example, physical attractiveness. Children who are physically attractive may generally receive more positive responses from others, but there is no specific reason why attractiveness may be beneficial for high-risk children but not low-risk children. The absence of interactive effects may also simply be an artifact of the research design. In a high-risk sample, for example, differences between those who are well adjusted and those who are not may represent interactions in other samples with a wider distribution of risk. Considering this, many researchers use main effects models that examine the direct effects of positive factors on children’s outcomes. In these models, the positive factor has an equally beneficial effect on those children exposed and those not exposed to adversity. Main effects models may be differentiated in terms of whether homogeneous or heterogeneous risk samples are examined. Researchers focusing on a homogeneous risk sample, such as children living in poverty, may examine main effect differences between high and low competence children experiencing adversity. In these studies, protective factors are defined as those positive variables that differentiate high-risk children who are experiencing positive adaptation from those high-risk children who are not. These studies may be better at detecting processes that are protective for a specific risk condition. The meaning or definition of resilience may also differ for children exposed to a specific risk. Maltreated children, for instance, rarely approach the functioning of nonmaltreated children. Yet, variation in adaptation does exist suggesting that some children achieve better than expected. Studies focusing on a within-group sample, such as maltreated children, can examine more closely profiles of resilient adaptation rather than specific, isolated attributes to understand the meaning of such variability. Rather than examining individuals experiencing high levels of risk, other studies identify factors that are associated with positive outcomes for a heterogeneous sample of individuals. These researchers use the term protective factors to describe main effect models that identify factors associated with desirable outcomes independent of the occurrence of social disadvantage or adverse circumstances. For example, athletic talent does not necessarily insulate the children from adverse circumstances, but instead may provide opportunities for additional successes. For such effects, more appropriate terms

Risk and Resilience

have been proposed including promotive or compensatory, none of which suggest that the attribute provides a buffer which protects the child from risk factors. Mediating Effects Models Mediating effects models define protective factors as those variables linking risk variables to developmental outcomes. These studies test variables hypothesized to serve as mediating factors between risk factors and developmental outcomes. There are two forms of mediation: deterioration and mobilization. In the deterioration model of mediation, the occurrence of risk decreases the ability of children and families to function effectively. For example, impoverished parents may experience greater depression which, in turn, decreases their ability to use effective parenting strategies. In the mobilization model of mediation, the occurrence of risk increases the ability of children and families to function effectively. For example, bereaved children with more active coping strategies may be better at eliciting support from others.

Developmental Outcomes: Competence and Maladjustment The definition of resilience depends on the outcome being assessed. Past researchers have defined resilience according to the absence of social deviance or psychopathology. Although the importance of competence was recognized in developmental research, the medical model which emphasizes symptoms, diseases, and treatments dominated the field. More recently, there has been a return toward positive psychology. This has encouraged a shift in focus from maladjustment to more positive developmental outcomes. As there has been so little attention to positive aspects of adaptation in the past, more recent researchers of resilience have developed a variety of methods to assess competence. Several researchers have examined social competence as a measure of resilience. Social competence is defined according to the success of a person meeting societal expectations. Other criteria include personal development and self-actualization. Studies have measured social competence on the basis of observable, behavioral criteria often assessed by multiple sources including the children themselves and their parents, teachers, and peers. These broader assessments may have greater validity due to its multiple informants. The definition of social competence also depends on the developmental stage being assessed. For example, social competence in infancy may be operationalized as having a secure mother–child attachment and positive affect. In early childhood, social competence may include measures of autonomous functioning and behavioral and emotional functioning.

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In middle childhood and adolescence, social competence can be defined according to positive friendships and academic achievement. Research in resilience has traditionally focused on defining competence in a single domain such as academic achievement. However, studies focusing on multiple dimensions of competence have realized that children who may be doing well in one area of development may suffer in another. For example, in distinguishing between externalizing (i.e., acting out) behaviors from internalizing (i.e, thought-centered) behaviors, so-called resilient children may react to their stressful experiences in a more covert, internal manner. In resilience research, there is the tendency to assume that if children are doing well in more external behaviors, they have managed to overcome adversity. However, evidence indicates that many so-called resilient children who have outstanding behavioral profiles experience considerable emotional distress. Since resilient children tend to be at higher developmental levels, as reflected in their intellectual maturity, their pathology is more likely to be expressed with internal symptoms rather than behavioral disturbances. For these reasons, some researchers have suggested that in order for high-risk children to be labeled as resilient, they must excel in multiple domains of competence. There has also been some disagreement whether competence should be defined according to a representative, heterogeneous sample or within a high-risk, homogeneous group. Some researchers consider high-risk children to be resilient when they demonstrate behavior within the expected average range of a normative cohort. Other researchers examine competence within a high-risk sample and define resilience in terms of doing better than other equally disadvantaged counterparts. The latter method considers the specific adversity and takes into account that the expression and definition of competence may differ according to the risk condition. However, the level of positive adaptation in a high-risk sample often does not equate with the competence of a more normative cohort. The definition of resilience is also dynamic and developmental in nature. Competence at one stage in development can serve as a protective effect at a later point in time. For example, high-risk children who are socially competent may have a greater capacity to elicit positive and support responses from others which, in turn, strengthens their positive development. Children are better able to benefit from protective factors in the future when they possess the capacity to engage in their environments in the present. On the other hand, there may be a cascade effect where maladjustment at one stage may contribute to the development of later problems. For example, antisocial behavior in childhood may undermine academic achievement which, in turn, contributes to later problems. Developmental research explores the dynamic, ongoing processes involved

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in children’s capacity for resilience. A key aim of developmental research is to understand the integration and organization of experiences that enable children to become successful, competent individuals.

A Resilience Framework for Interventions

vulnerabilities. Effective models must be development and be fully informed by current developmental theories and research. Developmental models consider the risks, protective processes, and competencies that are relevant to a specific age group and conceptualize interventions in terms of dynamic, ongoing processes that evolve and adapt to new developmental tasks and challenges.

Resilience research has provided new avenues of policy and practice for vulnerable children and families. Rather focusing on maladapative functioning and psychopathology, a resilience framework emphasizes the promotion of competent functioning and fosters the development of policies and interventions that reflect the belief in resilient adaptation. Intervention programs are also more developmental in nature in that they focus on redirecting children’s trajectories and strengthening cumulative protective processes in children’s lives. A resilience framework has been proposed by Ann Masten which conceptualizes mission statements, models, measures, methods for policy and practice.

Resilience research has highlighted the importance of developing appropriate measures assessing children’s capacity for resilience and the processes that support its development. Measures designed for children need to consider the major developmental tasks as well as the characteristics of the contexts of development such as families, schools, and communities that are relevant for a specific age group. Although resilience research has encouraged the development of measures for assessing competence, there is still work to be done that encourages the use of such tools in more field-friendly ways.

Mission Statements

Methods

Mission statements are key objectives for the development and implementation of policies and interventions. Within a resilience framework, mission statements are framed in terms of promoting competence rather than merely focusing on the reduction of problematic behaviors. The promotion of competence is one of the most effective methods of prevention. Comprehensive programs for high-risk children work better when goals include promoting positive achievements, in addition to preventing negative behaviors. The promotion of competence is also more appealing to policy makers and stakeholders. Parents and teachers, for example, who are usually involved as key players respond more positively when programs are focused on fostering success. Certainly, the focus of intervention – children – also respond better when their positive assets and potentials are reinforced rather than their challenges and problems.

Within the resilience framework, there are several strategies to consider when developing interventions for policy and practice. Masten has outlined three types of designs for policy and practice. Risk-focused designs attempt to reduce the level of risk exposure in children’s development. For example, risk-focused designs would include programs that provide sexual education to prevent teenage pregnancy and give low-income mothers more prenatal care to prevent low-birth weight infants. Asset-focused designs attempt to directly provide higher quality and/or more quantity of assets in children’s lives. They may also attempt to increase the presence and ability of individuals who are assets in the lives of children such as parents and teachers. For example, asset-focused designs would include teaching job skills to parents, training teachers to enhance the learning and achievement of their students, and increasing the after-school activities available in the neighborhood. Process-orientated programs attempt to improve the most important adaptational systems for children such as key relationships, intellectual functioning, and self-regulation systems. Process-orientated programs can focus on different system levels such as children, families, schools, and neighborhoods as well as their interactions such as parent–school involvement, children’s self-monitoring of school tasks, and student–teacher mentoring relationships. Interventions programs may also involve more than one design, for example, such as drug treatment along with programs to increase parent–infant attachment that may help reduce the risks facing infants of drug-abusing mothers.

Models Resilience and prevention scholars have elucidated theoretical and empirical models that focus on how children experience positive outcomes in the face of adversity. These models represent important steps in the development of programs that focus on promoting children’s assets and strengths. These models provide a springboard for policies and interventions that redirect children toward positive development, focus on improving the chances of good outcomes, encourage the development of protecting characteristics, and reduce the exposure to risk and

Measures

Routines

Conclusions According to Masten, resilience arises from ordinary magic in the sense that children are capable of astonishing resistance, adaptation, recovery, and success in the face of adversity using only the normal capacities and resources that individuals rely on to function everyday. Despite these strengths and capacities, however, children cannot simply make themselves enduringly resilient in the face of continuous adversities in their environments. As Emmy Werner has noted, when risk factors outweigh protective processes even the most resilient child will experience difficulties. With this in mind, research in resilience is shifting away from describing individual characteristics of resilient children and instead focusing more sharply on how children’s environments – families, peers, schools, and neighborhoods – can be adapted to meet the needs of children facing adversity. Evidence indicates that effective and effortful family-based and community-level interventions play an essential role in promoting resilience in the lives of vulnerable children. Yet, as Masten has noted, there is no magic bullet for resilience. That is, there is no one solution that can be adapted to promote children’s resilience in any and all circumstances. Risks are multifaceted and thus interventions must also be multifaceted to reflect the diverse experiences and environments of a child’s life. At the same

time, a number of risks in children’s lives – for example, premature birth, malnutrition, and homelessness – are preventable. Policies that provide families and children their basic needs such as healthcare, food, and shelter remain critical in order to maximize the potential of the future generations. See also: Abuse, Neglect, and Maltreatment of Infants; Attachment; Child and Day Care, Effects of; Depression; Divorce; Family Influences; Mental Health, Infant; Parental Chronic Mental Illnesses; Parenting Styles and their Effects; Self-Regulatory Processes; Temperament.

Suggested Readings Glanz M and Johnson JL (eds.) (1999) Resilience and Development: Positive Life Adaptations. New York: Plenum. Luthar SS (ed.) (2003) Resilience and Vulnerability: Adaptation in the Context of Childhood Adversities. Cambridge: Cambridge University Press. Masten A (2001) Ordinary magic: Resilience processes in development. American Psychologist 56: 227–238. Rutter M (1987) Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry 57: 316–331. Werner EE and Smith RS (2001) Journeys from Childhood to Midlife: Risk, Resilience, and Recovery. Ithaca, NY: Cornell University Press.

Routines B H Fiese and R S Everhart, Syracuse University, Syracuse, NY, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Behavior management techniques – Methods used to help children change or modify their existing behaviors, such as positively reinforcing good behavior or using time-outs to alter negative behaviors. Collectivism – Belief in the primary importance of the group and in the virtue of collective values. Conversational turn taking – How two or more people alternate and shift in response to questions and statements made while talking with each other.

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Family rhythms – Tempo and pace with which family sets its daily activities such as waking, eating, and going to work. Habits – Repetitive behaviors that individuals perform without conscious thought. Individualism – Belief in the primary importance of the individual and in the virtues of self-reliance and personal independence. Joint book reading – Typically involves adult and child reading together with adult and child commenting on different aspects of the story line and illustrations. Ritual routines – A sequence of highly ordered steps that occur in common settings such as mealtimes, bedtimes, and leisure activities.

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Introduction The early childhood years are replete with routines. Establishing routines around eating, sleeping, and toilet training are not only a topic of conversation for parents of toddlers but consume much of the daily life of families with young children. Children of preschool age learn to make the transition from ‘‘being a baby’’ to ‘‘I’m a big girl now!’’ through becoming more engaged in routines such as family mealtimes, nighttime stories, and household chores. Successful transition to school is often marked by negotiating such routines as learning to stand in line, respecting naptime as a set aside quiet time, and knowing that Friday’s are for show and tell. In this article, we discuss the importance of child routines from several different vantage points. First, we define what we mean by routines and how they are distinguished from such concepts as habits. Second, we identify the developmental course of childhood routines that encourage the child to take on a more active role as he becomes more competent. Third, we present some of the findings that suggest that predictable and regular routines in a child’s life are associated with positive outcomes such as enriched language development, empathy and caring for others, and well-regulated behavior. Finally, we discuss how children’s engagement in routines differs across cultures suggesting that cultural practices are conveyed, in part, by children’s engagement in daily routines.

What Are Children’s Routines? How might we best define and identify the routines that are important for child development? Families organize their busy daily lives through structuring routines around waking, eating, working (including homework), and leisure activities. At its most basic level, children’s routines include those that must sustain physical growth and development. These include activities that revolve around sleeping, eating, and toilet training. Thus, activities such as establishing regular naptimes, making the decision to introduce solid foods, and when to begin toilet training are geared toward fostering the child’s growth as a more mature individual. Routines are also organized to promote the child’s cognitive and social development and these include such activities as play, book reading routines, household chores, and parental discipline routines. Many of these routines are folded into daily family gatherings such as mealtimes and planned leisure activities. We can group these routines along lines of those that support biological rhythms, social development, and cognitive development. We present examples of these routines in Table 1. Although we outline these as classes of routines that evolve across developmental periods, we want to emphasize that these distinctions are somewhat

Table 1

Description of common routines in early childhood

Class of routine

Examples

Basic biological rhythms

Naptime Feeding Toilet training Mealtime conversations Household chores Joint book reading Homework

Social development Cognitive development

artificial. For example, bedtime routines can reassert their importance when a child moves from a crib to a ‘big boy’ bed, assignment of chores evolve as the child can take on more responsibilities, and homework routines are negotiated throughout the child’s school career. Thus, we provide these classes of routines for illustrative purposes and are not meant to be sharp taxonomies. Routines are different than habits and rituals. Habits are repetitive behaviors that individuals perform without conscious thought. Behavioral habits are done automatically and typically involve a restricted range of behaviors. For example, a child may have a habit of sucking on the end of her blanket when going to sleep. A routine, in contrast, involves a sequence of highly ordered steps. A child’s bedtime routine might include taking a bath, brushing teeth, reading a book, saying prayers, and then sucking on the end of a blanket before going to sleep. Rituals, on the other hand, tend to be more symbolic and linked to emotional bonds within the family. They often provide continuity across generations and are unique and meaningful to the family. A routine has the ability to become a ritual when it is repeated over time and takes on symbolic meaning. As we focus on children’s routines, we must also consider how the environment around them supports, or derails, these structured steps that constitute a full fledged routine. Certainly, parents play an important role. Children are also active contributors in the process, however. Let us examine the early years of establishing sleep, feeding, and social routines and how parents and children figure in this dynamic process.

Early Feeding and Sleep Routines The birth of an infant brings new challenges to young parents. It takes a while for new parents to adjust their daily routines to accommodate to the needs of an infant. For most families, daily routines such as dinnertime and weekend activities do not ‘get back on track’ until the child is of preschool age. Parents who have had previous experience in childcare routines before the birth of their first child often feel more confident in caring for their newborn. Feeding routines are one of the first caregiving

Routines

routines established in infancy. The extent to which these practices run smoothly depends, in part, on the match between parent and child rhythms and parent understanding of child social signals. There are at least three dimensions to establishing feeding routines in infancy: timing, social interactions, and biological rhythms. First, feeding routines evolve based on how often the infant is hungry and needs sustenance. This will depend on whether the child is breastfed or bottle-fed. Breastfed infants typically empty their stomachs every 2–3 h and bottle-fed babies are hungry every 3–4 h. Thus, the frequency and timing of the routine will depend on whether the mother is breastfeeding or not. An important part of early feeding routines is the opportunity for social interaction. At its most basic level, the child’s cry for food sets the stage for a developing awareness that his or her actions can influence others. Once in the arms of the caregiver, there are added opportunities for social interaction. Interestingly, the distance between a caregiver’s and an infant’s face during feeding is the optimal distance for social engagement. It is not an accident that during feeding infants will look intensely at their caregiver (often before falling asleep) and that responsive caregivers will use this as a time to talk in a soothing voice or even sing to the child. The third aspect of feeding routines is biological rhythms. Feeding routines are embedded in 24 blocks and become aligned with the child’s circadian rhythms. There is even some evidence that children who establish regular feeding schedules are also easier to calm to sleep and establish regular sleep schedules. The establishment of feeding and sleep routines during infancy is not a one-way street with parents imposing their wishes on the child – just ask any parent! It is the match between parent and child rhythms that allows for a relatively smooth or rocky launch of family routines. Establishing sleep routines illustrates this intersection between infant and family rhythms. Close to 25% of parents with children under the age of 5 report that getting their child to bed or having their child wake in the middle of the night is a problem. Although many sleep problems occur during the first 6 months of life, they are often seen as variations in normal development and may also be related to environmental factors such as disruptions in family routines or illness. As such, sleep behavior disorders are not diagnosable until after 12 months of age when sleep patterns are more stable. Children who wake less at night are perceived by their mothers as easier to care for and are more likely to be raised in homes with higher levels of routines. Further, when routines are in place parents feel more competent overall and their children experience fewer night-time waking problems. If this seems like a circular pattern with little assuredness of what comes first – child sleeping through the night or regular family routines – that is because the research literature is correlational and cross-sectional in nature.

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To date, we do not have strong longitudinal evidence that can answer whether regular family routines create easier sleep patterns in children or whether children who are easier to get to sleep by virtue of their biological rhythms make it easier to create family routines. We suspect that both cases may be true. The research evidence does suggest however, that when regular routines are in place in the home then children experience fewer sleep disturbances overall and that systematic alterations in bedtime routines can lead to a reduction in night-time tantrums, waking in the middle of the night, and poor sleep habits.

Social Routines We have commented on the importance of feeding routines in terms of eliciting social interactions between the infant and mother. However, there are also social routines that play an important role in the communicative and cognitive development of an infant. These social routines are often exhibited as sustained play routines (e.g., ‘peekaboo’, patty-cake’, ‘where’s your nose?’) with the infant becoming a more active play partner. Such routines might follow a feeding routine during which the infant is already intensely focused on the caregiver. These simple social routines are instrumental in enabling the infant to learn the skills of taking turns in conversations and how to be a partner in a conversation. Further, these social routines are important for the infant’s cognitive development. For instance, the infant is introduced to the temporal order of interactions and begins to learn to identify different objects and even parts of the face. Moreover, by participating in these social routines, infants learn to associate a sequence of actions with a routine and ultimately anticipate a future or final state of the routine. As we have seen, during infancy many of the caregiving routines are directed toward stabilizing the child’s day and night so that the child can fit in with the rhythms of the larger social world. Once the child is on a schedule that fits with the rest of the household, then the child becomes a more active participant in shaping daily routines. Let us now examine some of the daily living routines evident during the preschool years.

Child Routines During the Preschool Years There are a variety of routines that absorb much of a preschool child’s day. These include mealtimes, household chores, ‘getting ready’, joint book reading, and response to discipline routines. Let us examine each one in turn for how they get established and altered during the preschool years. In the following sections we will consider how these routine activities contribute to such important outcomes as cognitive and social development.

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Routines

In many ways, mealtimes can be seen as a microcosm of family life. Such mundane aspects of mealtimes as seat assignment, rules for conversational turn taking, and how the meal ends and begins reflect important features of family life that support child development. For preschool age children, mealtimes are settings where families decide when a child is old enough to sit at the table with everyone else and thus join in important conversations. They are also settings where opinions can be solicited (or not) and thus reinforces the child’s sense of belonging to the family as a whole. Household chores are another way that preschool children are brought into the fold of family life. Initially assigned relatively simple tasks such as cleaning up one’s toys, these roles and responsibilities are expanded to include other members of the family such as feeding a pet or looking after younger siblings. Every child perhaps has his or her own set of ‘getting ready’ routines. These can range from laying out clothes the night before school to elaborate bedtime routines that must be followed before getting settled in. Recall how we defined routines as a series of behavioral steps that are followed in sequence? For the preschool child, ‘getting ready’ for school, a visit to grandmother’s house, or going to bed involves ordering a sequence of steps that evolve into a routine. The young toddler needs considerable assistance in ordering these steps and is somewhat at a loss as to whether socks go on before shoes. However, the competent preschooler cannot only tell you what steps need to be taken in carrying out a routine they can do so on their own. It is this sense of individual accomplishment in carrying out routines that adds to the child’s growing sense of competence and independence that is fostered before the transition to school. The expression of ‘getting ready’ routines is one arena where preschool children experience growing self-reliance and competence. Independence and autonomy do not come without restrictions, however. Parents must shape their child’s behavior in such a way that they are protected from harm and limits are set in a consistent way. Discipline routines are typically developed during the preschool years. For some families this may mean instituting ‘time out’ policies whenever the child breaks a rule or misbehaves. Embedded within the practice of discipline routines are children’s understandings that families have a set of rules that are to be followed. These rules are relatively simple during the toddler and early preschool years and revolve around safety issues to protect the child. As the child grows older into the later preschool and early elementary years, the rules expand to include transgressions against others and understanding of others’ feelings. One of the ways in which children begin to understand others’ feelings and the impact that individual actions have on the family group as a whole is through the assignment of household chores. The participation of young

children in household chores or everyday routines, such as feeding the pets or making their bed, provides a major pathway for children to develop socially. Children are able to develop a sense of partnership, of helping others, and even the belief that they are competent and good enough to help others. Participating in such routines also encourages children to take responsibility for their actions and to acknowledge how such routines benefit the family as a whole. Neglecting everyday chores may lead to conflict within the family or even a sense that the child has let the family down. Encouraging children to participate in routines also allows children to develop a sense of concern for others, including people other than family members. To summarize, the daily life of young children is organized around routines that promote their growth and development. For infants many of these routines are centered around establishing regular feeding and waking routines so that the child can grow into a healthy participant in family life. Once the child’s rhythms are aligned with the larger social world, then expectations about participation in other activities such as mealtime, bedtime, and household chores evolve with expanding roles and responsibilities for the child. Newfound competence can be established as the child takes on a sense of accomplishment in carrying out their own routines such as ‘getting ready’ for the day or helping out around the house. Discipline routines are set into place to ensure that the child is kept safe and impart family rules. The regularity with which these activities are practiced and support social interactions is associated with important cognitive and behavioral outcomes in the early childhood years. Let us examine some of these links.

Routines and Child Developmental Outcomes We have mentioned that family mealtimes are one setting where regular routines are practiced and reinforced. It is estimated that about 73% of US families eat dinner together at least four times a week. Although 2006 surveys suggest this rate declines by about 15% for families with an adolescent, mealtimes continue to be an important routine for families with children of all ages. For young children, the flow of a brief mealtime allows for multiple opportunities for the child to engage in conversation with older members of the family. These mealtime conversations have been found to be related to a variety of child developmental outcomes. For example, adult’s use of rare or unusual words at the dinner table such as ‘oxygen’ and ‘stegosaurus’ is associated with children’s language development and reading achievement scores during the early school years. Researchers who examine these mealtimes in depth have found a variety of characteristics that

Routines

promote literacy and prepare the child for successful academic performance. Routine conversations during mealtime that are explanatory and engage the child in extended discourse are more likely to be associated with enriched language development than conversations that are primarily directive and focus on getting the child to behave. Further, routine conversations that incorporate rare words such as ‘twirl’, ‘colander’, and ‘iguana’ expand the child’s vocabulary in predictable ways. Researchers in this area argue that because children are exposed to these rare words during the course of an everyday event that includes rich social cues, children are more likely to retain and use these words than if they were drilled on them via flashcards or word lists. Politeness routines are another aspect of mealtime conversations that have been studied during the preschool years. Prompts such as ‘‘What do you say?’’, ‘‘What’s the magic word?’’ are typically responded to with ‘‘please’’, ‘‘thank you’’, or ‘‘you’re welcome’’. In an observational study of families with preschool age children it was found that these types of politeness routines were used, on average, 14 times per mealtime. Careful examination of these utterances have led researchers to consider that these politeness routines support the development of complex sentence structures as the child learns to pair words in a sequence – ‘‘May I have some more ...please?’’ Thus, a simple please and thank you extends beyond good table manners. Further, there is evidence to suggest that conversational routines between parent and preschool age children, which occur during mealtimes, are important in helping a child to understand temporal sequencing in conversations. We noted the importance of these routines (e.g., ‘peekaboo’, ‘patty-cake’) for infant cognitive and communicative development. Conversational routines continue to be important as the child matures. For preschool age children, research studies have found that conversations between parent and child about past events as well as conversations about future events aid in developing child memory. Moreover, conversations focused on past and future events serve to increase children’s awareness of sequencing and the order of events. Joint book reading routines can also support literacy and language development during the early childhood years. Just as there are multiple aspects to mealtime conversations and their effects on child development, joint book reading routines are composed of several layers. First is the frequency with which parents set aside routine times to read with their children. The evidence is fairly clear that frequency of joint book reading routines is related to later literacy skills and school success. The question then becomes, what is it about reading together that promotes literacy? While reading with their preschool age children, parents are able to limit distractions and direct the child’s attention to key points of the story or

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picture. Parents use this opportunity to highlight interesting points in the storyline or even humorous aspects of the illustrations. Researchers refer to this strategy as ‘specific commenting’, a style of social interaction that has been found to be related to print awareness and academic success. Oftentimes the types of comments that parents make during joint book reading link back to experiences familiar to the child during routine activities such as ‘‘Remember when we went to the zoo?’’ or ‘‘Remember your last birthday party?’’. Overtime, this type of reminiscing may aid children in understanding how they fit into a larger social world. Parents’ beliefs about joint book reading routines are also associated with how regularly they practice such activities. Parents who believe that book reading is important are more likely to read to their children on a regular basis and their children, in turn, are more likely to ask to be read to than in families where less value is placed on reading. Again, we are faced with the dilemma of which set of behaviors causes the establishment of regular routines. Do families who value book reading cause their children to read more or do children who like to read cause their parents to create more book reading routines? The answer to this question is not a simple one – as we have pointed out both parents and children contribute to the creation of routines over time. Let us now consider stability of routines over time and how they are associated to child developmental outcomes. There is some longitudinal evidence to suggest that stability, or predictability, in routines over time is associated with more optimal outcomes for children during the preschool and early school years. Families that practice regular and meaningful routines such as dinnertime and weekend activities when their children are of preschool age have children who perform better academically in the early school years. Further, when routines are disrupted and decline in importance during these formative years, children are at greater risk for developing behavioral problems associated with poorer school performance. Some researchers have found that even under highly stressful conditions, such as low-income single parent households, boys benefit academically and emotionally from regular and predictable routines. Authors have speculated that more routinized homes provide children with a sense of control and reduce the likelihood of developing behavioral problems that thwart school success. Recall, the early establishment of daily routines is often associated with the child’s sense of competence and self-reliance. While stability of routines during the preschool and early school years is associated with academic success and a sense of self-assurance, the converse is also true. Environments characterized by persistent chaos and lack of order over time bode poorly for child development. Children exposed to high degrees of environmental stress

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frequently experience a lack of order and unpredictability on a daily basis. Limited economic resources, environmental crowding, parental work stress, inaccessible transportation, and poor-quality childcare have all been found to contribute to parents’ feelings of hassle and burden that compromises their ability to carry out daily routines. This is not to say that predictable routines require lavish environmental support. This is certainly not the case. There is convincing research evidence that supports the notion that families who are able to create more predictable routines under challenging environmental conditions are able to protect their children from some of the harmful effects of limited economic resources. However, it should also be noted that when environmental stressors pile up it is more difficult for families to organize their daily routines and their children are placed at greater risk for developing academic and social-behavioral problems. Let us now consider some of the ways in which routines have been found to be associated with social and behavioral development. We have already mentioned that the predictability of routines may be associated with children’s emerging sense of competence of self assurance. There is also some evidence to suggest that regularity of routines is associated with controlling and regulating behavior. A major developmental task for preschool and early elementary school age children is learning how to control their behavior. Whether it is ‘getting the jitters’ out of their legs as they squirm in their seats waiting for the end of a school day or controlling an impulse to hit their baby sister, children learn to control their behavior, in part, by attending to routines that have order and consequences. The most obvious of these would be discipline routines that parents create to dissuade children from ‘acting out’, throwing temper tantrums, and learning the basic rules of the household. Families vary considerably in terms of the types of discipline routines that they create. Just as we noted that predictability and regularity of mealtime and book reading routines was associated with more positive outcomes, the same holds true for discipline routines. Consistency is the key element in most discipline routines – although they should never be carried out with harsh control. Much of the research literature on routines and discipline has evolved out of concern for behavior monitoring for children with developmental disabilities. For families with a child with a developmental disability, common household routines such as washing the dishes and preparing dinner are often interrupted by the child’s demand for attention. In some cases, the family’s routines are disrupted to the extent that daily life is put on hold to attend to the needs of one child. In these circumstances, the routines need to be put back in order by measured discipline of the child who is upsetting family life. Oftentimes this can be affected in relative short order with the use of behavior management techniques.

When we consider discipline routines and behavior management the focus is primarily on setting consequences for unacceptable behavior. There are other aspects of children’s routines that may also be associated with regulating behavior. The emotional investment in carrying out routines over time may foster stronger connections within the family unit. The creation of these emotional bonds in routine settings such as dinnertime, weekends, and special celebrations (i.e., birthdays, Thanksgiving) have been found to be associated with aspects of mental health and well-being of children. The empirical literature has focused primarily on children in the later school years and adolescence. In these studies, the importance of family routines and emotional investment made during these gatherings have been found to be related to lower rates of problematic drinking, sexual risk taking, anxiety problems, and somatic complaints. Pertinent to our focus on early childhood is how the meaning conveyed during these routines is related to parents’ satisfaction with their marital relationship. Some research has indicated that couples with preschool age children who ascribe more emotional connections during their family routines are more satisfied with their marriages. Why is this important for child development? Considerable research has documented the adverse effects of unhappy marriages on children. Parents who experience marital distress tend to be less effective as parents thus placing their children at risk for problems. In this regard, stable and meaningful routines may bode for better marriages which in turn allow parents to attend more fully to all the caretaking tasks we previously outlined. There is some evidence that for children of kindergarten age, regular routines and the emotional investment made in continuing them over time is associated with lower frequency of behavior problems as assessed by teachers and school nurses. The reason for this pattern of results is likely multifold. First, as we have noted, regularity of routines may provide behavioral guides for children such that they are able to follow a sequence, or steps, of events. These are crucial skills that come into play when entering a kindergarten classroom. Learning how to get in and stay in line is a monumental task for many children and often one of the settings where teachers note misbehavior. Children who understand how to follow a sequence of steps embedded in routines may be better equipped to follow directions and comprehend structure of a school day. Success in accomplishing ‘good line behavior’ may, in turn, lead to feelings of self-confidence and assurance that the next challenge – learning the alphabet – is also one that can be conquered. This may be a somewhat simplistic description of a relatively complex set of developmental achievements. However, the point to be made here is that the order and predictability experienced in the home translates to school settings as well.

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Cultural Variations in Children’s Routines Culture refers to the shared meaning of a group of people and the shared values, beliefs, and attitudes that are expressed through practices. One of the reasons that developmental psychologists are interested in the study of routines is because of the variations in daily activities across cultures. For example, while all children are likely to engage in some sort of play activity during the early preschool years the types of objects that they play with will vary by culture. Children in European American homes will often play with toys associated with children’s movies (such as stuffed animals from The Lion King) and with objects such as toy miniatures of dolls, cars, dishes, or telephones. In Chinese homes, children tend to have a modest number of play objects in relation to American homes, typically having a few toy cars or dolls. There are other ways, however, in which cultural variations in routines also express how development is tightly regulated to conform to values held by societies. These values and mores can be detected in the practices of some of the routines we have already examined such as feeding, sleeping, and mealtime. The time at which infants are weaned from the breast differs across cultures. For example, in Japanese and Philippine communities, infants are typically weaned before their first birthday. In rural Mexican families, infants are weaned around 4 months of age and in West African families, infants are often weaned at about 20 months of age. On the other hand, Caucasian infants are typically weaned between the ages of 1 and 2 years. The timing at which solid foods are introduced into an infant’s diet and the child is weaned from the breast depends, in part, on judgments made by society as to when children are ‘old enough’ to begin to eat on their own. Thus, the timings associated with age related routines are very much embedded in cultural contexts. One area that has received considerable empirical attention is how mealtime routine practices vary across cultures, particularly in the care and feeding of young infants and preschool age children. Intuitively, it is easy to think of variations among rural and urban communities, economically thriving cultures vs. those with strained resources, and between violent and safe neighborhoods. However, as most of the empirical literature has been directed toward individualistic vs. collectivistic cultures, our discussion will focus on these cultures. Differences between these cultures typically revolve around themes of whether the culture holds values for independence and autonomy (e.g., individualism) or places relative value on group cohesiveness and contributing to the betterment of the group (e.g., collectivism). Such differences can be seen in terms of each culture’s use of highchairs and infant seats in feeding routines. With respect to feeding routines, comparisons made among primarily Caucasian American, Filipino

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American, Pacific Islanders native to Hawaii, and Japanese American families have found differences in mealtime practices. For example, Filipino American mothers are more likely to hold their infants in their laps and spoon-feed them in comparison to American mothers. Researchers consider this a reflection of Filipino American mothers’ concern for good behavior and conduct and that it is only once the child can be fully competent should they be allowed to feed themselves. In contrast, American mothers are said to foster independence in their young infants and allow them to eat finger foods (i.e., breakfast cereals, crackers) at a younger age than their Filipino age mates. Tolerance for movement away from the dining table also varies by culture. Native-born Hawaiians are more likely to allow their toddler to roam around the kitchen with food in his hand than their neighbors of Japanese descent. These differences are thought to arise from cultural variations in values held for conduct of the individual and the group. We previously discussed how mealtime conversations may be associated with such child outcomes as literacy skills and academic performance. The topics of conversation vary systematically by culture. American families are more likely to engage in conversations about events that happened to individuals during the day. These are frequently referred to as ‘today’ stories – ‘‘What happened at school today?’’ ‘‘How was work today?’’ ‘‘Did you score a goal in the game today?’’ Researchers suggest that the focus of ‘today’ conversations is to highlight individual accomplishments. In contrast, Japanese and Taiwanese families have been observed to engage in daily conversations with their young children that revolve more around group activities and planning for the future. These types of conversations are proposed to reinforce the predominance of group needs over individual accomplishments. Behaviors during book reading routines in young children are also found to vary by culture. For example, research has found that when compared to Caucasian mothers, African-American mothers ask significantly fewer questions when reading with a young child. Caucasian children are more likely to respond to the mother’s questions, while African-American children elicit more spontaneous questions. Young Japanese children are also more likely to mimic their mother’s labeling during stories than American children, while American children are more likely to produce labeling after informationseeking questions from the mother. Discipline routines also vary by culture. Young children get into trouble for different reasons depending on which culture they live in. While parents in American culture may punish their 4-year-old for backing the car out of the garage (an event actually noted in the research literature) they will also speak of it with some pride as evidence of their child’s ingenuity and independence. Parents in

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Taiwan, however, will more likely discipline their preschool age children for causing shame to the family such as whining in public over an Aunt’s refusal to allow the child to ride a mechanical pony in a shopping mall (another example drawn from the literature). We provide these examples to illustrate that discipline routines created in the early years will be measured in accordance to cultural values and what counts as a transgression. Our discussion of routines in the context of families is by no means exhaustive. Different patterns in co-sleeping, childcare routines, and children in the workplace are also observed across cultures. In fact, the American routine of putting children in a crib to sleep by themselves through the night is an anomaly when compared to other cultures. For instance, research has found that Mayan mothers believe co-sleeping is important to the psychological development of infants. Co-sleeping in Mayan families is not only seen as a protective behavior against early mortality, but also as a way to socialize infants into a group as early as possible. On the other hand, Americans do not typically support co-sleeping as it opposes their cultural values of independence and autonomy.

Solitary Routines Thus far, we have discussed children’s routines in the context of interacting with others – primarily family members and teachers in the preschool and early school years. Young children can also develop routines that are more solitary in nature. Following our definition of routine as a sequence of behaviors (rather than an isolated habit), we can consider some individual activities as part of the child’s routine daily life. Recent surveys suggest that young children under the age of 6 spend 2 h a day watching television. Further, a 2003 survey conducted by the Kaiser Family Foundation of more than 1000 parents of children between birth and 6 years of age in the US found that 36% of those surveyed reported their children had television sets in their bedrooms. For families with children between the ages of 4 and 6, the rate was 43%. Not surprisingly, for those families where there was heavy television viewing in the children’s room there was less book reading in the home. Although there is not good research documenting whether children’s television viewing would meet our criteria for a full fledged routine, we do know that higher rates of television viewing is associated with consuming more snack foods and lower rates of family mealtimes. Thus, at the very least heavy television viewing may be said to disrupt other routines that have been shown to have a positive effect on children’s development. Another type of solitary routine in the early childhood years is the development of repetitive behavior routines. The incidence of these behaviors is very low in young

childhood, although 2–4-year-olds exhibit the highest rates of such repetitive behaviors among young children. Research indicates that repetitive behavior routines begin to disappear around the age of 6. These repetitive behavior routines in children are often observed in children’s games, such as tag, hopscotch, or even in reciting rhymes about stepping on a crack. In these examples, behaviors are followed to ward off harm, and they fulfill our criteria of routines in that they must follow an ordered sequence of steps. Other repetitive behaviors exhibited by young children might include requests to hear the same story over and over again, or to watch a video several times in a row. This insistence on repetition is used by children to prolong a situation in which they are comfortable and to reduce any anxious feelings they might have.

Summary In this article we have outlined several of the routines that children engage in during the early childhood years. What may appear as relatively mundane events such as getting fed, going to sleep, and being asked to clean up after yourself are integral parts of social and cognitive development. These are the everyday aspects of development that foster, in part, the child’s growing sense of competence and allow him or her to become more fully engaged with the social world. Because routines include an ordered sequence of steps, they provide behavioral guides for children that translate into more complex cognitive achievements during the elementary school years. The repetition of routines over time and the social interactions that accompany many of these routines provide the child with a sense of belonging and connection to the family and to peers that promote well-being. Many of these practices vary by culture to reinforce the values held by society. Thus, something as simple as saying please and thank you at the dinner table can serve to aid the young child in becoming a competent and self-assured member of society. See also: Discipline and Compliance; Family Influences.

Suggested Readings Fiese BH (2006) Family Routines and Rituals. New Haven, CT: Yale University Press. Fiese BH, Tomcho T, Douglas M, Josephs K, Poltrock S, and Baker T (2002) Fifty years of research on naturally occurring rituals: Cause for celebration? Journal of Family Psychology 16: 381–390. Fivush R, Reese E, and Haden CA (2006) Elaborating on elaborations: Role of maternal reminiscing style in cognitive and socioemotional development. Child Development 77: 1568–1588. Hofferth SL and Sandberg JF (2001) How American children spend their time. Journal of Marriage and the Family 63: 295–308.

Routines Huston AC, Wright JC, Marquis J, and Green SB (1999) How young children spend their time: Television and other activities. Developmental Psychology 35: 912–925. Kubicek LF (2002) Fresh perspectives on young children and family routines. Zero to Three 22: 4–9. Larson RW, Wiley AR, and Branscomb KR (2006) Family mealtime as a context for development and socialization. New Directions for Child and Adolescent Development. No. 111. San Francisco: Jossey Bass. Martini M (2002) How mothers in four American cultural groups shape infant learning during mealtimes. Zero to Three 22: 14–20.

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Parmar P, Harkness S, and Super CM (2004) Asian and Euro-American parents’ ethnotheories of play and learning: Effects on preschool children’s home routines and school behaviour. Journal of Behavioral Development 28: 97–104. Rideout VJ, Vandewater EA, and Wartella EA (2003) Zero to Six: Electronic Media in the Lives of Infants, Toddlers, and Preschoolers. Menlo Park, CA: Henry J. Kaiser Foundation. Sprunger LW, Boyce WT, and Gaines JA (1985) Family-infant congruence: Routines and rhythmicity in a family adaptations to a young infant. Child Development 56: 564–572. Weisner T (2002) Ecocultural understanding of children’s developmental pathways. Human Development 45: 275–281.


S Self Knowledge A E Bigelow, St. Francis Xavier University, Antigonish, NS, Canada ã 2008 Elsevier Inc. All rights reserved.

Glossary Ecological self-knowledge – Perceptually based knowledge of self within the local physical environment, for example, awareness of one’s spatial relation to objects in the environment. Episodic memory – Memory of a specific event that occurred at a particular time and place. Generic event memory – Memory of a script for a routine event, that is, memory of the general sequence of what happens in the event. Intermodal perception – The ability to integrate perceptions from different modalities, such that perceptions of an object from one modality allow recognition of the object in another modality. Interpersonal self-knowledge – Perceptually based knowledge of self in interaction with others, for example, awareness that one’s actions affect others’ behavioral responses. Joint attention – Child’s ability to attend to an object or event and a social partner at the same time, knowing that the partner is also attending to the child and the same object or event. Means-end understanding – The ability to combine actions, originally learned separately, to achieve new goals. Secondary emotions – Emotions requiring the ability to sense how self-actions might be perceived by others, for example, embarrassment or pride. Social contingency – Social responses to selected behaviors of a partner that immediately follow the behavior and match it in intensity, affect, and tempo. Social referencing – Checking the emotional or behavioral cues of others to determine self-action in an uncertain situation.

Introduction The development of self-knowledge is one of the oldest and most fundamental concerns in psychology. At the end of the nineteenth century, William James distinguished between the ‘Me’ and the ‘I’. The ‘Me’ corresponds to the self-reflective sense of self that is identified and recalled. Traditionally within psychology, it is this sense of self that was the focus of study. During the second year of life, infants begin verbally to refer to themselves and they communicate their desires and feelings through language. At approximately the same time, they show recognition of themselves in mirrors. Such behaviors indicate children have begun to have a reflective concept of themselves. During the past few decades, infancy research has had a resurgence of interest in the development of self-knowledge and has focused more closely on what is meant by the ‘I’. The ‘I’ is the sense of self as a differentiated entity distinct from other objects and persons, yet capable of operating upon them. For example, in reaching for objects, infants express a sense of self as capable of acquiring objects that are perceived as graspable within a reachable distance. Such a sense of self does not require representational thought, conscious identification, or recognition, and as such it is present in preverbal infants long before children have a conceptual sense of themselves. Humans share many aspects of the ‘I’ with other animals. Yet the ‘Me’, with its reliance on language or other representational systems and indications of visual self-recognition, may be uniquely human or shared only with few evolutionarily advanced species. Although the development of the ‘I’ and the ‘Me’ may be independent, much of recent research on self-knowledge supports the notion that conceptual self-knowledge is rooted in earlier developing preconceptual knowledge of self. Infants’ ability to sense themselves as objects of reflection and recognition does not develop suddenly in

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the second year, but rather emerges from earlier forms of self-understanding. By the second year, infants’ sense of self has already evolved from simpler beginnings and selfknowledge continues to develop through early childhood and beyond. There is not one form of self-knowledge, or even two as James proposed, but many that build upon each other in complex ways. What factors affect developments in early self-knowledge? Changes in the brain provide the foundation for these developments. Brain changes are rapid during infancy and early childhood and underlie cognitive developments important to self-knowledge, such as in visual processing, language development, and memory retention. There is debate about whether these brain changes are due to maturational factors, as traditionally thought, or are activity-dependent, that is, are based on the actions and perceptions of infancy that are universally experienced because of the similarity in human infants’ environments. Whether critical brain changes are dependent on experience or not, experience plays a primary role in the development of self-knowledge. Theorists differ on the relative importance of experience in the physical vs. social environments for developments in self-knowledge. For early forms of preconceptual self-knowledge, some theorists propose that infants’ engagement in the social and physical world have equal importance, but others support the dominance of infants’ interactions with others because people tend to be particularly responsive and engaging with infants, allowing them more readily to notice the effect of their actions. For children with the ability to reflect upon themselves, self-knowledge is especially influenced by how others respond to them and help shape their emerging sense of who they are. Young children’s experience in the world, perhaps particularly with others, is fundamental to their developing understanding of self.

Perceptually Based Self-Knowledge Newborns spend much of their time caught up in physical states of sleep, drowsiness, fussiness, or crying that inhibit their focus on the external environment. The one exception is the quiet alert state, where infants are fully awake without excess distracting limb activity. In this state they can take in the surroundings visually, as well as through their auditory, tactile, taste, and olfactory senses. This perceptual information is the basis for infants’ early self-knowledge. Essential to this self-knowledge is infants’ ability to notice the relation between their own actions and perceived changes. Ulric Neisser proposed that infants have access to two forms of perceptually based self-knowledge very early in life, probably from birth: the ecological self, which is self in relation to the physical environment, and the interpersonal self, which is self in relation to other people. These early perceptually based forms of self-knowledge do not

disappear when other forms of self-knowledge are added; rather they remain reality-based sources of information about self in the physical and social world. The ecological self is the sense of self within the local physical environment. Knowledge of the layout of the environment seen from the perspective of the self and knowledge of how that relationship changes with movement through space positions the ecological self in the environment. Young infants show evidence of the ecological self quite early. They react to looming objects by pulling back or moving away, which is not a simple reflex. When the object is a looming aperture, such as a framed window, infants as young as 3 months do not move away but rather lean forward to see what the window may reveal. When put in specially designed rooms that have walls that move, creating optic flow much like we see from windows of moving cars, infants make posture adjustments as if to maintain their position in the perceived moving environment. Such posture adjustments are clearly evident in crawling and walking infants, and also in the head adjustments of infants as young as 2 months. As infants’ physical capabilities and knowledge of the world grow, infants’ sense of their ecological self expands as well. For example, as infants develop locomotor abilities and increased strength, more objects are perceived as potentially attainable. Aspects of ecological self-awareness are shared with other species. Many animals with developed visual systems respond as young children do to the physical environment and to perceptual events in it, such as looming objects and optic flow. The interpersonal self is the sense of self within the social environment and is manifested in actions such as mutual gaze and reciprocal responding. Such activities are clearly perceivable and no inferences to internal states being communicated are required. The interpersonal self is not necessarily embedded in a sense of relationship; rather it is based specifically on perceptual information. Like ecological self-knowledge, infants show evidence of interpersonal self-knowledge very early. When engaged in face-to-face interaction with a social partner who suddenly becomes still faced, that is, silent and unmoving, infants as young as 2 months, and possibly younger, react to the still face with less attention and decreased positive affect. When the partner reengages, the infants become happier and attentive again, indicating that they were reacting to the disruption in the social interaction rather than to boredom with a prolonged visual display. The replay effect is even stronger evidence for infants’ interpersonal self-knowledge. To demonstrate this effect, infants engage in face-to-face interaction with a social partner over live video. Both the infant and the partner see and hear the other in real time over closed circuit television. The videotape of the social partner is then played back to the infant. In the playback, the infantdirected facial expressions and vocalizations of the partner

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are present as they were moments before except that the partner is no longer responding to what the infant is currently doing. Infants at 4 months, and in some studies at 2 months, show disinterest and less positive affect to the replay, similar to their reaction to the still face. When live video interaction with the partner is resumed, infants become engaged again, indicating that they are aware of when others’ behaviors are responsive to their own. Perceptions relevant to ecological and interpersonal self-knowledge can coexist in the same event, yet they are distinct. The two forms of self-knowledge are based on different information and can be salient on different occasions. Despite their early development, the coordination of ecological and interpersonal self-knowledge is thought to occur toward the end of the first year with the emergence of joint attention. In joint attention, infants are capable of attending to a person and an object at the same time, thus understanding that the object of their own focus is attended to by another person who simultaneously is also attending to them. Evidence of the separate development of ecological and interpersonal self-knowledge comes from studies of children who have impairments or difficulties with acquiring one of these senses of self but not the other. Children with autism typically have difficulty with interpersonal selfknowledge but not with ecological self-knowledge. They have difficulty acquiring information from the behavior of others and understanding how others’ behavior is affected by their own. Yet they have little trouble relating to the physical environment and objects in it. Children with autism also have problems engaging in joint attention, which in part may be due to the discrepancies between their development of interpersonal and ecological self-knowledge. Children born totally blind show a pattern of disturbance in early self-knowledge that is the reverse of children with autism. To be sure, blind children’s knowledge of their interpersonal selves is hindered. Many important avenues to the formation of interpersonal self-knowledge, such as mutual gaze, are absent in blind children. They have difficulty perceiving what others are attending to and, therefore, understanding the emotional reactions of others. Others also have difficulty knowing where blind children’s attention is focused because there is neither visual orienting nor pointing, and their facial expressions are more neutral. Nevertheless, blind children’s knowledge of their interpersonal selves can flourish if they perceive others’ actions as contingent on their own behavior, a perception that is difficult but not impossible without vision. Tactile and vocal responses to the children’s actions allow the children to sense the effect of their behavior on others. Interpersonal self-knowledge is attained as the children become aware that they can influence the actions of others in predictable ways. Blind children’s ecological self-knowledge is more fundamentally challenged. They cannot readily perceive the

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physical layout of their environment, the objects in the environment, the spatial relations among the objects, or the spatial relation of self to the objects and the physical space. Sound cues do not initially convey to blind infants an object’s location or sustained existence. Their difficulty understanding their position within the physical environment and to objects in it delays reaching and locomotion, which further impedes the infants’ interaction with and exploration of the environment. Blind infants’ ecological self-knowledge is initially thought to be indicated by their reaching for objects on external sound cues. By their reaches, they convey their awareness of themselves as positioned within the physical world with objects to which they can gain access through their own actions. It is not surprising that blind infants’ demonstration of joint attention, through acknowledgement that both they and another are sharing in the same event or object, occurs after their ability to search for objects on sound cues. Yet knowing where one is in physical space, where objects are in relation to each other and to self, and how these relations change with self-movement are lifelong challenges for blind children.

Bodily Awareness Although very young infants can perceive the social and physical world around them, they are particularly interested in watching and discovering their own bodies. A distinguishing feature concerning perceptions of their own bodies vs. external objects, both animate and inanimate, is the perfect contingency between self-actions and perceived changes. With the exception of watching one’s mirror reflection or live video image, perfect contingency is present only in self-actions on the self, such as sucking on one’s own fingers or watching one’s hand move; the perceptual feedback is consistent and simultaneous with self-action. From the beginning, infants show behaviors suggestive of an ability to differentiate self-actions from others’ actions. Newborns show differential responding to their own hand spontaneously touching their cheek, generating double touch in that the hand feels the cheek and simultaneously the cheek feels the hand, and having another person’s hand touch their cheek; they show rooting behavior to the latter but rarely to the former. They also show expectation of results of their actions on their own bodies. In moving their hands to their mouths, newborns open their mouths in anticipation of the hand entering. Young infants’ familiarity with self-actions on the self may originate in prenatal experience. The fetus in the latter months of pregnancy has tactile contact with its own body and babies are often born with marks on their hands and arms from prenatal sucking. Newborns’ differential responses to self vs. external actions may be attributed to reflex reactions built into the nervous system or to reinforced stimulus-response associations. But by 2 months of age, infants show active exploration of the

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effects of their own actions. For example, when given pacifiers which when sucked above a baseline pressure either produced sounds with pitch variations that were analogs to the pressure variations applied by the sucking or pitch variations that varied randomly, 2-month-old infants modulated their sucking to the pacifiers differently. Although sound from both pacifiers was produced by the infants’ sucking, infants more actively explored the effects of their sucking in the analog condition. Infants’ capacities for intermodal perception facilitate their ability to distinguish self from other people and objects. Piaget thought that young infants experienced their perceptions from different modalities as unrelated and only gradually came to the awareness that perceptions from separate modalities can specify the same object, for example, mother’s voice and her visual image originate from the same person. Research on infant development from the past several decades shows such thinking to be incorrect. From birth infants have the ability to integrate their perceptions from different modalities, such that they are able to perceive objects in one modality and recognize them in another. For example, 1-month-old infants who have sucked on, but not seen, a tactually distinctive pacifier visually discriminate that pacifier from a novel one when given a choice of looking at two different distinctively shaped pacifiers. Intermodal perception facilitates infants’ understanding and organization of the external world, but also greatly aids in their awareness of their own bodies. In the first few months of life, infants spend extended periods of time in self-exploration, for example, kicking, vocalizing, touching their bodies, watching their limbs move. These experiences are absorbing and do not include other people or objects. Such activities provide numerous opportunities for infants to experience intermodal perception of their own bodies and to notice the perfect match between their actions and perceived changes. When watching their hand move, infants see the movement as they proprioceptively feel the movement; when vocalizing, they hear sound as they feel air passing through their throat and mouth. Such actions help infants form their body schema; what belongs to their own body and what are its limits. By 2–3 months of age, infants become more interested in the relation between self-action and external responses in the environment, both social and nonsocial, than in selfactions on the self, perhaps because effects of the latter have become familiar. External responses to infants’ actions show high but imperfect contingency rather than perfect contingency. Imperfectly contingent responses occur immediately after self-action rather than simultaneously with self-action and do not occur in response to every self-action. Studies in which infants are given a choice of watching actions that are perfectly matched with their own bodies’ movement, for example, live video displays of their legs kicking, vs. actions that are similar but not perfectly matched with their bodily movement, for example, video displays of another infant’s

legs kicking, indicate that infants over 3 months of age prefer to watch the displays that are not perfectly matched to self-actions, but younger infants do not. The shift to focusing attention on imperfect contingencies present in the environment or in others’ social behavior rather than on intrinsic sensations is adaptive. Infants’ ability to detect differences between perfect and imperfect contingencies is acquired early and may be one of the first ways they distinguish self from other.

Self-Efficacy By noticing the relation between their own actions and resultant external changes, infants develop self-efficacy, a sense that they are agents of the perceived changes. Although infants can notice the effect of their behavior on the physical environment, it is in early social interactions that infants most readily perceive the consequence of their actions. People have perceptual characteristics that virtually assure that infants will orient toward them. They have visually contrasting and moving faces. They produce sound, provide touch, and have interesting smells. In addition, people engage with infants by exaggerating their facial expressions and inflecting their voices in ways that infants find fascinating. But most importantly, these antics are responsive to infants’ vocalizations, facial expressions, and gestures; people vary the pace and level of their behavior in response to infant actions. Consequentially, early social interactions provide a context in which infants can easily notice the effect of their behavior. Parents are generally infants’ most frequent and consistent social partners and as such their behaviors are those that most profoundly affect infants’ emerging sense of selfefficacy. The responses that are most effective in facilitating infants’ early self-knowledge are socially contingent and reflect the infants’ own behavior. In naturally occurring interactions with young infants, parental responses are primarily imitations of infants’ actions. These imitations are not exact but rather match the infants’ actions in intensity, affect, and tempo. Infants’ early perceptual capacities allow them to recognize these imitative behaviors as mirroring their own. From the beginning of life, infants are aware of the matching quality of their behavior and that of others. Infants may more easily recognize the external effect of their behavior when the actions of others mirror the behavior the infants produce. Some theorists propose that in mirroring infant behavior, which exposes infants to external perceptual manifestations of what they are internally experiencing, parents facilitate infants’ early understanding of their own experience. Parents are selective in responding to infant behaviors. The infant actions that parents respond to tend to be those in which the parents perceive emotion that they, either with or without awareness, wish to reinforce, modify, or share

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to particular levels of perceived social contingency based on past experience and, as a consequence, they are most responsive to other external stimulation that has similar levels of contingency. Evidence for this principle comes from studies in which infants participated in face-to-face interaction with mothers and strangers. When infants interacted with strangers whose responsiveness to them was similar to that of their mothers, infants’ responsiveness to the strangers was much like their responsiveness to their mothers. However, when strangers’ responsiveness to the infants was dissimilar to that of the mothers, either by being more contingent or less contingent than the mothers, the infants were less responsive to the strangers relative to their mothers. Such evidence is depicted as a U-shaped curve when infants’ responsiveness to mothers (Im) minus infants’ responsiveness to strangers (Is) is plotted against mothers’ responsiveness to infants (Mi) minus strangers’ responsiveness to infants (Si). The significant quadratic trends shown for vocal contingency in Figure 1 and for smiling contingency in Figure 2 are from adult–infant interactions involving 4- to 5-month-old infants. Similar significant quadratic trends have been found for adult–infant interactions involving 2-month-olds, indicating that infants show a preference for familiar contingency levels from the time they first show an interest in imperfect or social contingency. Individual differences in parental contingency levels also may influence infants’ ability to regulate their levels of stimulation. Initially parents do much of the work in Vocalizations 3

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with the infants. These emotions vary among parents because of the parents’ own emotional histories and expectations regarding infants. Consequently there are individual differences in the range of parental social responsiveness. What is important for infants’ sense of self-efficacy is that the presence of contingent responsiveness to them be such that the infants notice the effect of their actions on their parents’ behavior. Thus, individual differences in parents’ contingent responsiveness to infants’ actions can affect infants’ development of their self-efficacy. The contingent responsiveness present in early parent–infant interactions has been shown to influence infants’ subsequent sensitivity to various contingency patterns in others’ behavior. Infants become accustomed to particular levels of contingency that they experience in their family interactions, creating optimal contingency levels through familiarization that are reflected in infants’ responsiveness to new people. Maternal contingencies to infant behavior are relatively stable within mother–infant pairs but vary across the population. This stability within dyads and variability in the population is present in infants’ first year, possibly by the time infants are 3 months old. Infants’ detection of and preference for imperfect contingency at this age undoubtedly helps them orient toward people, but because people are imperfectly contingent to different degrees, infants are particularly oriented toward people whose levels of contingency are similar to the levels with which they have become familiar. This principle goes against the intuitive expectation that infants should be increasingly responsive to increased social contingency because in such conditions the association between self-action and external consequences would be more evident, thereby facilitating infants’ self-efficacy. Indeed, research does indicate that the more responsive parents are to infants, the more infants are able to rely on their own self-efficacy. For example, infants whose cries are readily responded to in early infancy cry less in later infancy. This contradicts learning theory, which would predict that responding to crying would reinforce the behavior and thus increase it. But infants’ learning processes are complex. By having their cries responded to, infants learn that their own actions are effective in getting their needs met, increasing their sense of self-efficacy. Then at later ages when they run into difficulties, they are more likely to trust their ability to deal with the problems, often succeeding, and therefore needing to cry less. Infants whose parents are less responsive to their cries maintain higher levels of crying throughout infancy. Intermittent reinforcement has been proposed as an explanation, yet all infants experience some intermittent responsiveness from their parents, making this explanation inadequate. Parental responsiveness facilitates infants’ understanding that they are effective agents in the world, which in turn influences infants’ readiness to seek the effects of their self-actions. Yet infants develop sensitivities

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Mi-Si Figure 1 The relational plot of the differences between the infants’ contingent vocal responsiveness to mothers and strangers (Im-Is) and the difference between mothers’ and strangers’ contingent vocal responsiveness to the infants (Mi-Si).Reprinted from Bigelow AE, Infants’ sensitivity to familiar imperfect contingencies in social interactions. Infant Behaviour and Development 21: 149–162, Copyright 1998, with permission from Elsevier.

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Mi-Si Figure 2 The relational plot of the differences between the infants’ contingent smiling responsiveness to mothers and strangers (Im-Is) and the difference between mothers’ and strangers’ contingent smiling responsiveness to the infants (Mi-Si). Reprinted from Bigelow AE, Infants’ sensitivity to familiar imperfect contingencies in social interactions. Infant Behaviour and Development 21: 149–162, Copyright 1998, with permission from Elsevier.

maintaining and regulating infants’ emotional engagement in interactions. But infants can influence the level of engagement by averting their gaze when stimulation becomes too high and by reengaging with attention and positive affect when seeking more stimulation. Sensitive parents adjust their interactive behavior to the infants’ current level of excitement, while also frequently arousing them to high but manageable levels of stimulation where the potential for learning is at its peak. Infants’ experience with parents as regulators of interactions influences infants’ ability to accommodate to wider ranges of stimulation and to self-regulate their own levels of engagement in the absence of the parents. In novel situations, the most arousing and interesting levels of contingency are those that are familiar. Infants with parents who respond to them at low levels of contingency may be most engaged in social situations in which low levels of responsiveness are present, and thus, they may have difficulty detecting the impact of their actions. Infants with highly contingent parents may be more sensitive to and interested in people who are highly responsive to them. In so doing they may learn more readily about their own effectiveness. The sensitivity infants show to the social contingency levels in their parental interactions raises concerns for infants who are exposed to persistent low levels of parental responsiveness. It is not uncommon for periods of low parental contingent responsiveness to occur as a result of parental illness, grief, or other emotionally distracting circumstances. But such periods tend to be temporary; infants are compelling forces for reinstating parental attention.

Yet for some infants, low levels of contingency persist in their most intimate interactions. Children of depressed mothers are such a population. Infants of depressed mothers are exposed to minimal contingent responsiveness and reduced synchronous behavior in their maternal interactions. Initially the infants attempt to engage their relatively unresponsive mothers, but by approximately 3 months of age, they tend to mirror their mothers’ depressed activity and affect. When with nondepressed social partners, these infants continue to be relatively unresponsive, and interestingly, seem to elicit depressive behavior from these partners. Either with or without awareness, the nondepressed partners adopt lower levels of social contingency, perhaps because it is at these levels that the infants can be most engaged. The infants’ familiarity with low levels of contingency within their maternal interactions generalizes to their interactions with others regardless of the contingency patterns provided. Thus the infants’ experience with minimal contingent responsiveness in their social interactions may be easily perpetuated. Extended experience with low levels of social contingency may impair infants’ ability to sense their self-efficacy, adding to the difficulties in cognitive, social, and emotional developments for which children of depressed parents are at risk.

Self-Reflective Awareness Self-reflective awareness requires the child to take an outside perspective of self. Children’s ability to take the role or perspective of another has a developmental trajectory that extends beyond infancy and early childhood, yet it is in this time period that the ability emerges. In the latter part of the first year, infants are no longer just engaged with the social and physical world through perception alone; that is, their sense of themselves is not limited to the immediacy of direct action and perception. Although younger infants can relate their actions to similar past experiences and, therefore, have expectations of the outcomes of their actions, infants at the end of the first year begin to act more intentionally with goals in mind. They start to use symbols to convey those goals to others and use tools as aids in acquiring those goals. Infants achieve what Piaget called means-end understanding. They are able to differentiate goals from the means that bring them about and can choose among alternative means to achieve their goals. For example, infants may have an action pattern for reaching to retrieve objects and an action pattern for batting or striking objects to push them away. When faced with a desired toy that is partially blocked by another object, like a pillow, they can use the striking action, which was not associated with retrieving objects, as a means to remove the pillow in order to get the toy. Or if a desired toy is placed on a table out of reach but on a cloth that the infant can grasp,

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infants at the end of the first year will pull the cloth to get the toy, whereas younger infants tend simply to reach for the toy with growing frustration. Infants become able to combine actions with intention to achieve specific goals. Infants also show intentional behaviors in their interactions with others and begin to treat others as beings with intentions that can be different than their own. Prior to the use of language, infants can use gestures to solicit help in obtaining desired objects. They point or reach for an object while glancing back and forth between the object and an adult. In so doing, infants not only are indicating their desire for the object but also are attempting to engage the adult’s help; they are attempting to affect the adult’s intention with their own. In addition, infants can direct others’ attention with the goal of sharing their interest in an object or event. Infants’ gestures of pointing, showing objects, gazing, and accompanying affective expressions are used as directives for adult participation in object play. The goal is purely social and indicates infants’ awareness that others’ attentional focus can be different than their own but can be changed to match their own focus. Although infants can use adults as social tools by following others’ gazes to find interesting objects from about 6 months of age, beginning around 9 months of age, they engage in joint attention. They can actively coordinate their attention to both an object and a partner, knowing that the partner is attending to them and to the same object that they are. The prototype joint attention episode involves an infant and an adult playing with a toy and the infant looks from the toy to the adult’s face and back to the toy. Initially infants are simply checking to see if the partner is attending to the object they are manipulating. Later in coordinated joint attention, they can show or give the object to the partner as a means of more actively participating in triadic interactions with adults and objects. Infants’ use of symbols increases during their second year. Knowledge that others’ attention and intention can be different than their own facilitates infants’ acquisition of language. They understand that novel labels used by adults generally refer to objects adults are focused on, which can be different from the objects on which the infants are focused. They also can reformulate their own communication when adults appear to have misunderstood them. Eventually, the use of symbolic gestures and language allows infants to move from a focus on the here and now to interactions that include multilayered temporal and spatial events. In the second year, infants also can make inferences about others’ intentions in their actions. For example, after watching an adult perform two actions in sequence, one of which is perceived to be intentional and the other as accidental, infants readily imitate the perceived intended action and tend to ignore the perceived accidental action

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regardless of which action came first. Perhaps even more impressive, infants who watch an adult perform a failed action on an object, for example, miss a bucket when attempting to drop a toy into it or unsuccessfully attempt to pull two objects apart, will complete the action for the adult. That is, infants read intention into the adult’s action and can imitate the intended, but unwitnessed, action. Around the same time, infants begin to use others to acquire emotional information through social referencing. When encountering a novel and uncertain situation, such as meeting a dog, a remote controlled toy, or a stranger, the infant will look to a trusted person, usually the parent, to see how that person has assessed the situation. Is the parent pleased, indicating encouragement for the infant to approach the new object, or is the parent wary, indicating retreat? In social referencing, infants show awareness that others have access to information that they themselves do not. Social referencing also indicates infants’ knowledge of others’ perceptual experience as different from their own. In order to ascertain whether the parent’s emotional cues are related to the object of concern, the infant typically must turn away from the object to look at the parent and then must determine whether the parent is focused on the object in question. This involves a sophisticated knowledge of space and an awareness of where another’s line of vision would intersect with their own if they themselves were looking at the object. Thus, infants show intentional actions in their social encounters as well as in their encounters with the physical environment. They use adults’ actions to change their own behavior and attempt to change adults’ behavior with their own actions. Inherent in infants’ use of communicative gestures, acts of joint attention, language use, imitation of intended goals, and social referencing is their awareness of intentionality in others’ behavior. Whether infants’ understanding of themselves as intentional comes before their understanding of others as intentional is debated. But it is likely that intention in self-actions comes first. Infants’ experience of intentionality in self behavior, through formulating goals independent of actions and then pursuing them, prepares infants to understand others as intentional agents, whose attention to objects and events may be shared, followed, or directed. Integral to this understanding is infants’ knowledge of themselves to be like others yet distinct from them. During their second year, infants not only are objects of thought to themselves, but they also begin to realize they can be objects of thought to others. One way this is manifested is in the emergence of secondary emotions. Primary emotions involve a direct response to an event; knowledge of, or concern for, others’ reactions is not necessary. Primary emotions include emotions such as joy, anger, and surprise. These emotions can be witnessed in infants during the first half year of life. Secondary

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emotions, sometimes called self-conscious emotions, involve a sense of seeing self from the outside, sensing how self-actions might be perceived by others. The emotions of embarrassment, shame, and pride involve a projected sense of self to another’s perspective. In their second year, infants can show a marked sense of embarrassment, typically manifested when doing a task or a performance that can be evaluated by others, and sometimes in the context of protracted attention by others. Incidents of secondary emotions increase in early childhood. Between 2 and 3 years of age, children begin to evaluate their actions against social expectations by holding in mind the standards of others and their own behavior at the same time. Significant others play a major role in the development of secondary emotions. How others respond to young children’s actions influences how children evaluate their own behavior. Such self-evaluations are beginning points of self-esteem and can either enhance or injure children’s growing sense of self-competence.

Visual Self-Recognition How infants learn to recognize their own image as themselves is still an open question. Watching one’s mirror reflection is a unique experience in many ways. The perceptual information pertinent to self-recognition is distinct from one’s own body yet generated by it. Self is perceived from the perspective of an outside observer. Most theorists agree that visual self-recognition does not emerge suddenly but rather develops gradually, building on earlier aspects of self-knowledge. Criteria for self-recognition vary among studies. Typically, baseline measures are taken of the infant’s self-directed behaviors in front of a mirror or live video and then surreptitiously a mark is made on the infant’s face or head, and subsequent self-directed behaviors to the marked area in front of the mirror or live video are noted. Significant increases in touching the marked area of the face or head indicate the infant knows the reflected image is of self. Such measures originated from studies showing self-recognition in chimpanzees. Alternative criteria for self-recognition include infants’ self-labels of their reflected images, their coy or embarrassed behaviors in front of a mirror, and their turning to find interesting objects that appear behind them in the mirror. Although justifications, as well as criticisms, can be made for each of these criteria, the timing of self-recognition is quite similar by each of the measures, lending credence to them all. Self-recognition occurs for most infants near the end of their second year. Although self-recognition occurs rather late in infancy, infants have an early interest in mirrors and other reflective surfaces. Initially, infants are more

attentive to the reflected images of objects or other people rather than to their self-images, probably because they readily see that two identically looking objects or people seem to be present and this attracts their interest. Then, beginning around 3–4 months of age, infants’ attention is directed toward the self-image. Smiles, vocalizations, touching the image, and even attempts to look behind the mirror become prevalent. Infants appear to treat the image in a social manner as if there were an interesting baby behind the glass, although studies of infants’ responses at this age to their reflected image and to a socially responding partner show infants to be more responsive to the social partner. Toward the end of the first year, infants’ behavior toward their mirror image takes on a new dimension. Infants begin to test the correspondence between the action of the image and their own behavior. They study the movements of their reflections while systematically varying these movements. Most characteristic is repeated limb activity while observing the limb in the mirror image or a repeated bobbing, bowing, or bouncing while attending to the image, at times turning away and then quickly back to the image as if to try to catch it off guard. Movement testing behavior indicates that infants are exploring the uniqueness of their reflected self-image and its perfect match to their behavior. Movement testing behavior accelerates around the time of self-recognition. The realization that the movement of the self-image is perfectly matched to the infant’s movement may be an initial cue to self-recognition. That is, the first recognition of the visual self-image may be the recognition of self-movement. Figure 3 shows infants’ movement testing behavior to different video conditions in a longitudinal study of the development of self-recognition beginning when infants were 18 months of age. On each monthly session, infants were shown a playback of a video of themselves taken at the beginning of the session (discordant condition), a live video of themselves (simultaneous condition), and a video of a similarly aged infant in the same setting (other child condition). The mean age of self-recognition in the simultaneous condition in this study was 22 months. Movement testing to this condition was clearly higher than in the other conditions and showed an increase prior to self-recognition. Infants’ interest in the movements of their mirror image may be due to advances in their imitative abilities and awareness. Around the time infants show an interest in movement testing with their reflected images, they show development in their ability to imitate novel behaviors not in their repertoire of actions and in their deliberate attempts to adjust their behavior to more accurately match that of a model. As infants’ imitative ability becomes more precise, they may notice that the actions of their reflected images are unique. The images consistently, simultaneously, and perfectly match their own movements, unlike that of a social partner.

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Age in months Figure 3 Mean percentage of attention time spent in movement testing in the simultaneous, discordant, and other child conditions from ages 18 to 25 months. Adapted from Bigelow AE (1981) The correspondence between self and image movement as a cue to self-recognition in young children. Journal of Genetic Psychology 139: 11–36, Copyright (1981), with permission from Heldref Publications.

Within a few weeks to a few months after infants can recognize themselves in mirrors or live video, they can recognize themselves in still images, such as picking out pictures of themselves from a series of photographs of babies, and on videotape that is not concurrent with their present movement. In the study depicted in Figure 3, self-recognition in the discordant condition occurred at a mean age of 24 months. Between self-recognition in the simultaneous and discordant conditions, movement testing increased in the discordant and other child conditions, although movement testing was virtually nonexistent prior to this time as can be seen in Figure 3. The infants may have been trying to identify the images in these conditions by means of the same process that facilitated recognition in the simultaneous condition, that is, by attempting to test for a correspondence between self and image movement. In these conditions, however, there was no visual feedback of a correspondence so the attempts were short-lived. Infants eventually become aware that their reflected self-image has unique visual characteristics, that is, it is always the same-looking child who moves exactly like self. Once they understand that particular image to be of self, they can match that image to other self-images that do not have exact correspondence to their current movement. Thus, the process of self-recognition may begin with infants’ interest in the correspondence between self and image movement, which leads to the realization that the image that shows such correspondence with self-movement is a

self-image, and be followed by the children’s development of mental representations of what they look like to which they can match the images they see. Interestingly, studies of 2- and 3-year-old children’s reactions to their delayed video images indicate that, although the children can recognize their delayed video images as self-images, they have difficulty recognizing the images as of themselves in the present unless the delay is less than 2–3 s. Young children’s recognition of self-images in the present is dependent upon their ability to detect the temporal matching of their current action and the action of the self-image. The temporal limits of recognition of self-images in the present correspond to the timing necessary for infants to detect socially contingent responses to self-action. The responses of others are perceived to be socially contingent only if the responses occur less than 2–3 s after the infants’ own behavior. Adults show similar temporal limits to the perception of social contingency. Experience with social interaction may be important for self-recognition. Such speculation is supported by findings that show chimpanzees raised in isolation, unlike those raised with other chimpanzees, do not perform selfdirected behavior when watching their mirror reflection. Perhaps it is necessary to experience the contingency between self-actions and those of a socially responding partner before it is possible to become aware that the unique simultaneous matching between self and image action is an indication that the image seen is a self-image.

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Early Autobiographical Self-Knowledge Our autobiographical self-knowledge consists of our memories of important events in our lives that help define who we are to ourselves and others. There are large individual differences in the age of first memories, as well as the number of memories reported from early childhood. Rarely do people report memories from before 2 years of age. Most people have some sporadic memories from the years 2–4, with more accessible memories from middle childhood. Freud labeled this phenomenon of little or no memory of early life infantile amnesia. He proposed the cause to be repression of memories that were too arousing for the ego, such as the child’s early sexual desires. It is unlikely that Freud’s explanation is the reason for the absence of self-memories from early childhood; all memories of very early childhood tend to be absent, not just those that are emotionally arousing or might be associated with the young child’s sensual pleasures. Piaget proposed a cognitive explanation. He thought that memories from early life are stored differently than memories from later childhood and adulthood, and therefore, the retrieval systems to those memories are not accessible or, at best, indirect. From a Piagetian perspective, thought in infancy is a product of the babies’ ongoing perceptions and motor actions. Babies think about what they currently perceive and what they are doing. In later infancy, these sensorimotor processes connect to previous learning in new ways, as in means-end understanding. Yet infants still do not have representational thought. From the end of infancy at about 2 years of age through the preschool period, young children’s thought is representational but is not yet logically organized, making access to memories fragmented. Thus, events that occurred in infancy and early childhood are not stored in ways that are easily retrievable by older children and adults. More recently, cognitive theorists have proposed that until children have a concept of self as an individual with unique characteristics, as evidenced specifically by mirror self-recognition, there is no framework around which to organize their personal memories and formulate their autobiographical past. Thus, autobiographical memory depends on developments in specific self-constructs. Developments in children’s memory storage and retrieval systems and constructs of the self are important to children’s ability to remember their own lives, but such developments may not fully account for the emergence of autobiographical memory. These theoretical positions cannot readily explain the large variation in age and number of early memories. Children across cultures develop neural cognitive structures relating to storage and retrieval of memories at approximately the same age, and visual

self-recognition is acquired within a narrow age range even in cultures with little or no experience with reflective surfaces. Social cultural theorists propose that autobiographical memory emerges gradually and is influenced by multiple factors that interact in a dynamic fashion. Important to autobiographical memory are advances in neural cognitive structures in the brain that facilitate encoding, consolidation, storage, and retrieval of memories; conceptual developments of the self that include a subjective view of how events make one feel and think, which has its basis in infants’ understanding of intentionality in self and others; language development, especially in narrative skills; developments in temporal concepts, particularly of self in time; and conversations with others about events the children have experienced. The importance of conversations with others is particularly intriguing and may help explain variations in age and number of early memories. There are individual differences in the ways parents and others discuss children’s life experiences with them. Some parents are more elaborate than other parents in their discussions with children about events in their lives, both at the time of the events and in reminiscing about them. In trying to help children remember, elaborative parents provide verbal props, expand on whatever fragments the child contributes, and are detailed in their descriptions. Less elaborative parents tend to repeat their questions rather than become more expansive in their detail and are more pragmatic in their questioning about the past, for example, where did you put your sweater. The differences among parents’ conversations with children about events in the children’s lives are most evident when talking with 2- and 3-year-olds because children at this age tend to contribute little original information to conversations about past events, resulting in the discussion being carried primarily by the parents’ comments. Although parents tend to become more elaborate as children grow older and acquire more narrative skills and parents tend to emphasize different topics with sons than with daughters, individual differences in how elaborative parents are in their conversations with children are robust. Parents’ reminiscing styles correlate over time and show similar patterns with multiple children in the family. One of the reasons there are such large individual differences in age and number of early autobiographical memories may be due to individual differences in how parents discuss events in young children’s lives with them. How do conversations with children about events in their lives affect autobiographical memories? Autobiographical memories are episodic memories, which are memories of specific events that happened at specific times and places. Children as young as 2.5 years report episodic memories, but whether they have autobiographical memories is questionable. Not all episodic memories

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become autobiographical memories. For instance, yesterday’s lunch may be remembered today, but unless the lunch was extraordinary for some reason, it is unlikely that it will become part of one’s autobiographical self knowledge. In talking with children about events in their past, children are helped to reflect on the events, which may facilitate the consolidation of specific episodic memories into autobiographical memories. To children of 2 and 3 years of age, routine events, rather than one time events, are particularly important. Young children are trying to figure out the world and themselves in it. Their particular interest is in how things are done and what to expect next. The scenarios of routine events are scripts or generic event memories, for example, bedtime scripts may involve taking a bath, getting into pajamas, getting a story read to you, having a glass of water, getting a goodnight kiss, hugging your teddy bear. When a novel event occurs, young children can hold it in their memories for a period of time. If a similar event occurs within that period, the event is remembered longer. Two-year-olds have been shown to remember an event for 3 months if it reoccurred within 2 weeks of the original occurrence. After an event occurs several times, it tends to become a generic event. For example, going to the zoo may be a memorable episodic event for a 2.5-yearold, but after several trips to the zoo, the child forms a script for zoo trips but does not remember what specific animals were seen on which trips. The underlying principle is that events must reoccur for young children to have sustained memories of the event, but those memories tend to get transformed into generic event memories. But when parents, siblings, and others talk to the child about experiences the child has had, the experiences are reinstated; the child revisits the event in conversation with the other person. Unlike generic or script memories, the revisits are not similar actual events, but rather involve mentally reinstating the specific episodic event. All autobiographical memories may be products of mentally reinstating specific episodic events. The difference between the establishment of autobiographical memories in early childhood and in later childhood and adulthood may be that, for young children, the mental reinstating of episodic events is facilitated by others. The influence of children’s conversations with parents and others on children’s memory implies that autobiographical memory is subject to social construction. What is salient to the parent from a particular event in the child’s life may not be what was salient to the child at the time, yet the parent’s version is what is discussed, especially in early childhood when information contributed by the child is minimal. Children’s reports of private memories that do not involve discussions with others tend to become more prevalent in the late preschool years. Although this may be because of increases in children’s narrative skills, it is also

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when children become more facile in using their thought processes to reminisce and reflect upon happenings for themselves, essentially reinstating the event in their minds without help from others. Yet social cultural theorists do not propose that conversations with others cause children’s memories. Although children with parents who are elaborate in their discussions of past events report longer and more detailed descriptions of their past experiences, children with less elaborative parents do not necessarily have fewer memories. From the perspective of social cultural theory, the frequency and manner of parents’ reminiscing with children about events in the children’s lives affect the development of several skills important to autobiographical memory. Parental conversation styles that are elaborate, both when events occur and when reminiscing about them, may help children organize their memories, which makes them more accessible. Parent–child conversations about the child’s past may facilitate the child’s understanding of self in time through focusing on the child’s experience in temporally specified events. Potentially, such conversations also may allow more opportunity for the parent and child to disagree on the facts (e.g., whether talking to Santa was scary or not) and thus facilitate children’s understanding of memories as representational and that self and others can have different perspectives of the past, allowing for the creation of a truly personal past. Children’s discussions with others about their experiences help them distinguish specific episodic events as significant from other events in their lives and to integrate such memories into their life story. Parent–child conversations about the past influence the way children think about their lives, the sense they make of their experiences, and how they share their experiences with others.

Conclusion Early forms of self-knowledge prepare the way for later more complex forms of self-knowledge to develop. Through experience with their own actions and perceptions, infants distinguish self-action from the actions of others or events in the physical world. They become aware of their own bodies and the effects their actions have on the physical and social environment. These effects become predictable and anticipated. Infants become intentional in their actions and begin to read intention in the actions of others. They become self-reflective, learn to recognize their own images, and begin to form their life narrative. In the first few years of life, self-knowledge progresses from simple beginnings to sophisticated forms of self-understanding that continue to develop throughout life. Experience is crucial to early developments in selfknowledge. The child’s experience when alone and when

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engaged with the physical environment provide the child with important information relevant to the self, but much of the experience most salient to self-knowledge occurs within social contexts. In early infancy, responding others facilitate infants’ ability to distinguish self from other and to learn that they are effective in producing external changes. In later infancy, self-recognition may depend on children’s awareness of the difference between the movements of their reflections and those of a socially responding other. The development of intentionality is enhanced through engagement with others by facilitating infants’ understanding that their intentions and those of others are distinct yet can be changed through their own behavior. Others’ communications with children influence how children begin to value their abilities and remember their own lives. Social encounters provide the fertile ground for young children to acquire self-knowledge. In early life, as well as throughout life, knowledge of self is embedded in interactions with others. See also: Emotion Regulation; Gender: Awareness, Identity, and Stereotyping; Social and Emotional Development Theories; Social Interaction.

Suggested Readings Bauer PJ (2007) Remembering the Times of Our Lives: Memory in Infancy and Beyond. Mahwah, NJ: Erlbaum. Bigelow AE (1981) The correspondence between self and image movement as a cue to self recognition in young children. Journal of Genetic Psychology 139: 11–36. Bigelow AE (1998) Infants’ sensitivity to familiar imperfect contingencies in social interaction. Infant Behavior and Development 21: 149–162. Carpenter M, Nagell K, and Tomasello M (1998) Social cognition, joint attention, and communicative competence from 9 to 15 months of age. Monographs of the Society for Research in Child Development 63. (4, Serial No. 255). Lewis M and Haviland-Jones JM (eds.) (2000) Handbook of Emotions, 2nd edn. New York: The Guilford Press. Neisser U (ed.) (1993) The Perceived Self: Ecological and Interpersonal Sources of Self Knowledge. New York: Cambridge University Press. Nelson K (1993) The psychological and social origins of autobiographical memory. Psychological Science 4: 7–14. Nelson K and Fivush R (2004) The emergence of autobiographical memory: A social cultural developmental theory. Psychological Review 111: 486–511. Rochat P (ed.) (1995) The Self in Infancy: Theory and Research. Amsterdam: North-Holland/Elsevier. Rochat P (ed.) (1999) Early Social Cognition: Understanding Others in the First Months of Life. Mahwah, NJ: Erlbaum. Stern DN (2000) The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology. New York: Basic Books.

Self-Regulatory Processes C B Kopp, Los Angeles, CA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Emotion regulation – A multidimensional mental and/or behavioral regulatory process that draws upon cognitions and motivations to influence emotion states with respect to: self needs, demands relevant to information intake, and interactions that involve group goals, others’ emotion states, and salient social conventions. Anticipatory forms of emotion regulation tend to be more effective than attempts to regulate highly elevated negative emotions. Executive attention – A behavioral regulatory process that involves top-down, focused, or supervisory control of attention that is relevant for cognitive activities such as learning and problem solving, or engaging in social interactions that also necessitate the monitoring of informational content and emotional tone. Executive functions (EF) – A constellation of behaviors that subsume adaptive decision making

involving conscious reflection, planning, monitoring, and evaluations of goals typically related to complex social–emotional contexts or difficult cognitive problems. Underlying effective EF are executive attention, inhibition of actions, and working memory. EF is typically evaluated with a series of laboratory tasks that induce cognitive conflict, appraisal of competing stimuli, controlled inhibition, and planful strategies. EF is developmental in that age, experiences, and degree of growth of the brain’s frontal lobes matter. Young children (3 years) are least successful in EF laboratory tasks despite age-related adaptations; in general, EF performance shows linear trends from childhood into adulthood. Recognize that some scientists debate the usefulness of the EF construct and measures used for its evaluation. Inhibitory control – A behavioral regulatory process that involves cessation of concentrated activity or thoughts because they are irrelevant to a primary


goal or undermine progress toward a goal whether set by the individual or designated by another. Regulatory processes – Biological, physiological, and behavioral mechanisms that facilitate adaptations of metabolic processes, sensory and motor systems, attentiveness, emotion regulation, and activities in order to plan, adjust, and implement goal directed actions related to self well-being, learning and thinking, social interactions and demands, and cultural standards. Regulatory processes can be reactive or intentionally guided by a conscious self, a point that has age-related relevance in that conscious awareness soars during the second and third years.

Introduction To be socially adept is to know the norms of one’s group, to understand when and how norms differ, and to generate self-regulated strategies for managing one’s behaviors particularly in complex social situations. To be cognitively adept is to know what one needs to learn, the kinds of learning required for different goals, and how to obtain relevant knowledge. Whereas knowledge gives us insight, how we behave typically draws upon regulatory processes such as inhibitory control, controlled attention, or emotion management for adapting our behavioral responses. Because behavioral fine-tuning is such an important human characteristic, it is not surprising that nascent forms of regulatory processes are observed in infancy. Ten-month-olds, for example, seem to realize if they make eye contact with another they can then direct the other’s gaze to something else that interests them. Perhaps though the most essential role of regulatory processes involves facilitating ‘executive functions’: these are the often conscious, self-motivated, supervisory aspects of humans’ planning, goal setting, monitoring, and evaluation whether involving an immediate or longer-term personal goal, facilitating teamwork to meet a competition, or planning a social event that includes fractious family members. Metaphorically speaking, a regulatory process such as controlled attention can narrow an individual’s cognitive frame such that the person can fully concentrate on an issue that requires resolution. Research reveals that healthy, cognitively adept adults seamlessly integrate several regulatory processes preparatory to goal setting, organizing actions, predicting outcomes, monitoring progress, and instigating changes when necessary. In general, think of regulatory processes as underlying mechanisms that facilitate the realization of goals. Conscious, intentional, self-directed modulation of regulatory processes begin to take shape during the

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end of the first year and are part of the constellation of distinctly human patterns of behavior that make their appearance during the toddler period (e.g., walking, elaborate forms of play, communicating with words, selfreflective awareness of agency and intentions, social imitation, verbalized self-awareness). These skills develop further because of children’s own motivations, adequate nurturing from others, parents’ socialization goals enacted with do’s and don’ts, and, new connections within and across the brain’s frontal lobes, specifically the prefrontal cortex. However as will be described in succeeding sections, the developmental growth of regulatory processes is neither straightforward nor trouble free. Several mitigating factors are involved. One, for example, involves the varied contextual demands made upon the young child’s limited psychological resources. Consider as one example peer play, which tends to be exhilarating for young children. However, the maintenance of play demands cooperation while minimizing disagreements about personal possessions and roles. Cooperation in play is a matter of learning how to adapt and cope and in so doing enabling regulatory processes. A second mitigating factor relates to the sheer magnitude of developmental change that occurs during the second year, and toddlers’ impelling need to practice every developing skill; those that are most exhilarating such as walking and exploring are practiced the most. Karen Adolph’s studies of relatively new walkers reveal numerous bouts of walking each day sometimes corresponding to lengths of many football fields. Data also suggest that although gross motor activities (walking, running, climbing) continue to be highly salient for young children, by the mid-toddler months they are better able to balance those activities with periods of small toy play that engage eye–hand coordination and attention. However, continued preoccupation with locomotion can have adverse implications for regulatory processes when parents negate the importance of toy play or do not intervene if a child has an exceedingly high activity level and engages in purposeless wandering. A third mitigating factor relates to the differential amount of time that newly emerging skills become functionally competent. Findings reveal that walking expertise is achieved in a few months, whereas communicative skills (i.e., vocabulary, sentence use, narratives) that are useful for conversing about bothersome events may take a year of more to become functionally adaptive to different social contexts. What this means in the practical sense is that the language component of child agency can be severely constrained by limitations in communicating needs and goals to others, and also in talking to one’s self and giving the self instructions. This developmental inequity is one reason that emotion regulation, which often requires self-issued reminders, is so difficult for most toddlers.

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Despite these challenges, the toddler and early preschool years are also witness to growing competencies that continually influence all manner of social and object interactions, and the growth of regulatory processes. Expanding cognitions represent growth in semantic and episodic memory, causal reasoning sometimes associated with strategic-like behaviors, and consciousness, which often coincides with increases in different kinds of pretend play. With respect to language, for many children after about 18 months or so, there are substantial increases in comprehension of objects and people, as well as increasing ability to use ideas when communicating with others. Equally important is the child’s growing sense of competence, which is tied to consciousness of an objective self, that is, a self represented by ‘I’ rather than only by a sense of ‘me.’ The former reflects a sense of personal agency, that is, ‘‘I can do . . . I can jump . . . ,’’ whereas the latter indicates a sense of awareness such as being warm, a girl, owning a toy, or feeling happy. Major patterns of change are typically observed between 18 and 24 months with clear differentiation of self from other, self as a ‘being’ who has preferences, and a self who can experience social emotions (e.g., an emotion akin to shame), again during the second and third years when language exchanges promote more defined reflective self-knowledge and increasing awareness of ‘‘I can . . .,’’ and between 3 and 6 years with autobiographical memory reflected in past and planned social interactions and in imaginary events. Although our human biological heritage provides an imprimatur for many early skills, their continuing development including the self as an agent, largely depends on a variety of social interactions. With some exceptions, developmental scientists have seemed largely indifferent to developmental aspects of regulatory processes, and the component skills that are concordant with patterns of change. Rather there has been considerable effort to explore individual differences at one or another age. In part, this emphasis is due to concerns about preschool-aged children who have problematic behavioral controls, and school children who have difficulty controlling emotions. However, at times it is a challenge to more fully interpret individual differences in the absence of a broader developmental context; nonetheless, these studies have highlighted the adverse roles of poverty, unstable family environments, low parent education, and harsh parenting. Moreover, the data serve as reminders that the development of regulatory processes demands an incalculable number of appropriate caregiverorganized experiences, a fact that serves as an underlying context for the emphasis on age changes in regulatory processes that forms the rest of this piece. The regulatory processes that are the primary focus of this entry are inhibitory control, executive attention (also referred to as focused, or controlled), and emotion regulation. Before turning to specifics, it is useful to highlight what

is inferred about general developmental trends in young children’s use of regulatory processes. Inferences: Developmental Issues and Regulatory Processes First, as noted earlier there are indications that inhibitory control and controlled attention in nonemotional contexts are more evident in toddlers’ and young preschoolers’ behavioral repertoires than emotion regulation. A crucial reason is that any number of situations can elicit a highly charged emotion and any number of strategies can defuse a potentially disruptive emotion encounter. However, young children rarely have insights about the causes of disruptive social interactions, and even if they do, their cognitive limitations often restrict options for successfully forestalling distressing emotions. Complex psychological demands tax young children’s psychological resources. This factor is one reason that the appropriate intervention of a parent greatly influences the young child’s emotion regulatory competencies. Second, young children’s motivations matter, a factor often overlooked in research. Toddlers, for example, devote much psychic energy toward regulating their movements when the goal involves protecting their balance upon encountering changes in ground surfaces (a steep incline or drop). Sometimes toddler actions appear intentional as if guided by a prescient self and other times seem accidental. Whether intentional or not, experienced walkers (about 4 months of functional walking) appraise situations by determining relative safety or risk to themselves, try out different strategies to avoid risks and when necessary coordinate and use multiple strategies, and discover that anticipatory planning about risk avoidance is more effective than responding reactively. Despite growing expertise in negotiating locomotion, failures occur that at times relate to insufficient control of attention to contextual features. Overall, the multidimensional studies by Adolph and colleagues reveal how young experienced walkers construct a perceptually and cognitively driven strategically adaptive, regulated mobility system to avoid risks. The lack of across domain (cognitive, motor, social) longitudinal studies of contemporary toddlers makes it difficult to translate these findings to other aspects of regulated behavior. However, it is intriguing that toddlers’ creative use of proactive walking strategies has an analog in anticipatory emotion regulation observed among children around the time of their second birthday. Whether encountering an obstacle while walking or hearing a parent say it is time to put toys away, children seem to sense that modifying the potentially upsetting situation before it actually occurs is more effective than trying to cope reactively. An anticipatory locomotion strategy might involve resorting to creeping in order to manage a flight of stairs, and for emotion regulation the


strategy might involve using words to bargain for a few more minutes of play. In addition to conditions and behaviors that foster the growth of regulatory processes, new competencies surface that raise challenges for toddlers’ use of behavioral controls. These new achievements include a deepened awareness of one’s own body and physical skills, stronger memories particularly related to salient events involving the self, and heightened cognizance of self-identity and personal possessions. Taken together, this burgeoning knowledge contributes to a sense of urgency to intentions, and when the child’s intent is thwarted frustration and protest result. This behavioral pattern becomes evident between 15 and 30 months, has an inverted U-shaped pattern with a peak about 21–24 months and shows gradual declines thereafter. Accompanying behavioral attributes include heightened whining and crying, temper tantrums, anger, physical aggression, and negativism (No!), and are exemplified by howling for juice, screaming and hitting when a pen was moved beyond reach, biting a peer overpossession of a toy, and angrily jabbing a crayon at a parent. The intensity and frequency of these negative behaviors vary among toddlers, although in general, crying and negativism are more common than physical aggression. It is not clear why these behaviors fade. Possibly, somewhat older toddlers and young preschoolers gain skill in delaying an action in the service of self-directed emotion control because of improved communication skills, better memory of consequences with respect to do’s and don’ts, and more concern about others’ feelings. Whatever the reasons, behaviors associated with ‘the terrible twos’ diminish, and in the ensuing years preschoolers increasingly use regulatory processes for self-promoted learning, and in dealing with social situations that have the potential to be distressing. Even young preschoolers begin to negotiate conditions of play with their peers. It is interesting that during the period of relative developmental upheaval when very young children often seem out-of-control, predictions about later behavioral vulnerabilities tend to be problematic. Exceptions occur in the presence of serious risks (e.g., meager rearing environments; young children’s persistent cognitive and language delays, heightened levels of irritability, and high levels of physical aggression).

Introducing the Study of Regulatory Processes Regulatory processes are discussed in detail in the following sections, with greater emphasis on the toddler and early preschool years than earlier or later. The reasons are twofold. First, prefrontal neuronal activation is increasingly activated around the first birthday and is associated with regulatory processes that are gradually more

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conscious and more linked to burgeoning cognitions. Second, the magnitude of change between 1 and 4 years is uniquely transformative such that the young human transitions from a mostly dependent being to one who knows a self and individuality, is increasingly entrusted with some independence, and who is expected to learn how to balance self-goals with those of others. This developmental period represents another waypoint toward assuming an active role in social activities and groups. In the following, the first section describes changes in brain functioning that occur during the early years and also summarizes information obtained with older children and adults about prefrontal cortex (PFC) activation, intrabrain interactions, and associated behavioral manifestations. The second section provides a figurative representation of the multiple factors and conditions that influence the development of regulatory processes including brain growth, parental and sociocultural influences, and child competencies. The goal is to emphasize the varied inputs and experiences that contribute to development. The third section draws upon selected cross-sectional and longitudinal studies to suggest various patterns in age trends in inhibitory control, executive attention, and emotion regulation, with particular emphasis on the years between 1 and 4. Indirectly, data support the notion that different regulatory processes make differential demands on the child’s psychological resources. Yet again, note that inhibitory control seems to be less effortful than emotion regulation because the latter requires effort to evaluate a particular situation including who is involved, the cause of one’s bothersome emotion, the potential resources available (another person), and, how to defuse the situation. The younger the child, the fewer the resources, a key reason for the crucial role of caregivers. Also, it will be apparent that it is easier for researchers to study controlled inhibition across a large age span than executive attention or emotion regulation. The reason is that task stimuli for the study of controlled inhibition can be more easily designed to be appropriate for a wide age range; this is not the situation for the other regulatory skills. This fact also has implications for the availability of data that extend across age groups. One last point needs emphasizing; the availability of multiple data points (cross-sectional or longitudinal) for across age comparisons during the toddler and early preschool years is markedly limited for emotion regulation.

The Brain: With Emphasis on the Prefrontal Cortex The basic structural organization of the brain takes place during the prenatal period, and at birth the infant’s brain looks like a miniature version of an adult brain. The newborn’s brain differs in size, the number of its folds,

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and connections within and across lobes. Given a healthy uterine environment, the developing prenatal brain represents a conserved human system that is only minimally dependent on specialized experiences. As Box 1 reveals, postnatal brain growth occurs first in the occipital and motor areas and then lastly, at about a year of age, crucial changes begin to occur in the frontal lobes. Evidence suggests that for very young primates (including humans), neuronal activations related to responses to certain visual stimuli and those related to control for postural patterns are subcortically innervated and then later cortically. In describing motor development, one prominent primate researcher suggests that ‘‘. . . primates appear to be forced to reconstruct on their own things that, paradoxically, may well be specified in their genes.’’ In other words, primates must not only discover what they can do with their bodies, but must also build flexible, intelligent representations of those discoveries. This means that sensory and motor

Box 1.

systems must become attuned, and stay attuned, to local ecologies including the family setting, and to social groups. Enter frontal lobe activation and initial glimmerings of regulatory processes. Consider again young human toddlers who walk hours each day and who try to maintain balance in the midst of changing conditions (e.g., light, spatial configurations, and floor surfaces). The more inexperienced the walker, the more likely the need to stop every so often to attend to the terrain beneath the feet, to look for support from a caregiver, and to take note of the caregiver’s positive or negative responses to the walking activity. In other words, there is nascent behavioral inhibition, attention management, and sensitivity to caregiver expectations. The human brain has a large number of neurons and high conduction velocity, which are associated with high information capacity and behavioral adaptability. Humans’ frontal lobes are also large relative to brain and

The brain: early development, in brief

Nature provides a first draft, which experience then revises. Gary Marcus General: size, growth patterns, and volume. The newborn’s brain is similar in structural organization to adult brains but differs in size (about 25% smaller), number of ridges and grooves (gyri, sulci), and connections within and across lobes. Postnatal brain growth occurs first in the occipital and motor areas, next in the temporal and parietal association cortices, and lastly in the lateral cortices and the prefrontal cortex. These regional patterns of growth are also reflected in relative rates of maturation with sensory areas maturing far earlier than the prefrontal cortex, which shows protracted growth into early adolescence. At about 6 years of age, cerebral volume is 90–95% of adult brains. Cerebral volume peaks at about 14 years for males and 11þ years for females. Although the peak in volume occurs during adolescence, the brain continues to be a dynamic structure. Connections continue to be fine-tuned and the process of myelination (of axons) continues into the adult years. Cortical gray and white matter. Most neurons (gray matter) are formed before birth; however, some areas such as the hippocampus show neuronal growth after birth. Apoptosis refers to the programmed death of unnecessary or redundant neuronal cells that occurs during development. White matter refers to myelin, which is a fatty substance that surrounds a neuron’s axis and hastens the transmission of impulses. Myelination refers to this process. By 3 years, major pathways are substantially myelinated with other pathways myelinated later on. In the broader context of development, gray matter decreases (likely due to synaptic pruning) and white matter increases with age. Wilke and colleagues’ recent study of a large group of normally developing children and adolescents confirm and extend these findings, with details about age and gender differences; gray matter losses greater in parietal lobes and least in the cingulate and posterior temporal areas; virtually uniform increases in white matter volume. Of importance, the study of gender differences in the brain and related behavioral competencies is still in early phases. Synaptic density. A rapid increase in synapse formation (connections made between axons and dendrites) occurs during the first year, and by the second year the increase in connections is 50% greater than synapses measured in adult brains. The peak period in growth of synapses is first observed in the area of visual cortex toward the end of the first year and into the second, and last in the prefrontal cortex between 2 and 5 years. In contrast, peak synaptic density in one of the layers of the motor cortex extends from a year of life to about 10 years. These increases in synaptic connections are one reason that brain growth occurs in the early years. However, synapse formation can occur through adult life. The periods of high synaptic density also result in far more synapses than can be used. Those that are not used gradually disappear (‘pruned’). Synaptic growth and synaptic pruning are also dynamic processes. Taken together, the regressive and progressive changes that occur across development within the brain result in fine-tuning and strengthening connections.


body size, and the PFC is larger and has a more complex structure than those of the great apes. Data indicate that the PFC is relatively young from an evolutionary standpoint probably evolving from nearby motor structures, and tripling in size in the past few million years. Overall, the human PFC contains a sophisticated neural architecture, interconnectivity within itself and across brain regions, and extended periods of neuronal firing that permit the coding, storage, and retrieval of long and complex sequences of behavior. Basically the PFC integrates information that is coming in, assesses the relative internal state of that individual, and facilitates the individual’s assessment of what is necessary for an appropriate response. Thus in a very real sense, the PFC provides the potential to adapt to varied contexts, to realize individual and cooperative goals, to grow intellects, and to consciously enjoy meaningful and lasting social and emotional relationships. It is also crucially important in situations that are novel, ambiguous, demand self and intentionality, for integrating disparate kinds of information, and is invariably associated with ‘topdown’ conscious awareness across a period of time. Given the complexity of these processing demands, it is not surprising that the study of PFC functions first emerged from careful behavioral analyses of individuals who experienced frontal lobe injuries, often revealing impulsive and emotionally explosive behavior and minimal concern for social norms. With advances in technology, studies extended to PFC activation with nonhuman primates; then with the availability of increasingly sophisticated neural imaging techniques, neuroscientists studied PFC activation in laboratory settings using varied kinds of stimuli with healthy human adults, adolescents, and older children. PFC activation is typically analyzed in relation to its subregions and interconnections, and also to connections to other brain structures such as the hippocampus (memory functions, particularly new memories), to the amygdala (regulation of emotions chiefly negative ones such as anger), and to the hypothalamus (regulation of endocrine and somatic functions). Figure 1 shows major PFC regions as well as the anterior cingulated cortex and the amygdala, emphasizing the interconnections of these brain structures and emotions. In the figure, orbital PFC is distinguished from ventromedial PFC, both of which are associated with emotion, affective styles, and emotion control albeit the orbital PFC may be more linked to emotion control. One of the central debates in the study of PFC relates to exactly how its neural circuitry functions, and how best to characterize these functions. Figure 2, from Wood and Grafman’s discussion of PFC and its possible representations, provides a useful guide for highlighting the central interconnectivity of the PFC as a unit, while also differentiating connections of the dorsolateral PFC from those of the ventromedial PFC.

(a)

(b)

(c)

(d)

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Figure 1 The prefrontal cortex (PFC) and two key areas of and ventromedial PFC interconnections: (a) orbital PFC in (b) dorsolateral PFC; (c) amygdala; (d) anterior in cingulated cortex. From Davidson RJ, Putnam KM, and Larson CL (2000) Dysfunction in the neural circuitry of emotion regulation – A possible prelude to violence. Science 289: 591–594.

Cingulate

Hippocampal formation

Parietal/occipital visual association areas

Motor structures

Dorsolateral prefrontal cortex

Posterior parietal heteromodal area

Amygdala complex

Inferior temporal visual association areas

Ventromedial prefrontal cortex

Figure 2 Interconnections between the prefrontal cortex and other brain regions. Adapted and reprinted from Wood JN and Grafman J (2003) Human prefrontal cortex: Processing and representational perspectives. Nature Reviews Neuroscience 4: 139–147.

The former is often more involved in top-down cognitive activities, whereas the latter is more often linked to emotionally laden situations that may also require cognitive inputs. The dorsolateral PFC supports decision making, the regulation of behavior and the control of nonemotional responses to environmental stimuli including motor control via the basal ganglia, premotor cortex, and supplementary motor area. It also has a role in performance

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monitoring via the cingulated cortex, as well as in higherorder sensory processing via the brain’s association area and the parietal cortex. Ventromedial PFC supports functions involving emotion processing and emotion control, the integration of emotion and memory, and higher-order sensory processing via the amygdala, hippocampus, and the visual association areas. In addition to regional connections and functions, Wood and colleagues, as well as other neuroscientists, hypothesize that there are specific integrative roles for left and right, anterior, and lateral PFC that await research confirmation. Among older infants and young children, evidence reveals PFC activation in some task situations, albeit measurement often lacks the precision that delineate links between PFC regions and other brain areas and behavior among older children, adolescents, and adults. Nonetheless, the potential for adaptive thinking and behavior begins to take shape at the beginning of the second year, with changes occurring again between 3 and 7 years, and then continuing well into adolescence, with activation increasing within and across the PFC to increasing connectivity with other brain regions. In general though, more mature PFC functioning is associated with less density of neuronal activation. Increasingly, more sophisticated brain measurement tools should allow neuroscientists a better window into PFC connections, developmental changes in the brain, and behavioral analogs across early and middle childhood with respect to the organization of attention, memory storage and retrieval, the growth of complex cognitive activities, and emotion regulation. More precise measurement tools should also provide additional insights about behavioral sequelae subsequent to brain insults that occur during the first years of life, and for very young children who show extremely elevated levels of irritability or out-of-control behaviors suggestive of prefrontal cortex involvement.

Presumed Biosocial, Developmental, and Self-Linkages with Regulatory Processes The preceding sections have introduced issues related to early behavioral development and regulatory processes, the varied roles involved in parental fostering of regulatory processes, and how brain growth is deeply embedded in behavior and development. Can these complex elements fit together into a coherent developmental picture? In the absence of relevant research, Figure 3 represents a provisional overview of the multiple factors that have a role in young children’s abilities to regulate their own behaviors, and, also serves as a reminder that development is a singularly complex process. The box on the far left distinguishes among the three legacies provided to all human children: our biological heritage provides a defined body

shape, a central and peripheral nervous system, internal organs and systems, and functions related to sensory systems and limbs – all of which show developmental change in the early years due to varied postnatal experiences. Family inheritance refers to recent ancestral roots with respect to gene pool contributed by both parents, and includes factors such as inheritance of skin color, hair texture, eye color, and potential size at maturity. To some degree, family inheritance influences temperament style such as sociability and activity level, as well as the potential for physical and mental health or illness. Humans’ sociocultural inheritance is both ancient and modern. Our distant ancestors, for example, learned that survival of social groups depended on cooperation and both physical and emotional investments in offspring. Modern-day counterparts of parent investments are found in different cultures in terms of use of available healthcare, attention to diet, availability of playthings whether simple or elaborate, clothing, type of discipline, and specific socialization practices such as independence training and tolerance for a young child’s self-assertion. The translation of sociocultural inheritance occurs through specific caregiving practices. The right side of Figure 3, with its focus on the young child, highlights contributors to the growth of regulatory processes and thus to executive functions. These include the growth of competencies related to cognitions, social awareness, motor skills, and more, and the all important role of child selfhood. Consciousness of self and intentions and goals are fundamental to toddler and preschool development, and include attempts at self-directed learning, including how to regulate one’s own behavior and to think strategically and planfully. Parental practices are at the nexus of legacies and the young child’s developmental status and contributions to regulatory processes and executive functions. Parents and other caregivers provide the translation of legacies, along with emotional support, teaching, examples, and provision of specific socialization goals. The direction of parental influence is not one way; parents are influenced by children’s goals, their developmental changes, individual child attributes such as personality, and sibling status. Thus the inter-connections of parents and children is an ongoing dynamic, and influences the nature and development of regulatory processes.

Three Regulatory Processes Inhibitory Control At 2.5 years, he was a precocious child already sounding out letters and a few words. He was also strong willed, often ‘‘working’’ his parents to achieve his goals. One dinnertime the child, his parents, and a guest sat around a small table enjoying a variety of foods. Mid-point in the


Selfhood: Evolving conscious sense of self, agency, and achievements; awareness when help is needed; motivation for mastery; nascent recognition that social relations require balance between self and others’ desires.

Biosocial contributions to young children’s development: Species inheritance Deeply conserved: brain/central nervous system; physiological systems; body structure and functions; basic sensory/ perceptual capabilities; social, cognitive, and communicative skills

Family inheritance Parental gene pool Sociocultural inheritance Culturally devised, evolving, flexible patterns of socialization that reflect need for: social cooperation, parental investment including protection of offspring, emotional bonds, specific socialization and learning experiences, and tools for communication

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Caregiving practices Parents, other caregivers: interactive style; protection from harm; type of nurturing; provision of learning, communication, and play experiences; teaching strategies; translation of sociocultural norms for child

Regulatory processes Physiological, inhibitory, attentional, emotional

Executive functions Goals, plans, monitoring, evaluation, adaptation

Developing domains: contributions to regulatory processes Perceptual processes Cognitions: knowledge of different contexts; production of strategic like behaviors; event memories, etc. Social/emotional relationships: bonds; social and emotional knowledge Motor capabilities: expertise in locomotion and grasp Communication: basic gestural and verbal skills

Figure 3 Contributors to young children’s development of regulatory processes.

meal, the father placed a piece of food on the child’s plate. The boy removed the food, placing it on the table beyond his placemat. The father replaced the food on the boy’s plate, which the boy again removed. This scenario was repeated several times with tension rapidly escalating between father and son. Suddenly the boy stopped moving; his body became rigid and his face contorted as he piercingly stared at a point on a nearby wall. The guest held her breath, waiting for an explosion. It did not occur. Instead after a minute or so the boy’s body relaxed; he looked at his father and accepted the food. For a toddler, this was an unusual display of effortful and conscious inhibitory control in the service of emotion regulation.

Inhibitory control is a phrase that has multiple meanings including an inhibited temperament style, a culturally related behavioral style such that one group of children, for example, is more likely to be physically active than another group, and inhibitory control (IC), which involves the cessation of an ongoing activity or thoughts, that are irrelevant to or undermine the goal of an individual or to an essential activity designated by

another. It is this kind of inhibitory control that is the focus here. IC reflects the inhibition of a prepotent (i.e., unaware, compelling stimulus) response such as acting impulsively, holding irrelevant thoughts, or being susceptible to interfering stimuli. Interest in IC is long standing, initially because individuals with frontal lobe damage often revealed impulsivity that was damaging to their thinking, social relationships, and emotion control. Although impulsivity had long been associated with toddler behavior, it was Alexander Luria, the great Russian neuropsychologist, who suggested that IC first emerged at about 4 years of age. Contemporary developmental research reveals that he underestimated young children’s abilities, albeit IC is fragmentary and fragile in early development. Why is IC important? It is an essential cocondition for effective controlled attention, a precondition for working memory that temporarily ‘holds’ the contents of memory ‘in mind’ long enough to attend to, and then initiate an action that is related to a goal, and for the ‘executive functions’ involved in planning and evaluating the steps for pursuing a goal. Problems with inhibition are found among young children whose rearing

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environments are inadequate for their needs, and among children who have attention deficit hyperactivity disorder (ADHD), prenatal cocaine exposure, severe auditory limitations, gene-based disorders such as PKU, and chromosomal abnormalities such as Down syndrome. Note that some researchers consider IC a supervisory system, whereas others think of it in terms of a dimension of EF. However defined, IC seems to have different components in that sometimes it is the cessation of activity that is crucial and other times the task demand is to respond quickly to several competing stimuli selecting the most appropriate one. Age trends

Clinical and research data indicate that IC improves across early childhood and into adolescence, given reasonably good childrearing environments. By mid-childhood and after, brain research reveals that IC is associated with bilateral dorsolateral PFC, inferior frontal cortex, and dorsal anterior cingulate cortex. Because IC is fragile in very young children, it is reasonable to conclude that frontal lobe connections are in their early stages. In the paragraphs that follow, evidence is marshaled to show general behavioral trends in IC; this is followed by laboratory studies in which children were asked to wait or to delay in relatively naturalistic settings. Then more recent data are summarized from research that used downward extensions of experimental procedures that involve presentation of two stimuli, one of which is highly salient but must be ignored in order to correctly follow task instructions. Controlled cessation of an activity, an early form of IC, is clearly observed about 10 months when infants show wariness to unfamiliar adults or objects and cease their ongoing activity until reassured by an adult. IC is also evident at this age when infants pause in their activities when confronted with an unfamiliar situation, are uncertain about how to act and seek information from another’s face to determine their course of action. This is called ‘social referencing’; recent research reveals that infants often take their cues from adults’ positive or negative facial expressions. With respect to IC research, the pioneering studies by Goldman-Rakic and Diamond with rhesus monkeys and human infants (7–12 months) unequivocally revealed that inhibition of actions was associated with dorsolateral PFC activation. Age-related data showed increases in inhibition times averaging about 2 s per month; these age findings mesh with those from other studies that used similar behavioral tasks. However, as will be seen below, depending on the IC task demand, response times may be seconds or minutes for toddlers and young preschoolers. IC, measured by delay or waiting time, has been evaluated in behaviorally oriented laboratory studies in which toddlers and young preschoolers (seated alongside their

mothers) were presented with a highly desirable toy, with a request not to touch the toy because experimenters had to leave for a brief period of time (180 s). Data revealed average waiting times of 10 s at 18 months, over a minute at 24 months, and close to 2 min at 30 months: half of 24-month-olds and more than half of 30-month-olds waited the full 3 min delay period. Toddlers who waited the longest often improvised strategies to help themselves wait: some turned to their mothers to gain her attention and converse with her, others sat on their hands, and still others turned away from the table that held the telephone. In a followup study, these delay strategies were studied more systematically, and findings again showed that keeping the goal out of sight or otherwise diverting attention helped keep the toy out of hand. The longer this strategy was implemented, the longer the delay. In an earlier decade, Walter Mischel and colleagues initiated a series of pioneering studies with preschoolers that involved self-imposed delay situations in which rewards varied as a function of length of children’s ability to delay. Data unequivocally revealed that (1) delay was more likely to occur when rewards were obscured, or (2) if rewards could be seen, children were more likely to delay when offered control strategies or if they generated self-produced strategies to avoid looking at the desired reward. By the age of 6 years, findings showed that children who successfully delayed did so without need of overt strategic aids, probably relying on cognitively derived self-induced delay tactics. Interestingly, Mischel used a similar delay paradigm with 6–12-year-olds who had behavior problems and found that knowledge about control strategies was associated with longer delay periods. Later follow-up studies revealed that longer delays at the age of 4 years were associated with more social and cognitive competencies during adolescence. In all, studies that have simply asked young children to wait, under one or another study conditions, reveal the following: delay is very difficult for young toddlers, improves between 2 and 4 years, increases appreciably by the end of the fourth year, and by age 6 years is even better. Of equal importance is the finding that for children 4 years or younger, the use of strategic behaviors facilitates their waiting times. What happens when delay tasks are modified so they place an additional psychological load on the inhibitory regulatory process such that both latency (delay) and erroneous responses to task instructions are measured? The classic Stroop test embodies such a task; here, words of colors are printed in the color of another word (the word red printed in green ink) with instructions to say the word not the printed color. IC responses are scored for number of errors (saying green instead of red), and for the amount of time taken to produce each correct answer. Numerous variations of Stroop task have been developed for toddlers and preschoolers, with the most interpretable


delay. What is not known as yet is when (at what age) and how child participants in the most challenging inhibition scenarios begin to generate rules that could guide their behavior. Recent data suggest that ‘rule-like’ strategies are more common among 5–7-year-olds than younger children, and moreover, recall that Mischel indicated that by the age of 6 years, children were able to delay without use of strategic behaviors presumably relying on internally generated (cognitive rule-based) commands. It is possible that the age period of around 6 and 7 years marks a turning point with respect to IC, perhaps due to self-produced cognitive activities. Other research shows several kinds of cognitive and social transitions occurring around 7 years.

Executive Attention: Managing One’s Attention At 36 000 feet, the jet’s flight was smooth. A momentary glare from her seat’s window drew her attention. The glare came from the sun shining on an abundance of snow-capped craggy peaks, some of which cast their shadows for miles on end. She immediately recognized New Mexico’s terrain and scanned the landscape for a view of Santa Fe. Sitting back she thought of past pleasures visiting this historic city. She also vividly recalled the contrast of her emotions – awe at the majestic beauty of New Mexico and her distinct feelings of unease – when in an earlier year she and her husband flew a small airplane along a similar flight path albeit just a few thousand feet above the terrain. Inadvertently she had been alerted to a scene, oriented to it and scanned for landmarks, and then consciously turned her attention to memories representing mixed emotions. Alert, orient, and executive attention are current day conceptions of the possibly inter-related ‘‘attention trinity’’, proposed earlier by Michael Posner and colleagues.

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and usable age-related data obtained with tasks that limit cognitive demands, task stimuli are interesting and appealing, and are suitable for younger and older children. In one study researchers used a computer presented Stroop-like IC task with a large group of participants who ranged in age from 3 years to mid-adolescence. The task involved naming drawings of animals (cow, pig, sheep, duck): some drawings showed a correct body and head (cow body and cow head), and other drawings with transposed heads and bodies (a pig body, a duck head). The researchers reasoned that humans of all ages are drawn to faces, and thus presentation of a stimulus that includes a friendly looking face makes it more likely that a person will respond to the face – unless instructed to do otherwise. Thus, the ‘correct’ response for participants was to name the animal’s body and inhibit the prepotent response of naming the animal’s head/face. Figure 4 adapted from the study’s data set shows age trends for response times and errors to incongruent stimuli (nonmatching head and body) across ages from 3 years into adolescence. Of particular interest are data from 3- to 7-year-olds. As can be seen, there are age-related changes in response times and errors with a steeper decline in the latter (from 3 to 5 years) than the former (from 3 to 7 years). Calculating the rate of reduction in both graphs and only comparing differences from age 3 to 5 years reveals a far greater improvement rate for error detection than response time. This finding suggests that the actual inhibition of a response may be more difficult for young children than detecting errors such as the noncorrespondence of an animal’s body and head. It is worth noting that this study protocol not only increased the psychological load for participants, especially the young ones, but also eliminated the opportunity to employ any kind of strategy to facilitate delay. Recall that in behavioral studies, young children often diverted their attention from a salient stimulus in the service of

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Figure 4 Across age response times and errors in an inhibitory control Stroop-like task. Adapted from Wright I, Waterman M, Prescott H, and Murdoch-Eaton D (2003) A new Stroop-like measure of inhibitory function development: Typical developmental trends. Journal of Child Psychology and Psychiatry 44: 561–575.

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The long and interesting history of attention research was recently reviewed by Raz and Buhl, with note made of significant advances made in understanding attention networks using imaging techniques, new measurement techniques, and current views of the anatomy of attention networks. In brief, alerting is associated with activation in frontal and parietal areas largely in the right hemisphere, orienting to a variety of areas (depending on the orienting processes) including pulvinar, superior parietal lobe, superior temporal lobe, temporoparietal junction, frontal eye fields, and more, and, executive attention with links between the anterior cingulate cortex and dorsolateral PFC with involvement of the locus coeruleus and dopaminergic areas within the ventral tegmental region. Executive attention (also labeled focused, selective, controlled, topdown, effortful) has all the earmarks of a regulatory process: it is involved with cognitive controls, planning, error detection, resolution of conflict, regulation of thoughts and feelings, and overcoming ‘habitual actions’. Not surprisingly, cognitive-driven attention influences emotion states which at the level of brain shows interconnections between PFC and the amygdala, the structure deep in the brain that is key to emotions. In contract to visual alerting and orienting, which has an extensive and distinguished history in developmental research, the study of focused/controlled/executive attention (note the terms are used interchangeably here) particularly with toddlers and young children is relatively recent with pioneering thinking and research by Mary Rothbart and Michael Posner, and by Holly Ruff. The former often address issues of temperament with executive or effortful attention or more recently with aspects of cognitive functioning. Their studies typically use variations of procedures used with older children or adults to tap executive attention. In contrast, Ruff has a more developmental emphasis on focused attention and its flip dimension, distractibility, often deploying a play scenario. Because focused attention is intrinsic to exploratory, functional, and pretend play, data obtained from these contexts can be useful in identifying age trends among young children. First, a step back in ontogenetic time to see how visual attention changes in the first year. Newborns show visual alertness most notably to patterns that are also characteristic of the contrast patterns of human faces, and their attention to human faces differs from attention to objects. Infants display other aspects of attention in their early months: they show obligatory attention at about 10 days, when they get visually locked onto an especially compelling nonhuman stimulus to the point of fatigue; they consistently produce eye-to-eye contact with their caregivers at about 2 months, which pleases parents; as they approach 3 months, infants spontaneously and consistently look at parents (and others) and smile broadly. This smile is both immediate and intense, and symbolizes a new form

of psychological connection between infant and others. Table 1 lists other developmental trends in visual attention during the first year of life: it also reveals the increasing integration of attention to other dimensions of development that are associated with more efficient and organized behaviors. In addition, note the important changes in attention occur toward the end of the first year, not the least of which involves infant decisions about choices. An example is the older infant’s conscious coordination of visual attention to the visual attention of another, which often signals a desire to share interest in an object, or to direct attention to an event. Not surprisingly, researchers have found frontal lobe correlates of joint attention using electroencephalogram (EEG) measures with young toddlers. Taken together, these findings point to the multiple roles of attention in learning and in social exchanges. It is likely that attention in general, and executive attention in particular, varies as a function of social relationships, emotional connections, and object interest. Age trends Holly Ruff and colleagues have studied various aspects of attention; however, one study in particular highlights different kinds of attention used in play scenarios with three age groups. The use of a play setting is a particularly good venue to study attention because play is another beloved and motivating activity for young children. The research was laboratory based and cross-sectional: the children were 10, 26, or 42 months of age. Three kinds of attention were defined: ‘casual’ was coded when children looked at toys but with limited engagement (akin to orienting), ‘settled’ was coded as a pause in casual attention in which the child looked steadily at a toy and manipulated it, and ‘focused’ attention reflected concentration, with an intent facial expression, minimal extraneous body movement, close visual inspection of the toy, or talking to self (akin to executive attention). Various toys designed to elicit the child’s attention and the nature of play. Distracters were also introduced to determine effects on attention, and audio presented in varying intervals. Figure 5, adapted from study data, shows mean looking times by type of attention and child age when children were given multiple toys to play with, and, similarly within 2-min blocks of a 10-min period of play. With respect to duration of attention, 26 months marks a crossover time in which casual and settled begin to reverse positions, with casual a lower priority activity. The 2-min blocks reveal more a complex pattern of attention. At 10 months all forms of attention declined at mid-point in the period, perhaps a sign of fatigue, whereas at 42 months, changes occurred within the blocks perhaps indicating changing interests in one or another toy and toward the end of the block decreasing curiosity about the toys.

Self-Regulatory Processes Table 1

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Developmental perspectives: visual attention in the first year of life Colombo

Rothbart

Ruff and Rothbart

Behavioral linkages

Conceptual approaches

Development of four interrelated aspects: alert state, spatial orienting, objects, endogenous control; neural substrates

Adaptive to social/ physical environment, essential for learning; links w/ motivation; control and engagement

Linkages: key elements of organized, integrated, and efficient behavioral adaptations Examples below: visual attention

Birth–1 month

Newborns, minimal alertness; obligatory attention; increase alert state, 1 month

Attention processes: temperament; links to neural substrates; focus on reactive vs. self-regulative attention Reactive attention, with obligatory looking and difficulty with disengagement

2–3 months

Changes in alertness, spatial orienting (the ‘where’ system), attention to objects (the ‘what’ system), flexible responses, disengagement Inhibition of saccadic responses; better control spatial orienting; more sensitive object related form/color; sustained attention Relatively mature spatial orienting including disengagement; increase in endogenous attention

4–6 months

9–12 months, on

Attention often directed to hairline and edge of face

Eye contact with others, has social implications; ‘active sampling of two objects’

w/ social: eye-to-eye contact w/ emotions: smiles to others w/ self: visual re-orienting when distressed

Disengagement from stimuli; ‘avoid overstimulation through self-regulation’

Acuity markedly better; increase in flexibility of attention, influences via experience, novelty

Effortful control, awareness of inputs; maintain focus: attention, executive control, planning

Decline in attention to static displays; increase in attention to toys; wariness to unfamiliar people; improved control of distractions

w/ social: uses eye contact to initiate social exchanges w/ memory: orients to novel stimuli w/ grasp: coordinates w/ vision w/ social: joint attention; facial expressions; gestures w/ memory: landmarks; object characteristics w/ self: object preferences

Casual Settled Focused

Casual Settled Focused Attention during play: five 2 min blocks

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Figure 5 Casual, settled, and focused attention during play at 10, 26, and 42 months. Adapted from Ruff HA and Capozzoli MC (2003) Development of attention and distractibility in the first 4 years of life. Developmental Psychology 39: 877–890.

Turning to distracters, research from another laboratory reveals that the tendency to look toward a distractor is related to the length of looks that occur before the distractor is introduced. Although not yet studied empirically, it is

probable that distractors are less potent under conditions of executive/focused attention than more casual types of attention. In the Ruff study, age trends revealed that combined audio–visual distractors caused the most diversions at

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each age, with diversions dropping from 56% at 10 months to 14% at 42 months. This decline nicely parallels increases in settled and focused attention. Lastly, given the similarity of trajectories of settled and focused attention raises the question of whether these types of attention represent a continuum of controlled attention with settled representing somewhat less control and focused, more control. What this point suggests is that executive attention is not simply a process that is immediately ‘turned on’ but rather moves from a less heightened state to a more heightened one depending upon the nature of situational demands. If confirmed empirically, this gradual process might be more indicative of young children’s attention management than that of more mature individuals. What factors might influence changes in patterns of attention? Possibly, practice as part of young children’s continuing interest in play, their increased curiosity and selectivity of toys and what one can do with toys (motivation), and vastly improved hand coordination that allows young children to concentrate less on controlling their fingers and thumbs and more on toy characteristics. Relatedly, an older study revealed that holding and manipulating objects enhanced visual attention, in contrast to just looking at an object placed on a surface. In terms of caregiving, it has been suggested that parents’ use of everyday routines facilitates child learning because routines provide ‘an invisible attentional structure’ to the most salient things that need to be learned. Turning to problematic attention, especially executive attention, those factors (e.g., prenatal drug exposure, in some instances pre-term birth, ADHD) that interfere with IC also disrupt executive attention. Finally, there is a group of older toddlers who do not have diagnosed developmental disorders but who tend to be inattentive, show episodes of listless-type wandering, and have mild cognitive limitations; a small group of studies suggest that these children are at risk for later cognitive and social problems. These data give further credence to the developmental importance of focused attention during the early years. Emotion Regulation The family sensed the young toddler was becoming more difficult day by day, but they did not see the whole picture until months had passed. A fairly typical toddler, it was about 17 months when he began to be irascible and seemingly wired. He could not make up his mind, vacillating from one desire to the next. He rejected the old canister vacuum cleaner he had loved to roll along the floor. He became angry with his beloved grandfather, and one day hid from him behind a door. The door was glass. Exhausted, he refused to take naps. Whining was a daily event. Then at about 21 months, he began to change again.

Better able to articulate annoyances, his pretend play also became increasingly rich, and his self-awareness in terms of preferences were more apparent – all of which reflected cognitive and language growth. Might these changes have contributed to his ER? The only fact that is certain is that among older children and adults cognition and successful emotion management are linked. ‘Emotions’, said famed neuroscientist Antonio Damasio, provide a natural means for the brain and mind to evaluate the environment within and around the organism, and respond accordingly and adaptively. Among adults, studies have revealed various patterns of medial and lateral PFC activity, along with activity in the anterior cingulate cortex and the amygdala depending on particular cognitions (e.g., expectations about an aversive emotional episode, changing an emotional situation) and ER. Much of this research is relatively recent and employs sophisticated brain imaging techniques along with well-controlled stimuli designed to elicit certain cognitive states – neither technique can be used with very young children. From a practical standpoint, this means that studying ER with young children requires different procedures along with different data collection goals. Whatever the context, ER should be viewed as a vital, generative regulatory process in which children and adults use different constellations of mechanisms to adapt to their own physiological needs (managing arousal states), to maintain valued social relationships while also meeting social requirements, and to accommodate to their own goals such as learning. Unfortunately, at present there are major disagreements about defining ER, how to measure it, how to precisely identify causes of upsets and when ER occurs, the other processes involved in ER such as behavioral inhibition and attention, the specific contexts in which ER might occur, the constellation of domain competencies such as cognitions that contribute to ER, and how ER changes over time. These conceptual and methodological challenges are magnified because the study of ER in children is a recent occurrence in contrast to research on infants and toddlers’ emotion expressions that extend back to the 1930s. Also contributing to research difficulties are obstacles involved in tracking individual and age-group increases and decreases in tantrums, aggression, and irritability, and interpreting the meaning of these patterns in relation to the child’s other skills, the family environment, and culture. Despite these unknowns and the challenges, the study of ER begs for developmental consideration. Indeed, some general age trends have been identified in infancy. For example, it has long been recognized that regulatory mechanisms such as thumb sucking are present at birth and offer some protection from variations in the immediacy of caregivers’ attentiveness. Throughout the


first year, infants engage in forms of distraction when they are lightly distressed, and when more deeply distressed they often signal caregivers with visual contact, gestures, and tears. However as noted earlier, what sets apart toddlers apart from infants is a burgeoning and explicit sense of mastery and of being agentic, the rise in ‘collisions’ with parents who are attempting to socialize the newly walking child with don’ts and do’s, and the variety and display of negative emotions that may include intentional jealousy, physical aggression, temper tantrums, and resistance. In a very real sense, the cognitive growth that increasingly contributes to the toddler’s sense of self and mastery also contributes to a sense of dismay or anger when selfmotivated actions are restricted. Utilizing data collected in a longitudinal study, Figure 6 provides an indication of developmental trends in crying and refusals observed during home and laboratory visits in a study located in the US. Researchers noted instances of crying whenever it occurred in their presence, whereas they noted negative responses only at the end of laboratory visits when children were requested to put toys away. Crying and negativism were linked at 21 months, with 70% of criers also refusing to put toys away. The dramatic decrease in crying by 30 months still left a high proportion of children across older age periods who used words or deeds to utter ‘‘No’’ to a request. Although this negative behavior could be attributed to willful disobedience, it seems more likely to reflect cognitive limitations such being relatively clueless about parents’ motivations along with an inability to figure out how to balance self-needs with those of others. Alternatively, developmental scientist Ellen Skinner questions whether the peak period of crying

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Figure 6 Developmental trends in crying and negativeresistive behaviors. Adapted from Kopp CB (1992) Emotion distress and control in young children. New Directions for Child Development: Emotions. Motivation, and Self-Regulation 55: 41–56; and Klimes-Dougan B and Kopp CB (1999) Children’s conflict tactics with mothers: A longitudinal investigation of the toddler and preschool years. Merrill-Palmer Quarterly 45: 226–232.

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and negativism represents ‘‘. . . a developmental moment in which toddlers’ cognitive representations of what they want (to do, have, or not do) become durable enough that can persist even through the best efforts of caregivers to distract and divert them?’’ It may be, she continues, that it is the persistence of desires that often make 2-year-olds hard to handle, yet the fact that they can occasionally deal with their emotions represents major growth. Age trends Given the difficulties that young children have controlling their emotions, the fact that instances of negative emotions do decline, and the conceptual and measurement issues noted above, is there evidence of intentional, self-motivated ER during the toddler years? Yes: data from two cross-sectional studies suggest that between 18 and 24 months toddlers pursue efforts at self-distraction and intentional use of their mothers to reduce levels of emotion upset. This is representative of major developmental growth suggested by Skinner. Drawing upon published and unpublished observations and comments from a variety of sources supports this view of ER. However, how can the data be organized to obtain a reasonable developmental view of ER? James Gross’ process model of ‘adult’ ER provides a valuable tool as a point of deparure. By way of background, Gross demarcated five points in the emotion generative process in which ER can occur. Four of these are ‘antecedent focused’ ER, and include: (1) making a decision about a situation to attend or to avoid; (2) generating possible ways to modify a potentially difficult situation; (3) altering one’s attentional deployment by using strategies (e.g., distraction); (4) using cognitive change mechanisms such as reappraisals (i.e., cognitively transforming a situation to modify its emotional impact). The fifth, ‘response focused’ ER, involves trying to decrease or suppress emotion expressions that have already begun. In general, Gross and colleagues’ studies with adults reveal that antecedent focused (cognitive) controls are less psychologically and physiologically costly than response focused (behavioral) controls such as suppression. Table 2, adapted from Gross’ ER model, suggests one form of antecedent ER adopted by children who ostensibly seemed to modify an emotion-arousing context into something less stressful. The specific entries in Table 2 suggest that youngeraged children attempted to use their mothers as a multipurpose support system with particulars depending on context. In contrast, the older children either generated ideas to modify the situation on their own or accepted an adult directive while also protecting the self (putting toys away, choosing the sequence). Note too the role of language, which has been suggested as having a contributing role to ER. The fact that the table has empty cells and cells with only a few entries provides

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Indications of emotion regulation during the toddler and early preschool years

ER

Age

Context

Observed behavior

Antecedent Context: avoid A – Context: modify

4 yr 21 moþ 2 yr

Preschool setting Park Home/laboratory Lab: toy cleanup

2.5 yr

Study: home visit

3.5–4 yr

Laboratory: toy cleanup

4 yr

Laboratory: child given a box, told contains gift. Box is empty. Home Laboratory-delay and separation

Child tells teacher he is upset, indicates he wants to go in another room to be alone Child sees large dog on path; warily crosses to another Child recognizes toy puzzle too difficult to solve, seeks help Mother asks child to put toys away: time to leave Child leaves play area, goes to nearby chair and sits, then tells mother she has to go potty Researcher (R) shows child toys: a small, wind-up spider frightens him. R takes toy outside and places on hood of her car. Conclusion of visit, mother and child accompany R to car. Child spies toy. Clutches mother, telling her to get toy and let it run on ground. He peers around her back, watching intently Child indicates will put toys away, but will make decision about how toys are put away (e.g., yellow toys first, using one shelf and not another) Some children hid box under table; others use box as a drum; one child tapped finger on cheek, and said: ‘‘an empty box, an empty box, what can I do with an empty box? I know I can put my shoes in it.’’ Child uses object (e.g., piece of cloth, favorite toy) as soothing tool Child finds toy to use as distraction, and is most effective when adult is present; separation is far more difficult and less successful regarding distraction than delay ? ?

A – Distract self

18 moþ 2 yr

A – Cog. transform Response focused: decrease Adaptation of James Gross’ model of ER: examples of young children’s ER.


Table 2


tentative evidence that some forms of ER may be especially challenging for young children. Although interpretative caution is warranted because the examples in Table 2 may not be representative, they do appear to support Pamela Cole’s thesis that ER can reflect a rapid response system especially among toddlers and young preschoolers who tend not to be intensely reflective thinkers. Lastly in terms of caregiving, ER is as susceptible to adverse family and parenting conditions as are inhibitory control and executive attention. However, there may be specifics in the caregiving process that may be more relevant to ER than for inhibition and attention. For example, detached parenting (irrespective of social class or parent education) may be particularly detrimental for young children’s ER because parental support is so essential to the developmental process. What comes to mind are uninvolved parents of toddlers and young preschoolers who show especially high levels of explosive behaviors including physical aggression. Finally, because ER itself, and its associated developmental trajectory, are so complex, it is essential to learn more about correlates with children’s cognitive and language skills.

Summary At the end of the first year, the frontal lobes show increasing activation, with subsequent growth largely a function of young children’s experiences. The prefrontal cortex is implicated in executive functions such as conscious, self-directed activities such as goal setting, planning, and evaluation, and, the regulatory processes that contribute to executive functions. In a very real sense, the regulatory processes of controlled inhibition, executive attention, and emotion regulation facilitate all manner of learning and positive social interactions. Nascent forms of regulatory processes are observed during infancy. However, it is during the toddler years that conscious and intentional displays of regulatory acts can be identified. Although insufficiently documented, the growth of young children’s cognition, language skills, and self-awareness contribute to more adaptive regulatory processes. Data also suggest that children are active in the growth of their regulatory processes, as for example, in controlling attention during play. Age changes in regulatory processes suggest growth is modest during the second year, and improves thereafter albeit slowly. By 4 years, there is evidence of relatively effective use of the regulatory processes of controlled inhibition, executive attention, and emotion regulation. However, the latter may be the most difficult for young children to begin

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to achieve, and thus far is the most difficult regulatory process for researchers to study. See also: Emotion Regulation; Temperament.

Suggested Readings Berger SE and Adolph KE (in press) Learning and development in infant locomotion. In: von Hoftsen C and Rosander K (eds.) From Action to Cognition: Progress in Brain Research. Amsterdam: Elsevier. Brownell CB and Kopp CB (2007) Socioemotional Development in the Toddler Years: Transitions and Transformations. New York: The Guilford Press. Calkins SD and Fox NA (2002) Self-regulatory processes in early personality development: A multilevel approach to the study of childhood social withdrawal and aggression. Development and Psychopathology 14: 477–498. Colombo J (2001) The development of visual attention in infancy. Annual Review of Psychology 52: 337–357. Davidson RJ, Putnam KM, and Larson CL (2000) Dysfunction in the neural circuitry of emotion regulation – A possible prelude to violence Science 289: 591–594. Eisenberg N, Champion C, and Vaughan J (2007) Effortful control and its socioemotional consequences. In: Gross JJ (ed.) Handbook of Emotion Regulation. New York: The Guilford Press. Gomez JC (2004) Apes, Monkeys, Children, and the Growth of Mind. Cambridge, MA: Harvard University Press. Gross JJ (2007) Handbook of Emotion Regulation. New York: The Guilford Press. Klimes-Dougan B and Kopp CB (1999) Children’s conflict tactics with mothers: A longitudinal investigation of the toddler and preschool years. Merrill-Palmer Quarterly 45: 226–232. Kopp CB (1992) Emotion distress and control in young children. New Directions for Child Development: Emotions. Motivation, and Self-Regulation 55: 41–56. Marcus G (2004) The Birth of the Mind: How a Tiny Number of Genes Creates the Complexities of Human Thought. New York: Basic Books. Mischel W, Shoda Y, and Rodriguez ML (1989) Delay of gratification in children. Science 244: 933–938. Raz A and Buhle J (2006) Typologies of attentional networks. Nature Reviews, Neuroscience 7: 367–379. Rueda MR, Posner MI, and Rothbart MK (2004) Attentional control and self-regulation. In: Baumeister RF and Vohs KD (eds.) Handbook of Self-Regulation: Research, Theory, and Applications. New York: The Guilford Press. Ruff H and Rothbart MK (1996) Attention in Early Development. New York: Oxford University Press. Ruff HA and Capozzoli MC (2003) Development of attention and distractibility in the first 4 years of life. Developmental Psychology 39: 877–890. Tomasello M (1999) The Cultural Origins of Human Cognition. Cambridge, MA: Harvard University Press. Wilke M, Kra¨geloh-Mann I, and Holland SK (2007) Global and local development of gray and white matter volume in normal children and adolescents. Experimental Brain Research 178: 296–307. Wood JN and Grafman J (2003) Human prefrontal cortex: Processing and representational perspectives. Nature Reviews Neuroscience 4: 139–147. Wright I, Waterman M, Prescott H, and Murdoch-Eaton D (2003) A new Stroop-like measure of inhibitory function development: Typical developmental trends. Journal of Child Psychology and Psychiatry 44: 561–575.

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Separation and Stranger Anxiety

Separation and Stranger Anxiety A Scher and J Harel, University of Haifa, Haifa, Israel ã 2008 Elsevier Inc. All rights reserved.

Glossary Anxiety – The psychological and physiological reaction to an anticipated danger, real or imagined. Distress – An intense negative reaction to adverse events. The reaction may be emotional and/or physical. Person and object permanence – The understanding that people and objects continue to exist when they are not directly observed. Separation anxiety – A distress reaction in response to separation from the primary caregiver. Separation anxiety disorder (SAD) – Developmentally inappropriate and excessive anxiety concerning actual or anticipated separation from the caregiver, most often the parents. Stranger anxiety – The fearful, distressed response that infants exhibit when approached by an unfamiliar person, in the second half of the first year.

partners, typically their parents. Moreover, at this stage when parents leave the room, even for a short time, babies often become distressed and start crying. Another trigger for distress during this period is the approach of an unfamiliar person. Upon encountering strangers, infants of this age observe the unfamiliar face intently, turn their heads away, and sometimes cry. In the developmental literature, the emergence of these distress responses – to separation and to strangers – is considered a major developmental milestone. When describing the reaction to the approach of an unfamiliar person, researchers use the terms wariness, apprehension, distress, fear, and anxiety depending, partially, on the theoretical perspective they are using to explain the response. In psychoanalytic theory, the reactions to the disappearance of the familiar caregiver and to the approach of an unfamiliar person are conceptualized as anxiety: separation anxiety and stranger anxiety.

Stranger Anxiety Introduction In the second half of the first year, infants show signs of distress when approached by an unfamiliar person and when their primary caregiver leaves. The study of these phenomena underscores the link between advances in the child’s ability to mentally represent people and events, along with changes in the emotional tie to the caregiver. Separation anxiety is an important psychological construct within a number of emotional development theories. While the reaction is normative, some children develop a separation anxiety disorder.

Reactions to the Approach and Disappearance of People The second half of the first year of life is a time of major cognitive and emotional discoveries and challenges. In this period, infants not only explore and manipulate the environment more actively, but they also start expressing clear social preferences and apprehensions. While infants happily exchange smiles with strangers during the first months of their life, in the second half of the first year they begin to exhibit a clear preference for specific social

Around 6–8 months, when infants are approached by an unfamiliar person, a new response appears: the expression of wariness and distress. At this stage, infants react to encounters with unfamiliar people who try to engage them in ways they are not used to, including becoming sober and quiet, staring and frowning, lowering the gaze or turning the head away, getting a frightened expression, or even starting to cry or scream. These responses are particularly striking when they show up with family acquaintances or relatives who were greeted with smiles a month or so earlier. While there is variation in the form, intensity, and duration of the response, infants across diverse cultures show some degree of wariness toward strangers which tends to peak toward the end of the first year of life and generally decreases thereafter. The contextual variables that affect the intensity of the stranger anxiety response include proximity and accessibility to the mother. More distress is shown when the mother is not present in the room; when the mother is holding the infant, the reaction is least intense. A sudden and abrupt approach of the stranger, as opposed to a slow warm-up period, also intensifies the distress reaction. Research on stranger characteristics is mixed, suggesting that infants react more favorably to child than adult strangers (presumably because children are perceived as more like themselves), while findings regarding stranger gender are inconclusive.


The emergence of the anxious response to strangers, which is widely acknowledged in child development textbooks and often discussed in the popular parenting media, was a topic of focused research during the 1960s and 1970s, but has received less attention in recent years. A review of the empirical studies reveals discrepancies and disagreement as to the prevalence of the behavior, the age at which it is first observed, and how it fades across time. In a number of reports, the reaction to strangers is described as emerging between 6 and 8 months or even earlier, while others conclude that the phenomenon is first evident only toward the end of the first year. There is also considerable discrepancy concerning the specific ages in which the response peaks (9–10 months according to some reports, 12–15 months according to others) and diminishes (toward the end of the first year vs. during the course of the second year). The different timetables described in these studies partially reflect differences in methodology. Still, a fairly consistent finding is that sometime in the second part of the first year infants display a noticeable new response to unfamiliar people – showing signs of distress when approached by strangers. What makes this response particularly interesting is that it underscores the important links between emotion and cognition. Cognitive Advances Underlying the Response to Strangers Object permanence

In the latter part of the first year infants are capable of evaluating situations and responding to them in a more complex way. Advances in sensory–motor capacities allow more regulated attention to relevant components of novel situations and more awareness of violated expectations. The examination of these evolving capacities is the hallmark of Jean Piaget’s theory of cognitive development. Piaget was interested in how infants develop an understanding that objects are independent of themselves, occupy physical space, and continue to exist even when they do not see them. Piaget used the term object permanence to describe this capacity and suggested that the concept of people as permanent develops before the understanding of the permanence of objects. This is important for conceptualizing the infant’s developing discrimination of the mother from the other. However, the prediction that the anxious reaction to strangers would occur only after the achievement of object permanence (typically around 12 months of age) is not supported, given that this phenomenon may appear as early as 6 months. Research on the maturation of distance vision has indicated that it is not until 6 months of age that infants reach adult-like discrimination, allowing them to identify familiar faces from different angles and distances, and across a wide variety of situations. Nonetheless, we know that

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infants learn to recognize and differentiate between their parents and other people at a much earlier age; for example, it has been shown that newborns are able to identify the face, voice, and smell of their mothers already in the first weeks of life. Extensive research over the past few decades suggests that infants learn to recognize the invariant features of people and objects, as well as the concepts of appearing and disappearing and occupying different locations, earlier than Piaget claimed. Using internalized schemes and representations to bring past experience to bear on the present, young infants engage in detecting regularities and discrepancies in stimuli, and form expectations about events. Through repeated exposures during the early months, infants come to distinguish between the familiar and the unfamiliar. But why do they start expressing apprehension, avoidance, and distress when encountered by a less familiar or a strange person? Incongruity between the familiar and the unfamiliar face

A number of investigators have argued that the reaction to unfamiliar people results from an incongruity between the stranger and the internalized schema of the familiar caregiver. Donald Hebb’s cognitive theory, which links perception and behavior to the neuronal network, offers insight into infants’ fearful response to strangers. Hebb argued that perceptual experiences establish memory traces in the form of neural circuits, and that these are activated when a new perceptual experience is sufficiently similar to a previous one. But when the new stimulus is not similar enough to maintain continued smooth transmission in the neural circuit, the ensuing disruption produces a distress reaction. According to this explanation, an approaching adult could seem somewhat familiar to an infant at first, but then turn out to be different from the well-established mental representation of the familiar caregiver, and this disruption stirs up emotional distress. The intensity of the reaction to novel experiences depends on the extent to which the child has developed an internal representation of the stimuli and the degree of discrepancy between the new situation and the internalized schema. According to the incongruity principle, it is the discrepancy between the novel face and the internalized standard (e.g., the caregiver) that is responsible for the distress reaction, not social interaction with the stranger per se. However, as noted earlier, infants can discriminate between their mothers and strangers already in the first weeks of life, but they do not show fear of strangers until 6 or 8 months of age. Jerome Kagan, who has been studying the links between children’s cognitive capacities and emotional reactivity for over 30 years, maintains that perceptual experiences and memory traces yield interest rather than fear in infants younger than 6 months; in older infants, who are better able to generate explanations

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about new and unexpected events, a discrepant event that they cannot explain generates emotional distress. This developmental account adds to the incongruity model in that it links the newly acquired capacity to explain the discrepancy between the familiar and the strange to distress when the explanation fails. Although this concept is plausible, it is difficult to test. Brain maturation

During the latter part of the first year, the ability to retrieve knowledge from memory and use this information for performing tasks improves dramatically. Adele Diamond, who studied the development of memory functions and their neural basis, provided evidence that links the improvement in infants’ search for hidden objects to the maturation of the prefrontal cortex, including the growing differentiation of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter known to play an important role in the regulation of anxiety and behavioral reactivity. Another critical development during this period is the integration of the limbic and endocrine systems into the memory networks. The capsula interna, which links the cerebal cortex with the amygdala, develops mature myelin around 10 months of age, allowing increased connectivity and efficient integration between the two systems. As the amygdala is also linked to the hypothalamic– pituitary–adrenal (HPA), or the stress axis, the improved connectivity between stimulation, interpretation, and emotional processing also increases the involvement of the stress axis in the processing of experiences. Fear and Anxiety as Indicators of Emotional Advances in the First Year The 8-month anxiety

Although distress reactions to strangers were described by the pioneers of infant observation at the turn of the nineteenth century, the first systematic study of the phenomenon was conducted by Rene Spitz. As a psychoanalyst working with infants in group care, he methodically observed and recorded behavioral patterns that marked the changing relations between infants and the social environment. The observations were documented in a film entitled Anxiety: Its Phenomenology in the First Year of Life, and discussed in a 1950 paper on the manifestation of anxiety in the first year. The naturalistic observations showed that between 6 and 8 months, infants no longer responded with smiles when unfamiliar visitors approached them, and instead showed apprehension and distress. While the specific behaviors of different children varied (e.g., turning the head away, covering the face, or screaming), the common denominator was an avoidant response, refusal to contact, and distress. Spitz called this pattern the 8-month anxiety and considered it the earliest manifestation of psychological anxiety.

According to Spitz, the 8-month anxiety is unique and differs from earlier expressions of fear, for instance, a fearful reaction to repeated inoculation. In reacting to a stranger, the infant is responding to a person with whom no previous unpleasurable encounters have been experienced. So why manifest wariness and anxiety? Using psychoanalytic reasoning, Spitz argued that the response to approaching strangers is triggered by the realization that, since the unfamiliar person is not the mother, mother has left. The anxiety results from an inference process involving the comparison of the stranger to an internal representation of the mother, and the fear of losing her. In attributing the 8-month anxiety to the infant’s wish for the mother and the disappointment that the approaching person is not her, Spitz underscored the role of the infant’s affective communication in the caregiving process, and attributed to the 8-month anxiety a major organizing role in the evolving psychological self. Fearfulness as a marker of a new level of emotional organization

Inspired by Spitz’s work, Robert Emde and colleagues conducted a longitudinal investigation of emotional development in the mid-1970s. Following a sample of 14 infants throughout their first year, at home and in the laboratory, the researchers collected an elaborate database that included naturalistic behavioral observations, interviews with mothers, structured tests, as well as EEG recordings. Emde, like Spitz, identified two organizing principles of emotional development that emerge in the course of the first year: the social smile and stranger distress. Around 2 months of age, infants typically show the milestone of social smile, which is a marker for inquisitive, active engagement with their surroundings. At this age, infants’ curiosity is on the rise as they develop and master new ways to maintain and increase interesting stimulation (e.g., shaking a rattle). Whereas Piaget viewed sensory–motor schemas of exploring and understanding the world (e.g., hand–eye coordination, mouthing) as the major organizers of experiences in the first year, Emde and colleagues emphasized the role of emotionality as a key organizer. The appearance of the social smile marks a new way of interacting with the world. Whereas crying, the key organizer in the first weeks of life, conveys an urgent need for change and a plea for alleviating discomfort, smiling signals positive engagement, an invitation for the continuation of a pleasurable exchange. Emde observed that by 2.5 months, infants smiled regularly in response to the faces of their parents, as well as the faces of unfamiliar individuals. By 4 months, the infants in the study showed more smiling and motor responsiveness in the presence of their mothers than with other people. At around 5 months, some infants curiously studied and compared their mother’s face with that of


strangers, and between 5 and 7 months, they stared soberly at strangers faces. Around 8 months, the infants in Emde’s study manifested a distress reaction to unfamiliar people which, according to his model, marks the second shift in emotional expression. While the average age was 8 months, considerable variation among the infants was observed; as to the duration of the response, 11 of the 14 infants manifested distress for 2 consecutive months and eight continued to show stranger distress into the third month. In their attempt to explain the roots of the fearful response to strangers, Emde and colleagues acknowledged the importance of the infant’s changing relationship to the mother and the cognitive advances of the second part of the first year, but also suggested a new focus: the emergence of the capacity for fearfulness. Evidence from numerous studies shows that around 7–9-month infants not only show distress to strangers and unfamiliar surroundings, but also start to manifest wariness of heights, mechanical toys, masks, etc. Before this age, distress was nonspecific, mostly a reaction to physical discomfort, whereas the new distress responses are linked to specific stimuli in the environment, as evidenced by the fact that infants look and evaluate before displaying distress. Cardiac measurements support the idea of a developmental shift in the capacity for fear. At 5 months of age, the approach of an unfamiliar person led to heart-rate deceleration in the infant, accompanied with a facial expression of delighted curiosity, but at 9 months, the stranger’s approach was associated with cardiac acceleration, frowning, gaze aversion, and crying. Emde argues that from a social communication perspective, the fearful reaction to the approach of a stranger conveys a clear message to the mother: a preference for her company and a plea not to be left alone with unfamiliar people. This new message to the primary caregiver is linked to another major emotional milestone of infancy: separation anxiety.

Separation Anxiety Sometime in the middle of the first year, when infants understand that people exist even when they are out of sight (person permanence), they react to the everyday recurring disappearances of their parents by attempting to maintain proximity through the behaviors available to them, including crying, cooing, and crawling. In manifesting these responses, infants not only indicate their desire to stay in proximity with the caregiver but also the development of ways to control distance and separation. During this stage, infants increasingly initiate interaction with their parents and actively protest when their primary caregiver departs, even for a moment. By the first birthday, behaviors that indicate separation distress are even more clearly detected, with infants tending to become agitated and upset upon separation.

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The Normative Course of Separation Anxiety Separation distress, signaled by crying in response to parental separation, may be observed as early as 4 or 5 months of age, but most accounts identify 8 months as the age when separation anxiety emerges. Distress from brief separations continues to characterize toddlers’ behavior well into the second year of life; the normative response typically peaks around 12–18 months and then fades after 2 years of age. In diverse cultural contexts, such as the Kalahari Bushmen, the Israeli Kibbutz and Guatemala, infants display distress in response to separation from their mothers; this is considered a normative part of development and its emergence is viewed as a major milestone in the formation of the emotional tie between the child and primary caregiver. The reaction to separation from the mother appears to be a universal phenomenon; however, specific parenting practices and cultural experiences may impact the timing and the intensity of the response. For example, in cultural settings where infants experience constant physical contact with their mothers distress to separation was observed earlier than 8 months; Japanese, as compared to Western toddlers were found to express more intense reactions to separation from their mothers. The use of an inanimate companion such as a blanket or doll (also known as a transitional object) is one of the ways toddlers attempt to alleviate separation distress. While separation anxiety gradually fades for the majority of children after the second birthday, some children will continue to express extreme distress in the face of parental separation. In many cases, these children will be subsequently diagnosed as suffering from separation anxiety disorder (SAD), a psychological disorder briefly discussed in the final section of this article. The role of cognitive and social factors The emergence and decline of separation distress has been linked to the cognitive advances of the first and second year. As with stranger anxiety, object permanence has been suggested as one of the determinants of the response to the disappearance of the familiar caregiver. In a series of experiments on infants’ early representational capacities, Chris Moore and colleagues demonstrated that while infants younger than 6 months are able to detect violation of identity of objects (characteristics of the objects), they only appear to understand the concept of permanency of objects at 9 months. However, Piaget suggested that understanding person permanence comes earlier, and Mary Ainsworth’s observation of infants and mothers in Uganda revealed that around 4–6 months, when mothers left the infants and went out of sight, some of the infants appeared distressed and cried. Silvia Bell, who compared object vs. person permanency, confirmed that indeed the concept of persons as permanent

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objects appears before infants understand the permanency of inanimate objects. The understanding that the parent continues to exist when out of sight, together with advances in motor control, are believed to shape the process of active searching for the caregiver (e.g., crawling). In the same vein, advances in cause–effect reasoning shape infants’ responses; they begin to grasp that calling or crying increases the likelihood of the parent’s reappearance. The establishment of an integrated and enduring representation of the caregiver plays a critical role in the formation of the emotional tie between the child and parent, but it is less clear why infants at this stage show distress when separated from their primary caregivers. Drawing on the concept of discrepant event, discussed earlier with respect to stranger anxiety, Kagan maintained that the infant is likely to display separation anxiety when the sight of the mother leaving is a discrepant event which the child is unable to prevent and/or integrate with previous experiences. It was found that infants showed less distress in a home setting when the mother departed through a door she used frequently, compared to when she exited through a door she rarely used. The decline of separation distress in the latter part of the second year is believed to be associated with the toddler’s increased cognitive capacity to understand the circumstances of the separation and maintain the expectation that the parent will return. For example, when the mother left the room through a door rarely used, it was found that some of the toddlers approached the door and engaged, on and off, in play with toys, but did not cry. In the second half of the first year, as infants gain better control of posture and movement and become more active explorers of their environment, they appear to pay extra attention to the location of other people, both caregivers and strangers. Infants at this stage frequently monitor their relative proximity to the caregiver; while venturing away from their mothers, they tend to frequently look toward their mother’s face. Social referencing, an active search for others’ emotional expression as a source of information to help clarify uncertain events, begins around 8–9 months. At this age, infants can understand that facial expressions have emotional meanings and they make use of others’ emotional expressions to guide their own behavior with reference to specific situations and events. By monitoring their parents’ facial expression, infants obtain information as to the danger or safety of their planned actions. When infants encounter a potentially dangerous setting, such as a visual cliff (a glass-covered table with an illusionary deep drop), they make use of parents’ facial information to regulate their actions; when mothers smile, infants typically cross the deep part whereas when mothers show fear, infants avoid crossing.

The Developmental Significance of Separation In psychoanalytic theorizing, separation anxiety ininfancy is viewed as a consequence of, on the one hand, the capacity to mentally represent the mother, and on the other hand, the interpretation of her absence as ‘losing’ her. In other words, the cognitive ability to keep the mother in mind even in her absence not only triggers feelings of longing, but also stirs up the distress of separation. To understand the anxiety produced by separation, it is essential to conceptualize the significance of the absence and its implications from the perspective of the infant. When separated from the primary caregiver, infants lose a significant regulator of their needs, not only physical but, just as crucially, emotional. Consequences of Separation in Animals Significant insights into the formation of the emotional bond between infant and mother, and the detrimental consequences of maternal separation, come from studies of animal behavior, specifically the work of Harry Harlow and Stephen Suomi with monkeys, and Myron Hofer’s studies with rats. For example, rat pups emit initial separation calls and their heart rate falls significantly after separation, regardless of supplemental heat. By studying a number of systems, such as those controlling sleep and arousal, activity level, and sucking, Hofer and colleagues identified changes in the activation of these systems that resulted from maternal separation and concluded that through ongoing interactions, mothers regulate their offspring, and that the loss of the maternal regulators has serious consequences, including a decrease in growth hormone secretion. In demonstrating the regulatory function of mother–infant proximity, animal models have significantly advanced our understanding of the neurobiological nature of separation distress, and provided important clues as to how proximity-maintenance shapes the well-being of mammals, including humans. Physiological and Behavioral Correlates of Emotional Distress Studying emotional distress among infants and young children presents many challenges of measurement and interpretation. Since fear and distress involve complex neural interactions and coordinated activities of psychobehavioral, physiological, and hormonal systems, measurement can take place at different levels. Facial expressions provide one avenue. Charles Darwin underscored the innateness, universality, and survival value of children’s fear and distress responses when he documented, in a series of photographs, facial expressions displayed by different youngsters in circumstances of pain, hunger, and discomfort. Since then, a number of researchers have devised


detailed measurement systems for coding facial expressions that index specific emotions (e.g., Izard’s MAX coding system and Baby FACS, which is based on Ekman’s Facial Action Coding System). In the MAX, for example, criteria of distress/pain expression include closed eyes and a squared and angular mouth, whereas in the fear expression, eyelids are lifted and the mouth corners are retracted straight back. Vocal response is another way to study the expression of distress, but there is still a debate whether infants cry distinctively when they are physically as opposed to emotionally distressed. Measuring cortisol, a blood-borne hormone that increases under stress, has significantly advanced our understanding of children’s responses to daily normative challenges, as well as the long-term effects of poorly regulated stress levels. For more than two decades, Megan Gunnar has been studying children’s stress by measuring cortisol; she showed that the quality of the mother–child tie regulates levels of cortisol secretion. Children who experience secure relationships with their mothers show stable cortisol levels even when emotionally upset, whereas in insecure mother–child relationships, even minor challenges raise cortisol levels. The way different children react to stress-producing stimuli has been studied within the conceptual framework of temperament. Kagan, who longitudinally studied children with different reactivity levels to unfamiliar stimuli, found that inhibited infants were more fearful as toddlers and were more likely to manifest symptoms of anxiety at school-age compared to uninhibited infants. Together with other studies, these findings point to a relative stability across time in children’s reactivity. Temperamental disposition is one source of individual variability in the ways children cope with fearful events. Mothers’ behavior is another determinant. For example, recent findings from Nathan Fox’s laboratory show that infants who received insensitive caregiving display higher levels of right frontal electroencephalogram (EEG) asymmetry and fearfulness to unfamiliar stimuli compared to infants whose mothers were more responsive and sensitive in their daily caregiving behavior. The ways in which temperament, social learning, and caregiving variables jointly modulate stranger and separation anxiety during infancy have yet to be comprehensively investigated. The focus of the subsequent section is separation anxiety from the standpoint of the psychoanalytic and the attachment perspectives. The Mother–Child Dyad and Separation Anxiety Freud’s description of his nephew playing with a reel of string is the first account in psychological literature describing a toddler coping with separation and anxiety. The child, in his crib, was throwing the reel and pulling it back again. Freud maintained that for the playing child, the reel represented his mother, who had to leave him several times.

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The play sequence helped the child gain control over his mother’s disappearance and return, which in real life was an experience he endured passively, anxiously, and as beyond his control. Since then, many theoreticians have tried to describe children’s reactions to separation and differentiate between the normative and disturbed variations. The concept of separation is central to two influential theories of emotional development: John Bowlby’s Attachment theory, and Margaret Mahler’s Separation– Individuation theory. Both of these theories had a major impact on the way we understand separation reactions and separation anxiety today. Both these theories emphasize the relationship between the child and the parent (especially the mother) as the regulating factor of separation reactions, both normative and pathological. Attachment as a window on separation anxiety John Bowlby, the founder of attachment theory, was among the first to emphasize the human infant’s biological disposition to participate in relationships, and proposed that the formation of the mother–child tie is controlled by mechanisms that evolved as a result of evolutionary adaptedness. This tie – the attachment relationship – is shaped through interactions in which proximity to the caregiver plays a significant role. In his book, Separation: Anxiety and Anger, Bowlby discusses the situations that trigger fear in children and lists four main categories: noise, strange people/objects/places, animals, and darkness. He also notes that being alone significantly increases the likelihood that fear will be aroused by these stimuli. In studies of infants’ fear of strangers, the presence of the mother served as a moderator of the intensity of the distress: in the absence of the caregiver, infants were more fearful. It was found that the proximity to the mother was particularly significant around 12 months of age; Bowlby explains that as their emotional tie to mother becomes better consolidated, their knowledge of objects and situations becomes more sophisticated, and their ability to move in space becomes more skillful, infants are better able to coordinate moving away from a fearful situation toward the comforting proximity of the attachment figure, usually mother. From an evolutionary perspective, proximity to the parent allows protection and thus provides a survival advantage; a predisposition to seek the protection of caregiver is particularly advantageous in times of danger and distress. According to Bowlby, attachment behavior – responses that aim to keep the caregiver in proximity to the baby – evoke caregiving behavior that promotes infants’ sense of security. Attachment is a primary survival system, akin to other instinctual systems like feeding and sexual behavior, and is irreducible to other drives. Infants are born with the motivation and capacity to form emotional ties with their caregivers, and to use them as a source of comfort in times of danger and stress. During

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the first 6 months of life, the infant learns to prefer the primary caregiver as a source of comfort and security, thus creating an attachment bond. The attachment system is activated by external danger conditions (for instance, darkness, loud noise, sudden movements) and by internal conditions (such as illness, fatigue, pain). When the system is activated, the child seeks proximity to the caregiver to attain a sense of security. The caregiver can alleviate the child’s distress by different means, depending on various factors including the child’s age and the level of anxiety aroused. With young children, physical contact is the most effective response; with older children, more distal means like talking are also effective. When the danger is serious, even older children (and adults) may need physical contact to relieve the distress and anxiety. Attachment theory explains why situations of separation or threats of separation arouse anxiety in people of all ages, but since children are more dependent on the protection provided by the caregiver, they suffer more intense separation anxiety. Bowlby and his coworkers described the sequence of typical reactions when young children are separated from parents. Children first protest, then show despair, and if the caregiver does not return, they subsequently show detachment. When the child perceives a threat of separation, she/he protests by crying, clinging, expressing anger, and looking for the parent; the protest is often expressed around sleep, at bedtime, and in the course of the night. When in despair, babies looks sad, move slowly and sometimes cry persistently, withdraw, and even act hostile. In the detachment phase, the child seems to return to normal behavior and is willing to accept comfort from unfamiliar adults. The problematic behavior shows up upon the parent’s return: the child ignores the parent, or avoids and walks away. These behaviors might alternate with crying and extreme clinging, showing the child’s suffering and anxiety regarding a possible future separation from the parent. A key principle in attachment theory is the interrelation between the attachment, fear, and exploration systems. For example, the activation of the fear system generally heightens the activation of the attachment system and deactivates the exploration system. Bowlby maintained that the biological function of the fear system, like the attachment system, is protection. Because the two systems are inter-related, frightened infants increase their attachment behavior and seek protection; the fear not only triggers a desire to escape from the frightening stimulus but also a search for the anticipated security provided by the attachment figure. Separation anxiety occurs when attachment behavior is activated by the absence of the attachment figure, but cannot be terminated because the caregiver is not available to provide security. With the cognitive advances of the latter part of the first year, infants become capable of expectant anxiety in situations that seem likely to be threatening or in which

the attachment figure is likely to become unavailable. As discussed, the presence or absence of the mother was found to attenuate or enhance the fear of strangers – in attachment terms, the proximity and trust in the availability of the attachment figure makes the infant less fearful. As the attachment and exploratory systems are linked, a child who is anxious about separation or does not have a secure relationship with the caregiver is expected to be inhibited in exploration and learning. Separation anxiety in secure and insecure children Attachment research identified different patterns of relationships between the infant and the attachment figure. Empirical studies, particularly those that use Ainsworth’s Strange Situation procedure, differentiated between secure and insecurely attached infants. Secure children represent their relationship with mother as providing a sense of security, while insecure children encounter difficulties in attaining a sense of security, developing unique strategies to counteract this. Avoidant children tend to minimize their signals of needing mother, while anxious ambivalent children tend to exaggerate them; they have learned which strategies are most effective in eliciting caregiving from their mothers. The different attachment patterns are schematically represented in the child’s mind as internal working models, guiding the child’s behavior in relationships and specifically in stressful and emotionally charged situations. For secure children, the represented relationship with the attachment figure potentially provides security and alleviates anxiety, even in the absence of mother. Children with secure attachments are better equipped to cope with situations evoking negative emotions, including separation anxiety, than children with insecure attachments. For example, in Bell’s study of person and object permanence, it was found that infants with secure attachment more actively searched for their mothers. The separation–individuation process Margaret Mahler was the first psychoanalyst to observe nonpatient mothers and infants as a source of information about emotional development, making her an innovator at a time when the accepted investigation method in psychoanalysis was the reconstruction of infancy from adult patients’ narratives. In Mahler’s opinion, the human infant’s physical birth does not coincide with his or her psychological birth. The psychological birth involves a separation–individuation process, which is based upon the child’s maturation and dependent not only on the child, but on the mother and eventually the father too. The process has two components which usually develop at the same pace: separation, the attainment of an experience of separateness from mother as opposed to nondifferentiation from mother (a different body), and individuation, the attainment of a sense of having specific, individual characteristics (being somebody).


Mahler describes several stages in the infant’s journey from a state of nondifferentiation between infant and mother to a state of differentiated representations of self and mother, as well as in the attainment of differentiation between inner and outer worlds. Grasping these differentiations is an important step in the child’s ability to function independently from mother without experiencing too much separation anxiety. The child who successfully goes through the separation–individuation process is one who can separate from the actual mother since he/she has an internally represented mother who is available to comfort the child when distressed, frustrated, and anxious. The first two stages, labeled by Mahler as the ‘normal autistic’ and the ‘symbiotic’, span the first half-year of life. The infant’s emergence from what Mahler referred to as ‘symbiosis’ marks the beginning of the separation– individuation process proper; the infant is ‘hatching’ from the mother–infant unit and turning his or her attention toward the world out there. In the differentiation phase, the infant, still in his mother’s arms, starts exploring mother, pushing his body away from her and looking at her from a distance, pulling her hair, and fingering her face. The infant is comparing the mother who is known to the unfamiliar elements in the environment. The peek-aboo game, much enjoyed at this age, is an exercise in separation, a way of facing this basic fear in a controlled, pleasurable atmosphere. When the child is able to move away from mother (e.g., by crawling), the ‘practicing’ phase begins, peaking with the attainment of walking. With the achievement of this milestone, children are able to move further away from mother, and new cognitive abilities enable them to further explore the world outside them and enjoy new experiences. The child is at the height of feelings of omnipotence, in love with the world and with his or her own skills. Still, periodically the child will return to mother for emotional support when he momentarily becomes aware of being alone and anxious. During the second half of the second year the toddler enters the phase of ‘rapprochement’ (approaching again) which lasts to about 2 years of age, considered one of the most sensitive, difficult periods of the separation– individuation process. During this phase, the toddler experiences the need to explore and function without mother, but at the same time, the need for mother is rediscovered because the growing awareness of separateness is anxiety-arousing. Reapproaching the mother is, on the one hand, a source of comfort to the infant, but it also triggers fear of regressing to earlier states of less differentiation and loss of independence and identity. Mothers find it difficult to adjust their behavior to the changing moods of the child who is clinging one moment and pushing her away the next. Mahler contends that both mother and toddler experience the loss of earlier ways of being with each other during this phase. The toddler

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experiences anger and sadness, and expresses these feelings by separation protest and temper tantrums. As the child explores separation from the mother, the father becomes a valuable alternative, a less conflicted caregiver figure for the child. One of the main achievements of the rapprochement phase is the mastery of separation anxiety. Toddlers who have successfully resolved the conflicts of rapprochement enter the next phase, beginning around the third year of life: consolidation of identity and the beginnings of integrated self and other representations. The integration of the maternal representation, including positive and negative aspects of mother, establishes in the child’s mind an ‘internal mother’ who is always with him/her and available to comfort the child when separated from his or her parents, or feeling anxious or distressed. Although Mahler’s theory, and mainly her first two subphases came under severe criticism, it is a rich source of insights and understanding of normative separation anxiety, as well as the more pathological separation reactions. Toddlers at risk for developing problems, including different degrees and forms of intense separation anxiety, are those with developmental limitations (e.g., regulatory disorders), those whose mothers have failed to respond sensitively to the child’s needs during the separation– individuation process, and those experiencing an inordinate number of separations. Separation anxiety as a marker of emotional development

Both Bowlby and Mahler underscored separation-related experiences and theorized about their developmental significance. Bowlby focused more on the observable aspects of the behavior, whereas Mahler emphasized the implicit, subjective experiences of the child. Both theories provide a detailed description of the child’s development from a state of needing the actual, physical presence of the parent and experiencing distress and anxiety when separated from the parent, to a stage when the parent and the relationship with the parent are represented in the child’s mind, consequently lessening the need for the parent’s actual presence. In both theories, the representation of the caregiver takes the role of the comforting parent when anxiety is aroused. The qualities of the representation, and thus its effectiveness in reducing anxiety, are dependent on the child’s experiences with the parent. Children who have had more positive experiences, whose parents are more attuned to their needs, are expected to form more positive representations of themselves, their caregivers, and their relationship. Whereas Bowlby gives more room to the real, objective aspects of the relationship, and assumes a closer correspondence between the real relationship and the child’s representation of it, Mahler adds the child’s subjective experience of the relationship, and the child’s own drives and fantasies, as an additional

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formative factor of the representation. In both theories, the separation and reunion of the child and the caregiver, as well as the anxiety induced by the separation and its regulation, serve as key theoretical constructs for explaining child development in general, and emotional development in particular. Maternal separation anxiety

The way in which mother and child negotiate separations has been a topic of continued developmental research. While separation anxiety has been typically addressed from the perspective of the child, mothers also experience distress when separation occurs. Bowlby postulated that caregiving is governed by a behavioral system which is reciprocal to attachment and is biologically predisposed to protect the child. The system is activated by the child’s distress, for example, when separated from the parent, or by the caregiver’s perception of danger to the child (e.g., at night); when the caregiving system is strongly activated, the parent seeks proximity to the child in order to insure protection. In situations of danger, real or imagined, when separated from the child, and the provision of care and safety cannot be maintained mothers experience anxiety. Maternal separation anxiety has been studied by Ellen Hock, who defined it as an unpleasant emotional state that reflects concern and apprehension about leaving the infant. Maternal separation anxiety involves feelings of guilt, worry, and sadness that accompany short-term separation from the child. As mothers’ separation concerns are likely to shape their tolerance of staying apart and their behavior upon return, it has implications for child behavior and development. For example, it has been found that high levels of maternal separation anxiety was linked to infants’ sleep difficulties as well as to SAD in older children.

Separation Anxiety Disorder in Young Children While SAD occurs most frequently after age 5 years (and is thus outside the age group addressed in this article), it is nevertheless important to include a brief description of the characteristics and correlates of the disorder as in some cases children as young as 2 years old are diagnosed. SAD is one of the most common disorders in childhood; prevalence estimates for SAD in community samples range from 3% to 13%. Though it is common and causes much distress to child and family, in most cases it is not severe and does not predict future emotional disorders. The clinical presentation of SAD includes a variety of signs of anxiety; it is not easy to differentiate between severe normal separation anxiety and the pathological variety, or among the different types of anxiety disorders (panic disorder and general anxiety disorder).

Differentiating Separation Anxiety Disorder from Normal Separation Reactions SAD is suspected when the child expresses excessive anxiety upon actual or anticipated separation from the caregivers, most often the parents. Age is one criterion in diagnosing pathological separation anxiety. Although children older than 3 years are not supposed to show separation anxiety under regular circumstances, when ill, fatigued, or in a strange environment, they might exhibit signs of anxiety even at later ages. In diagnosing SAD, clinicians need to observe whether the child regresses to behaviors that were present at earlier ages; for example, children who stopped wetting the bed might begin bedwetting again as part of a SAD. An additional criterion in diagnosing SAD is the severity of the anxiety reaction. Children often cling, protest, and cry when separated from their parents and/or appear sad and distressed when their caregiver is away. However, children who throw up, cry for hours, and cannot be soothed, exhibit severe nightwaking and bedtime settling problems, and/or suffer from persistent depressive mood might be suffering from SAD. Another criterion often used in diagnosis is the pervasiveness of the reaction. Children who react anxiously or show physical distress in every situation unless they are in close proximity to their parents could be suffering from SAD. Some children express fears that something terrible might happen to them or to their parents, are afraid of being alone, refuse to go to sleep, or express a fear of monsters. Others complain of more diffuse feelings that are disturbing them and have difficulty describing why they are troubled. Children suffering from SAD try to coerce their parents not to separate and may react to separations with anger and aggression. Since some young children suffering from SAD are unable to verbalize their feelings and distress, it is important to look out for physical and somatic symptoms that may be signs of emotional distress. To assess separation anxiety in infants and very young children, the DC: 0–3R (Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood) may be used. Although the DC: 0–3R is intended to diagnose children in the first 3 years of life, it is maintained that SAD is difficult to diagnose at this early age (for reasons we have delineated before). Clinical and Etiological Consideration While there is some evidence that secure attachment serves as a protective factor against psychopathology, the link between insecure attachment and anxiety disorders proved difficult to establish. Nevertheless, in the clinical literature on SAD, the child’s and parent’s failure to develop a secure realtionship is considered a key factor. It is assumed that this failure might arise for different reasons, including the child’s temperament or parental mental problems that lead to compromised parent–child

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relationship. Normal anxiety reactions might become chronic or exaggerated by specific life events or circumstances. Children experiencing prolonged separations, death of a parent, traumatic events like war, as well as children living with anxious, overprotective, or neglectful parents are more vulnerable to SAD. In young children, even experiences such as vacations or illness might cause difficulties with separation. Bowlby stressed that separation anxiety might be heightened in children who are chronically exposed to actual separations or threats of separation, making them more vulnerable to normally occurring separation events. Clearly, not all children experiencing the above conditions and circumstances develop SAD. So far, risk factors rather than causes of the disorder have been identified. Although the causes of SAD are still unknown, parents who consult with professionals are often told that their own anxiety about separation negatively influences the child’s ability to cope with separation. Informed by both the psychoanalytic and the developmental approach, many clinicians view sensitive parental responsiveness to the child’s needs and attachment security as protective factors against SAD. Finally, with respect to intervention and prognosis, clinicians maintain that children who are effectively and timely treated for SAD develop into mentally healthy individuals. When untreated, children with SAD may be at risk for depression and other anxiety disorders. In young children, sleeping and eating problems can be related to SAD; if not treated properly, more complicated problems in

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these areas might develop. Given the multiple contributing factors, difficulty in diagnosis, and different intervention approaches, there is a need for more research in the field, including longitudinal investigations of the antecedents and consequences of SAD, as well as intervention studies. See also: Attachment; Emotion Regulation; Fear and Wariness; Independence/Dependence; Mental Health, Infant; Self-Regulatory Processes; Social and Emotional Development Theories; Social Interaction; Temperament.

Suggested Readings Cassidy J (1999) The nature of the child’s ties. In: Cassidy J and Shever PR (eds.) Handbook of Attachment: Theory, Research and Clinical Applications. New York: Guilford Press. Eisen AR and Schaefer CE (2005) Separation Anxiety in Children and Adolescents: An Individualized Approach to Assessment and Treatment. New York: Guilford Press. Emde RN, Gaensbauer TJ, and Harmon RJ (1976) Emotional Expression in Infancy: A Biobehavioral Study. New York: International University Press. Fonagy P and Target M (2003) Psychoanalytic Theories: Perspectives from Developmental Psychopathology. London and Philadelphia: Whurr Publishers. Spitz RA (1965) The First Year of Life: A Psychoanalytic Study of Normal and Deviant Development of Object Relations. New York: International Universities Press. Witherington DC, Campos JJ, and Hertenstein MJ (2001) Principles of emotion and its development. In: Bremner G and Fogel A (eds.) Blackwell Handbook of Infant Development, pp. 427–464. Oxford: Blackwell.

Shyness J B Asendorpf, Humboldt-Universita¨t zu Berlin, Berlin, Germany ã 2008 Elsevier Inc. All rights reserved.

Glossary Behavioral inhibition to the unfamiliar – Tendency to react with wary, inhibited, and sometimes fearful behavior to novel situations and strangers. Modesty – Tendency to act in a reserved, modest, unassuming way in the presence of others. Shyness – Tendency in social situations to show inhibited or modest behavior. Social anxiety – Tendency to react with anxiety to others because of anticipated neglect or rejection. Social isolation – Being alone because of social neglect or rejection. Social withdrawal – Being alone because of shyness, social isolation, or unsociability.

Unsociability – Preference to be alone rather than with others. Wariness to strangers – Wary, inhibited, in older children sometimes also coy behavior to strangers.

Introduction Shyness is a term deeply rooted in everyday language that, when applied to infants and young children, refers to various forms of modest, reserved, wary, inhibited, anxious, or withdrawn behaviors in social situations, and to a temperamental personality trait. After discussing different facets of shyness (wariness to strangers, behavioral

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inhibition, social anxiety, and modesty) and distinguishing shyness from related constructs such as social withdrawal, social isolation, and unsociability, a simple developmental model for the development of trait shyness from infancy into early and middle childhood is provided. Finally, the evidence for the long-term outcome of early shyness in adulthood is reviewed.

Shyness: Social Behavior, Affective State, Temperamental Trait In everyday discourse, ‘shy’ is used for describing (1) the subjective experience of uneasiness and discomfort in social situations (‘‘I feel shy’’); (2) observable modest, reserved, wary, inhibited, mildly anxious, or withdrawn behavior in social situations (‘‘she reacts shy’’); and (3) a recurrent tendency to experience shyness or to react with shyness frequently and intensely (‘‘he is a shy person’’). In developmental psychology, shyness in infants and young children refers to (1) an affective state in social situations, characterized by shy behavior and underlying physiological reactions, that may vary from bold disinhibition to a totally inhibiting phobic reaction, or (2) a temperamental personality trait that may vary from boldness to social phobia. Around 8 months of age, nearly every infant starts reacting shy to adult strangers once in a while, and later most children react shy from time to time in particular situations. Both extreme shyness and the complete absence of shyness indicate problems with social–emotional adaptation. Interindividual differences in shyness to strangers do not show sufficient temporal stability over the first 18 months to be considered a personality trait; only later, they begin to show substantial stability, and this stability increases over childhood. Therefore, shyness can be considered a personality trait not before the second half of the second year. Because this trait refers to an affective state, it is part of children’s temperament.

Facets of Shyness and Related Constructs In this section, four facets of shyness and three psychological constructs that are related to shyness, but not identical with it (see also the glossary for brief definitions), are discussed. These different constructs are used in different research traditions, and the similarities and differences between the constructs are far from clear. Therefore, a careful discussion is in order to avoid confusion of similar but nonidentical constructs. Wariness to Strangers When infants and young children are exposed to unfamiliar people, they often react with a specific form of shyness

that is called ‘wariness to strangers’. Five stages of intensity are commonly distinguished: wary brow (a subtle movement of the eyebrow), wary averted gaze (wary brow plus gaze aversion), avoidance (body movement away from the stranger), cry face (distressed, fearful face without crying), and crying. Wariness to strangers is one of the earliest observable fearful reactions in infants (fear reactions to the visual cliff emerge even earlier). Wariness to strangers can be observed as early as 6 months of age although most infants begin to show this reaction around the age of 8 months. Wariness to strangers is a normal reaction that peaks in intensity around 12 months of age, and generally lasts into the child’s second year. Just as separation anxiety, it is an observable indication that infants are cognitively able to differentiate between familiar and unfamiliar people. Rather than indicating emotional difficulties, the emergence of wariness to strangers and separation anxiety in the second half of the first year is a milestone of mental development. The setting and way in which the stranger approaches the child can influence how the child may respond. If the stranger approaches slowly when the caregiver is nearby, smiling and speaking softly, offering a toy, the infant will sometimes show interest rather than distress. Experimental variation of stranger characteristics has shown that stronger, more fearful responses are evoked by strangers who approach faster, are taller, and have lower voices. In an intriguing study, infants were exposed either to an unfamiliar adult, an unfamiliar peer, or an unfamiliar midget (small adult). Although the midget was the most unfamiliar type of person, infants responded strongest to the adult, with intermediate intensity to the midget, and with least intensity to the peer. Thus, it is not the discrepancy between a general mental image of human interaction partners and the stranger that evokes wariness of strangers, as assumed by the so-called discrepancy hypothesis, it is the unfamiliarity of the stranger paired with cues that signal danger (fast approach, body size, low voice). The predominantly negative reactions to strangers in the first and second year of life are later followed by emotionally ambivalent responses that consist of both negative and positive components, particularly a coy smile. A coy smile is a smile during a wary averted gaze, signaling both approach and avoidance motivation. Ambivalent responses to strangers peak around the age of 3 years, and then decrease in intensity. Detailed analyses of the videotaped behavior of the caretakers that accompany infants and children during encounters with strangers have shown that most caretakers also react with mild forms of wariness, particularly a wary brow, a coy smile, or a brief wary averted gaze. These studies support a ‘social referencing’ hypothesis according to which the caretaker’s reaction is an important cue even for 8-month-olds on how to react to the

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stranger: The stronger the caretaker responds with wariness, the stronger the infant responds. The intensity of wariness to strangers varies greatly among agemates. One source of inter-individual differences is the different developmental onset of the wary reaction. For example, some 8-month-olds will not show any wary behavior simply because they are not yet cognitively able to differentiate between familiar and unfamiliar people, and some 15-month-olds may react only slightly more because their wariness peaked already at 12 months, whereas some of their agemates just reached the peak of their responsivity. If this source of interindividual differences is controlled in longitudinal studies that compare infants at their individual peak of responsivity, substantial interindividual differences remain that are often considered as an early form of trait shyness or trait fearfulness. However, both the cross-situational consistency and the temporal stability of these inter-individual differences are so low that such a trait interpretation is not valid. Shy behavior reaches sufficient consistency across different unfamiliar people and sufficient temporal stability, not before the end of the second year of life. At this age, it begins to show consistency not only between adult and peer strangers but also between unfamiliar social and nonsocial situations. For example, a 2-year-old who reacts with strong wariness to a stranger is expected to explore unfamiliar rooms rather slowly, even if no stranger is present. At this age, a first form of trait shyness can be observed which is called behavioral inhibition to the unfamiliar. Behavioral Inhibition ‘Behavioral inhibition to the unfamiliar’ is a term introduced by Kagan and associates in 1984 that refers to a temperamental trait of young children. According to both parental reports and behavioral observations in the laboratory, approximately 15% of toddlers react with marked inhibition to novel situations or unfamiliar adults and peers. They cease their play behavior and withdraw to the proximity of their caregivers, remaining vigilant of the situation and rarely approaching novel objects or unfamiliar people. Behavioral inhibition has been initially studied by comparing extreme groups of young children characterized by very high or very low inhibition. Later research in North America, Europe, and China has shown that interindividual differences in behavioral inhibition are gradually, continuously distributed and show moderate stability over childhood. Building on neuroscience models of fear, Kagan suggested that high behavioral inhibition in infancy is due to an overactive amygdala, resulting in an enhanced fear response to unfamiliar situations. This hypothesis relates to early forms of behavioral inhibition that are mainly

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based on initial affective response tendencies. One prediction is that inhibited children should show higher heart rate and heart rate acceleration in response to novel stimuli, another prediction is that inhibited children should show higher salivary cortisol levels. Both predictions have only found mixed support, however. Concerning precursors of interindividual differences in behavioral inhibition, behavioral inhibition after age 2 years shows only weak correlations with the intensity of wariness to strangers during the first 18 months of life. It seems that the many and profound changes in toddlers’ cognitive ability during the second year affect also interindividual differences in reactions to novelty. It is assumed that the ability to understand social norms and rules and the ability to self-regulate one’s affective responses according to such rules that both begin to emerge during the second year are important sources of interindividual differences that overlay the earlier developing interindividual differences in wariness to novelty. Indeed, research on the development of self-regulation in infants and young children has described a gradual transfer of control over affective responses at both the behavioral and the neural level. Whereas infants’ responses are initially governed only by affective response tendencies generated predominantly by the limbic system, with age and cortical development, cognitive control capacities such as response inhibition and attentional control increase, allowing for a greater cortical control over the initial response tendencies. Concerning the later development of behavioral inhibition over childhood, children show an increasing repertoire of behaviors in response to novel situations and strangers, and despite a moderate stability of interindividual differences over shorter time periods, there is much evidence for long-term differential change in behavioral inhibition. Behavioral inhibition is by no means a fixed temperamental trait. The main reason seems to be, again, children’s increasing ability to self-regulate their attention and initial affective responses. For behaviorally inhibited children, the shifting of attention to a different aspect of a situation, or distracting oneself, can be an effective means of regulating their emotional distress in novel situations. Another means of coping with novelty that is more difficult to study in young children is the cognitive re-assessment of the situation as less dangerous or arousing. Indeed, there is increasing evidence that the emerging interindividual difference in self-regulation over childhood moderates the stability of the early temperament-based affective reactions to novel situations. Research by Eisenberg and colleagues took up the hypothesis originally put forward by Rothbart and Bates that the development of ‘effortful self-regulation’ leads to important changes in children’s temperament-based reactions. Effortful control is commonly defined as the

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efficiency of executive attention, including the ability to inhibit a dominant response and/or to activate a subdominant response, to plan ahead, and to detect errors. It involves abilities to focus or shift attention as needed, and to activate or inhibit behavior as needed. Eisenberg and colleagues distinguished effortful control from reactive control that is less under voluntary control, such as behavioral inhibition as an immediate reaction to unfamiliarity. They found some evidence that effortful control fosters the skills needed to get along with others and to engage in socially constructive behavior. Although effortful control seems to be most effective for preventing problems due to reactive undercontrol (high impulsivity), there is also some evidence that the ability for effortful control also helps children disposed to reactive overcontrol (high behavioral inhibition) in self-regulating their initially inhibited response to strangers. Indirect evidence is also provided by a longitudinal study by Asendorpf who found that social competence as judged by preschool teachers and general intelligence as assessed by standard intelligence quotient (IQ) tests both moderated the long-term outcome of preschool inhibition: more competent and more intelligent children were better able to overcome inhibition in both laboratory and school settings. There is much evidence that more socially competent and more intelligent children are better able to self-regulate their reactivity, and therefore Asendorpf ’s finding may be interpreted in terms of the enhanced self-regulation ability of the more competent children. Other studies have focused on interactions between behavioral inhibition and attachment to parents. There is some evidence that infants’ early temperamental characteristics influence the development of both behavioral inhibition and anxious-ambivalent attachment. For example, in a 2-year longitudinal study by Fox and colleagues, observed distress to the withdrawal of a pacifier at 2 days of age was related to insecure attachment at 14 months, and reactivity to novelty at 5 months was related to inhibition at 14 months. Furthermore, anxious-ambivalent attachment to parents may impede the self-regulation of behavioral inhibition. For example, in the above longitudinal study, anxious-ambivalent attachment at 14 months was related to behavioral inhibition at 24 months. In addition, a temperament by attachment interaction was found. Infants who were classified as anxious-ambivalent with their mother at 14 months and who had not cried to an arm restraint procedure at 5 months were the most inhibited at 24 months. The few studies of attachment–temperament interactions over the first years of life suggest neither a main effects model for temperament (later inhibition is due to early temperament independent of attachment) nor a main effects model for attachment (later inhibition is

due to early attachment independent of temperament). Instead, these studies suggest a transactional model such that early differences between infants in temperament, together with differences between parents in the sensitivity to their child’s needs, give rise to insecure attachment to the parents which, in turn, interacts with infants’ increasing self-regulation ability in unfamiliar situations. More recently, behavioral inhibition has found increasing attention by clinical child psychologists because a few studies have shown that strong behavioral inhibition in early childhood is a risk factor for diagnosed anxiety disorders later in childhood and in early adolescence, particularly social anxiety disorders. Therefore, intervention programs have been developed that aim at reducing this risk. For example, Rapee and colleagues developed a short-term educational program designed to help parents of preschool-aged children with withdrawn/inhibited behaviors to better understand their child’s problem and to better support the child in overcoming inhibition and anxiety. The children were randomly allocated to the education condition, or to no intervention. The children whose parents participated in the educational program showed significantly lower anxiety 1 year after the end of the intervention, as compared to the children in the control condition. However, no effects of the program were observed on measures of inhibition/withdrawal. This pattern of results suggests that the intervention affected children’s subjective experience of anxiety but not their temperament. Social Anxiety As the more clinically oriented studies of behavioral inhibition show, behavioral inhibition is linked to social anxiety in childhood and adolescence. However, behavioral inhibition should not be equated with social anxiety for three reasons. First, behavioral inhibition is more general because it refers also to nonsocial situations. Second, it refers to observed behavior whereas anxiety refers to both behavior and subjective experience. One important consequence is that studies of social anxiety in older children sometimes include interview data or self-reports of their experience in social situations. Third, and most importantly, social anxiety is the more general concept for social situations because it includes fearful, anxious responses also in response to familiar people or situations. Studies of social anxiety in adolescence and adulthood show that a main reason for anxious reactions in social situations are concerns of being negatively or insufficiently positively evaluated by others (familiar or unfamiliar). Asendorpf suggested the hypothesis that shy behavior in children might be linked to either behavioral inhibition (thus, to children’s temperament) or to acquired fears of being negatively evaluated or ignored by others (thus, to social experiences).

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He interpreted this two-factor model of shy behavior in terms of the temperamental theory of Gray. Based on his animal and psychopharmological research, Gray proposed the existence of a behavioral inhibition system at the neurophysiological level that mediates responses to three kinds of stimuli: novel stimuli, conditioned cues for punishment, and conditioned cues for frustrative nonreward. According to Gray, any such stimulus evokes behavioral inhibition, increased physiological arousal, and increased attention. Interindividual differences arise due to a different sensitivity (strength) of this behavioral inhibition system, and to interindividual differences in learning history (how many and which stimuli become cues for punishment or frustrative nonreward through conditioning). Asendorpf applied this model to shy behavior in children (see Figure 1). According to this model, either strangers or cues for being rejected or ignored by others trigger the behavioral inhibition system in social situations. The resulting inhibitory tendencies are responsible for the reactivity component of both behavioral inhibition to the unfamiliar and social-evaluative concerns. Whether these inhibitory tendencies result in shy behavior depends on the child’s self-regulatory abilities (see Figure 1). Furthermore, the child can modify the situation by both self-regulation ability (e.g., when a person that arouses fear is revaluated as being more friendly) and by overt behavior (e.g., by presenting oneself as modest and nonassuming in order to prevent criticism). These abilities to cope with inhibiting situations increase as children grow older and ultimately may be more important than their underlying temperament or earlier experiences with others. According to this concept of shyness, a child may react shy to a particular person because of a temperamental disposition that may be genetically based or due to early caregiving, or because the child has been often rejected or ignored by this person (a parent, a sibling, or a familiar peer).

Unfamiliarity

Cues for being rejected or ignored by others

Behavioral inhibition system

Self-regulation ability

Overt behavior Figure 1 A three-factor model of shyness. Bold lines indicate sources of interindividual differences.

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Because the second experiential source of shyness also triggers the behavioral inhibition system, it interacts with the temperamental source in a predictable way (amplification of response). Thus, a child with a ‘weak’ behavioral inhibition system that is often rejected by the parents may nonetheless not become shy whereas a child with a ‘strong’ behavioral inhibition system that is moderately rejected or ignored by the parents may nonetheless become shy in their presence. First evidence for this two-factor model of shyness in children was provided by Asendorpf in 1990. German children were observed in confrontations with adult and peer strangers in the laboratory, in their preschool and kindergarten peer group, and in play situations with a familiar peer in their familiar preschool. As expected, observed shyness was consistent between adult and peer strangers, but inconsistent between unfamiliar and familiar peers. Thus, a child who reacted with strong inhibition to an adult stranger in the laboratory tended to react also with strong inhibition to an unfamiliar peer in the same laboratory setting, but its shyness to a familiar peer was unrelated to its inhibition to peer or adult strangers. Longitudinal analyses in the classroom showed an increasing influence of peer neglect or rejection on shyness in the classroom. Follow-ups of extreme groups with stable inhibition toward strangers vs. stable shyness in the more familiar peer group in the second and third year in preschool revealed that stable high inhibition toward strangers was unrelated to self-esteem up to age 12 years, whereas stable high shyness in the familiar peer group significantly predicted low social self-esteem between 8 and 12 years of age. Thus, shyness in the familiar peer group which was very likely due to social-evaluative concerns was a risk factor for internalizing problems throughout childhood but not inhibition toward strangers. In line with this finding, a more recent longitudinal study also showed that early peer neglect and rejection in preschool increased the risk of developing stable social anxiety and depression. Because temperament is more likely stable than experiences of peer neglect or rejection across different peer groups, the consistency between inhibition to the unfamiliar and social-evaluative anxiety is expected to increase with age. This hypothesis was confirmed in another longitudinal study where inhibition to strangers was not correlated with negative peer relationships in late childhood, but in early adulthood. The bottom line of this developmental model of shyness in childhood is that shyness is the outcome of a continuous transaction of stable temperament and fluctuating social-evaluative experiences. During this transaction, the two initially independent factors become more and more correlated, and are hard to distinguish in adulthood. In early childhood, however, shyness due to the temperamental factor and shyness due to social anxiety can and should be

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distinguished. The former can be identified in its purest form in encounters with strangers, the latter in evaluative situations with familiar people. Modesty Shyness is not only used to describe children who react inhibited but also to describe children who act in a reserved, modest, unassuming way in the presence of others, without signs of fear or anxiety. As the model in Figure 1 suggests, modesty can be an outcome of selfregulated inhibition, but this is not necessarily the case; children may be simply socialized to behave in a modest way. It depends then on the cultural norm for modesty – how often modesty is the outcome of self-regulated inhibition and how often it is the result of socialization favoring modesty. This cultural influence became first obvious to developmental psychologists in a cross-cultural study by Chen who compared the peer reputation of shy-sensitive children, defined as shy, usually sad, and easily hurt by others, between Canada and mainland China in 1990. Whereas these children were less popular among their peers in Canada, they were above-average popular in China and showed superior school adjustment. The authors interpreted this result as the influence of the Confucian norm for modesty in China at the threshold of westernization. In line with this interpretation, studies carried out 8 and 12 years later could not replicate the Chinese results; instead, shy-sensitive Chinese children in large cities today are as low in peer popularity and school adjustment as in Western cultures. These findings highlight the problem that shy behavior may be due to inhibition but also to self-regulation according to cultural norms favoring modesty, without underlying inhibition. The bottom line is that three different types of shyness in children can be distinguished: stranger shyness (behavioral inhibition to the unfamiliar), anxious shyness (behavioral inhibition to social-evaluative cues), and regulated shyness (self-controlled social restraint characterized by modesty and an unassuming demeanor). Shyness vs. Social Withdrawal, Social Isolation, and Unsociability It is important to distinguish shyness from social withdrawal, or solitary behavior, because solitary behavior can be due not only to inhibition and modesty but also to social isolation (sometimes also called social exclusion) and to unsociability, that is, a genuine preference for being alone rather than with others. Social isolation occurs when children are rejected by their peers. Shy children are neglected by their peers rather than rejected (see also next section). Children are more often rejected by peers because of high

aggressiveness. Aggressive-rejected children show a characteristic form of solitary behavior, often called solitaryactive behavior, consisting of often-repeated sensorimotor activity and solitary dramatic play. For example, they move a play car back and forth for a long time, run around without any purpose, or pretend to be a famous movie star or a wild animal without interacting with others. Obviously, this would not be called shy behavior. More difficult is the distinction between shyness and unsociability. Uninformed adults often believe that children are social by nature; therefore, they believe that children who spend much time with solitary behavior have some social or emotional problem. Research by Rubin and colleagues has shown, however, that solitary activity in early childhood is not necessarily problematic. Children’s solitary-passive activity defined as exploratory and constructive solitary play in the presence of peers can be the outcome of a successful self-regulation of behavioral inhibition to the unfamiliar (if the peers are unfamiliar) or of social anxiety, of a norm for modesty (they would like to play with others but are socialized to wait until others approach them), or simply because they prefer to explore and play alone. Indeed, children can be classified in terms of their dominant social motivation as being sociable (they prefer being with others rather than being alone), as being unsociable (they prefer to be alone rather than with others), as shy (they would like to be with others but do not dare to approach them because of inhibition or an internalized norm for modesty), or as avoidant (they avoid others because of experiences of rejection, without any motivation to approach them). From this motivational perspective, shyness is characterized by an approach-avoidance conflict rather than pure avoidance, and shyness is different from unsociability which is characterized by a lack of both approach and avoidance tendencies.

Development of Shyness: Infancy to Middle Childhood Many cross-sectional and a few longitudinal studies have been conducted on the development of shyness from infancy to middle childhood. The major findings within a simple developmental model that borrows much from similar, more complex models by Rubin and colleagues (see Figure 2), are discussed. Genetic and early environmental risks lead to an infant temperament that was described in the classic work by Thomas and Chess as ‘slow-to-warm-up’, and that is characterized in the second year of life by behavioral inhibition to the unfamiliar. In terms of the temperamental model shown in Figure 1, this early temperament is due to a strong behavioral inhibition system. Behavior genetic studies have supported that a substantial portion of the

Shyness

Environmental risks

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Genetic risks

Parental insensitivity Slow-to-warm-up inhibited temperament

Inadequate parenting

Anxious-ambivalent attachment

Inhibition to unfamiliar and social-evaluative situations

Peer neglect Reticent behavior Peer rejection Social anxiety Adult shyness Figure 2 A developmental model of shyness.

observed variability in behavioral inhibition in the second year of life is due to genetic differences, but currently the relevant genes are still unknown. Concerning early environmental influences on behavioral inhibition, only few specific pre- and perinatal risk factors are known. Interestingly, one is the season of pregnancy. Studies have replicated for both North American and Australian samples that mid-pregnancy at the time of the year with the shortest daylight (December in North America, June in Australia) is a risk factor for behavioral inhibition. This might be less surprising as it seems because hormones such as melatonin and serotonin vary with daylight intensity, and play some role in neuroscience models of fear and behavioral inhibition. As already discussed in the section on behavioral inhibition, this early temperamental trait, together with parental insensitivity, increases the risk for an anxiousambivalent attachment to the parents and inadequate responses by the parents to the child such as overprotection or rejection. Anxious-ambivalent attachment as well as inadequate parenting, particularly involving rejection or neglect of the child, reinforce children’s inhibitory tendencies, not only to unfamiliar situations but also to familiar social-evaluative situations, resulting at the end of the second year of life in a shy, somewhat socially

anxious child who is sensitive to unfamiliar situations and criticism by others. When such children enter the unfamiliar social world of preschool, they face the risk of being ignored (but initially not rejected) by their peers which, in turn, leads to reticent behavior such as long phases of just looking at others, being unoccupied without playing, and socially wary behaviors, and social-evaluative concerns of being insufficiently accepted by the peers. Around second grade peers become more and more aware that these reticent children deviate from the ageappropriate pattern of social interaction which increases the risk that they now reject the reticent children. Such peer rejection, in turn, increases social-evaluative anxiety and social withdrawal. If these children later during adolescence also face rejection by their potential dating and sexual partners, adult shyness likely results. It is important to note that, in line with modern developmental psychology, this is a multifactor model of development where a single factor alone has little to no influence on development; what counts is the interaction between multiple risk factors. Also, personality traits such as early temperament alone are not sufficient for explaining later development; what counts is the transaction between personality and environment over age.

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Long-Term Outcome of Early Shyness The earliest evidence for a predictable long-term outcome of shyness in adulthood came from Kagan’s analysis of data from the Fels Longitudinal Study where two measures of observed anxiety in unfamiliar social situations at ages 3–6 years were both significantly correlated with social anxiety in adulthood. The later extensive studies of temperamental inhibition by Kagan and associates did not result in reports about significant predictions from early inhibition toward the unfamiliar to adulthood personality or social–emotional adaptation. However, only a small number of children were followed into adulthood in these latter studies such that firm conclusions about the long-term effects of early temperamental inhibition cannot be drawn. Much better evidence for the long-term outcome of early inhibition is provided by the Dunedin Longitudinal Study which follows a large, representative New Zealand birth cohort into adulthood. Based on behavioral observations in various situations, 8% of the sample were classified by Caspi and colleagues as inhibited at age 3 years and followed up until age 26 years. Compared to a control group of well-adjusted children (40% of the sample), the inhibited children reported more harm avoidance, less social potency, and positive emotionality at both ages 18 and 26 years, and at age 26 years were described by informants as lower in extraversion but not higher in neuroticism. Psychiatric interviews at age 21 years showed that the inhibited children were not more likely to have anxiety disorders of various kinds, including social phobia, but were more often depressed and had more often attempted suicide. Thus, the evidence for internalizing disorders in adulthood for formerly extremely inhibited children was mixed. Importantly, social phobia was not related to early inhibition, neither we are aware of any other prospective longitudinal study into adulthood that has shown this, contrary to frequent claims in the clinical literature based on retrospective reports of adults. Thus, despite findings that early inhibition predicts social anxiety and phobia during childhood and early adolescence, early inhibition has not been found to be a risk factor for adult anxieties including social phobia. With regard to life course sequelae of childhood inhibition, two longitudinal studies reported delays in social transitions for children classified as inhibited in middle childhood. In their reanalysis of the Berkeley Guidance Study, Caspi and colleagues found such delays only for inhibited boys at ages 8–10 years. These inhibited boys married 3 years later, became fathers 4 years later, and entered a stable occupational career 3 years later than the remaining boys. No such delays were found for the inhibited girls; instead, these girls became women who spent less time in the labor force and married men with

higher occupational status. This should not be attributed to instability of female inhibition because inhibition as assessed in clinical interviews at ages 30 and 40 years correlated significantly with both boys’ and girls’ inhibition. The strong sex difference in the outcomes can be attributed to the traditional gender roles for this 1928 birth cohort that required action and social contacts, particularly from men. In an attempt to replicate these life-course patterns in a 1955–58 Swedish cohort, Kerr and colleagues studied children who were rated as shy with unfamiliar people by their mothers at ages 8–10 years when they were 25 and 35 years old. Self-judgments of inhibition at age 35 years correlated with childhood inhibition significantly for females but not at all for males. Inhibited boys married 4 years later than controls and became fathers 3 years later; shy girls were educational underachievers, that is, reached a lower educational level after controlling for IQ. No effects on the number of job changes or monthly income were observed. Thus, this study replicated the delays for inhibited boys regarding marriage and parenthood as well as the absence of this effect for girls; unfortunately, the age at the time of beginning a stable career was not recorded. In a recent follow-up of the Munich Longitudinal Study on the Genesis of Individual Competencies (LOGIC), Asendorpf and colleagues replicated the findings of delayed social transitions into adulthood not only for boys but also for girls, and also found a low stability of shyness between early childhood and adulthood. In this 19-year longitudinal study, the 15% most shy children at ages 4–6 years in a normal German sample were targeted by teacher judgments, and were compared with controls who were below average in preschool shyness. As adults, shy boys and girls were judged as shy by their parents and showed a delay in their first stable partnership and their first full-time job. This diminishing of a sex difference found in earlier generations was not unexpected because the LOGIC participants grew up in a culture characterized by more egalitarian gender roles than one or two generations earlier. Only the upper 8% in terms of shyness tended to show internalizing problems, including self-rated shyness; this tendency was of a similar effect size as in the Dunedin Longitudinal Study but not significant because of the smaller longitudinal sample. Together, these longitudinal studies draw a consistent picture of the long-term consequences of early shyness. There is some stability of the core temperamental trait of inhibition to unfamiliar situations. This temperamental trait makes it more difficult for inhibited persons to cope with social life transitions where they are confronted with unfamiliar people. They are ‘slow-to-warm-up’ in such situations even as adults when they meet dating partners, enter new educational settings such as university, and apply for jobs which results in delayed social development.

Siblings and Sibling Rivalry

This early temperamental core of shyness interacts so strongly with parental and peer influences over development that it is detectable in adults’ self-judgments only in cases of extremely high childhood inhibition. Besides that, according to our present knowledge, early shyness does not lead to any identified psychological problems in adulthood, particularly not to social phobia. See also: Attachment; Birth Order; Emotion Regulation; Fear and Wariness; Friends and Peers; Nature vs. Nurture; Parenting Styles and their Effects; Social and Emotional Development Theories; Social Interaction; Temperament.

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Suggested Readings Asendorpf JB (1990) Development of inhibition during childhood: Evidence for situational specificity and a two-factor model. Developmental Psychology 26: 721–730. Caspi A (2000) The child is the father of the man: Personality continuities from childhood to adulthood. Journal of Personality and Social Psychology 78: 158–172. Chen X, Cen G, Li D, and He Y (2005) Social functioning and adjustment in Chinese children: The imprint of historical time. Child Development 76: 182–195. Kagan J and Snidman N (2004) The Long Shadow of Temperament. Cambridge, MA: Harvard University Press. Rubin KH and Asendorpf JB (eds.) (1993) Social Withdrawal, Inhibition, and Shyness in Childhood. Hillsdale, NJ: Lawrence Erlbaum.

Siblings and Sibling Rivalry N Howe and H E Recchia, Concordia University, Montreál, QC, Canada ã 2008 Elsevier Inc. All rights reserved.

Glossary Complementary interactions – Hierarchical exchanges in which one partner is invested with greater knowledge or authority as seen in parent–child interactions (e.g., teacher and learner roles). Differential parental treatment – When parents’ positive and negative treatment of their children is different for siblings in the same family. Reciprocal interactions – Mutual and egalitarian exchanges typical of peer interactions, where both partners are invested with relatively equal levels of power and knowledge and can contribute to the interaction in fairly equal ways (e.g., during play). Sibling rivalry – Siblings’ resentment and jealousy typically associated with competition for parental affection, attention, and approval.

Introduction Family systems theorists, in particular Salvatore Minuchin, have conceptualized the family as a system of reciprocally interactive and interdependent subsystems (marital, parent–child, sibling) that together form the whole family system. Although there is a large literature on the importance of the marital and parent–child subsystems to family functioning, considerably less attention has been devoted to

the sibling system. Yet, more than 80% of children growing up in North America have at least one sibling and during the early years children spend more time with their sibling than any other family member. Nevertheless, parents (but most research has only included mothers) exert a strong influence on the quality of sibling relations. In addition, for most individuals, the sibling relationship will be their longest and most enduring relationship over their lifetime. Historically, the significant role of siblings in the lives of individuals and families is acknowledged by their prominent place in myths, biblical and classical stories, religion, history, autobiographies, and literature. In the twentieth century, clinicians and family systems theorists, particularly those working within a psychoanalytic tradition, such as Alfred Adler and David Levy, wrote about the role of siblings (and rivalry) in family life and personality development. Sibling rivalry was believed to be the result of competition for parental attention after the second child’s birth ‘dethroned’ the older sibling’s position of importance in the family. Rivalry was manifested by jealous, agonistic behavior between the two children. This work was followed by research (mainly in the 1970s and 1980s, although there are still proponents of this approach today) emphasizing the role of structural variables (e.g., birth order, age, gender) in explaining why siblings differ from one another in their personality, temperament, intelligence, etc. Since the 1970s or so there has been a shift away from examining the role of structural variables in sibling relations toward more process variables (e.g., understanding of the social world, relationship quality) with an emphasis on

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investigating types of interactions, the development of the sibling relationship in early childhood, and the influence of siblings on one another’s development. As a case in point, research on the role of structural variables (birth order, number of siblings) in the development of children’s theory of mind abilities is rather inconsistent; thus, more recent work has shifted to examining the role of process variables (e.g., relationship quality, pretend play) in explaining individual differences in theory of mind skills in early childhood.

Relationships Theory and the Sibling Relationship as a Context for Development Theoretical work on the development of relationships, as articulated by Robert Hinde and Judy Dunn, informs much of the empirical literature. The basic premise underlying relationship models is that children’s development occurs within the context of close, intimate relationships. Hinde argued that relationships can be described by their reciprocal and complementary features. Reciprocal interactions involve mutual and egalitarian exchanges, typical of peer interactions, whereas complementary interactions are hierarchical exchanges in which one partner is invested with greater knowledge or authority as seen in parent–child interactions. Sibling relationships are uniquely characterized by both reciprocal and complementary features. Specifically, differences in siblings’ ages and development dictate differential roles (e.g., caretaking, teaching) that define complementary interactions and are characterized by instrumental assistance, instruction, and guidance. Complementary interactions have typically been considered via structural variables (e.g., age, birth order) rather than by examining children’s behavior; however, recent research points to the significance of individual differences in the complementary features of exchanges. Proximity in age also promotes egalitarian exchanges (e.g., play) that define reciprocal interactions as illustrated by mutual understanding and companionship. Reciprocal interactions may provide key opportunities for facilitating development as siblings co-construct shared meanings during mutual and returned exchanges characteristic of play and conflict. Mutual engagement may facilitate emotional support, particularly in times of stress, because children are uniquely positioned to understand their sibling’s perspective and experiences. The processes inherent in reciprocal exchanges (e.g., common interests, perspective-taking) may be important for promoting children’s interpersonal and cognitive development. Thus, Dunn has argued that the reciprocal features of interactions are the building blocks of relationships because of the opportunities that they afford children for

understanding self and others. Yet, the role of complementary interactions in children’s development is not to be underestimated. The distinction between reciprocal and complementary interactions provides a somewhat artificial dichotomy between different kinds of sibling exchanges, since most interactions probably contain both reciprocal and complementary features. This suggests some limits to the practical usefulness of this distinction. For example, during play children may engage in a series of reciprocal and equal exchanges as they develop a pretend scenario together (e.g., assigning roles, creating scripts); however, there may be opportunities for the older child to teach the younger (e.g., how to build a wooden barn, or that pigs eat corn). The degree to which reciprocal or complementary interactions predominate differs across dyads, and may illuminate our understanding of sibling dynamics and potential mechanisms of influence on development. Further, sibling-relationship quality and children’s competencies may influence the balance between these two types of interactions and the patterns of individual differences evident in sibling interactions. Wyndol Furman and Duane Buhrmester delineated a four-factor framework for describing sibling-relationship quality, namely warmth, conflict, rivalry, and relative power. Warmth, conflict, and rivalry are hypothesized to relate to the reciprocal features of relationships and relative power to the complementary features. Since these four dimensions are considered to be independent of one another, children may exhibit seemingly ambivalent combinations of behaviors in the same relationship; for example, interactions may be both intensely warm and conflictual. Sibling-relationship quality may also exert an influence on children’s socioemotional understanding and interpersonal problem solving. Thus, the sibling relationship provides an excellent window into studying young children’s development. Shared and Nonshared Environments One important question regarding siblings concerns the extent to which children’s experiences in the family serve to make them similar or different. Originally, the assumption was that children in the same family were predominantly influenced by their shared environment; that is, by virtue of growing up in the same family, any existing genetic similarities would be magnified to make siblings even more alike. However, contrary to this hypothesis, siblings tend to be quite different from one another. For example, the average correlation between siblings on personality variables is about 0.15; given that siblings share up to half of the same genes, this relationship is surprisingly weak. In fact, studies comparing adoptive and biological siblings, as well as identical and nonidentical twins reveal that most environmental influences on siblings are nonshared. For instance, they estimated that 40% of variance


in personality is due to genes, 35% to nonshared environment, 10% to error, and only 5% to shared environment. So, for those who study siblings, the important question has become: what environmental factors exert their influence ‘differently’ for young children in the same family? First, though some experiences do differ consistently between families (e.g., neighborhood, divorce, socioeconomic status (SES)), it is likely that these experiences influence siblings in dissimilar ways. In fact, 69% of shared but unusual events during childhood are experienced differently by two siblings (based on their temperament, developmental level, birth order, etc.). Further, siblings engage in ecological niche-picking, and thus take on complementary nonoverlapping roles in the family. Other factors that contribute to differences between siblings include different relationships with parents, with peers and teachers, gene-by-environment interactions, and general idiosyncrasies of each child’s experience. Finally, one important factor is siblings’ differential relationships with each other. Whether one grows up with an older or younger sibling is associated with different experiences. Furthermore, there is no guarantee that siblings will be equally friendly or unfriendly with one another, and these inequalities will certainly contribute to children’s differential experiences and later socioemotional outcomes.

Summary of the Introduction Certainly, the sibling relationship is an integral part of most children’s social worlds. Given their extended history of shared experiences including highly affectively intense prosocial and negative exchanges, siblings have an important socializing influence on one another’s development. In early childhood, four major characteristics of the sibling relationship are prominent. First, sibling relationships are emotionally charged and defined by strong, uninhibited emotions of a positive, negative, and sometimes ambivalent quality. Second, sibling relations are defined by intimacy; since children spend large amounts of time together, they know each other very well. This long history and intimate knowledge translates into opportunities for providing emotional and instrumental support for one another, engaging in pretend play, in conflict, and for understanding others’ points of view. Third, there are large individual differences in sibling-relationship quality. In addition, the age difference between siblings often makes the issues of power, control, and rivalry a source of contention for children. Fourth, environmental effects on children’s development are mostly nonshared between siblings, and thus researchers are investigating the processes that serve to make brothers and sisters different. These characteristics sometimes make sibling relations challenging for parents to deal with on a daily basis, because of the emotional and highly charged nature of the relationship and the potential for differential parental treatment.

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In the sections that follow, issues related to the birth of a sibling and the transition to siblinghood over the infant and toddler period are discussed. Then the features of sibling interactions over the preschool period, along with the influence of parents on these interactions are addressed. Finally, the limitations of current knowledge are discussed.

Birth of a Sibling and the Transition to Siblinghood The birth of a second child launches a time of major changes in the functioning of the family system and the nature of interpersonal relationships between parents and children. Of course, this transition marks the beginning of the sibling relationship. The transition from one to two children, who are frequently close in age, signals a time of adjustment for all family members. Several longitudinal studies have charted the initial reactions and adjustment of the older child and the development of the sibling relationship over the infant, toddler, and preschool periods. Judy Dunn and Carol Kendrick conducted a naturalistic observational study of early sibling relations in British families beginning 1 month prior to the arrival of the new sibling, and again at 1, 8, and 14 months after the birth. Their findings form the backbone of our knowledge, which is complemented by other longitudinal studies, such as Robert Stewart’s work on the transition to siblinghood. Firstborn children generally have marked affective responses to the birth of a sibling, although individual differences in the range and intensity of affect have been noted. Compared to before the birth, firstborns exhibit a combination of positive (e.g., interest, affection, imitation of the baby) and negative behaviors (e.g., clingy, demanding, confrontational, distress), perhaps indicating their overall ambivalence to the event. Older firstborn siblings (age 3–4 years) engage in more mature behaviors such as greater self-help skills and assisting with the newborn, whereas younger firstborns (age 1–2 years) are frequently more distressed and clingy. Mothers report that at 1 month after the birth of the sibling, firstborns often have problems with toileting and sleeping, engage in baby talk, and are more confrontational and deliberately naughty, particularly when the mother is feeding or caring for the infant. Children may be jealous of the attention that the newborn receives by engaging in more negative behavior. Further, some boys respond by withdrawing after the birth of the sibling, whereas girls show more dependent behaviors (e.g., clingy, fussy, greater use of pacifier or bottle). Problematic behaviors are more evident in same-gender dyads. Certainly, mothers are less available to the older child once the baby arrives, but many mothers attempt to involve the older child in the

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care of the younger one, partly to ease this decrease in attention and involvement. Yet, most firstborns respond quite positively to the birth of a sibling and, within several months, the more overt negative responses typically decrease significantly. The older sibling’s initial confrontational behavior decreases by the time the younger sibling is 4 months old; however, at this time, firstborns show more anxious behaviors. By 8 and 12 months, firstborns’ confrontations are more likely to be directed to their increasingly mobile and intrusive younger sibling than to the parents. The temporary nature of the more overt negative behaviors may be a response to a number of changes that the firstborn may experience after the birth of a sibling, including changes to their physical environment (e.g., new room, new furniture, or having to share a room); a decrease in maternal availability and her preoccupation with the newborn; the initial separation when mother is in the hospital and the presence of less familiar adults (e.g., grandparents, babysitters) who focus their attention on the newborn; the development of new family routines reflecting the dynamics of three vs. four members; and, helping the newborn to achieve a regular pattern of sleeping and eating. The firstborn’s initial adjustment to the birth of a sibling and the transition to siblinghood appears to be tempered by several factors, including their own level of cognitive understanding. Preparing the older sibling in advance of the birth is a frequent parental strategy and may include reading books about babies and families, having contact with other families with young infants, talking about the impending changes, and/or attending a sibling preparation class offered by a hospital or community public health program. Children who attend such classes are reported to exhibit fewer negative problems after the sibling’s birth and mothers also coped more effectively with the child’s negative behaviors, perhaps because they were also prepared for the range of the firstborn’s possible reactions. Parental support is also critical for the firstborn’s adjustment; maternal support for older sisters who exhibit high distress prior to the birth helps them to alleviate some of the stress following the birth. Fathers’ support is also important, particularly after the birth when the mother may be preoccupied with the infant. Finally, having a strong friendship with a playmate who enjoys engaging in shared pretense may be a positive buffer for the older sibling’s transition and acceptance of a younger sibling. In sum, the empirical evidence is weak for the clinical (psychoanalytic) view of ‘dethronement’ of the older child after the arrival of the younger sibling as setting the stage for jealousy and sibling rivalry. In fact, as outlined below, the literature focusing on siblings’ influence on each other and the development of their relationship suggests that other processes are equally relevant to children’s development.

Development of the Sibling Relationship over the First 2 Years Our knowledge of the early development of the sibling relationship has been greatly enriched by several longitudinal studies that have charted the processes implicated in the quality of sibling relations and the role of parents (especially mothers). Links between the older child’s initial reaction and the development of the quality of the sibling relationship are evident over time; namely, friendlier sibling relations at 14 months are associated with firstborns who are initially interested (and not withdrawn) and who imitate the newborn. Maternal interaction with the firstborn is also a critical factor associated with later sibling-relationship quality. Specifically, both (1) intense close relationships between mothers and older sisters at the time of the sibling’s birth, and (2) between the mother and the secondborn at 8 months were associated with less friendly sibling relations at 14 months. Since we know that siblings direct less interaction to one another in the presence of a parent than when alone, these patterns may suggest that intense maternal closeness and very frequent interaction with the children does not allow youngsters the opportunity or emotional space to construct a positive and friendly sibling relationship on their own. In contrast, when mothers and daughters engage in frequent verbal confrontations after the baby’s birth (but less frequent interaction), by 14 months the sibling relationship was positive and friendly. Thus, interestingly, a very close, nonconflictual relationship between mother and firstborn child does not seem to promote friendly sibling interaction, but rather the opposite. Related to this point, when mothers experienced fatigue and postnatal depression, by 14 months the sibling relationship was positive and friendly. This pattern suggests that in the absence of maternal attention or intimacy, siblings may have turned to one another as sources of interaction and interest, perhaps to buffer the lack of maternal emotional involvement. On the other hand, some maternal behaviors are positively associated with the development of a friendly sibling relationship. For example, mother and firstborn’s discussion of the newborn’s internal states (feelings, desires, infant as a person) is positively associated with a friendly sibling relationship over time. Mothers who discuss internal states are also more likely to engage in pretense with the children, to enlist the older sister in caretaking, and to use language for complex purposes (e.g., comparisons, generalizations, explaining intentions and motives, and providing justifications in disciplinary situations). This maternal style may be a key process in helping older siblings to consider their younger sibling as a person with feelings, desires, intentions, and to be sensitive to their emotional needs and behavior. Apparently, siblings growing up in families where mothers employ


such a verbal style are more likely to develop a friendly relationship, which is already evident by the time the younger sibling is 1 year old. In sum, as younger siblings enter their second year, there are two critical features that highlight the nature of the sibling relationship. First, the salience of siblings for one another is apparent as seen in the younger sibling’s high rates of imitation of the older’s actions and language (27% of all interactions as reported in one Canadian study). These imitative acts along with frequent episodes of joint play suggest that siblings are often highly desired play partners for each other. Second, the marked affective tone of the interactions, particularly as the younger sibling becomes a more active and verbally skilled dyadic partner, cannot be missed. Sibling exchanges in the reciprocal (joint play, cooperation, affection) and complementary (comforting, teaching, helping) aspects of their relationship can be both positive and negative in tone. Some sibling relationships are characterized by frequent prosocial interactions, while others are more agonistic in tone; finally, some relationships are affectively mismatched (i.e., older sibling is more negative and younger child is more positive). Dunn reported that 22% of interactions when the younger sibling was 14 months old were defined by the older sibling’s negative behaviors and the younger sibling’s friendly behaviors. Clearly, the range of affective contexts that siblings co-construct may have an impact on the ways that they influence one another’s development. The reciprocity evident in all of these interactions reflects how well siblings come to know each other and their pragmatic understanding of one another’s likes, dislikes, how to tease and annoy one another, etc. During the second year, younger siblings engage in observer/follower roles, whereas older siblings are leaders during play situations and initiate invitations to play, create, and control pretense scenarios. As discussed below, distressed younger siblings may turn to older siblings (especially sisters) for comfort. The developmental implications of these two features of their relationship become evident as the younger sibling enters the early childhood period.

Sibling Relationships in Early Childhood Clearly, sibling relationships are dynamic and reciprocal from their inception. Nevertheless, as younger siblings enter their third year of life, they become more active and interesting relationship partners for their older siblings. As such, at this age, mothers tend to withdraw from their mediating role in sibling interaction, and siblings spend more time interacting with each other than with their mother. During early childhood, there are various striking features of sibling dynamics. Research has typically

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focused on the negative aspects of sibling relationships, such as rivalry and conflict, given their implications for later development. However, sibling relationships are also characterized by play, prosocial behavior, caretaking, and teaching, which contribute in important ways to later social, cognitive, and affective development. Each of these features of relationships is discussed in turn. Rivalry As described above, the birth or arrival of a new sibling can precipitate strong negative feelings in their older brother or sister and in some cases, sibling rivalry continues into the early childhood years. To some degree, this resentment may be based on valid perceptions, as there is evidence that laterborn children tend to be somewhat favored by mothers. Mothers are more responsive, verbal, controlling, and emotionally expressive with their younger children, though they may be more consistent with same-sex pairs. In fact, about half of mothers in North American and British samples reported feeling more affectionate toward their younger child, whereas less than a quarter of mothers reported feeling more affectionate toward their older child. Although mothers may behave and feel differently toward their two children at any one particular time, they apparently behave in similar ways toward their two children when those children reach the same developmental age. In fact, paying more attention to the younger child makes sense, as they do require more care. However, only the older child is privy to the enhanced attention and affection that mothers show to younger children, and thus is selectively affected by this experience. Related to this point, parental differential treatment has negative effects only when children perceive differences in treatment as unfair. About 50% of children perceive that they are treated differently than their sibling (either better or worse). In this case, the degree of differential treatment during childhood is related to a number of negative outcomes, including concurrent internalizing (i.e., directed inwards toward the self such as depression, anxiety) and externalizing (i.e., directed toward others such as aggression, disruptive or argumentative behavior) problems as well as a diminished sense of self-worth. Differential treatment predicts self-worth even after controlling for initial differences between children, suggesting that though differential treatment may occur partly because children are different, it also contributes uniquely to adjustment. Furthermore, differential treatment (especially by fathers) is negatively associated with sibling-relationship quality. This is true for both siblings, even the child who is favored. However, as suggested above, when children perceive differential treatment as fair, this is linked to more positive sibling relationships. Finally, longitudinal studies reveal that differential treatment during childhood predicts maladjustment and delinquency in adolescence. Differential

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treatment may be especially problematic when children are insecurely attached or family stress levels are high. Siblings of children with disabilities are especially likely to experience differential treatment, due to the special needs of their brother or sister. However, when children are cognitively sophisticated enough to recognize the need for differential treatment, there are no negative outcomes. In contrast, in two-child families, sibling rivalry is more pronounced than in families with three or more children. Children are also more hostile toward their sibling with a disability when their parents have ambivalent attitudes toward that sibling. Although siblings of children with disabilities may get less parental attention, they may also benefit in other ways. For instance, while mothers employ more power-assertive discipline techniques with their child with a disability, their siblings are more often the recipients of reasoning and compromise strategies. In more general terms, competition and social comparison between siblings clearly occur from the beginning of their relationship. Older siblings may respond to as many as 75% of interactions between their mother and baby sibling (usually with protests or demands for attention). Similarly, beginning around 14 months of age, younger children pay close attention to interactions between their mother and older sibling. After their third birthday, younger children become increasingly adept at intervening in these conversations and turning them around to serve their own interests. Finally, when children describe conflictual events that occurred between themselves and their siblings, they tend to compare themselves favorably to their brothers and sisters. They often claim that their sibling engages in more harmful actions overall and provide more justifications for their own negative actions than those of their sibling. Furthermore, these relative differences in appraisals of self and sibling are at least partially due to children’s deliberate attempts to manage the impressions of others. Naturalistic observations of sibling interaction support this claim, as children’s lies tend to be self-serving in nature, and are commonly used to avoid responsibility and falsely accuse one’s sibling. For preschool children, tattling is also a means to report selectively on sibling misdeeds. Thus, social comparison and competition between siblings are salient facets of the relationship. Conflict Sibling conflicts in early childhood are frequent, poorly resolved, and can sometimes be emotionally intense, aggressive, or violent. Estimates of the frequency of sibling conflicts during the preschool years vary from about 3 to 10 times per hour. When sibling conflict occurs, over 80% of disputes end either without resolution or with the submission of one child, typically the younger sibling. Thus, constructive resolutions such as compromises and conciliation occur infrequently.

However, sibling conflict is not necessarily aggressive and hostile, and has the potential to contribute positively to development, particularly if we consider the differences between constructive and destructive conflict-resolution strategies. Constructive strategies include reasoning, enhancing understanding between parties, and attempting to reach collaborative resolutions. Destructive strategies involve hostile or aggressive behaviors and becoming entrenched in one’s own position, which result in conflicts being left unresolved. Thus, conflict resolution can be a useful context for learning skills critical to social competence. Specifically, when in conflict, children are faced with competing perspectives that are incompatible with their own. As such, divergent beliefs, goals, intentions, and motivations are made salient, helping children learn to differentiate their own perspectives from those of others. In support of this point, siblings often refer to internal states (goals, beliefs, etc.) while in conflict, which is linked to children’s ability to develop shared meanings in other contexts (i.e., pretend play). Furthermore, sibling conflict may help children to improve their interpersonal relationships as they coordinate perspectives with those of others. Indeed, an intervention program aimed at improving understanding between siblings, promoting positive play interactions, and improving conflict-resolution skills resulted in friendlier sibling relationships with less rivalry and conflict. Given the above, it is not surprising that sibling conflict is one of parents’ biggest concerns about their children’s behavior. There are competing arguments regarding the benefits and drawbacks of parental intervention into sibling conflict. On the one hand, it is important for children to develop conflict-resolution strategies on their own, as these skills have been found to have numerous later benefits including improved social understanding, relationships with friends, and school adjustment. For instance, there is evidence that siblings help children develop their use of justifications in the context of disputes; thus, parental interventions may deprive children of the opportunity to learn these skills. In fact, some parental interventions actually make disputes worse. When mothers are present, conflicts last longer and children may behave in more combative ways. Thus, intervening may provide positive reinforcement for attention-seeking conflictual behavior; however, other studies suggest that children are ‘less’ combative when mothers are present. The proponents of intervention claim that parental involvement in sibling conflict may have numerous positive results. Parents usually intervene when conflicts are extended in duration, particularly aggressive, or when property has been damaged. Parental involvement under these circumstances, beyond simply keeping children safe, may help to reduce tension and uphold family rules. In addition, those who argue against intervention assume that siblings will learn and use positive conflict-resolution skills on their own, which is not necessarily the case.


Given that there is an inherent psychological and physical power differential between siblings, older siblings may not learn that power-assertive strategies are an unsatisfactory way to resolve conflicts. On the other hand, intervening by consistently punishing the older child and supporting the younger may actually lead to ‘increased’ aggression. Thus, though results are somewhat mixed, parental socialization of positive conflict behaviors may be necessary. Indeed, more frequent maternal interventions are associated with a number of immediate positive changes in conflict behaviors by the children. Clearly, beyond the question of whether parents should intervene into their children’s conflicts, some types of interventions may be more beneficial than others. Maternal discussion of rules and feelings, other-oriented reasoning, and intervening (but leaving the final solution up to the children) are linked to children’s later use of constructive conflict strategies. In contrast, self-oriented reasoning and punishment are linked to children’s later destructive strategies. Thus, the nature of maternal interventions may be related in specific ways to children’s later conflict-resolution styles indicating one way that parents influence siblings’ behavior. Intervention studies involving mediation training for parents also provide concrete support for the notion that constructive parental interventions have a number of positive outcomes on siblings’ conflict-resolution strategies. Siblings exposed to mediation talk more about emotions, are less negative during conflict negotiations, and have a better understanding of their sibling’s perspective. In addition, secondborn children exposed to mediation are more likely to provide justifications and initiate solutions, suggesting that they have been empowered to participate more fully in the conflict-resolution process. Beyond parental interventions into sibling conflict, other features of family relationships are related to the nature of sibling disputes. Specifically, parent–child and marital conflict, overcontrolling mothering, and insecure attachment are linked to sibling conflict. In contrast, parental alliances, positive marital relationships, and family cohesion are associated with less negativity in the sibling relationship. Individual characteristics of parents and children are also related to the quality of the sibling relationship; when parents exhibit more negative affectivity, sibling relationships are less positive and more negative. Further, children (especially older siblings or children with negative parent–child relationships) who have highly active, emotional temperaments and who do not adapt easily to change, engage in more sibling conflict. Temperamental mismatch between siblings is also associated with conflict, and fights are more frequent in same-gender dyads than in mixed-gender pairs, although this may be especially true of boys. Girls also tend to be more submissive in conflict than boys, consistent with literature suggesting that they are socialized to be less assertive.

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Instances of sibling abuse and violence go beyond the normal range of conflictual behaviors between young children. However, unfortunately many cases of abuse go unreported as they are misperceived as ‘normal’ sibling rivalry. Extremely aggressive and hostile sibling conflict has been linked to later adjustment problems (e.g., conduct disorder), psychopathology (anxiety and depression), and academic problems, as well as later violent, aggressive, and delinquent behavior. This may be especially true for boys. In fact, sibling interaction can be a potent training ground for coercive behavior. Further, younger siblings seem to learn aggressive behavior from older siblings, though overall, older siblings are more aggressive than younger siblings. Sibling relationships tend to mirror other relationships later in life; children who are violent toward their siblings tend to be violent toward others as they get older, whereas children who are victimized by their siblings tend to be later victimized by their peers, but also themselves to be more aggressive toward others. Sibling abuse and violence are more likely to occur when parents do not effectively monitor their children and are also linked to child abuse by parents, parental abuse history, maternal deprivation/rejection, extreme parental differential treatment, unhappiness, helplessness, children’s medical illness, and parental condoning of abusive behavior. Sexual abuse occurs most frequently at the hands of a much older brother. The correlates of sexually abusive sibling relationships tend to be similar to those described above for physical abuse, but also include parental encouragement of a sexual climate in the home, family secrets, parental childhood sexual abuse, and rigid family rules regarding the denial of emotions. To summarize, although sibling aggression and abuse is associated with negative outcomes, less extreme sibling conflict and negative affectivity are relatively normative aspects of this relationship, and may even contribute positively to children’s development. However, the sibling relationship is also characterized by a number of positive features, to which we now turn. Play and Prosocial Behavior By the time the younger child is age 3, siblings turn to each other as play partners and spend more time playing with one another than with their mother. Prior to this, mothers are often actively involved as a partner in the children’s play or support the children’s playful and prosocial interactions through guiding, making suggestions, or talking about positive ways of interacting. However, as the younger sibling becomes more socially and cognitively competent, mothers take on a less directive and more supportive secondary role and allow the children greater opportunities to play by themselves. Siblings are more desirable as play partners than mothers for several reasons. Older siblings probably

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experience greater intrinsic pleasure in playing, especially engaging in pretense, than do mothers. Certainly, friendly, cooperative behavior by the older sibling is reciprocated by the younger both contemporaneously and longitudinally over the preschool years, particularly in same-sex dyads. Older siblings (especially sisters) initiate about 65% of the prosocial behaviors, although younger siblings increase the frequency of these behaviors over this time period. In fact, when preschoolers direct cooperative behaviors toward their younger sibling, the latter are also more likely to be cooperative, conciliatory, but also to engage in more teasing behavior. Teasing certainly reflects the degree of intimacy between siblings and their shared history, because to be successful the teaser must be able to understand the sibling’s point of view, have an awareness of his/her weaknesses, desires, and intentions, and be able to anticipate what will annoy the other. This knowledge apparently comes partly via close, frequent, and prosocial interactions. Thus, a warm and supportive sibling relationship provides a developmental context for promoting prosocial interactions such as sharing, cooperation, nurturing, teaching, comforting, goodnatured teasing, and loyalty, which may foster emotional understanding, moral sensitivity, and understanding of the sibling’s capabilities and point of view. Over early childhood, sibling friendliness and aggression are quite stable, particularly for older siblings, but interestingly it is especially the lack of a positive and warm relationship, even more than the level of conflict, that best predicts maladjustment in children. In sum, positive, friendly sibling relationships in early childhood are associated with adaptive functioning later in life. Due to their shared history, siblings know each other intimately and have constructed a body of shared knowledge that makes them desirable play partners. Older siblings become quite skillful in creating scaffolds for enticing their younger sibling to enter collaborative play, partly due to their knowledge of their sibling’s interests. For example, older preschoolers employ a range of complex strategies (e.g., invitations, descriptions, extending, building-on to ideas) to draw their sibling into and sustain their engagement in play, whereas younger preschoolers rely more on paralinguistic cues (e.g., play voice, sounds) and simple strategies (e.g., calls for attention, repetitions). Initially, the older sibling takes the lead in negotiating and enacting the role play; older firstborns are more likely to draw the younger sibling into the play than are younger firstborns. However, as the younger sibling’s cognitive, linguistic, and cooperative skills increase after age 3, they begin to initiate more games and to take an active and sustained role in the creation of reciprocated play, particularly during pretense. Many sibling dyads spend a considerable amount of time engaged in joint pretend play, although there are large individual differences in the frequency and sophistication of dyadic sibling pretense. In fact, sibling dyads

who engage in frequent pretense appear to approach the play situation differently compared to dyads who are less interested in pretend play. The former employ a greater number of the sophisticated strategies described above to create shared meanings in the play. Frequent pretenders also engage in significantly more high-level negotiations regarding assignment of pretend roles, object transformations, and scaffolding (‘Let’s pretend . . .’). In contrast, dyads who engage in less pretend play focus on the set-up of the concrete play props (figurines, houses, animals), are more likely to become distracted, and are more interested in control issues, thus engaging in more frequent agonistic behavior. This is not an approach conducive for the development of sophisticated joint play; in contrast, dyads who engage in frequent pretense appear to use strategies reflective of sophisticated social cognitive skills. In fact, the frequency of pretend play between siblings has been associated with the development of children’s understanding of their social worlds. For example, dyads who engage in pretend play are more likely to use internal state language (references to emotional, mental states) during their pretense negotiations and while scaffolding. It may be that children who are adept at understanding other’s internal states are effective play partners, because they are sensitive to the sibling’s ideas, thoughts, and conceptions about the world, all of which create a context conducive for developing joint pretend scenarios. Moreover, individual differences in the propensity to engage in pretense with one’s sibling are related to the development of greater social understanding (e.g., affective perspective taking) over the preschool period. The evidence concerning the association between the frequency of sibling pretend play and sibling-relationship quality is inconsistent. Engaging in pretend play has been positively associated with both friendly and agonistic sibling relationships, while some authors report no associations or a negative association between frequency of play and negative affect expressed in the play context. More frequent sibling conflict appears to be negatively associated with the frequency of pretend play, suggesting that the nature of children’s disagreements does not produce a context conducive for joint play. Sibling Caretaking and Attachment When laterborn siblings reach the early childhood period, elder children in the family often play important caretaking roles for their younger brothers and sisters. Though these roles are rarely formalized in Western industrialized societies, sibling caretaking is a critical childhood task in many other cultures. For instance, one study conducted in the 1970s found that in fewer than 20% of 186 societies, mothers acted as primary caregivers for their young children. In about 25% of societies, older children (mostly females) acted at least occasionally as caregivers


for younger children. Cultural conditions associated with sibling caretaking include larger family size, lineal descent and residence patterns, an emphasis on family and community cooperation in tasks and chores, and a daily routine that results in the presence of child caregivers. Sibling caretaking is a valued task, not only because it frees parents to engage in work activities, but also because it prepares children, especially girls, for their later adult roles and may promote their sense of self-esteem, prosocial behavior, and interdependence. Although even very young caregivers (i.e., 3-year-olds) can be gentle and nurturant in their caretaking, they tend to largely imitate caregiving patterns of adults. As such, younger children may learn values, skills, and knowledge from their siblings in these contexts. Though sibling caretaking in industrialized societies may occur less frequently (especially in the early years), it certainly exists, but may be a more informal and infrequent role for children. For instance, in one study of preschool-aged siblings, when their siblings were in distress, children only responded in a comforting way about 10% of the time (or 20% if they themselves were the cause of the distress). However, in unfamiliar situations (e.g., a university laboratory) preschoolers may be more likely to respond to their younger sibling’s distress by approaching or hugging them, particularly when they have been talking about internal states with their younger sibling. In these cases, younger siblings may approach and seek comfort from their older brothers and sisters. In other unfamiliar settings (e.g., outdoor backyard), in the presence of their older siblings, infants left their mother sooner, explored more frequently and independently, and displayed less distress. As such, there is interesting evidence that at least some older siblings may be a secondary attachment figure for their younger brothers and sisters. In Western cultures, outcomes of caretaking are generally positive. Specifically, sibling caretaking is negatively associated with anxiety and depression in normative samples. One final context in which sibling caretaking has been reported is for children of siblings with disabilities. Typically, these children engage in more helping, caretaking, and teaching behavior than children whose siblings are not disabled, which in some cases has been positively associated with their anxiety and depression. However, as opposed to quantity of caretaking, the quality of their sibling relationship and especially the degree to which their sibling with a disability is aggressive toward them may be more strongly associated with negative outcomes for the typically developing child. Furthermore, birth order, temperament, and gender, as well as parental marriage quality and attitudes appear to moderate the links between caretaking and children’s adjustment. Thus, there is not a clear-cut relationship between caretaking for siblings with disabilities and children’s adjustment, and children exhibit a

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great deal of variability in this regard. Overall, the meaning and outcomes of sibling caretaking likely depends on the frequency and context in which it occurs. Sibling Teaching The literature on sibling teaching has been largely guided by the work of the Russian psychologist, Lev Vygotsky. He believed that teaching and learning occurred within the zone of proximal development; namely, with the guidance and encouragement of a more skilled individual (usually an adult), the child is able to accomplish a task that he/she would not be able to do independently. The knowledgeable person guides or scaffolds the less knowledgeable child (e.g., provide hints, suggestions) so that this child can successfully learn to complete a task. In this respect, the pairing of an older and a younger child affords an excellent context for the younger, lessexperienced child to acquire knowledge and develop skills. This may be true of both sibling pairs and mixedage peers. Nevertheless, older siblings are particularly important socialization agents for younger children, given their history of collaborative interactions and the emotional intensity of the relationship. In support of this argument, younger children are more likely to solicit teaching from older siblings than from older peers and are more likely to participate actively in the teaching process. They also learn more from older siblings than from older peers, which may be partly due to the fact that the former provide more extensive explanations, feedback, and spontaneously instruct and correct their younger sibling more often than the latter. Apparently, older siblings are comfortable assuming the role of teacher, while younger siblings take on the corresponding role of learner during interaction. The small literature on sibling teaching in a Western cultural context reveals considerable individual differences in children’s tendencies to use strategies such as verbal instruction, physical demonstrations, control, and learner involvement in the task. To some extent, these differences are related to age and birth-order effects. Chronologically older sibling teachers use more verbal instruction and encourage learner involvement. However, older teachers also tend to be more controlling than younger teachers. Preschoolers tend to mainly demonstrate during instruction. Nevertheless, even preschool-aged sibling teachers (when supported by their mothers) are able to provide instruction to their infant sibling, to capture the younger child’s attention and to modify instructions based on the infant’s responses. In addition to developmental effects, birth-order differences in sibling teaching are also evident. Firstborn children use more frequent and varied strategies for teaching their younger siblings when the age gap is larger rather than smaller. Furthermore, secondborn teachers are more likely to involve the firstborn learner

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than vice versa. On the other hand, firstborn teachers tend to be more controlling. These results are consistent with the idea that placing a high-ability child in a novice role and a lower-ability child in an expert role may facilitate more collaboration and joint construction than in pairs where the lower-ability child is the novice. The relationship between gender and sibling teaching is inconsistent; sometimes school-aged girls are more likely than boys to teach and use a positive style of guiding; however, sometimes there are no gender differences. Many older sisters in the early school years employ an inductive method (i.e., explaining rules, describing with examples), particularly with younger brothers. In contrast, older brothers employ a deductive method (i.e., providing examples for learners to deduct the rules on their own with varying amounts of teacher help). Interestingly, older sisters provide less feedback, perhaps because their teaching style is already more informative and responsive to the younger sibling’s learning. Unfortunately, we know little about how sibling teaching transpires naturalistically in the home setting, although there is some evidence to support the notion that it occurs, in particular that older siblings (but not younger) frequently engage in this behavior. Most of their teaching behavior involves instructing their siblings in procedural skills (e.g., for playing games or use of objects). However, older siblings also sometimes teach their younger brothers and sisters verbal skills and concept knowledge (e.g., labels, numbers). Furthermore, during play children do not often engage in direct teaching, but it is clear that a great deal of socialization occurs in this context. Namely, older siblings engage in talk about social rules and expectations, direct attention, provide missing perceptual information, use nonverbal cues, and construct simple messages. As such, they may promote more advanced levels of play in their younger brothers and sisters. Older siblings are prone to emphasizing their own competence relative to their siblings and can be highly critical, hence providing clear and unambiguous teaching messages and making the younger child’s incomplete knowledge salient. In contrast, adults tend to be more subtle and less critical. Thus, interestingly, it has been argued that when older siblings try to ‘show off ’, they may be effectively socializing their sibling. In fact, children’s interactive play with older siblings tends to be more sophisticated than with adults. Younger children pay close attention to their older sibling’s cues, imitate frequently, follow directions, and request help, again suggesting the potency of the relationship for influencing siblings’ development. Cross-cultural research reveals that the form and content of sibling teaching varies as a function of cultural practices, beliefs, and values. For example, ethnographic research examining Mayan children’s sibling teaching reveals that they teach their sibling important everyday tasks (such as making tortillas) using a distinct teaching

style. This style consists of observational learning that incorporates scaffolding and contextualized talk, as well as physical closeness between teacher and learner, the expectation of obedience, and the possibility of multiple teachers. As such, verbal instruction is less important in this context than in Western culture or a formal school setting.

Limitations There are a number of important limitations in the extant empirical literature on sibling relationships and sibling rivalry. First, the vast majority of research has been conducted on Caucasian, middle class, Western (British, Canadian, US) intact families. Unfortunately, we know little about the development of sibling relationships in other cultures or demographic groups. The nature of sibling relationships may possibly differ in more collectivistic cultures (e.g., Latin America) vs. the less collectivistic cultures of the industrialized West. Nor do we know much about how sibling relationships may vary within minority ethnic or linguistic populations in the West (e.g., Hispanic, French, South Asian), or rural or urban populations, etc. Only recently have researchers examined the quality of sibling relations between step- and half-siblings in nontraditional families (e.g., single parents, divorced). Second, researchers have not addressed the nature of sibling relationships in families with more than two children, thus there is no empirical evidence on the dynamics of families with three or more children. For example, the kinds of interactions that might exist between first- and thirdborn or secondand thirdborn siblings remain an open question. Third, in many studies the age gap between the children is confounded with the age of one of the siblings, thus we know little about the effects of this variable on the quality and types of sibling interaction. Fourth, although there is a small literature on the sibling relationships of children with a physical or intellectual disability, the impact of this experience on family and sibling functioning is a neglected area of research. Most studies rely on parental reports or employ questionnaire/interview methods and there are few naturalistic observational studies examining sibling interactions in these special populations.

Conclusions In conclusion, the sibling relationship has been described as a natural laboratory for very young children to learn about their social worlds and social relationships. The sibling relationship is a safe and secure context in which to learn how to manage the positive and negative aspects of interaction with a partner who is close in age and with whom one has a shared, intimate, and affectively intense

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history. There are many opportunities to learn how to handle disputes in constructive ways and to regulate both positive and negative feelings in socially acceptable ways within the family context. In interaction with their sibling, youngsters develop an understanding of social relations with a partner who may be warm and affectionate one minute and nasty and aggressive the next. Certainly, the range and intensity of affection between siblings may be stronger than in any other relationship that young children experience. Further, the sibling relationship affords many opportunities for young children to foster their social cognitive skills to understand others’ point of view, engage in prosocial behavior and play, imitate, teach, engage in caretaking and affectionate behaviors, and use their powers of persuasion. The positive benefits of constructing a warm and positive sibling relationship may last a lifetime, whereas more difficult or ambivalent early relationships appear to be associated with a poor developmental trajectory for children. The task for young siblings is to achieve a balance between the positive and negative features of the relationship as they develop over time.

Suggested Readings

See also: Attachment; Birth Order; Empathy and Prosocial Behavior; Play; Social Interaction; Temperament.

http://www.excellence-earlychildhood.ca – Centre of Excellence for Early Childhood Development.

Brody G (1998) Sibling relationship quality: Its causes and consequences. Annual Review of Psychology 49: 1–24. Dunn J (1983) Sibling relationships in early childhood. Child Development 54: 787–811. Dunn J (2002) Sibling relationships. In: Smith PK and Hart CH (eds.) Blackwell Handbook of Childhood Social Development, pp. 223–237. Oxford: Blackwell. Dunn J and Kendrick C (1982) Siblings: Love, Envy, and Understanding. Cambridge, MA: Harvard University Press. Dunn J and Plomin R (1990) Separate Lives: Why Siblings are so Different. New York, NY: Basic. Furman W and Buhrmester D (1985) Children’s perceptions of the qualities of sibling relationships. Child Development 56: 448–461. Hinde R (1979) Towards Understanding Relationships. London: Academic Press. Stewart RB, Mobley LA, van Tuyl SS, Salvador MA The first born’s adjustment to the birth of a sibling: A longitudinal assessment. Child Development 58: 341–355 Volling B (2003) Sibling relationships. In: Bornstein MH, Davidson L, Keyes CLM, and Moore KA (eds.) Well-Being: Positive Development Across the Life Course. Mahwah, NJ: Erlbaum.

Relevant Website

Smiling D Messinger, University of Miami, Coral Gables, FL, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Anticipatory smile – A pattern in which a young child smiles at an object and then gazes at another person while continuing to smile, sharing positive emotion about the object. Duchenne smile – Smile involving eye constriction (caused by orbicularis oculi, the Duchenne marker) involved in the communication of intensely positive emotion. Cheek-raise smile. Joy – An emotional process characterized by pleasurable feelings of engagement, a desire for the engagement to continue, and action tendencies, such as smiling, that tend to continue the engagement. Open-mouth smile – A smile involving a dropped jaw typically occurring during arousing play. Play smile. Secure attachment – A categorization of infants and toddlers who are able to explore the environment,

confident in their caregivers’ emotional and physical availability should the need arise. Simple smile – A typically weak smile that involves neither the Duchenne marker nor mouth opening. Smile – The sideways raising of the lip corners caused by contraction of the zygomatic major. Strong smile – Smile involving stronger contraction of the zygomatic major.

Introduction Early smiles are a prototypical expression of joy and a window on the development of positive emotion. Smiles elicit positive emotion and engagement in others, a process that contributes to the development of joy and social competence in the young child. Infants express different intensities and qualities of positive emotion through

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alterations in the temporal and facial dynamics of their smiling and through the incorporation of other expressive actions such as laughter and jumping up and down. Through the first two years of life, infant smiles and laughter become increasingly social and affectively intense, and increasingly used in referential communications about objects; between 2 and 4 years, smiles reflect the social structure of peer interactions. Difficulties with smiling in early interactions reflect a variety of risk conditions, while emotionally positive and responsive interactions can index optimal developmental trajectories.

Historical Interest in the Study of Smiling Early smiling is the quintessential physical expression of positive emotional engagement. Infant smiles appear to be direct behavioral expressions of joyful feelings (see Figure 1). This apparent link between behavior and meaning has motivated over a century of research on the emotional significance, causes, behavioral correlates, and developmental consequences of early smiling. Seminal figures in child development have concerned themselves with the meaning and causes of infant smiles. Freud regarded infant smiling as a signal of sensory pleasure and contentment, while Piaget considered the smile of mastery an index of pleasurable accomplishment. In his work on the expression of emotion, Darwin observed his own infants to determine whether their first smiles were expressions of joy. This article begins with a review of contemporary theoretical perspectives on the emotional significance of

smiling. It continues with an overview of the neurophysiology of smiling and common methods for measuring smiling in infants, toddlers, and preschoolers. The article continues with a discussion of smiling as a joyful process involving arousal regulation, a discussion which includes definitions of different types of smiling. A central section concerns the development of smiling from the neonatal to the preschool period. The penultimate section considers how smiling reveals deficits and competencies in infants with various disabilities. The final section documents the developmental continuity of smiling and its links with emerging social competencies.

Theoretical Perspectives on Early Smiling Behaviorist Approaches Social learning and behaviorist approaches suggest that the caregiver’s contingent responsivity to the infant’s actions produces increases in smiling. Smiling can, in fact, be reinforced. If an examiner contingently responds to an infant’s smiling with standardized periods of smiling, talking, and tickling, the infant will initially smile at an increased rate. Infants, however, soon habituate to these reinforcers and smiling then declines precipitously. Behaviorism is one of the only theoretical approaches to divorce smiling from emotion. Behaviorist approaches to understanding smiling have been largely abandoned in favor of approaches that focus on the dynamic relationship of smiling to the infant’s emotional engagement with the changing environment. Cognitive Differentiation Theory Cognitive differentiation theory maintains that joy is located in the meaning of the environment to the infant and young child. Infants’ active cognitive understanding of events, and maybe even early awareness of their own pleasure, is thought to be necessary for the emergence of joy. Cognitive differentiation theory holds that joy and other emotions develop out of more diffuse states such as pleasurable positive valence. Early smiling, such as that triggered when recognition of a visual stimulus elicits a relaxation in tension, is held to index pleasure but not joy. Joy is thought to develop around 9 months of age and involve pronounced drops in cognitively mediated arousal and to be accompanied by particularly intense infant smiling and laughing. Discrete Emotion Theory

Figure 1 This 6-month-old infant’s strong smile involves the Duchenne marker (eye constriction) and mouth opening.

In contrast to a cognitive differentiation perspective, discrete emotion theory proposes that infant joy is expressed in the infant’s first waking smiles. Discrete

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emotion theory emphasizes the role of brain-based affect programs such as joy in organizing the output of multiple expressive systems in the infant. Smiles and other infant facial expressions are thought to directly express emotions produced by these discrete affect programs. By this account, smiles index an irreducible joyful feeling state throughout infancy, early childhood, and, indeed, the entire lifespan. Like other approaches, discrete emotion theory suggests that joy motivates infants to approach and interact in an affiliative fashion with caregivers and other social partners.

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for the association between positive emotions and smiling. Despite their differences, there are clear areas of overlap between different theoretical perspectives. Cognitive differentiation theory’s emphasis on engagement in the emergence of smiling, for example, exemplifies the dynamic systems emphasis on the bottom-up emergence of emotional expressions out of multiple interfacing constituents. Each perspective provides overlapping insights that will illuminate the presentation of the meaning and development of smiling in this article. Below, we review the anatomical and neurophysiological basis of early smiling, and methods used to measure smiling.

Functionalist Theory While discrete theories locate joy within the infant, functionalist and dynamic theories locate joy in the relationship of the young child and his or her often social environment. Functionalist theoretical perspectives emphasize the adaptive role of emotions such as joy in the creation and maintenance of relationships with the environment, especially the infant’s social partners. The infant’s smiles and the infant’s comprehension of the smiles of others are seen as part of the process of pursuing and attaining goals in the social world. The functionalist emphasis on pursuing goals in relationships is not limited to human beings. Extensive ethological research, guided by a functionalist perspective, has painstakingly documented the communicative functions of smiles and similar expressions in young monkeys and chimpanzees. Attachment theory also borrows from functionalist theory to describe the function of smiles from an evolutionary perspective. From the ethological and functionalist perspective represented by attachment theory, early smiles are attachment behaviors that maintain the proximity of caregivers to the infant. Dynamic Systems Theory Dynamic systems theory conceptualizes smiles and other expressive configurations as constituents of infant emotional processes. The process of smiling is part of the infant’s experience of joy as well as an element in the infant’s emotional communication with others. Dynamic systems theory focuses on the bottom-up interrelationship between smiles and other constituents of social interactions. The theoretical approach focuses on the temporal dynamics of smiles and positive emotional processes. The idea is that the formation of smiles during social interaction can provide insights into the emergence of smiling developmentally. Summary and Overview These diverse theoretical perspectives offer different definitions of positive emotion and different arguments

The Neurophysiology of Smiling Definition of Smiling Physiologically, the contraction of the zygomatic major muscle creates a smile by pulling the corners of the lips upward and laterally (see Figure 1). The zygomatic is innervated by the seventh cranial nerve, the facial nerve. The facial nerve emanates from the facial nucleus, a group of motor neurons located at the level of the pons in the brainstem. Neurophysiology of Smiling The facial nucleus receives inputs from two pathways. One pathway controls deliberate smiling and the other controls spontaneous expressive smiling. More deliberate facial actions may occur when a young child is asked to smile and involve pathways from the cortical motor strip through the pyramidal system. Spontaneous smiling predominates in infancy and early childhood. Spontaneous facial expressions involve an extrapyramidal pathway that involves subcortical structures such as the basal ganglia and amygdala. Although spontaneous smiling is linked to joyful emotions, contemporary neuroimaging studies have not unambiguously identified structures that are activated by positive emotions. Candidate structures include portions of the anterior cingulate cortex as well as subcortical structures mentioned above such as the basal ganglia. The degree to which neurophysiological studies identify localized structures involved in positive emotion is of central importance to discrete emotion theory. This theory’s hypothesized modular affect program for joy rests on the eventual identification of specific structures and pathways. Robust evidence has been found for the association of joy with laterality differences in cerebral activation. Emotions involving an orientation or motivation to approach, particularly joy, are associated with greater left frontal cerebral activation than right. Laterality differences suggest a distributed cerebral basis for positive emotional processes and processing, one involving multiple

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networks of activation. This possibility is congruent with a wide range of theoretical perspectives such as cognitive differentiation and dynamic systems approaches. Measurement of Smiling Researchers typically measure the frequency and duration of infant smiling from videotaped records. Smiles and other emotional expressions are coded either with wellvalidated infant-specific coding systems, or according to study-specific criteria. These coding systems are also used to measure a set of smile-related actions such as eye constriction (the Duchenne marker) and other communicative actions such as changes in infant gaze direction. Researchers may also code vocal, gestural, and wholebody expressions of infant emotion, such as jumping up and down in joy, as well as the facial and other expressive actions of the caregivers and testers with whom the infant may be interacting. Neonatal smiling is typically observed in hospital nurseries, laboratories, and homes where early infant smiling in response to experimentally controlled visual and vocal stimuli such as the static image of a human face and high-pitched tones has been carefully documented. Social smiling between 2 and 6 months of age is often studied during playful face-to-face interactions with a parent (see Figure 2). These interactions are typically videotaped in either the home or in a laboratory playroom and are usually between 2 and 5 min in length. Individual infants typically show a range of relatively stable levels of smiling in these face-to-face interactions. Level of smiling during these interactions is also associated with more general ratings of infant emotional valence over 2–3 h home observations. Smiling is also measured during experimental procedures involving a period of parental nonresponsivity. The face-to-face/still-face (FFSF), for example, is an experimental procedure in which a period of face-to-face play is followed by a period in which the parent is asked to hold a still-face and not respond to the infant; this is followed by a reunion episode in which the parent is asked to renew

play with the infant. Smiling typically declines precipitously in the still-face and rises in the reunion episode, though not quite to initial face-to-face levels. Through 48 months of age, smiling is often observed during observations in the home, daycare settings, and preschools, and observations in laboratory playrooms. Naturalistic observations may be supplemented or supplanted with structured protocols carried out by a tester or parent such as tickling, peek-a-boo, and the presentation of standardized stimuli such as a jack-in-the-box used to document the development of positive emotion. These protocols have been incorporated into structured assessments which, along with parental reports of positive emotion expression, are also used to assess individual differences in infant temperament.

Smiling, Joyful Positive Emotion, and Arousal Smiles are simultaneously expressions of joy and indices of arousal modulation. Early discrete emotion theories held that the basis of positive emotion is a sharp reduction in neurally based arousal. Cognitive theories held that positive emotions involve active engagement with a challenging feature of the environment followed first by recognition and then by smiling. In support, infant heart rate – an index of arousal – is more rapid during smiling than during neutral expressions. Infants also accompany smiling with a variety of tension-reducing activities. Infants are likely to put their hands in their mouths while smiling and, after 3 months of age, tend to avert their gaze before ending a smile. Smiles may, in fact, be a mechanism for infants to maintain visual contact with arousing features of the environment for as long as possible. The general role of arousal in smiling is also relevant to links between smiles and negative emotional expressions. When a period of engagement yields an experience that the environment is safe and interesting, positive

Figure 2 Four-month-old infant and mother smiling interaction as captured by Automated Face Analysis at the Carnegie Mellon University, Robotics Institute, compliments of Jeffrey Cohn, PhD. The infant and mother’s faces are outlined to illustrate lip movement, mouth opening, and eye constriction.

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emotion and smiling results. When engagement yields an experience of the environment as overwhelming and unsafe, negative affect results. This might occur, for example, when an interaction with a caregiver or parent becomes temporarily overstimulating for the infant. Although related to the management of arousal, the smiles of infants and young children are also expressions of joy. Smiles, for example, are perceived as more emotionally positive than neutral expressions, even among infants with serious facial deformities. The smiles of infants and young children are part and parcel of a process of positive engagement with the environment. They occur during periods of interaction likely to elicit positive emotion and tend to elicit positive emotion on the part of others. Smiles, then, can signal a desire for arousing interaction even as they are part of a process or arousal modulation. We now turn to a discussion of different types of smiles and their role in the expression of positive emotion. Different Types of Smiles The smiles of young children have different forms. Some appear to be tentative, others appear to communicate a sense of personal connection, and yet other smiles appear to be part of hilarious outbursts. Infant smiles differ along a variety of dimensions. They can be stronger and weaker and can involve different degrees of eye constriction (the Duchenne marker) and mouth opening. In this section, we explore evidence suggesting that different types of smiling express different degrees and types of positive emotion. Simple smiles

Smiles that are not particularly strong, and do not involve the Duchenne marker or mouth opening, are known as simple smiles. The types of situations in which infants produce simple smiles and ratings of those simple smiles indicate that even these smiles are more emotionally positive than neutral expressions. A functionalist view of facial expressions in nonhuman primates offers additional clues to the meaning of simple smiles. Chimpanzees (Pan troglodyte) possess a zygomatic major muscle active in producing a bared teeth display that is similar to simple human smiling. The bared teeth display was originally a signal of submission (I accept your dominance). It has come to be a signal of affiliation (I mean you no harm), which is frequently followed by behaviors such as holding out a hand. Likewise, simple infant smiles may signify a positive affiliation with others that may be a stepping stone for more positive engagement. Infant simple smiles occur, for example, during the warm-up phases of games and when infants are approached by an impassive stranger. While simple infant smiles are emotionally positive, smiles involving stronger zygomatic contraction, eye

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constriction and/or mouth opening are more emotionally positive than simple smiles. Below, we review evidence that strong smiles, and smiles involving eye constriction and mouth opening are more likely to occur during periods of interaction likely to elicit positive emotion than are simple smiles and are perceived as more emotionally positive than other smiles. Smiles involving mouth opening (play smiles) and smiles involving vocalizations

Infant smiles involving mouth opening caused by jaw dropping have a specifically social and excited quality. They tend to occur while infants gaze at their mothers’ faces and are typically perceived as reflecting more positive emotion and arousal than closed-mouth smiles. The open-mouth human smile is also morphologically similar to the relaxed open-mouth display of nonhuman primates. These displays develop in infant chimpanzee in the context of mock biting play with mothers. Like the open-mouth smiles of human infants, these displays communicate playful, aroused engagement. Relaxed open-mouth displays and infant open-mouth smiles are also related to laughter. Laughter is a rhythmic, smilelinked vocalization that appears to index intense positive emotion. More generally, infant vocalizations tend to be embedded within the time course of ongoing smiles such that the smiles are punctuated by the vocalizations. The vocalizations may serve both to recruit attention to the smile and to intensify the expression of joy. Duchenne smiles The Duchenne marker – eye constriction caused by orbicularis oculi, pars lateralis, which raises the cheeks toward the eyes – is perhaps the best known index of smiling intensity in infants. Infants tend to produce Duchenne smiles when their mothers are smiling and when they are approached by their smiling mothers. Infants also produce more syllabic sounds when Duchenne smiling, a potential marker of emotional intensity. Duchenne smiling is also associated with greater relative activation of the left than right frontal cerebral hemispheres, a pattern which suggests greater approach orientation and joy. Although smiles involving the Duchenne marker are often regarded as the only index of strong joyful emotion in adults, this distinction does not appear to be absolute in infants. In infants, smiles with and without the Duchenne marker often follow one another directly in time, suggesting that infant Duchenne smiles are more intense indices of positive emotion than smiles without the Duchenne marker. Strong smiles Smiles are continuous muscular processes in which the degree of zygomatic contraction determines the strength of the smile, the degree of lip corner movement. Strong smiles index more intensely positive emotion, the infant’s

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positive emotional engagement with ongoing activities. More exciting parts of games elicit stronger smiling than the preparatory phase of the games. Tickling, for example, is accompanied by stronger smiling than getting ready to tickle or pretending to tickle. Smiles involving stronger zygomatic contraction are also perceived as more positive and joyful than weaker smiles. Stronger smiling – involving greater zygomatic contraction – tends to be associated with eye constriction and mouth opening. Simple smiles without these features are the weakest while smiles involving both eye constriction and mouth opening are the strongest (see Figure 3). These intensity parameters vary together in time over the course of an infant smile. As the strength of an infant’s smiles increase and decrease, the degree of eye constriction and mouth opening involved in the smile, also increase and decrease. Combined strong, open-mouth Duchenne smiles

Infant smiles involving the Duchenne marker tend to involve mouth opening (and vice versa) (see Figure 1). These combined smiles – sometimes called duplay smiles – tend to occur during unambiguously positive period of interaction such as when young infants are gazing at their smiling mothers. Strong smiles involving mouth opening and eye constrictions are perceived as the most joyful of infant smiles. They occur in circumstances – such as while being tickled – which appear likely to elicit the strongest and most engaged positive emotion. Conclusion: The meaning of different types of smiles

It is possible that Duchenne smiles are involved in reciprocating another’s positive emotion, while open-mouth smiles involve a more aroused, playful quality of positive 5.0

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Figure 3 Mean smile strength of different smile types.

emotion. If different types of smiles have qualitatively different meanings, this would challenge the discrete emotion theory proposition that there is single affect program for joy. An alternate possibility – that different types of smiles express different degrees of a single dimension of positive emotion or joy – is consonant with a wide range of theoretical perspectives. Discrete emotion and cognitive theories are congruent with this dimensional perspective, although the dimensional perspective’s emphasis on real-time changes in smiling intensity have been a more central concern of functional and dynamic systems approaches.

The Development of Smiling Developmental Overview The development of smiling reflects the emerging cognitive, social, and emotional competencies of the young child. Smiles first emerge during sleep during the neonatal period and rapidly become a centerpiece of face-to-face social interactions in the first half year of postnatal life. Between 6 and 12 months, infants begin to intentionally communicate desires and experiences about objects and events in the world to their communicative partners. Between 12 and 48 months, smiling and laughter within the parent–child dyad becomes more sophisticated and intricate. At the same time, the smiles of young children become essential features of their social interactions with peers. We review these developments below. Neonatal and Early Smiling: 0–2 Months of Age Neonatal smiling: 0–1 month of age Neonatal smiles are an emotional puzzle. They are referred to as endogenous or spontaneous smiles because they are prompted by internal stimuli, suggesting they have no emotional content. Neonatal smiles occur more frequently in sleeping and drowsy states of rapid eye movement (REM) – about one smile every 5 min – than in other states. These smiles, however, do occur in other behavioral states, including states of alertness, suggesting the possibility that they are related to positive emotion. The form of neonatal smiles suggests an association with positive emotion. Neonatal smiles can have a relatively mature form that involves strong muscular contractions and the Duchenne marker. These smiles occur against a backdrop of frequent lip and mouthing movements. Nevertheless, approximately one-third of these neonatal smiles are recognized by untrained observers, suggesting their potential signal value. Neonatal smiling is unrelated to ‘gas’ as its frequency is unaffected by time since last feeding. Instead, neonatal smiling appears to have a subcortical origin, as evidenced by the observation of neonatal smiling in an infant with

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microcephaly. Infants born prematurely show more neonatal smiling than full-term newborns and the quantity of their endogenous smiling declines with age. These factors also suggest a subcortical origin for neonatal smiling, which may limit the emotional meaning of these smiles. Theoretical perspectives differ on the meaning of neonatal smiles. While discrete emotion theory suggests that neonatal smiles – at least those occurring during waking states – are expressions of joy, a cognitive differentiation perspective regards them as physiological responses to internal or environmental stimuli. Neonatal smiles illustrate the dynamic systems emphasis on heterochronicity; that is, the neonatal smile appears to develop physically before it is integrated into patterns of cognitive engagement and social interaction that provide evidence for joyful emotion. Early smiling and the transition to social smiling: 1–2 months of age

Over the first 2 months of life, smiling becomes gradually linked to environmental stimulation, which sets the stage for the emergence of social smiling. Infants first smile in response to auditory stimuli, and then respond to auditory plus visual stimuli, and finally smile in response to visual stimuli alone. Specifically, through 1 month of age, infant smiles often occur during states of drowsiness or even sleep when they are elicited by high-pitched tones including the human voice. After 1 month, smiles during alert states are increasingly elicited by visual stimuli such as gazing at a face or an upright image of a face. Infants become increasingly likely to smile to high-pitched auditory stimuli (such as the human voice) or visual displays (particularly static images of the human face) until about 3 months of age. Cognitive differentiation theory maintains that while neonatal smiles involve a reduction in physiological arousal, the smiling of young infants involves a reduction in psychological or cognitively modulated tension. It is the emerging psychological meaningfulness of visual stimuli rather than their physical/perceptual properties that occasions smiling. In support of this proposal, as infants become more capable of rapidly recognizing more complex stimuli in the first months of life, latencies to smile decrease. This cognitive differentiation perspective is also relevant to the emergence of social smiling, to which we now turn. Social smiling develops in a developmental period when infants are spending less time asleep and more time in periods of alert inactivity, awake but not fussing or crying. These states facilitate social interaction as infants spend increasing amounts of time gazing at the caregiver’s face. The period in which social smiles emerge is also marked by the development of new patterns of visual attention between 1 and 2 months of age. One-month-olds gaze alternately at the edge of the head

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and the eyes. Two-month-olds gaze between the edge of the head, the eyes, and the mouth. This more integrative pattern of gazing suggests attention to the facial expression of others which may also facilitate social smiling. Social smiles typically first occur while gazing at the parent in the 4–6 weeks after birth. Age of social smiling appears to be contingent on a certain level of neurological maturity. For infants born prematurely, age of social smiling must be adjusted to account for the number of weeks the infant was born before due date. Maternal reports of the first social smile precede tester’s first elicitation of social smiles by several weeks. Parents may experience infant’s first social smiles as providing a sense of connection, fulfillment, and even reward (‘my baby recognizes me’) after the hard, sometimes sleep-depriving work of caring for a neonate. In the first month of postnatal life, infants gaze at and away from mother’s face without smiling. In the second month, the social smile emerges, heralded by periods of concentration. Several seconds of brow knitting and visual fixation of the mother’s face are followed by relaxation of the brows, indexing apparent cognitive recognition, and a smile. This pattern links processes elucidated by cognitive differentiation perspectives to the emergence of social smiling. Dynamic systems approaches indicate – in complementary fashion – that the real-time occurrence of this attention-related smiling pattern may provide a window into the first developmental emergence of smiling. The Development of Social Smiling in Face-to-Face Interaction: 2–6 months of Age Social smiles develop during interaction. The period between 2 and 6 months is one of intense social interaction and rapid emotional development. During this period, infants become both increasingly responsive to the smiles of others and increasingly likely to initiate smiles to others. We begin this section with a discussion of general features of smiling in face-to-face interaction and then turn to the development of interactive smiling between 2 and 6 months. General features of face-to-face interactive smiling Overview of infant and parental activities during interactive smiling

Overall, infants smile for about 20% of face-to-face interactions and smiling typically occurs in bursts of smiles separated by periods without smiling. Infant interactive smiling is strongly linked to gazing at the parent’s face and smiling tends to be associated with vocalizations that are also used to express positive emotion. During face-to-face interactions, infant smiles are a high point of play with both mothers and fathers. Fathers tend to employ a more physical style of play with their infants

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(e.g., bouncing games) whereas mothers rely more on visual and vocal expressivity to elicit smiles. Although the term mother is often used in this article because of the preponderance of research findings on mothers, mothers and fathers are equally adept at eliciting smiles from their infants. During interaction, parents both stimulate and entertain their infants, attempting to elicit engagement and expressions of positive emotion while at the same time attempting to prevent and modulate their infants’ fussing and crying. In addition to smiling, parents hold, touch, and tickle their infants, move toward and away from the infant, and engage in high-pitched infant-directed speech. These rhythmic multimodal displays increase and decrease in emotional intensity over the space of several seconds in concert with and in reaction to infant smiles and other expressive actions. Infant and mother responsivity to smiling

A key feature of interaction is the degree to which each partner influences and is responsive to the other. Mothers’ smiles and vocalizations are typically necessary to elicit infants’ smiles but may not be sufficient to elicit infant smiles. Mothers are optimally successful at eliciting infant smiles when they combine different communicative modalities with smiling such as vocalizing, leaning toward the infant, and smiling simultaneously. Infant smiles are more likely to elicit mother smiles than mother smiles are to elicit an infant smile. An infant smile is typically sufficient to elicit a mother smile, usually within a relatively brief two second time interval. In fact, an infant neutral gaze at mother’s face is often sufficient to elicit a mother smile, and mothers frequently initiate smiles in the absence of discrete infant behaviors. Infants, then, may experience parental contingency in the midst of a wide array of parental expressive behaviors. Patterns of infant and mother smiling

As suggested by a dynamic systems perspective, infant and parent individual propensities toward smiling combine to create more complex dyadic patterns of interaction in time. Infant smiles typically occur when the infant gazes at the mother and the mother smiles. Once infants are smiling, parents will rarely cease smiling, which would break off a bout of mutual smiling. The young infant’s experience of smiling, then, is, prototypically, smiling with a smiling parent. Infant and mother also impact one another continuously in time. Stronger smiling on the part of the infant is likely to lead to stronger mother smiling. Stronger mother smiling may be mirrored by the infant or the infant may disengage, gazing away to regulate their levels of arousal. These levels of interactive influence vary among different infant–parent dyads. Generally, however, infant expressions of joy are mirrored and intensified by the parent. The infant responds to this intensification with either

intensified engagement and positive emotional expression or disengagement, gazing away, and terminating smiling. The exchange of smiling is a nonverbal dialogue whose topic is the shared experience of joy and the regulation of emotion. Prototypically, infants’ experience of positive emotion as they smile is mirrored back in intensified form by the smiling parent. The infant perceives this increase in the parent’s smile and simultaneously perceives his or her own increase in positive emotion that the parent’s smile engenders. Sources of the infant’s positive responsiveness to the parent’s smile may be mirror neurons or related neurophysiological processes that produce feelings of sympathetic joy in the infant who perceives the smile of another. Whatever the source, infants’ awareness of their own changing feelings occurs in concert with their experience of their impact on the parent. The dynamic interplay that results suggests that one path to the development of joy involves experiencing the joy of another. The infant’s simultaneous awareness of their own feelings and those of the parent is known as primary intersubjectivity. We now turn to the development of primary intersubjectivity and interactive smiling between 2 and 6 months. Developments in interactive smiling between 2 and 6 months of age

As infants develop and increase their smiling around 2 months, there is a related increase in positive maternal expressions such as smiling. Infants appear to become accustomed to specific levels of positive responsivity such that 2-month-olds smile less at a stranger who is either more or less contingently responsive to the infant than the infant’s mother. Early on, then, infants appear to show dyad-specific levels of interactive contingency that affect smiling levels. This may be one mechanism through which infants between 2 and 6 months increasingly differentiate between adults and come to reserve their smiling to a familiar attachment figure. The development of smiling in face-to-face interaction occurs concurrently with changing patterns of infant attention to the caregiver’s face. Between 2 and 6 months, infants spend decreasing periods of time gazing at their mothers’ faces but become increasingly likely to smile when they are gazing at the mother’s face. As infant smiles become more strongly coordinated with gazes at mothers’ faces, patterns of gazing and smiling change. At 3 months, infants tend to begin and end their smiles within gazes at the parent’s face; that is, infants’ early expressions of positive emotion are dependent on visual contact with the parent. At 6 months, infants tend to gaze at mother’s face, smile, gaze away, and only then end the smile. Gazing away from the parent during smiling appears to be an early mechanism of emotion and arousal regulation. Five-month-old infants playing peek-a-boo tend to avert their gaze from the mother’s face more frequently

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and for longer periods of time during stronger smiles and during longer-lasting smiles. This suggests that stronger and longer-lasting smiles involve more intense affectively positive arousal which infants regulate by gazing away from their parents’ faces. In addition, smiles in which infants gaze away before the peak of the smile is reached may have a ‘coy’ quality which leads naı¨ve observers to perceive some of these smiles as communicating shyness. These developmental patterns of gazing at and away from the parent’s face are the context in which smiling develops during face-to-face interactions. As infant smiling increases between 2 and 6 months, infants also become more active participants in smiling dialogues. Infants’ tendency to smile in response to mothers’ smiles increases with age as does infants’ propensity to initiate smiles – even in the absence of a previous maternal smile. The age at which infants become reliably responsive to their mother’s smiles and the range of responsivity between different infants and mothers is a topic of active research. The development of different types of smiling

and infants are gazing elsewhere. In sum, highly positive types of smiling become selectively associated with more positive periods of interaction. Infants’ increasing tendency to engage their smiling mothers with openmouth cheek-raise smiling appears to index their emerging capacity to fully participate in intensely joyful interactions. The period approaching 6 months is one in which infants also become increasingly likely to gaze away from mother during the course of a smile in order to control their own arousal levels. As infants, then, become more capable of using very intense smiles to participate in highly arousing social situations they also begin to exercise more control over the direction in which they smile. Infants are increasingly controlling their own positive emotion by exercising control over their involvement in the interchanges that lead to this positive emotion. Another clue to the emotional meaning of infant smiles is the infants’ perceptions of the smiles of others. By 4 months of age, infants can visually match their mothers’ smiles with a matching vocalization and, by 5 months, recognize the smile–vocalization pair posed by an experimenter. These abilities suggest the infant’s appreciation of the affective meaning of the smiles of others is blossoming in the same period in which the infant is able to more flexibly engage in his or her own intensely positive emotional expressions. Smiling between 6 and 12 Months of Age: The Development of Referential Smiling In the first half year of life, infant emotional expression during face-to-face interactions reflects a primary, nonreflective communication of immediate experience. In the second half of the first year of life, infant smiling takes on

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Considered as a whole, infant smiling during face-to-face interaction increases between 2 and 6 months. Different types of smiling, however, show different patterns of development. Simple smiles that involve neither eye constriction nor mouth opening show a nonspecific rise in different interactive periods (see Figure 4). By contrast, the more emotionally positive open-mouth smiles involving eye constriction show a specific developmental pattern. Between 2 and 6 months, infants become increasingly likely to use open-mouth Duchenne smiling to respond to their smiling mothers. These combination smiles decline in periods when mothers are not smiling

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Figure 4 (a) Open-mouth Duchenne smiling increases when infants are gazing at their mothers’ faces while their mothers are smiling. It decreases when infants are not gazing at their mothers and while their mothers are not smiling. (b) By contrast, simple smiling with neither characteristic tends to increase irrespective of where the infant is gazing and whether or not the mother is smiling. All smiles are positive, but some smiles are more positive than others. From Messinger D, Fogel A, and Dickson KL (2001) All smiler are positive, but some smiles are more positive than others. Developmental Psychology 37(5): 642–653.

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a qualitatively new form as smiling is integrated into intentional communications. We begin by reviewing the form of infant smiling and laughter during this period, examine smiles associated with walking, mastery smiles, and then turn to the development of smiling in intentional communications. The development of different types of smiling, laughter, and mastery smiles

Between 6 and 12 months of age, strong smiles combining the Duchenne marker and mouth opening occur in the midst of positive and exciting periods of interaction such as physical play with a parent. Simple smiling without these features predominates both during the preparatory phases of active games (e.g., getting ready to tickle) and during slower-paced activities (e.g., book reading). While games such as tickle become more potent elicitor of smiles between 6 and 12 months, it is not clear if the relative frequency of different types of smiling – or their association with different types of elicitors – changes in this period. The conditions that elicit laughter, however, change developmentally. Laughter is a smile-linked vocalization indexing intense positive emotion and arousal that becomes more common between 6 and 12 months. During this period, physical stimulation such as pat-a-cake remains potent elicitors of laughter even as infants become more likely to laugh in response to social games such as peek-a-boo. One factor in this development is that infants are become increasingly active agents in social games (e.g., moving the parent’s hands in peek-a-boo and eventually hiding the parent) and eventually become full partners in producing their own smile- and laugh-inducing experiences. Cognitive differentiation theory holds that mastery of a challenging task is intrinsically rewarding. In support, infants approaching 1 year of age engage in more smiling and laughing when engaging in newly acquired capacities such as pulling to stand than when engaging in more practiced tasks such as pulling to sit. Smiling is linked to the developmental achievements of the toddler and young child. For early walkers (before 12 months), the onset of walking is associated with an increase in infant positive emotional expressions such as smiling. Walking onset is also, however, associated with a decrease in maternal expressions of positive affect to the early walker and increases in interpersonal struggles. This ‘testing of the wills’ may reflect the toddler’s delight in the experience of increased mobility and the mother’s work to ensure that the young toddler stays safe despite their increased mobility. The mischievous smile may develop around this age as toddlers gaze back at a parent from a distance while smiling to ascertain the level of prohibition or acceptance associated with a potential path of action. Such actions would reflect the toddler’s developing secondary intersubjectivity, a topic to which we now turn.

Smiling in referential communication Overview

In the period between 6 and 12 months, infants and parents increasingly integrate objects into their play. Smiles tend to occur in the context of coordinated joint engagement in which the infant actively shifts attention between a toy and a social partner. When initiating joint attention, infants use gestures and gaze to refer to objects and events outside the infant–partner dyad. Infant smiles are related to the communicative meaning of these gestures and gazes. Infants are more likely to smile during communications that show or share an object than they are to smile during communications that request an object or action. In sum, infants begin to smile at others with reference to particular objects or events in what is known as triadic communication.

The development of referential communications involving smiles

Between 6 and 9 months, infant initiation of joint attention by gazing between a toy and a responsive adult increases. Yet even among infants who gaze between the toy and an adult, the percentage who accompany this gaze with a smile rises between 6 and 9 months. This suggests that integrating a smile into a gaze at a responsive adult indexes a more complex communicative message than gazing alone. Such smiles index the infant’s secondary intersubjectivity, the infant’s awareness of the relationship between the adult and toy. An additional index of the infant’s secondary intersubjectivity involves the sequence of smiling and gazing. The infant is aware not only of the parent, but increasingly aware of the parent’s attentional state with respect to an object or event. Anticipatory smiles involve a specific sequence of smiling and then gazing at a partner that appears to index the infant’s secondary intersubjectivity (see Figure 5). Infants engage in anticipatory smiles when they smile at a toy or event and then turn to gaze at an adult while continuing to smile. The infant’s smile anticipates social contact and communicates pre-existing positive affect with another person. It seems to communicate something like, ‘‘that was funny, wasn’t it.’’ Infant anticipatory smiles increase between 8 and 12 months. An infant’s likelihood of engaging in anticipatory smiling is associated with the infant’s general capacity to engage in intentional communications and to understand means–end relationships. This suggests that anticipatory smiles index infants’ emerging ability to understand and refer to the relationship of an adult and an object. From a dynamic systems perspective, the real-time process of smiling and then referencing an object to another suggests how positive emotion may motivate the development of early triadic communications.

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Figure 5 Anticipatory smile. A 12-month-old infant gazes at an object (left), smiles at the object (middle), and gazes at the experimenter while continuing to smile (right).

Smiling between 12–48 Months of Age: Smiling among Toddlers and Preschoolers As toddlers become more mobile and young children become more involved in play with peers, many researchers have neglected the observation of smiling, focusing instead on other dimensions of social competence. From 1 to 2 years of age, however, smiling and laughter remain revealing elements of play with parents during a period in which toddlers become increasingly aware of the social meaning of the parents’ smiles Between 1 and 4 years, smiling is also an essential feature of the young child’s developing peer play where it reveals emerging patterns of social affiliation. These two topics – smiling with parents and smiling with peers – are the focus of this section. Toddler smiling and laughter with the parent

Infant comprehension of the smiles of others in social referencing paradigms provides evidence for the development of secondary intersubjectivity. In social referencing paradigms, infants are confronted with an ambiguous stimulus such as a moving mechanical object that might be interpreted as interesting or as threatening. Between 12 and 18 months of age, infants respond differentially to adult smiles (and associated vocalizations) than to fear and neutral expressions. Infant’s interpret these adult smiles not as direct expressions of joy (primary intersubjectivity), but as referential signals that the ambiguous situation is nonthreatening (secondary intersubjectivity). The toddler’s developing understanding of pretense is also related to maternal smiling. Mother’s smile more when engaging in pretend than actual versions of the same activity (e.g., pretending to eat vs. really eating a snack). Toddlers also give more clues that they understand that the activities are pretend – they participate more and smile more themselves – when mothers smile more. The 12–24month period also involves developments in dyadic laughter. When engaged in play during this period, infants and mothers begin and end their laughs increasingly closer together in time. The members of the dyad appear to become increasingly responsive to the onset and offset of one another’s positive communications, leading to the emergence of dyad-specific patterns of positive communication. Thus infant understanding of smiling as a

social signal (‘this is a pretend activity’) develops at the same time as infants and mothers continue to evolve complex patterns of dyadic responsivity to each other’s positive emotion expressions. Smiling in peer play Peer play is an increasingly important context for social development and smiling after 1 year. By 18 months, level of smiling is linked to increased interaction with peers, particularly when there is a relative absence of peer conflict. Additional evidence for the importance of peers involves three types of smiling identified among preschoolers. A closed smile in which the teeth are covered that is likely related to simple smiling has been identified in preschoolers. Closed smiling predominates in solitary contexts and levels of closed smiling change little between 2 and 4 years of age. Upper smiles and broad smiles and openmouth smiles show different patterns of occurrence and development. Upper smiles display the upper teeth and may include Duchenne smiles; broad smiles display both the upper and lower teeth and are likely to include openmouth smiles. Upper and broad smiles occur in social situations and are increasingly used with same-sex peers between 2 and 4 years. Male children, in particular, are increasingly selective in directing broad smiles toward male peers and not to female peers. Different types of smiling may, then, reflect and reinforce developing patterns of social affiliation such as the increasing sex segregation of young preschoolers. With respect to more recent typologies of smiles among preschoolers, by 3.5 years of age, stronger smiles are likely than weaker smiles to accompany success in a game. By 4.5 years, children tend to produce Duchenne smiles in games in which they produce – rather than simply being shown – an interesting display. Mastery, success, and failure during a given trial of a game are not, however, always accurate predictors of smiling. Gaze at the examiner – or whomever the child is playing with – remains a prepotent elicitor of smiling, whether the child has failed or succeeded at the game. In the preschool period, then, smiling continues to serve multiple masters. It expresses both joy at success and the happiness associated with interacting with a cooperative adult or peer.

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Smiling as an Index of Developmental Risk and Disability Individual differences in smiling are meaningfully related to concurrent risk factors. Levels of smiling differ between infants at risk for disturbed developmental outcomes and typically developing infants. We review evidence for differences in smiling associated with prematurity, maternal depression, and infants who are blind, infants with Down syndrome, and infants with autism spectrum disorders (ASD) – emphasizing how such differences shed light on the disorders and conditions in question. Smiling in Premature Infants and the Infants of Depressed Mothers Infants born prematurely spend less time than full-term infants engaging in relatively strong open-mouth smiles during face-to-face interactions and exhibit fewer strong smiles during peek-a-boo games with an experimenter. This likely reflects the difficulties of many premature infants in coping with high levels of even positive emotional arousal. Infants of clinically depressed mothers and mothers with high levels of depressive symptomatology also show reduced levels of smiling. This is likely to reflect a lack of maternal positive emotional initiation and responsivity to the infant. Effects are clearest when maternal depressive symptomatology is chronic rather than brief. Thus reduced smiling is likely to reflect physiological difficulties in premature infants and reduced opportunities for positive interaction among infants of depressed mothers. Smiling in Blind Infants and Children The impact of environmental influences is evident in the development of smiling in blind infants. Blind infants demonstrate social smiling in response to social events such as hearing a familiar voice and their smiling typically elicits a parental response. The frequency of these social smiles increases between 4 and 12 months. However, the smiles of blind infants are less regularly elicited and more fleeting than those of sighted infants. Blind infants, of course, cannot enter into mutually reinforcing visually mediated smiling exchanges with others, which may limit the duration of their smiling. Lack of contingent visual feedback to smiles is also likely to play a role in the decrement in smiling observed in blind infants after 2 or 3 years of age. Smiling in Infants with Down Syndrome Infants with Down syndrome – trisomy – show delayed development of positive emotional expressivity with the most substantial delays evident among the most cognitively delayed infants and the infants with the most flaccid muscle tone. Although levels of smiling are typically low

in infants with Down syndrome, these infants do show mastery smiles consonant with their cognitive level. They also show the typical developmental pattern of smiling – first to auditory, then to visual and tactile, and then to social stimuli and activities. Infants with Down syndrome show patterns of indiscriminate smiling whose cognitive and affective bases have not been adequately specified. Infants with Down syndrome direct open-mouth Duchenne smiles both to their mothers and to toys, whereas typically developing infants direct these smiles only to mother. Infants with Down syndrome also do not show decrements in smiling when their mothers adopt a still-face as dramatic as the decrements of typically developing infants. It remains to be seen whether such indiscriminate smiling is associated with the level of cognitive functioning of individual infants with Down syndrome. Smiling in Children with Autism Spectrum Disorders While children with Down syndrome show indiscriminate smiling, children with ASD show deficits in facial expressivity frequently including low levels of smiling. Low levels of smiling are associated with deficits in initiating joint attention and are particularly salient when children with ASDs are oriented toward an adult. These effects are evident as early as 12 months among infants who will later be diagnosed with an ASD. Even among infants at risk for autistic symptomatology because they are siblings of children with an ASD, levels of neutral affect are higher in early face-to-face interactions than among other infants. Smiling in children with ASDs reflects a deficit in the degree to which face-to-face contact with others is rewarding that may have cascading repercussions for the social development of affected children.

Developmental Continuity in Smiling: Predicting Social Competence Individual differences in smiling are meaningfully related to subsequent developmental outcomes. This section is concerned with the continuity of early expressions of positive emotion and the association between early smiling and later indices of social competence. We begin with a discussion of smiling and security of attachment and other indices of social competence, turn to genetic and environmental influences on smiling, and end with a discussion of interactive smiling and its impact on socialization. Smiling and Attachment Infants who smile when their parent adopts a nonresponsive still-face have a tendency to develop socially appropriate relationships. They are perceived by their parents

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as having fewer externalizing behaviors (such as being loud and rough) 1 year later than infants who do not smile during the still-face, and may be more likely to develop secure attachments. Infants whose level of smiling during face-to-face play with the parent rises between 2 and 8 months are more likely to be classified as securely attached than other infants. Similarly, smiling with the parent in play sessions around 18 months of age is associated with concurrent attachment security. It may be that regular smiling interactions in which the parent helps the infant modulate their level of positive arousal are a route to the development of a secure attachment relationship. This modulation involves not only responding positively to the infants’ smiles but being responsive to the infant’s need to look away after intense smiling bouts. This allows infants to calm themselves and then look back (and perhaps smile) at the parent. Face-to-Face Smiling, Joint Attention Smiling, and Social Competence Early social smiling in face-to-face interaction with a parent positively predicts ‘anticipatory smiling’, a tendency to communicate positive affect about an object to an adult tester. In addition, highly sensitive maternal caregiving predicts a more general measure of infant smiling at any point during an infant joint attention episode. It appears that infants’ experience with earlyrewarding social stimuli contributes to a later predilection to initiate positive communicative referencing with others. Anticipatory smiling toward 1 year of age predicts parent-reported social expressivity and social competence scores at 30 months. Positive affect sharing indexed by anticipatory smiling may be a developmentally focal activity that is predicted by early social smiling and predicts subsequent social expressivity and competence. Likewise, infant Duchenne smiling during reunions with mother in the Strange Situation predicts parent ratings of extraversion and openness to experience when children are 3.5 years of age. In sum, positive emotion expression elicits positive responses from social partners that foster later sociability and social competence. Smiling: Genetic and Environmental Effects Parent reports on dimensions of infant temperament involving questions about infant smiling and laughter reveal the influence of both genetic and environmental effects. This contrasts with negative emotion expression, which showers higher genetic and lower environmental effects. Shared environmental effects in positive emotion expression point to possible socialization effects in factors that determine parent perceptions of level of smiling. This may mean that more emotionally positive infant–parent

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interactions influence future levels of infant smiling and positive emotional expression. Developmental Continuity in Smiling Infant reaction to standardized elicitors of smiling and other positive emotional expressions such as a puppet show and jack-in-the-box show moderate developmental stability between 1 and 3 years of age. Infants who engage in extremely high levels of smiling, positive vocalizations, and motor movement at 4 months in response to a mobile and auditory stimuli show different developmental patterns than infants who are nonresponsive or show more emotionally negative reactions. The infants who display earlier smiling are less behaviorally inhibited in unfamiliar situations over the first 2 years of life than the other infants. They continue to show a more exuberant temperamental style at 4 years when they are more likely to talk and engage with peers. Concurrent Validity of Smiling to Social Stimuli Infant smiles to social stimuli such as peek-a-boo games with examiners and infant smiles to nonsocial stimuli such as a jack-in-the-box appear to have different meanings. Only infant smiles to social stimuli are associated with infant positive emotion expression in the parent–child relationship and with parent ratings of their children’s day-to-day positive emotion. Infant smiling in the parent–child relationship is in turn associated with later social competence. Predictive Validity of Interactive Smiling Through smiling in face-to-face interactions infants come to engage in simultaneous, reciprocal, and mutually enjoyable exchanges. Affecting and being affected by the positive emotional expression of the parent may lead infants to experience the happiness of others as essential to their own happiness. In support, shared infant–mother positive emotional expressions such as smiles – when they occur in conjunction with maternal responsivity to infant – are associated with two indices of social competence: children’s internalization of social norms (obeying the rules) and committed compliance to maternal directives (cleaning up without reminders). In this way, experiences of affectively positive responsivity emerge from social interaction and shape the infant’s developing social competence into childhood. Conclusion Early smiling has a relatively constant function. It expresses the infant and young child’s positive emotional engagement with the environment even as it elicits positive emotional engagement in parents and peers. Yet smiling becomes

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more emotionally intense and multifunctional with age. From the first social smiles at 1 – 2 months to mischievous smiles at 1 – 2 years, smiling indexes increasingly complex cognitive engagement and social awareness as it becomes integrated into increasingly complex interactions involving objects, actions, and peers. The level and social specificity (appropriateness) of smiling is also sensitive to risk factors such as prematurity, maternal depression, and early psychopathology (e.g., Down syndrome). As such, smiling is a relatively stable index of age appropriate social communication and functioning in infancy and early childhood. See also: Attachment; Autism Spectrum Disorders; Emotion Regulation; Humor; Imitation and Modeling; Self Knowledge; Social Interaction.

Kochanska G (2002) Mutually responsive orientation between mothers and their young children: A context for the early development of conscience. Current Directions in Psychological Science 11: 191–195. Messinger D, Fogel A, and Dickson KL (2001) All smiles are positive, but some smiles are more positive than others. Developmental Psychology 37(5): 642–653. Sroufe LA and Waters E (1976) The ontogenesis of smiling and laughter: A perspective on the organization of development in infancy. Psychological Review 83: 173–189. Striano T and Berlin E (2005) Coordinated affect with mothers and strangers: A longitudinal analysis of joint engagement between 5 and 9 months of age. Cognition and Emotion 19(5): 781–790. Venezia M, Messinger DS, Thorp D, and Mundy P (2004) The development of anticipatory smiling. Infancy 6(3): 397–406. Waller BM and Dunbar RIM (2005) Differential behavioural effects of silent bared teeth display and relaxed open mouth display in Chimpanzees (Pan troglodytes). Ethology 111(2): 129–142. Weinberg MK and Tronick EZ (1994) Beyond the face: An empirical study of infant affective configurations of facial, vocal, gestural, and regulatory behaviors. Child Development 65(5): 1503–1515.

Suggested Readings Aksan N and Kochanska G (2004) Heterogeneity of joy in infancy. Infancy 6(1): 79–94. Barrett LF and Wager TD (2006) The structure of emotion: Evidence from neuroimaging studies. Current Directions in Psychological Science 15(2): 79–83. Cohn JF and Tronick EZ (1987) Mother infant face-to-face interaction: The sequence of dyadic states at 3, 6, and 9 months. Developmental Psychology 23(1): 68–77. Fox NA and Davidson RJ (1988) Patterns of brain electrical activity during facial signs of emotion in 10 month old infants. Developmental Psychology 24(2): 230–236.

Relevant Websites http://face-and-emotion.com – A site devoted to the human face, Dataface (contains information on the anatomically based Facial Action Coding System for the measurement of smiles and other expression). http://www.psych.utah.edu – Alan Fogel’s website. http://www-2.cs.cmu.edu – Automated Face Analysis at the Carnegie Mellon University, Robotics Institute. http://www.psy.miami.edu – Daniel Messinger’s website.

Social and Emotional Development Theories C R Thomann and A S Carter, University of Massachusetts, Boston, MA, USA ã 2008 A Carter. Published by Elsevier Inc.

Glossary Affordances – Learning opportunities and external supports. Canalized – Behaviors that are likely to appear in development across a very wide range of environmental conditions. Ecology – This term is used in Urie Bronfenbrenner’s ecological systems theory and refers to the layers of contexts that influence and are influenced by children’s development. These layers include the family, community, and culture. Ethology – Ethological theories of development focus on the influence of evolution on development, proposing that caregiver–infant interactions are the product of environmental adaptation.

Goodness of fit – The match between a child’s temperamental and other characteristics and the parent/caregiver’s expectations and caregiving style. Protective factor – Protective factors can exist within the individual, family, community, or culture, and improve an individual’s response to a risk factor, creating a more adaptive outcome. Psychopathology – Non-normative behaviors and emotions that are maladaptive for the child’s developmental progress and that often cause distress to the child or family. Risk factor – Most simply, risk refers to the probabilistic relationship between a predictor and an outcome. For example, individuals with poor literacy are at risk of being held back in school. A risk factor is


a variable that, if present for an individual, increases the likelihood that a particular outcome will occur. Scaffolding – This term refers to an approach to teaching children in which the adult adapts to the child’s level of ability. The purpose of this approach is to promote independent functioning. Social and emotional milestones – A set of behaviors with a normative developmental timing that can be considered universal. Temperament – Individual differences in behavioral style usually thought to have a biological origin. Zone of proximal development – A term pioneered by Vygotsky, referencing the gap between what individuals can do and what they have the potential to do. In child development, this is understood as the gap between what children can do independently and what they can do with adult assistance.

Introduction We begin this article on social and emotional development in young children by sharing several definitions of emotion. Next, we briefly discuss some of the most widely held theories of early emotional development and the function of emotion in early development. Following a discussion of relevant theories, we turn our attention to important milestones in emotional and social development. In addition to interest in universal developmental patterns, or those social and emotional behaviors that unfold consistently across children living in very different circumstances, there has been a great deal of interest and attention to individual differences in social and emotional functioning. The largest body of research on individual differences in social and emotional functioning in early childhood has been in the area of temperament. Based on the importance of temperamental variation in children’s social and emotional development, we briefly discuss several important dimensions of temperament and introduce the concept of goodness of fit. Finally, we discuss some of the ways in which children can manifest difficulties in the domains of emotional and social development in early childhood and some of the contexts that place children at risk for such difficulties.

What Are Emotions? Many definitions of emotion have been offered over the centuries. Current emotion theories offer definitions that vary based, in part, on the relative emphasis placed on evolutionary and biological influences, the expression or communicative component of emotions, subjective

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experience, physiological activation of the parasympathetic and sympathetic systems, neuro-chemical activity in the brain, and the extent to which emotional experience is constructed in a psychosocial or relational context. Mainstream theories of emotion relevant to early childhood share the view that early emotions have evolved over time due to their importance in ensuring the survival of the human species. Thus, emotions, and in particular emotions that manifest early in life, are innately structured, biologically prepared abilities that serve alerting and organizing functions. The term emotion can be used to refer to multiple levels of an organism’s system, including the following: (1) the brain state association with the presentation or withdrawal of an incentive; (2) the subjective experience of a feeling state (e.g., butterflies in stomach); (3) the labels or meaning attributed to the feeling state (e.g., excited vs. anxious); and (4) a behavioral manifestation such as an action or facial expression (e.g., muscle tension, eyes widening). Scientific investigators utilize each of these levels to deepen understanding of emotional processes. However, it is critical to recognize that there tend to be small associations between measurements of these different ways of operationalizing emotion so that different conclusions may be drawn when different methods are employed. Moreover, there is dramatic individual variation across each of these systems, such that the appearance of joy may reflect multiple brain, feeling, and appraisal states (i.e., outside appearances do not necessarily reflect internal states). Moreover, although we talk about discrete emotions as if they are unitary constructs, the reality is much more complex. Feelings are better understood as members of sets and life’s complexities often lead to complex or blended feeling states (e.g., feeling both angry and disappointed that one is unable to achieve a particular goal). A change in emotional state provides both an internal and communicative alerting signal that can facilitate or interfere with behavioral adaptation. Further, modern theories recognize that emotions influence cognitive processes, including how individuals perceive and appraise events and contexts. For example, an individual’s emotional state can impact which features in the environment are salient or most noticeable and whether objects or events are appraised as threatening, neutral, or inviting. In addition to influencing perception and appraisal systems, emotions can also influence how individuals learn and remember information. Indeed, to the extent that you are enjoying this article you are more likely to remember its contents, as positive mood tends to promote learning. It is important to recognize that emotions, like many phenomena, become more differentiated and complex with development. For emotion theorists who hold a social constructionist view of emotional development, socially constructed schemas can be viewed as mediating the relation between environmental or internal stimuli and emotional

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reactions. Thus, some emotion theorists argue that the subjective experience and expression of emotions depends on a social construction regarding when, where, and what is appropriate to feel as well as when, where, and how to behave. Within the social constructionist framework there are two general groups of human emotions. The first group emerges very early in development and can be seen in many different animal species. These emotions include joy, sadness, and fear. The second group of emotions is more complex, requiring cognitive attributions. Good examples of this second group of emotions are shame and guilt because it is only possible to feel shame or guilt if one has an understanding of right and wrong. It is this second group of emotions that are most likely influenced by cultural variations. The first group of emotions tends to be seen as more universal, or shared across cultures.

Theories We present several theories of emotion to further deepen understanding of the concepts of emotion and social and emotional development. Ethological theory highlights the survival value of emotions while discrete emotions theory emphasizes the innate structure and universality of a core set of emotions. In contrast to discrete emotions theory, cognitive emotions theory proposes that the ability to experience and communicate discrete emotions is connected to the appraisal of internal and external events and therefore, the development of cognitive abilities. We also highlight the importance of the caregiver–child relationship, the primary context in which emotions develop. We conclude the section on emotion theories with the functionalist approach, which connects emotions to the goals of the individual. Finally, we conclude the section on theories with a very brief review of psychosocial theories highlighting the important contributions of social learning theory. Ethology Ethological theories of development focus on the influence of evolution on development, proposing that caregiver–infant interactions are the product of environmental adaptation. In contrast to many other species, human infants cannot survive without caregivers and have a relatively long period of dependence on their caregivers: For the first several years of life humans cannot feed themselves, find shelter, or protect themselves from harm. Thus, an effective infant– and toddler–caregiver relationship is essential to survival, and, ultimately, the survival of the human species. Ethology proposes that natural selection has given infants and caregivers an inborn set of behaviors that promote the development of a strong caregiver–child relationship and infant survival.

According to ethology, infants have instinctual behaviors and physical characteristics (e.g., large head, large eyes) that help keep caregivers nearby. For example, one function of the infants’ cry is to signal distress that brings caregivers closer and motivates them to meet the infant’s needs. As infants get older, they have a more complex set of behaviors to maintain proximity to their caregivers (e.g., crawling, walking, and running). Infants also encourage caregivers to stay close to them by making interactions fun through smiling, laughing, and making eye contact. Finally, when caregivers respond to a distressed infant and the infant subsequently becomes calmer, this serves as a sort of reward and promotes appropriate caregiving. Attachment theory, which has generated hundreds of studies in developmental psychology, emerged from John Bowlby’s adopting an ethological perspective on early human bonding behavior. Attachment theory is centered on understanding the manner in which children internalize and elaborate a working model of the history of their caregiving relationships. When the child’s basic social and emotional needs are met within the parent– child relationship, the child develops a ‘secure’ attachment to the parent. A child’s ‘secure attachment’ to the parent is viewed within attachment theory as a sign of healthy social and emotional development that will positively impact the development of future relationships. In contrast, there are several ‘insecure’ attachment styles, believed to reflect a failure within the parent–child system. These styles include an avoidant pattern, in which children learn to over-rely on themselves, a resistant pattern, in which children seek out assistance but are not easily soothed, and a disorganized pattern, in which there is not a coherent attachment style and atypical attachment behaviors may be observed. Recent research has highlighted that children with different temperamental styles have different parenting needs. One dimension of parenting that has consistently been associated with positive outcomes, however, is parental sensitivity, a style that is characterized by responsiveness to the child’s cues, warmth and emotional positivity, and acceptance of the child’s range of emotional expression. Parenting dimensions that are associated with insecure attachment include intrusiveness, hostility, and detachment. In the infant/toddler period, studies have relied primarily on the strange situation, a series of play and separation segments involving the parent, child, and a novel examiner, to determine attachment status. In later childhood, adolescence, and adulthood, play- and interview-based narrative approaches have been utilized. The assessment of attachment security is somewhat controversial as different methods can yield different results. Discrete Emotions Theory Charles Darwin suggested that some fundamental emotions are inborn and universal in both animals and humans.


He went on to propose that emotions are adaptive and important for survival in young children, as infants can use emotions to communicate their needs to their caregivers. Over time, these ideas developed into what is known as ‘discrete emotions theory’, which has been pioneered by Carroll Izard and Carol Malatesta. This theory proposes that infants are born with an innate ability to experience and express discrete emotions. Discrete emotions theory states that each discrete emotion has three elements: (1) a neural element comprised of a particular pathway and area in the autonomic nervous system associated with the emotion; (2) a motor expressive element, which encompasses facial, vocal, and bodily expression patterns that give information to others about the intensity and quality of the emotion; and (3) a mental processes element, or the conscious and unconscious subjective feelings of emotion. The eight discrete emotions are happiness, sadness, interest, fear, contempt, anger, surprise, and disgust. This theory further posits a developmental timetable for the emergence of these discrete emotions. At birth, the infant’s emotional repertoire is quite limited, and includes only interest, a nonsocial reflex smile, distress, and disgust. By 4–6 weeks of age, a social smile that reflects happiness appears. By 3–4 months, one can observe anger, surprise, and sadness and shortly thereafter, fear emerges, including the presence of stranger anxiety in many infants. More complex emotions continue to emerge with all eight of the discrete emotions present by the end of the second year of life. According to discrete emotions theory, the processing of emotion starts with a stimulus, such as a startling noise or a stranger’s face. This stimulus triggers the neural component of the emotional system. Next, the nervous system communicates with the motor expressive component, creating facial, vocal, and bodily expression. The muscle contractions which create these expressions also activate the nervous system, which creates the subjective experience of emotion. The facial feedback hypothesis expands on this last step of the system, as the facial muscle contractions (e.g., smile, frown) send additional information back to the neural system. Thus, smiling when mildly distressed really can make one feel better, as the facial muscles associated with the smile send feedback to the neural system that influences subjective emotional experience. Discrete emotions theory proposes that infants, regardless of age, express their subjective feelings of emotion though their facial expressions. For instance, a crying and fussing baby feels sad and distressed and a laughing and smiling infant feels happy. According to this theory, caregivers are able to discern and respond to their infant’s subjective feelings of emotion simply by interpreting their facial, vocal, and bodily expressions. For example, facial and vocal expressions of pain might help a caregiver to attend to a too tight diaper, while an infant that smiles and

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laughs might encourage a caregiver to stay close and interact playfully. Importantly, as children get older and learn to mask their feelings (i.e., smiling when disappointed), there is no longer a 1:1 correspondence between facial display of emotion, neural systems, and subjective experience. Cognitive Approaches In contrast to discrete emotions theory, cognitive emotions theory proposes that an infant’s ability to experience and communicate discrete emotions is connected to the development of cognitive abilities. Thus, although infants cry and have a nonsocial smile at birth, not all approaches accept that infants possess an innate ability to experience emotions. Rather, within the cognitive approach, the experience of distress and happiness emerges at 2–3 months of age, as cognitive skills develop. Among the cognitive-centered approaches to early social and emotional development is Vygotsky’s theory of social development. Vygotsky is best known for introducing concepts such as the zone of proximal development, which refers to the range of capacities and problem solving that the infant can achieve independently and those that the infant can achieve in collaboration with adult support and scaffolding, which refers to the behaviors that parents and other older interactive partners employ to enhance the infant’s capacities. Central to Vygotsky’s theory is the idea that infants develop new social and cognitive skills through interactions with older individuals. Vygotsky believed that, as an infant and caregiver participate in an activity, the adult begins by guiding and leading the experience (i.e., scaffolding the infant’s experience), slowly giving more control to the infant. Vygotsky proposed that infants collect ‘tools’ to help them learn and grow. The older individuals in an infant’s social network are some of these ‘tools’. Thus, the older individuals in the child’s world teach him or her not only about objects in the environment, but about the social context in which specific objects are employed and the kinds of social interactions that can be expected. Emotional experiences are interpreted within this social framework. In his theory of early social development, Vygotsky highlighted the importance of ‘all’ social interactions. Not only are mother–child interactions important, but any older peer or adult influence can be significant. This is particularly relevant when considering the different models of caregiving found across cultures, as well as varied family constellations within cultures. For example, some cultures might emphasize interactions across generations, with grandparents filling the primary caregiver role. Other cultures might advocate community-centered caregiving, with infants and children spending time with many different members of the community. All of these relationships are thought to be essential to early social development.

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The Context of Early Emotional Communication The most central context for the development of emotional understanding and regulation in early childhood is primary caregiver–infant relationship. Caregiver–infant relationships are built on the multiple sequences of interactions that occur throughout daily routines. If infants and caregivers are able to accurately interpret each others’ emotional expressions, these transactions are enhanced by greater mutuality and reciprocity. Research by Carroll Izard suggests that adults can identify many different emotions in infants. For example, in one of her studies, she showed adults pictures of 1–9-month-old infants exhibiting anger, fear, interest, sadness, surprise, happiness, and disgust. Adults were able to correctly identify these emotions at a high level of accuracy. Moreover, they became more accurate after being trained in the associations between certain facial expressions and certain emotions, suggesting that parents are learning to read their infant’s emotional cues over time, rather than this being a completely innate ability. Studies have also found evidence that infants can understand their caregiver’s facial and vocal emotional cues. At 5 months, infants were able to distinguish between contrasting emotions by listening to only vocal cues. By 7 months, infants were able to distinguish between contrasting emotions by looking at caregiver facial expressions. This suggests that infants begin to understand emotional expression by listening to their caregiver’s voice, and, eventually, learn which facial expressions match the tone of voice. Infants also respond emotionally to their caregiver’s emotional cues. For instance, one study found that 10-week-old infants tended to match their emotional expressions to their mothers’ display of various emotions. For example, infants reacted to ‘happiness’ by smiling, to ‘anger’ by frowning, appearing angry, or freezing, and to ‘sadness’ with thumbsucking or other self-soothing behaviors. It appears that caregivers likely shape the way their infants express emotions. Carol Malatesta and colleagues also examined the way that mothers respond to the emotional expressions of their 3–6-month-old infants. Infants in this study displayed a broad range of emotions and changed their expressions every 7–9 s. Mothers reacted by trying to influence their infants’ emotional expression, modeling, and imitating positive emotions and trying not to display negative emotions. Functionalist Approaches More recent views of emotional development connect emotion with the goals of the individual. From this ‘functionalist’ perspective, emotion is seen as a dynamic process coming from significant transactions between the individual and the environment. Within this functionalist framework, emotion is viewed as a process in which an

individual marks the significance of a bodily or mental event. This approach focuses on the idea that (1) emotion is experienced in relation to adaptive goals; (2) emotional expression can be seen as ‘social signals’, not only indications of internal states; and (3) the physiological component of emotion can regulate and be regulated by social processes. In addition, it is not possible to determine an individual emotional response based on knowing what event preceded the emotion. Any eliciting event can cause multiple emotions depending on the manner in which an individual construes that event. These theories represent a range of different understandings of social and emotional development. However, with few exceptions, it may be difficult for the average caregiver to apply these theories to daily interactions with children. Knowledge about universal aspects of social and emotional development, referred to as social and emotional milestones, may be more helpful in everyday life. Psychosocial Theories In addition to theories that focus on emotion, additional theories focus on social development. Psychoanalytic theory may be the earliest psychosocial theory and the first to adopt a developmental approach to the study of social– emotional phenomena, delineating both stages (e.g., oral and anal) and processes (e.g., fixation) in social and emotional development. Although psychoanalytic theory continues to have a presence, social learning theory has become more dominant in mainstream developmental research. Albert Bandura has been a leading advocate for social learning theory, which is concerned with the role of social context in learning. Early social learning theory focused on constructs such as observational learning and modeling (e.g., learning through watching others solve problems) and imitation. This theory highlighted that learning can occur without doing and what has been learned is not always reflected in observed behavior (i.e., the child may not show you what he or she knows). More recently, social learning theory has emphasized self-efficacy expectations, or an individual’s appraisal of how likely they are to be successful at a given task, which, in turn, influences how likely they are to attempt the task. Gerald Patterson went on to employ social learning theory and behavioral principles to explain why parents and children escalate in negative coercive interaction cycles, as well as to explore how to use parent management interventions to break these cycles. Social and Emotional Milestones With increasing attention to the importance of social and emotional development, there is now general consensus regarding the normative developmental timing of a set of behaviors that can be considered universal. Indeed,


recognizing the importance of early detection of children who may not be achieving these social and emotional milestones in a timely manner and may therefore be in need of early intervention, the US Center for Disease Control and Prevention has recently posted a set of social and emotional milestones along with milestones in other more traditional developmental domains. One can posit that the behaviors we call developmental milestones, or their developmental timing, are highly canalized, in that despite wide variation in parenting in the infant and toddler periods, these behaviors emerge in approximately the same time period and sequence around the world. These behaviors may also reflect qualitative shifts or behavioral reorganizations in infant and toddler behaviors, akin to the manner in which the motor milestone of transitioning from crawling to walking can dramatically change the affordances in the toddler’s environment. There is a dramatic behavioral reorganization in the infant at approximately 2–3 months that has been described as the infant waking up to the world. During this time, the social smile emerges and the infant begins to enjoy reciprocal interaction with a more skilled partner. Indeed, the infant may protest when an adult ceases interacting with the infant. The infant also becomes much more expressive and communicative at this time. The enjoyment of social interaction continues to develop. By 6–7 months of age infants clearly enjoy social play and are interested in exploring objects as well as their own image in a mirror. They are very sensitive to their emotional climate – responding to facial and vocal expressions of joy and becoming distressed or turning away in response to expressions of anger, fear and sadness. Although not universal, many infants will begin to exhibit stranger anxiety at approximately 6 months. For example, an infant may become extremely distressed when a loving grandparent, who has not visited since the infant was 3 months old, approaches to hug and kiss him or her. Around the conclusion of the first year of life is another period of reorganization. At this time, the infant is transitioning into a toddler and should have a strong attachment to his or her caregivers, preferring to be held and soothed by the caregiver and looking to the caregiver for guidance when interpreting novel information. In addition to his or her caregivers, the toddler will have clear preferences for some people as well as specific toys and activities. The 12-month-old enjoys imitating other people in play and can express delight in mastering new skills. Depending on the demands and expectations placed on the toddler, he or she may also begin to feed him or herself (e.g., finger foods) and cooperate during routine caregiving activities (e.g., raising his or her arms when it is time to remove a shirt). In the second year of life, toddlers become fascinated and excited by other children and babies. They are also becoming aware of themselves as independent agents in the world

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and may begin to test the limits of their own authority. Although labeled the ‘terrible twos’, challenging behaviors such as temper tantrums and ‘testing’ routinely begin to emerge at approximately 18 months of age. Although stressful to parents, these behaviors can be understood as a reflection that infants are sorting out the meaning of ‘Me!’ and ‘Mine’ in relation to you, yours, and ours. By the age of 2 years, there is also a clear interest in doing things independently and a greater awareness of success and failure. With greater cognitive understanding come more complex emotions, such as shame, which is evident in 2year-olds who are beginning to grapple with learning what is permitted and what is not. Two-year-olds are typically very motivated to play with other children, although they are not very skilled at negotiating conflicts and therefore require adult supervision. Peer contact provides opportunities to practice social skills. The second year of life is also the time in which pretend play emerges. By 18 months of age, the toddler should delight in simple pretend activities such as feeding a stuffed animal. By the time a child turns 3, they have strong preferences for particular playmates and have more elaborate play skills. For example, pretend play is more developed, such that they can now use a stuffed animal to be the active agent rather than the passive recipient of an activity (e.g., having the bear feed the baby). In addition, rudimentary turn-taking is possible and beginning inhibitory control permits appropriate responses to learning that an object belongs to another child. By this age children will often express their affection toward playmates and caregivers quite openly and can express and react to a wide range of emotions. At approximately the age of 2.5 years, many children begin to show a preference for doing things the same way, or having set routines. Some have argued that this is an effort to assert control over an increasingly complex environment that, with greater cognitive understanding, may provoke more fear responses. The child’s ability to predict what is going to happen allows them to assert some control and minimize fear. Thus, having a specific routine, such as a bedtime routine that always involves the same activities (e.g., bath, pajamas on, brush teeth, read two books, backrub, sleep), can sometimes ease challenging transitions such as bedtime. Throughout the preschool period, social skills with peers are increasing and pretend play is marked by increasing creativity and flexibility. Children use play to understand the complexities of their relational and physical world. One of the most salient developmental tasks for the preschooler is learning to negotiate the peer environment and make friends. It is important to recognize that early in the preschool years the boundary between reality and fantasy is not well understood. Thus, a 3- or 4-year-old may become quite frightened by monsters under his or her bed, and may have more difficulty sorting out fantastical images viewed on television or movies.

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The study of social and emotional milestones has greatly informed parenting and professional practices, both in terms of the early detection of emotional delays and deficits as well as the development of prevention programs. For example, careful study of early crying patterns reveals that there is a significant peak in crying at approximately 2 months of age that is often characterized by long periods of inconsolable and unpredictable crying. Dissemination of this information to parents, along with specific strategies for soothing infants, has been shown to reduce the incidence of shaken baby syndrome, an early form of child abuse. While social and emotional milestones are highly canalized, emerging in approximately the same period and sequence around the world, there is also great individual variation in how infants express emotions. Individual Differences: Temperament When discussing emotional and social development, it is essential to consider the way infants express emotions and their overall behavioral style when responding to environmental stimulation. These elements of infant personality are known as ‘temperament’. Definitions of temperament vary on several dimensions. While most theorists believe that temperament is inherited, stable, and exhibited early in life, there is some variability. For example, some theorists also believe that temperament might be affected by the infant’s environment (e.g., caregiving practices). Of note, no temperament style is inherently good or bad. Rather, some temperamental styles are better suited to some environmental conditions and others are better suited to other environmental conditions. Thus, in conditions of famine, children who are very quick to cry and cry intensely are most likely to survive. In contrast, in conditions of plenty, this same temperamental style is associated with heightened behavior problems and parenting stress. Thus, it is not a question of good or bad temperamental trait, but of good or bad fit with the environmental conditions. As children get older, they are able to have more control over their environments, engaging in what has been termed niche seeking, or pursuing environments that are a good fit for one’s temperamental style. Additionally, only some aspects of temperament have been found to be stable over time (for instance, negative emotionality, attention span, and activity level). Finally, there is some evidence that temperament begins to be exhibited in the uterus, as shown by heart rate and activity level, while other aspects of temperament do not manifest or are not measurable this early in life. There are multiple approaches to the study and description of temperament, but all include dimensions of emotionality and sociability among the dimensions of behavior assessed. In their seminal New York Longitudinal Study, Alexander Thomas and Stella Chess developed the

temperament categories ‘easy’, ‘difficult’, and ‘slow-towarm-up’. Approximately 40% of the infants studied by Thomas and Chess fell into the easy category, and were characterized by regular eating, sleeping, and toileting patterns. These infants adapted well to changing environments, were open to approaching novel people or objects, had generally low-to-moderate levels of reactivity, and were typically happy. In contrast, approximately 10% of the infants studied by Thomas and Chess fell into the difficult category, and were characterized by more unpredictable schedules. These infants had difficulty adapting to changing environments, often withdrew from novel people or objects, had generally high levels of reactivity, and often cried or fussed. Finally, approximately 15% of infants studied by Thomas and Chess fell into the slow-to-warm-up category, and while they often withdrew from novel situations and had difficulty adapting to changing environments, they also exhibited relatively low levels of activity and reactivity. The rest of the infants studied by Thomas and Chess did not fit into any of the categories, presenting a possible issue with the use of categorical temperament systems. However, typologies are not the only way to measure temperament. For instance, the multidimensional, bottom-up approach used by Mary Rothbart in the children’s behavior questionnaire (CBQ) offers an alternative. The CBQ assesses individual differences along 16 different dimensions, which cluster into three larger factors: ‘extraversion/surgency’, ‘negative affectivity’, and ‘effortful control’. Children are not grouped into any one of these factors. Rather, they are measured on each factor, as well as on each of the 16 smaller dimensions. Studies that tested and honed the scales of the CBQ supported the idea of a multidimensional view of temperament. For example, individuals who were high in negative affect were not necessarily low in positive affect, suggesting that at least two separate factors were needed to measure the emotional domain. By measuring individuals on multiple, hierarchical, dimensional scales (e.g., several different types of positive and negative aspects of emotionality), instead of simply grouping people based on a few temperamental attributes (e.g., easy, difficult, slow-to-warm-up), we gain the ability to detect more subtle individual differences. Finally, Rothbart also looked for biological models to support her temperament dimensions. For example, ‘effortful control’, which works to regulate the more reactive aspects of temperament, is believed to be related to the anterior attention network, comprised of areas of the midprefrontal cortex, including the anterior cingulate gyrus and portions of the supplemental motor cortex. However, while Rothbart’s model has a biological component and suggests that temperament is inherited, it also assumes that infants’ caregivers and environments have a significant influence on their social and emotional developmental trajectories.


Early Emerging Psychopathology Until fairly recently, all individual variation in social and emotional development in early childhood was discussed in terms of temperamental variation. There was little or no acknowledgement that some extreme behaviors reflected early emerging psychopathology, rather than an extreme normative variation in temperament. It is now recognized that some infants and toddlers exhibit patterns of behaviors that cause them or their families significant distress and that can impair their day-to-day life activities. Recognizing that a set of behaviors constitute psychopathology rather than normative variation is very challenging, and requires an examination of the frequency, intensity, duration, and quality of a set of behaviors. For example, although it is normative for 2-year-olds to have some temper tantrums, they may be part of a broader pattern of disruptive behavior when a child is having many temper tantrums each day with multiple caregivers. Temper tantrums are characterized by intense negative affect, aggression (e.g., kicking, biting, hitting parents) and/or destructiveness (e.g., breaking toys or household objects), last for over 15 min, and appear to have multiple triggers (e.g., fatigue, disappointment, frustration) or to appear without a trigger or ‘out of the blue’. The child who spends 20 min multiple times each day having a tantrum because of simple frustrations (e.g., he cannot make the block tower in the way he envisioned it, he is asked to try a new cereal, a parent must run to the store to buy an ingredient for dinner unexpectedly, someone changed the television channel) is losing precious opportunities for learning a variety of social, emotional, and cognitive skills. Moreover, caregivers will be more likely to experience high levels of parenting stress and interactions are likely to be characterized as tense rather than positive. Recent work demonstrates that parents and other caregivers are able to describe children’s social and emotional problems and competencies in a differentiated and reliable manner on questionnaire assessments and interviews. Moreover, problem behaviors that emerge early in childhood tend to be as stable as those observed in later childhood and adolescence, with approximately half of children who show extreme scores continuing to show extreme scores one year later. Moreover, a significant percentage of children who parents and teachers rate as having significant social–emotional problems in kindergarten and first grade can be identified as having social and emotional problems before 3 years of age. Importantly, identifying problems in very young children does not suggest that the etiology or cause of the problems is isolated within them or that the intervention must be focused on the child. Indeed, as detailed in the next section, there are a variety of known risk factors that increase risk for psychopathology in young

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children and we believe that interventions must focus on child–caregiver relationships. Risk and Protective Factors Risk Most simply, risk refers to the probabilistic relationship between a predictor and an outcome. For example, individuals who have difficulty reading are at risk of being held back in school. In other words, holding everything else constant, they are more likely than good readers to be held back. A risk factor can be an event (e.g., exposure to violence, separation from, or loss of, a caregiver), a condition, (e.g., having asthma or another chronic illness, living in poverty), or characteristic (e.g., being male, having a ‘difficult’ temperament) that increases the chance of the outcome associated with the risk factor happening. While risk factors may play a part in the etiology of a particular outcome, they are not considered causal factors. Contextual risks: They come in clusters

Most children do not experience one isolated risk factor or stressor. As Bronfenbrenner, a proponent of viewing children in their ecological contexts, pointed out, risk factors usually cluster in the same individuals, and are present within many different systems in the child’s ecology (e.g., the individual, the family, and the community). Further, stressors are often embedded within each other. For example, a parental job loss is often followed by increased parental stress, significant loss of income, and moving. Given that children frequently experience multiple risks and stressors, focusing on an isolated risk factor does not create an accurate picture of children and their contexts. Multiple risks: The more risk, the greater the negative impact

There is substantial evidence that measuring the cumulative impact of multiple risk factors predicts child outcomes better than any one single factor. For example, in Rutter’s study of 10-year-olds, risk for developing a psychiatric disorder was only 2% for families with zero or one risk factor. Risk increased to 20% for families with four or more risk factors. Risk factors examined were severe marital distress, large family size or overcrowding, maternal psychiatric disorder, paternal criminality, low socioeconomic status, and admission of the child to foster care. Other studies have included a wider range of risk factors such as the number of residence and school changes (with a higher-number conferring greater risk), low socioeconomic status, single parenthood status, marital separation or divorce, poor family relationships, seeking marriage guidance, young motherhood, low maternal cognitive ability, and maternal psychopathology. Across several studies there is strong evidence that single risk

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factors show small effects on child outcomes, when compared to an aggregate of the multiple stressors and risks that distinguish high-risk children. The more risks that are present in a child’s life, the greater the negative impact on children’s social and emotional functioning.

example of the myriad of ways in which culture can shape early social and emotional development. It also highlights the importance of cross-cultural studies for understanding both universal and culture-specific aspects of social and emotional development.

Protective factors

Summary and Conclusions

However, not all children who face significant risks experience problems in their social and emotional development. There is increasing interest in identifying factors that may serve as buffers, or protective factors, in the lives of children who face cumulative adversity. To develop effective prevention and intervention strategies to promote the social competence of children facing cumulative risk and to identify those children at greatest risk, it is imperative to explore these potential protective factors. In particular, it is essential to identify protective factors that are amenable to change and that can introduce positive shifts for children who are exposed to multiple risk factors. Culture and Social and Emotional Development In the study of social and emotional development, we often focus on individual characteristics (such as temperament) and relational components (such as parent–child interactions, attachment, and peer relationships). However, as Bronfenbrenner suggests, it is important to remember that both the individual and relational aspects of social and emotional development are held within a larger cultural macrosystem. Culture is an array of shared attitudes, beliefs, values, rituals, and behaviors that are transmitted across generations. Cultural attitudes and values can shape which individual characteristics are nurtured or suppressed and help determine the acceptability of particular interactions and relationships. For example, child outcomes based on behavioral style vary depending on the cultural context. For example, Kenneth Rubin found that having a temperamental style labeled ‘behaviorally inhibited’, meaning the child responds with higher levels of ‘wariness and fear’ to unfamiliar people and situations, was associated with different outcomes for children living in Canada as compared with children living in the People’s Republic of China. In Canada, behavioral inhibition was associated with having less positive peer relationships, low feelings of self-regard, and feelings of loneliness in adolescence. In contrast, shy-inhibited behavior is valued and encouraged in China, and children with this behavioral style developed positive social relationships and positive feelings about themselves. The way behavioral inhibition is understood and the meaning it holds for social interaction clearly varies across these two cultures. This is but one

In this article, we explored several definitions of emotion and discussed some of the most widely held theories of early emotional development. We also explored universal milestones in social and emotional development as well as individual differences in social and emotional functioning. Finally, we discussed some of the ways children can manifest difficulties in the domains of emotional and social development and some of the contexts that place children at risk for such difficulties. Our attempt was to emphasize the importance and complexity of early social and emotional development. In particular, we hope that this article highlighted the importance of focusing not only on the individual child, but on the child’s broader ecology, with respect to caregiver relationships, family, and community risk and protective factors, and the larger cultural context that critically influences social and emotional development. See also: Attachment; Birth Order; Discipline and Compliance; Emotion Regulation; Empathy and Prosocial Behavior; Fear and Wariness; Gender: Awareness, Identity, and Stereotyping; Humor; Play; Postpartum Depression, Effects on Infant; Risk and Resilience; Separation and Stranger Anxiety; Shyness; SocialEmotional Development Assessment; Socialization; Temperament; Vygotsky’s Sociocultural Theory.

Suggested Readings Briggs-Gowan MJ, Carter AS, Bosson-Heenan J, Guyer AE, and Horwitz SM (2006) Are infant–toddler social–emotional and behavioral problems transient? Journal of the American Academy of Child and Adolescent Psychiatry 45(7): 849–858. Carter AS, Briggs-Gowan MJ, and Davis NO (2004) Assessment of young children’s social–emotional development and psychopathology: Recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry 45(1): 109–134. Cole PM, Martin SE, and Dennis TA (2004) Emotion regulation as a scientific construct: Challenges and directions for child development research. Child Development 75: 317–333. Eaton W (1981) Demographic and social ecological risk factors for mental disorders. In: Regier D and Gordon A (eds.) Risk-Factor Research in the Major Mental Disorders, pp. 111–130. Washington, DC: US Government Printing Office. Lieberman A (1993) The Emotional Life of the Toddler. New York: Free Press. Malatesta CZ, Culver C, Tesman JR, and Shepard B (1989) The development of emotion expression during the first two years of life. Monographs of the Society for Research in Child Development 54: 1–2 Serial No. 219.

Social Interaction Rothbart MK, Ahadi SA, Hershey KL, and Fisher P (2001) Investigations of temperament at three to seven years: The children’s behavior questionnaire. Child Development 72: 1394–1408. Rothbart MK and Derryberry D (1981) Development of individual differences in temperament. In: Lamb ME and Brown AL (eds.) Advances in Developmental Psychology, vol. 1, pp. 37–86. Hillsdale, NJ: Lawrence Erlbaum Associates. Rothbart MK and Putnam SP (2002) Temperament and emotion regulation. In: Pulkkinen L and Caspi A (eds.) Paths to Successful

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Development: Personality in the life course, pp. 19–45. New York: Cambridge University Press. Rutter M (1979) Protective factors in children’s responses to stress and disadvantage. In: Kent MW and Rolf JE (eds.) Primary Prevention of Psychopathology: Vol. 3. Social Competence in Children, pp. 49–74. Hanover, NH: University Press of New England. Rutter M (1987) Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry 57: 316–331.

Social Interaction E Tronick, University of Massachusetts, Boston, MA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Developmental disorganization – A normal developmental process in which one well-organized behavior, capacity, or state of consciousness is disassembled in order to reorganize it in a more complex and coherent form. Mutual regulation model – The bidirectional process of communicating and responding to the relational intentions and meanings of the other during social interactions. Reparation – the process of changing mismatching affects and intentions to matching affects and intentions. Resilience – The individual’s ability to resist and regulate stress. Individual differences in resilience in part emerge from differences in interactive reparatory experience. Still-face – An experimental manipulation during interactions in which one partner is instructed not to respond to communicative displays of the other. States of consciousness – The psychobiological organization of one’s self in relation to the world. It is one’s sense of self in the world. It does not imply awareness.

and in adulthood. An infant experiencing abnormal social interactions becomes sad or angry, hesitant and withdrawn, anxious and vigilant, unengaged with people, the relationships they do have lack emotional closeness, have a limited emotional range and may lack empathy. They are likely to disengage from acting on the world of inanimate things. Whether the interactions are normal or abnormal, social experience not only becomes part of the content of the brain, but may actually sculpt the brain. Though interactions the infant makes meaning about the nature of him or her self and his or her relation to other people and the world. Infants must be seen as a component of a dyadic – a two part – communicative system in which the infant and adult mutually regulate and scaffold their engagements with each other and with the world of things. In interactions, they communicate their individual needs and intentions and respond to each others needs and intentions. They exchange their private meaning of themselves and the world and they create new meanings. The infant has capacities to express their intentions and sense of the world and capacities to respond to the expressed needs and intentions of the other person. Of course, the other person has to have the same capacities.

Macro-Development Introduction Infants’ and young children’s social engagement with other people, along with genetic and other experiential processes, is a fundamental process shaping a child’s normal as well as abnormal development. Normal social interaction leads to positive emotions, curiosity about the world of things, the capacity to cope with stress, and the development of close relationships during infancy

Though the classic milestone charts make the sequence of development appear like a smooth progression, normal development is neither smooth nor steady. Development actually is characterized by periods of stable organization in one domain followed by periods of disorganization in which the old organization is disassembled followed by a period of reorganization out of which a new more complex organization emerges. Crawling is an effective way of getting around in the world but it is disassembled to allow

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for the emergence of walking. Crawling allows the hands to be used only when sitting and stationary, whereas walking frees up the hands to be used while being mobile. Yet taking apart crawling in order to put together walking is energetically costly. The process is also emotionally costly because intentions cannot be fulfilled. Crawling has become less effective but walking is not yet in place such that achieving goals is difficult and frustrating. The sequence of organization, disorganization (sometimes referred to incorrectly as regressions, because the infant does not go back to an old form but rather takes apart the old), and reorganization into a more complex and coherent form of functioning characterizes the development of all systems (see Figure 1). Periods of disorganization are an ‘inherent’ characteristic of self-organizing systems which grow and develop greater levels of complexity. Adding to this complexity and costliness, the disorganization of one domain can disorganize other domains. For example, the infant who is beginning to change from crawling to walking not only becomes disorganized motorically, but also is likely to become emotionally and diurnally disorganized. The regulation of this disorganization falls to the internal self-organizing resources of the infant. These resources are not trivial and include for instance brain processes that control the limbs and posture (motor cortex, vestibular mechanisms), and other areas that control wake-activity cycles (reticular formation). Yet some of the time for all developmental changes the infant’s internal resources are inadequate to the task of controlling the disorganization. To overcome this limitation we have evolved a system to externally supplement the infant’s internal resources – caretaking, or more formally a system of mutual regulation in which the infant is part of a larger dyadic system that includes an external regulator, an adult. Under normal circumstances the combination of internal and external regulation is adequate and development

Infant’s functional and developmental status

Parent Walking

Crawling Mood Infant

Sleep Interaction

Time Figure 1 Normal development is not a smooth process but one characterized by organization, followed by disorganization and then reorganization. Disorganization in one system can disorganize other systems. The disorganization is regulated by a dyadic system made up of the infant and an adult.

moves forward. However, when the internal and external resources are inadequate development may be seriously disrupted. Disorganization increases and becomes long lasting, and in turn the development of new forms of organization fail or become compromised and coherence and complexity are lost. Note however, that a critical feature of the model is that disorganization is part of the ‘normal’ process. Disorganization is ‘necessary’ for development to move forward. It is only problematic when it exceeds the capacities of the dyad to regulate it.

Micro-Development: The Moment-byMoment Process of Mutual Regulation The infant is motivated to communicate with people, to establish intersubjective states, states in which there is mutual expression and knowing of the intentions and needs of oneself and of one’s partner. This motivation is assumed to be a biological characteristic of our species. The child also is inherently motivated to act on and make sense of their place in the world – reach for objects to know what he or she can do with it. The accomplishment of motivated action on the inanimate world, however, is often dependent in the infant and young child on the establishment of intersubjective relationships. As is the case for Homo sapiens, children can only create meanings in collaboration with others. Their understanding of the world of objects, no matter how primitive, is dependent on establishing intersubjective states with others and the mutual creation of meaning. Though we are impressed with our ability to manipulate the world of things and create new technology the primary context in which the understanding of the world emerges is when we are in social relationships. Thus the child who successfully accomplishes communication with others, develops normally. Their understanding of themselves, others and the world expands. A child who does not engage the world in a culturally appropriate manner does not develop normally no matter what causes the failure – chronic or acute illness, congenital malformations, poor parenting, toxic exposures, or parental psychopathology. Success or failure in accomplishing intentions is dependent on at least three critical processes among others. The first is the integrity and capacity of the child’s physiologic systems and central nervous system to organize and control the child’s physiologic states and behavior. The second is the integrity of the infant’s communicative system including the central nervous system centers that control and generate messages and meanings and the motor system that makes the messages manifest (e.g., gestures and facial expressions). The earliest and continuing function of the communicative system is to express the child’s intention for action to the caregiver and to communicate the

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extent to which the infant is succeeding or failing in fulfilling his or her intentions or goals. The third process, reciprocal to the second, is the caretaker’s capacity to appropriately read the child’s communications and willingness to take appropriate action. Therefore successful engagement with the world of people and things depends on the status and the effectiveness of the child–caretaker communicative system in facilitating the child’s motivated intentions. These processes make up the process of mutual regulation – the capacity of each interactant, child and adult, to express their motivated intentions, to appreciate the intentions of the partner, and to scaffold their partner’s actions so that their partner can achieve their goals.

The Mutual Regulation of Infant–Mother and Other Adult Social Interactions Infant social interactions and emotions are also regulated dyadically. The principal components are the infant’s central nervous system (e.g., primarily the limbic system) and the behaviors it controls (e.g., facial and vocal emotional displays) and the caregiver’s regulatory input (e.g., facial expressions, gestures, vocalizations). Thus, the dyadic (collaborative) regulatory system is guided by communication between internal and external components, the infant and the caregiver (see Figure 2 for one such example).

Figure 2 In (a) the infant is pulling on the mothers hair and in (b) she tries to disengage herself. In (c) she makes and angry face because it hurt as she disengaged. The infant reacts immediately and in (d) he places his hands in front of his face to defend himself. In (e) they have reestablished contact.

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The Normal Individual and Cultural Variation of Social interactions Interactions have been found to have enormous individual variation. In studies of normal mother–infant face-to-face interactions, expressions of positive affect by either the mother or the infant occur respectively about 42% for the mother and 15% for the infant. The standard deviation for positive affect for the mother varie from almost 0 to 80% or more. There is also variation between what mothers and fathers do with infants. Relative to mothers, fathers express positive affect with infants less often and spend a greater proportion of time in physical play with infants. During mother–infant interaction, infant arousal cycles between medium and low levels, and high positive affect appears gradually. In contrast, infants’ arousal during father–infant interaction is high, sudden, and organized in multiple peaks that appear frequently as play progresses. For both mothers and fathers, positive affect predicted infants’ positive affect at 6 months. Thus the ‘what’ and ‘how’ of mothers and fathers interactions with their infants is different but neither is more optimal. Another and particularly telling instance of normal variation are findings of gender differences in the affective and regulatory behaviors of normal 6-month-old infants as well as differences in interactive coherence between mothers and sons and mothers and daughters. Infant boys are more emotionally reactive than girls. They display more positive as well as more negative affect, focus more on the mother, and display more signals expressing change or stop, and demands for more contact than girls. Girls show more interest in objects, a greater constancy of interest, and better self-regulation of emotional states. Their message is more that they can do it on their own. Girls also evidence greater stability of sadness over time than boys. Sex differences in interactive coherence or matching have also been demonstrated with mother–son dyads evidencing more coherence than mother–daughter dyads. These gender differences reflect normal variants and highlight the range of affective expressiveness, regulatory behavior, and synchrony that occurs during normal interactions. Cross-cultural findings further make the point that there is no single optimal form of interaction. Among the Gusii, an agricultural community in western Kenya, mothers turn away from their infants just as their infants become most affectively positive and excited. This maternal behavior presages the socialization of later restrictions on the expression of positive affect among different individuals (e.g., younger individuals do not look directly at older individuals especially when expressing strong affect). This looking away pattern is normative for the Gusii, but is quite different from that seen in the US. American middle income mothers respond to the infant’s affective excitement with continued intense looking and

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heightened positive arousal. Looking away in a Gusii fashion by an American middle class mother would be seen as pathological. And in the US, it might be correct judgment, and it might also be correct that a American middle class gaze pattern by a Gusii mother might be pathological. The Quechua of the altiplano of the Peruvian Andes have a pattern of child-care and interaction that if engaged in the US would be seen as bordering on neglect. Quechua mothers tightly swaddle and fully wrap their infants in blankets from head to toe and then carry them on their backs. There is no light inside the wrappings, sound is muffled, and the infants can hardly move because of how they are swaddled. In addition, though the infants are nursed, the duration between feedings may be several hours and it is done in a nurturing but perfunctory manner. Thus there is minimal nurturing interaction. According to some, this pattern would be ‘abusive’, because they argue it is necessary for the infant to experience affectively intense interactions to develop normally, yet somehow Quechua infants do develop normally, but of course as Quechua. Another perhaps dramatic example is the child rearing pattern of the Efe foragers of the Ituri forest. In this community, infants are with their mothers less than half of the time in the first year and regularly interact with many different individuals per hour. Even when the mother is in proximity, a crying infant is as likely to be calmed by someone other than the mother as by the mother. Moreover, infants are regularly nursed by individuals other than their mothers. There are playful interactions, more often with individuals other than the mother, but much of the time the infant is held or carried in a sling. Despite the fact that the Efe are foragers and live in the purported niche of evolutionary adaptation, the Efe pattern of care does not conform to a universalist evolutionary model, such as attachment theory, that postulates an evolutionarily given constraint that infants ‘need’ to be taken care of by one individual, usually the mother, or at most only a very few individuals, and that they are only able to develop other relationships slowly over the first years of life. Certainly, the Efe infant will be

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different than singularly (sometimes double) reared infant in an American or European middle class family, but neither is inherently more optimal the other. And if these examples from technologically simple societies seem too distant, one need only consider that in Japan many individuals from birth to death never sleep alone, or that many Italian families’ children do not have a bedtime, but stay up or fall asleep while the rest of the family is awake and only get put to bed when the family goes to bed. These findings make it clear that there is no singular universal optimal form of mother–child interaction from which deviations are considered pathological, as implied by the attachment model. Interactions vary among cultural communities (and the individuals in those communities) in culturally meaningful ways. On a daily basis, infants repeatedly participate in a culturated but variable set of interactions which results in their internalization of culturally accepted social–emotional interactive practices. Culturated interactive ways of being can be thought of as having a narrative structure, even though it is a narrative of communicative action and not words. The child comes to ‘know’ that ‘‘this is what is happening; this is what will happen; and this is how it will feel.’’ This meaning system is established long before the child can engage in a narrative of words.

Matching, Mismatching, and Reparation The typical mother–infant interaction is one that moves from coordinated (or synchronous) to mis-coordinated states and back again over a wide affective range (see Figure 3). The mis-coordinated state is referred to as a normal interactive communicative error. It is a bit of interactive disorganization or messiness. The interactive transition from a mis-coordinated state to a coordinated state is referred to as interactive repair. The process of reparation, like the dynamics of regulating homeostatic states, is mutually regulated. The partners, both infant and adult, convey their evaluation of the state of the interaction

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Figure 3 Normal interactions move between matching and mismatching states. Each state has different emotional consequences. The change from a mismatch to a match is a reparation.

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(b)

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Figure 4 Sequence of (a) mismatch, (b) match, (c) mismatch, and (d) match.

through their affective configurations (Stop! Continue.). In turn, in response to their partner’s expressed evaluation, each partner attempts to adjust his/her behavior to maintain a coordinated state or to repair an interactive error. Critically, successful reparations and the experience of coordinated states are associated with positive affective states whereas interactive errors generate negative affective states. Thus the infant’s affective experience is determined by a dyadic regulatory process. Figure 4 presents a sequence of matching and mismatching states. Interactive mismatches have a high rate of occurrence but they are quickly repaired. In studies of face-to-face interaction at 6 months of age, repairs occur at a rate of once every 3–5 s and more than one-third of all repairs occur by the next step in the interaction. Other studies using different analytic methods have found that maternal sensitivity in the mid-range, rather than at the low or high end, typify normal interactions. Mid-range sensitivity is characterized by errors and repairs as contrasted to interactions in which the mother is never sensitive, or always sensitive. In interactions characterized by normal rates of reparation, the infant learns which communicative and coping strategies are effective in producing reparation and when to use them. This experience leads to the elaboration of communicative and coping skills, and the development of an understanding of culturated interactive rules and conventions. Reparations are associated with positive affect and with the experiential accumulation of successful reparations and the attendant transformation of negative affect into positive affect, the infant establishes a positive affective core. This internal positive affective core is a resource that allows the infant to come to new situations feeling positive about him or herself and the unknown situation. The infant also learns that he or she has control over social interactions.

Specifically, the infant develops a representation of himself or herself as effective, of his or her interactions as positive and reparable, and of the caretaker as reliable and trustworthy. These representations are crucial for the development of a sense of self which has coherence, continuity, and agency and for the development of stable and secure relationships. The functional consequences of reparation from the perspective of mutual regulation suggest that when there is a prolonged failure to repair communicative messiness, infants will initially attempt to reestablish the expected interaction, but when these reparatory efforts fail, they will experience negative affect. To evaluate this hypothesis mothers were asked to hold a still-face and remain unresponsive to the infant. Thus, the mother fails to engage in her normal interactive behavior, carry out her regulatory role, and does not allow for reparations. The effect on the infant is dramatic. Infants almost immediately detect the change and attempt to solicit the mother’s attention. Failing to elicit a response, most infants turn away only to look back at the mother again (see Figure 4(a)–4(d)). This solicitation cycle may be repeated several times. In more intense reactions when an infant’s attempts fail to repair the interaction he or she may lose postural control, withdraw and selfcomfort. The disengagement is profound even with this short disruption of the mutual regulatory process and break of intersubjectivity.

Reparatory Failure and Pathology To examine the process of reparatory failure in natural settings the interactions of depressed mothers and their

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infants have been studied. It was hypothesized that maternal depression, like the still-face, disrupts the mutual regulatory process and constitutes a break in intersubjectivity. The break is brought about by the effects of depression on maternal affect and responsiveness. Depression compromises the mother’s, and eventually the dyad’s capacity to mutually regulate the interaction. Overall, depressed mothers look away more and express more negative, angry and sad affect than do nondepressed mothers. They engage in less play and use less motherese (exaggerated intonations in adult speech to infant). The infants of depressed mothers look away more, self-comfort more, and express more sad affect than do infants of nondepressed mothers. Depressed mothers and their infants share more negative dyadic states more often and positive behavior states less often than nondepressed mothers and their infants. Depressed mothers with similar levels of depressive symptoms do not engage in the same interactive style. There are at least two interactive patterns (intrusive and withdrawal) and each disrupts the regulatory process. Importantly, in terms of the argument that development is shaped by social–relational experience each form has a different effect on the infant. One way depressed mothers act is to be ‘intrusive’. These mothers engaged in rough handling, spoke in an angry tone of voice, poked at their babies, and actively interfered with their infants’ activities. Withdrawn mothers, by contrast, were disengaged, unresponsive, affectively flat, and did little to support their infants’ activities.

As a striking demonstration of the sensitivity of the infant to these different maternal ways of being with their infants, infants of intrusive mothers (re)acted one way, whereas infants of withdrawn mothers (re)acted another way. Infants of intrusive mothers spent most of their time looking away from the mother, and seldom looked at objects. They infrequently cried. Infants of withdrawn mothers were more likely to protest and to be distressed than the infants of the intrusive mothers, suggesting that maternal withdrawal may be particularly aversive to young infants. These differential infant reactions are expected. The infants are reacting to and acting on different kinds of external social input; the affective reality they are regulating is different. Infants of withdrawn mothers are failing to achieve social connectedness because of the mothers’ lack of response and their inability to repair the interaction. Initially, they may become angry. However, since they are unable to successfully cope or self-regulate this heightened negative state, they become dysregulated, fuss, and cry. This dysregulation, similar to the dysregulation associated with homeostatic failures, compels them to devote much of their coping resources to controlling their dysregulated state. With chronic exposure moment-by-moment, day after day they develop a disengaged and self-directed regulatory style characterized by self-comforting, self-regulatory behaviors (looking away, sucking on their thumb), passivity, and withdrawal as a way of coping with their state. To the extent that this

Figure 5 In the still-face (a) the infant greets the mother as usual but in (b) almost immediately detect her lack of response the change, and attempt to solicit the mother’s attention. In (c) he looks away and in (d) turns fully away. Typically, the infant will then try to elicit the mother, much as in (a) and then cycle through (b) through (a) repeatedly.

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coping style is successful in stabilizing their affective state, it is deployed automatically and becomes defensive. This selfdirected style of coping is used in an effort to preclude anticipated negative emotions even in situations in which negative affect may not occur. This interpretation explains findings that infants of depressed mothers have less engaged and more negative interactions with a friendly stranger than do infants of non-depressed mothers. The infants of the depressed mothers are utilizing this strategy automatically without evaluating whether or not it is warranted. Eventually with the reiteration and accumulation of failure, these infants develop a negative affective core primarily characterized by sadness and anger, a representation of their mother as untrustworthy and unresponsive, and of themselves as ineffective and helpless. The infants of hostile intrusive mothers must cope with a different regulatory problem. The mother’s behavior prevents reparation of the interaction because she consistently disrupts the infants’ activities. These infants initially experience anger, turn away from the mother, push her away, or screen her out. However, unlike the failure experience of the infants of withdrawn mothers, these coping behaviors are occasionally successful in limiting the mother’s intrusiveness. Thus infants of intrusive mothers erratically experience reparation, such as a transformation of their anger into a more positive state. To the extent that these coping behaviors are successful in fending off the mother, these infants eventually internalize an angry and protective style of coping which is deployed defensively in anticipation of the mother’s intrusiveness. These infants are easily angered when interacting not only with their mother but with others as well and are more easily frustrated when acting on objects. More speculatively, these differences in infant reactions to maternal withdrawal and intrusiveness suggest an interpretation of differential effects associated with parental neglect and abuse. Infant failure to thrive, withdrawal and lack of motivation seen in situations of parental neglect, probably result in the lack of parental scaffolding leading to a constant demand on the infant to self-regulate. The infant is continuously required to control his or her own physiologic and affective states. This self-directed coping style compromises the infant’s interchanges with the environment and motivation to engage with the world. By contrast, in the abusive situation, parental abuse leads to chronic physical defensiveness and anger as well as heightened vigilance, and fear. These observations need to take into account gender differences in infant regulatory and affective styles. Boys are more affectively reactive and less able to self-regulate their affective states. This would make them particularly susceptible to the withdrawn style associated with depression because maternal withdrawal denies them the regulatory support that they need. On the other hand, girls, who are significantly more focused on objects and more

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able to maintain their own states than boys, may be more vulnerable to the intrusive style of depression which interferes with their self-organizing capacities. Combined with the findings that girls show more stability of sadness than boys, and boys show more stability of distancing and escape behaviors than girls, these gender differences in regulatory styles may be the first signs presaging the differential proportion of depression in girls and hyperactivity and aggressiveness in boys. Note, that it is not the case that girls are inherently depressed and boys inherently hyperactive. Each has different regulatory styles that in interaction with different caregiving styles make one or another outcome more likely. This perspective also has implications for the higher rates of conduct and delinquency disorders in boys. We know from the literature on juvenile delinquency that boys commit many more crimes than girls. However, there is not a very good explanation for this phenomenon, but gender differences in infancy may already set the stage for this differential rate. The explanation, however, is not simply that boys are more aggressive than girls. Rather, it is that boys have greater difficulty controlling their emotional reactions. Because of this difficulty they are more likely than girls to fail to accomplish their goals. This failure generates frustration and anger and may lead to aggression. This may be exacerbated in those situations where parenting behavior is also compromised by, for example, depression. Other at-risk populations have been studied and reparatory failure is at the heart of the interactive problems observed. Mothers with borderline personality disorder (BPD) have major emotional regulation difficulties during the social interactions and during the still-face procedure. Mothers with BPD are more intrusive and affectively negative. The infants of mothers with BPD exhibited more emotion dysregulation such as more hiccupping and spitting up. Prenatal cocaine and opiate exposure are also thought to subtly compromise social and emotional development. Mothers of cocaine-exposed infants showed more negative engagement than mothers of unexposed infants and showed higher overall levels of mismatched engagement states than nonexposed dyads, including more negative engagement when the infants were in states of neutral engagement. Infants exposed to heavier levels of cocaine showed more passive/withdrawn negative engagement and were more likely to engage in negative affective matching with their mothers than other infants. Though the effects are relatively small, cocaine exposure in general and heavy cocaine exposure in particular were associated with subtle patterns of negative affective interchanges, which may have a cumulative impact on exposed infants’ later development and the quality of their relationship with their mothers. Similar effects have been for other in utero drug exposure as well as medical conditions such as low birthweight, small size for gestational age, gestational age, and white matter disorders.

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Mutual Regulation, Brain Psychophysiology, and Resilience One way to think about the long run effects of these risk conditions is to consider the interface and interaction between the nervous system and behavior. It is well established that there is a mutual influence of brain and behavior. Mother–infant interaction in animals and humans has long-term effects on the regulation of fearful behavior and on the systems regulating stress. The stress system of the human child appears to exhibit plasticity during development, which is mediated at least in part by social factors. During the first half of the second year, an infant who has been attended by highly responsive, sensitive, loving adult will exhibit a period of low cortisol responsivity. This is hypothesized to protect structures of the brain that are developing during that time from the deleterious effects of high cortisol. Moreover, individual differences in temperament can affect the likelihood that children will show increases in stress hormones as the quality of their care decreases. Children who exhibit more negative affect are more vulnerable to elevating cortisol as quality of care. In fact work with at-risk children has shown that the longer a child is neglected, the higher the degree of developmental delay. The longer a child experiences severe neglect, the less the hypothalamic, pituitary, adrenal (HPA) system recovers when conditions are improved. Innovative research looking at the psychophysiology of relationships has made major advances and demonstrates that mutual regulatory processes not only regulate affect and behavior but physiology as well. Simultaneous recordings of cardiac responses and skin conductance have been carried out with infants aged 6 months and their mothers during normal interactions and in the still-face. The cardiac measure, heart rate and respiratory sinus arrhythmia index the parasympathetic nervous system which has an important function in downregulating arousal. Skin conductance, a measure that has been difficult to use with infants because of movement artifacts, measure the sympathetic nervous system that has a primary role in arousal. Findings suggest that maternal behavior and psychophysiology and infant behavior and psychophysiology are mutually related. Parasympathetic and sympathetic activity between mothers and their infants was found to be concordant as was infant negative engagement and parasympathetic and sympathetic activity. The finding on sympathetic activity may be of particular importance because sympathetic activity is related to the activity of the amygdala, a brain site intimately related to emotionality and reactivity. These results open up an area of relational psychophysiologic research that may deepen our understanding of mutual regulation, the development of relationships and the development of infant emotion regulation.

Conclusion Social–emotional development is a critical process affecting all developmental domains. It leads to both the sculpting of the brain as well as its experiential content. The infant as well as the adult are active participants in the interaction. It is regulated by mutual regulatory processes. The mutual regulation of the interaction however is not smooth, but rather it is a messy process characterized by the matching and mismatching of affect and intentions. Reparation of mismatching to matching states powerfully affects the development of infants’ sense of self and the emotional quality of their relationship with their partner(s). However, there is not an optimal universal form of interactions, but only interactions that are culturally appropriate resulting in the development of an culturated sense of self, even in infants. Nonetheless, interactions that produce unrelenting mismatches and failure of reparatory processes lead to withdrawal and a sense of helplessness. Humans are makers of meaning and in essence, interactions are about making meaning – meaning about the infant’s and adult’s way of being together and what they want to do together. Successful interactions lead to shared states of knowing – dyadic states of consciousness – about the infant’s and the adult’s relation to each other and to the world. Meaning making during interactions is a creative process in which the uniqueness of the infant and adult generate new meanings out of the inherent messiness of interactions. When new meanings emerge there is a growth and expansion of the complexity and coherence of the infant’s state of consciousness and infants are all about growth and development. See also: Attachment; Autism Spectrum Disorders; Breastfeeding; Child and Day Care, Effects of; Depression; Discipline and Compliance; Emotion Regulation; Empathy and Prosocial Behavior; Family Influences; Friends and Peers; Gender: Awareness, Identity, and Stereotyping; Independence/Dependence; Marital Relationship; Mental Health, Infant; Parenting Styles and their Effects; Play; Pragmatic Development; Self Knowledge; Separation and Stranger Anxiety; Shyness; Siblings and Sibling Rivalry; Smiling; Socialization; Theory of Mind; Twins.

Suggested Readings Nadel J and Muir D (eds.) (2005) Emotional Development. Oxford: Oxford University Press. Tronick E (2007) The Neurobehavioral and Social Emotional Development of the Infant. New York City: Norton Press. Schore A (2003) Affect Regulation and the Repair of the Self. New York City: Norton Press.

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Social–Emotional Development Assessment L Godoy and A S Carter, University of Massachusetts, Boston, MA, USA R Clark, University of Wisconsin, Madison, WI, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Dimensional assessments – Type of assessment that characterizes social–emotional deficits, competencies, subthreshold manifestations of symptoms, and risk factors. Emotion regulation – Refers to voluntary or automatic processes that help children control/manage their emotional reactions. For example, being able to sooth oneself by diverting attention away from distressing stimuli. The intensity and duration of emotional reactions can serve as indicators of emotion regulation abilities. Difficulties regulating negative emotions have been linked to social–emotional and behavioral problems. Joint attention – When two individuals (e.g., parent and child) are focused on or engaged in the same activity or event. Multigated or multistage screening procedures – A cost-effective, multistep screening process used to identify children exhibiting atypical behavior and psychopathology. Short, inexpensive screeners are first used to identify children at elevated risk for behavior problems from a larger pool of children and identified children are then referred for more comprehensive assessments. Semistructured observational diagnostic tools – Specialized laboratory paradigms used to assess behaviors symptomatic of particular disorders. These assessments involve a variety of ‘presses’ designed to elicit behaviors relevant to a particular diagnosis that might not be commonly observed in an evaluation session. Sensitivity – Proportion of a sample found to fall within a diagnostic category or the proportion of true positives. Sensory sensitivity and reactivity – Hypersensitivity to sensory stimuli and difficulty regulating reactions to sensory stimulation. Oversensitive and overly reactive to sensory stimuli. Social referencing – A form of emotional communication that helps young children learn about their environment through the emotional reactions of others. Children can use the emotional responses of

adults to gauge their own affective responses in unfamiliar situations. Specificity – Proportion of a sample not falling within a diagnostic category or the proportion of true negatives. Story stems – An interviewing technique used with children as young as 3 or 4 years in which the child is introduced to a story through props and narration and is asked to complete the story by showing and telling what happens next. Responses are coded based on the coherence of children’s narratives, their representations of adults as positive or negative socialization agents, and their use of coping strategies.

Introduction Since the mid1990s tremendous progress has been made in the conceptualization of young children’s social– emotional problems and competencies and psychopathology. Progress has been fueled by an emerging consensus, supported by both clinical case review and research, that infants, toddlers, and young preschoolers suffer from mental health disturbances and clinically significant dysregulated mood states, such as profound sadness, disruptive anger, and debilitating fears. Early emerging psychopathology frequently persists and is associated with child- and family-level impairments and delays in child social–emotional and academic competence. Failure to identify and address social–emotional and behavior problems early on likely leads to the exacerbation of problems and may diminish parents’ sense of efficacy in the parenting role. In short, there is a growing body of work documenting the prevalence and persistence rates of psychopathology in early childhood that are comparable to that observed in older children and adolescents. Recent Advances in the Field of Child Assessment Research documenting early child psychopathology has only emerged relatively recently due to the historical neglect of young children’s mental health issues. Previous disregard of children’s mental health needs has multiple

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determinants, including general societal stigma associated with young child psychopathology, parental fear of blame for the child’s difficulties, cultural differences in belief systems regarding both children’s development and mental health service utilization, and, until a short time ago, a lack of developmentally appropriate instruments to assess early emerging psychopathology. There has also been reluctance to dispel the notion that early childhood is a ‘sacred’, happy time and to acknowledge the seriousness and persistence of psychopathology among very young children. Many individuals, including healthcare professionals, often minimize or dismiss parental concerns assuming that early problem behaviors are temporary (i.e., ‘only a stage’ or ‘he’ll grow out of it’) and/or that the parent is overly anxious. Despite prior neglect of young children’s mental health issues, recent empirical findings support the view that young children evidence significant social–emotional and behavioral problems and psychopathology and counter the notion that these early emerging problems are transient in nature. Research contributing to recent shifts in our recognition of young children’s mental health needs is in part due to significant improvements in the assessment of young children’s social–emotional functioning and indications of psychopathology. Improved assessment techniques have allowed researchers to begin documenting the prevalence, persistence, and course of early disturbances in emotion and behavior, as well as competencies. In this sense, improvements and availability of assessment methods have fueled progress in our understanding of young children’s mental health. At the same time, advances in the conceptualization of young children’s mental health needs have contributed to improvements in assessment techniques. Acknowledgment of the complex and multifaceted nature of child development has made researchers and clinicians increasingly aware of the need to approach assessment in a manner that recognizes these complexities. For example, advances in our understanding of child development through concepts such as emotion regulation, social referencing, joint attention, and sensory sensitivity and reactivity, have contributed to more focused, developmentally salient, and empirically informed assessment techniques that are beginning to be validated through large-scale epidemiological studies. Thus, the relationship between our understanding of young children’s social–emotional development and our ability to assess behavioral problems and competencies is bidirectional and advances in both these arenas over the past decade have underscored the importance of recognizing and treating the mental health needs of very young children. A key improvement in recent years has been the broadened approach researchers and clinicians have taken to conceptualizing and evaluating children’s social–emotional functioning. Traditional approaches have been limited by

an overemphasis on diagnostic considerations focused on identifying whether a child is exhibiting prominent deviations from expectations in social–emotional functioning based on meeting criteria on a list of symptoms developed for use with older children, adolescents, and adults. Assessing extreme or deviant behaviors is critical to the accurate identification of disorders, but a more developmentally sensitive and dimensional approach to assessment provides a more comprehensive understanding of young children’s social–emotional development. Such an approach not only characterizes social–emotional deficits but also subthreshold manifestations of symptoms and risk factors, as well as competencies. Assessments have also been broadened by evaluating patterns of strengths and weaknesses across multiple domains of functioning and by considering behaviors within a developmental framework that acknowledges the relevant ecologies that transact with the individual’s functioning over time.

Difficulties Involved in Child Assessment While dramatic improvements in the conceptualization and assessment of young children’s social–emotional development have been made, it is useful to examine the inherent difficulties involved in evaluating very young children. Caregiver Reporter Issues Infants and young children have little or limited speech, which makes it difficult for them to convey their thoughts and feelings to their parents, other care providers (e.g., extended family members, daycare teachers), clinicians, and researchers. Even young children who have a better grasp of language lack the meta-cognitive ability to reflect on their experiences. Skepticism about the reliability of child report data, especially with very young children, has compelled researchers and clinicians to look elsewhere for reliable and valid sources of information about young children’s social–emotional functioning. Reports from adult sources, though considered more reliable than child report data, still pose considerable concerns due to potential biases and response style differences that can stem from a number of factors. Parental affective symptoms, especially depression and anxiety, can distort perceptions of child behavior. Often parental psychopathology increases negative reports of behavior problems as children’s problems may seem worse when a parent has limited emotional resources for responding to a child’s emotional needs, to state expectations clearly, to set limits, or to respond appropriately to problem behaviors. Alternatively, some parents under-report symptoms for fear of stigma or of involvement by outside agencies.


Varied response patterns can also emerge from differences in familial and cultural interpretations of child behavior. Families construct meanings of young children’s behavior based on the history of interactions between the parents and child, the caregivers’ prior relational or attachment history, and cultural values and beliefs. The interpretation or meaning attributed to the child’s behavior influences the parents’ level of concern about and responses to the child. Thus, the same set of child behaviors may evoke widely disparate reactions from different parents. This poses some problems in distinguishing children who have social–emotional/behavioral problems from those whose parents interpret typically developing behaviors as evidence of a problem. Distinguishing Typical from Atypical Development Discriminating typical from atypical development is complicated by the rapid pace of children’s development. Behaviors considered normative at one stage of development may be cause for concern if exhibited at a later stage. For example, temper tantrums during toddlerhood are normative since oppositional behavior during this time signifies an emerging sense of self and an assertion of autonomy that reflects the child’s understanding of their individual agency. However, tantrums that persist beyond the preschool years or significant anger outbursts in later childhood are most often evidence of atypical, or maladaptive social–emotional functioning. In addition to considering the presence or absence of a particular behavior, the frequency, intensity, quality, and context in which the behavior emerges, as well as whether or not there is a broader pattern or constellation of problems is also important in distinguishing typical from atypical adaptation. For example, even during the toddler years, prolonged temper tantrums that cannot easily be assuaged, that occur multiple times a day across many different settings (e.g., home, daycare, supermarket) and that include hitting, biting, or destroying toys would be considered atypical. Characterizing typically occurring behavior problems, such as temper tantrums, by degree of intensity, frequency, or duration makes it difficult to establish the boundary between typical development and psychopathology. Observational attempts to distinguish typical and atypical behaviors are made difficult by young children’s changing mood states. Assessment of optimal functioning is state dependent and infants and young children’s states change often and are affected by lack of sleep, hunger, and illness. Due to children’s variability in mood states and behaviors across time and sessions, when assessing young children directly, it is important to schedule multiple assessments across several different sessions.

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Given rapid developmental shifts in early childhood, creators of dimensional assessment tools have attempted to identify coherent clusters of problem and/or competence behaviors. Although it was once believed that it would not be possible to see differentiation of different types of social–emotional problems in early childhood, large-scale normative studies have demonstrated that parents can report about their children’s problems in a manner that distinguishes children who are predominantly anxious or withdrawn from those who are aggressive or overactive from those who have problems with sleep, eating, or sensory sensitivities. Normative data about the clustering of behaviors and data about children with known psychopathology are used to establish cut-points that are then employed to assign caseness (e.g., clinical or at-risk status). Ideally, measures designed to assess young children’s development rely on narrow age bands for comparison that gradually increase over the course of development. The need for narrow comparison groups is particularly salient for social–emotional behaviors, such as competencies, which change at a more dramatic rate throughout early childhood, when compared to problem behaviors. Normative data are clearly needed to evaluate children’s development, yet there is very limited epidemiological or national standardization data regarding very young children’s expression of social–emotional/behavioral problems and competencies. Limited normative data makes it difficult to discern typical from atypical development, especially when symptom presentation is not extreme. Fortunately, with the development of new assessment tools, researchers are now able to conduct largescale epidemiological studies to gather data on individual behaviors, symptom clusters, and disorders. Given that the absence of sufficient normative data likely contributes to the under-identification of psychopathology in young children, current epidemiological studies are providing the momentum needed to document young children’s mental health needs and facilitate earlier identification of young children exhibiting early signs of psychopathology. Assessing Children within the Caregiving Context A final and critical difficulty in the assessment of young children’s social–emotional development is the need to consider children within the context of their relationships. Young children’s development is embedded within their caregiving relationships making it critical to examine child behavior, functioning, and impairment within these contexts. Caregivers structure children’s environments through affective, regulatory, verbal, and physical support. Parents can therefore impact child problem behaviors and competencies through the quality of affective involvement and scaffolding they provide. For example,

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a caregiver who does not provide adequate responsiveness may elicit and/or reinforce problem behaviors that are not observed in other contexts. Alternatively, a child who has significant problem behaviors across several settings may appear well-regulated with a particular caregiver due to the unique sensitivity, accommodations, and affordances that s/he provides. In addition to evaluating the ways in which caregivers structure the child’s environment, consideration must also be given to the match (or mismatch) between a child’s temperament and developmental functioning and the situational demands and supports in his environment. Parents’ perceptions of their child’s behavior and of themselves in the parenting role is also important to assess in order to understand the nature of their interactions with their child. Thus, problem behaviors in a young child may reflect a mismatch between the child and the caregiving environment or caregiver capacities to meet the child’s needs. In short, young children and their caregivers are inextricably linked, making assessment of the parent–child relationship critical to the evaluation of a child’s social and emotional development. Problem behaviors that occur across relationships are generally viewed as of greater concern than those that are limited to a single caregiver. Also of greater concern are behaviors viewed as impairing, including those behaviors that impede the acquisition of new developmental capacities and skills, interfere with relationships, or threaten adaptation to developmentally appropriate demands. For older children and adults, individual impairment is necessary for a diagnosis of psychopathology, but with very young children, individual markers of impairment may be absent despite the presence of risk or disorder, as caregivers may minimize demands that would illuminate the child’s impairment. Moreover, since young children develop within their caregiving relationships, evaluations of impairment that consider both child and family individual and relational impairments may be more appropriate. For example, parental distress or indicators that the child’s behavior interferes with the parent’s ability to maintain family routines (e.g., eating together as a family in a restaurant), household activities (e.g., making a telephone call to family members or friends), or employment (e.g., stopping or changing work settings because of difficulty obtaining appropriate child care) could be considered an appropriate gauge of impairment for young children. From a developmental–contextual perspective, it is therefore important to evaluate the functioning of both the child and the family in determining level of impairment. Evaluating the family context requires first characterizing basic features such as who is considered a member, how many members make up the family, and the gender and age of each family member. In addition to descriptive features of the family context, broader characteristics

of family climate and relationships should be assessed, including communication styles, affective tone and expressiveness, sensitivity, warmth and responsiveness, cohesion, mutuality, reciprocity, and adaptability. These characteristics, which can be assessed with questionnaires and observational methods, have been shown to influence cognitive and social–emotional outcomes for children. Race, Ethnicity, Culture, and the Caregiving Context Critical to evaluations of the family context is an understanding of families’ racial, ethnic, and cultural backgrounds. Though not unique to child assessment, considerations of race, ethnicity, and culture are fundamental to the mental health evaluation process and thus deserve considerable attention. Race is a socially constructed classification system based on physical traits. From a population genetics perspective, there are no discrete boundaries between racial groups. Culture refers to shared values, beliefs, and practices that are transmitted across generations within a group. It is critical to recognize that culture is not a static entity, but is dynamic and responsive to the settings and conditions to which the family must adapt. Ethnicity is used to denote a particular kind of culture, which is usually associated with a common geographic region, or national origin. Distinctions between culture, ethnicity, and race are often ignored, yet families of color face unique challenges associated with societal racism and stereotyping. Thus, the caregiving context may be influenced by race, independent of the contribution of culture and ethnicity. Considerations of culture, race, and ethnicity are vital to sensitive evaluations of the caregiving context. Yet, understanding the role of culture in development is becoming more complex in part because families are increasingly multiethnic, cultural, and racial. There are also wide variations in acculturation patterns within and across ethnic, cultural, and racial groupings and generations. Thus, researchers and clinicians should talk with families about their cultural formulations/expectations of caregiving and child behavior. Specifically, parents can evaluate the child’s behavior relative to other child behavior in their cultural group(s) and they can discuss cultural explanations for the child’s difficulties or distress. With a clearer understanding of a family’s worldview, clinicians and researchers can better evaluate the child’s behavior and the context in which it emerges and is understood by the family. Increased awareness of differences between the evaluator and the child’s family should improve the gathering of reliable and valid data about child and family functioning. In addition to determining cultural explanations for child behavior, it is critical for researchers and clinicians


to engage in a continual process of self-reflection and awareness about their own background and worldview in order to avoid biases that could lead to over- or underpathologizing the child or family practices. In short, cultural proficiency is central to gathering reliable and valid information about child behavior, the caregiving context, and the way in which the family understands the child’s behavior. Summary: Difficulties Involved in Child Assessment In attempting to evaluate children’s social–emotional functioning, researchers and clinicians face several challenges. Some of these challenges, such as limited meta-cognitive abilities and rapid developmental shifts, are unique to the process of child assessment, but several of these challenges, such as the need to consider contextual factors, are faced by researchers outside of the field of child development. Acknowledging the difficulties inherent in the evaluation of children’s social–emotional development is vital to conducting competent assessments. Moreover, advances in the field of child psychopathology and in the assessment of social–emotional development have the potential to address several of the difficulties currently faced by investigators.

Types of Assessment Several assessment techniques exist with which to examine young children’s social–emotional functioning, each differing in terms of advantages and drawbacks. Having an understanding of each technique allows for a more thoughtful and appropriate approach to assessment. Whenever possible, multiple techniques are combined to develop a more comprehensive understanding of the child and family context. Caregiver Report: Rating Scales, Questionnaires, and Interviews Rating scales and questionnaires are the most commonly employed assessment tools in research applications as they are inexpensive, quick, and easy to administer to a large number of individuals in a flexible manner (i.e., in person, via mail, online). Parents or primary caregivers are the most frequent reporters on questionnaires about young children’s development, but other caregiver (e.g., daycare providers) can contribute valuable information as well, particularly to gain an understanding of the pervasiveness of problems and competencies across caregiving relationships and contexts. The response format of questionnaires typically requires the person completing

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the questionnaire to consider certain characteristics or behaviors and evaluate the extent to which these behaviors are representative of the target child and/or how often they occur. Likert scales are commonly employed ranging from never/uncharacteristic to often/very characteristic. Thus, questionnaires often cross ratings of the frequency of a behavior with ratings of whether the behavior is typical of the child. Although this is sufficient for identifying children at elevated risk for psychopathology, it does not yield information that is sufficient for determining clinical diagnostic status. To determine whether or not a child meets criteria for a diagnosis, information about onset, duration, and intensity of behaviors, as well as the extent to which they are impairing the child’s development is required. Moreover, questionnaires often exclude behaviors that are rare in the population or that have very low base rates of occurrence because their inclusion compromises psychometric sufficiency (i.e., reduces internal consistency). These rare behaviors may be very informative clinically and may also be elements in diagnostic criteria for specific childhood diagnoses. Structured or semistructured interviews with parents or caregivers, commonly employed in clinical assessments, allow for a more in-depth examination of child problems and competencies than do questionnaires. Interviewers can obtain specific examples of child behavior and inquire about the onset, offset, frequency, duration, intensity, quality, and context of occurrence through follow-up questions and probes. Thus, interviews allow for a more comprehensive understanding of the child’s behavior and they permit diagnostic determinations. Unfortunately, structured and semistructured diagnostic interviews are too rarely administered because of time constraints and training issues. The use of both questionnaires and interviews often yield information about areas that a parent is not worried about but that the clinician determines to be an area of clinical concern. Thus, gathering information about multiple aspects of children’s social–emotional and behavioral functioning, whether through questionnaires or interviews, is an important component of best practice for young child evaluation. Obtaining information from the child’s primary caretaker through questionnaires and interviews is beneficial because caregivers have an intimate knowledge of their child’s development. Parents are familiar with their child’s behaviors, temperament, and routines. Moreover, unlike observational techniques that only provide information about a moment in the child’s development, parents can provide a historical account of the child’s development, can report on how the child’s behavior has changed, and can explain the context of the child’s current and past behavior. For example, a parent is in the unique position of being able to report on the number of temper tantrums

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a child has per week, whether there has been an increase or decrease in the tantrums, what normally triggers the tantrums, how long they last, and what supports the child needs to help him or her calm down. In sum, parents can provide information about the child’s current and past behaviors that is informed by a rich developmental and contextual knowledge of the child. Parents are attractive reporters because they know the most about a child and that child’s development. Moreover, research has demonstrated that parents can describe their young children’s social–emotional and behavioral problems and competencies in a differentiated manner, distinguishing between problems and competencies in various domains. However, as discussed above, parents vary in their explanations of child behavior, which poses difficulties to the interpretation of parent reports. Additionally, parents can be biased reporters and poor historians making sole reliance on parent reports questionable. Thus, information obtained from parent interviews and questionnaires should be considered in light of potential biases and differences in responding and should be supplemented, whenever possible, with additional sources of information. Child Report: Puppet Interviews and Story Stems Innovative interviewing techniques targeting children are one possibility for obtaining supplemental information. For example, puppet interviews have been devised in which puppets are employed to ask children a series of questions about their perceptions of their family, school, and emotional states. The interviewer has two puppets, each endorsing a different statement. The puppets then ask the child which statement he or she would endorse (e.g., Puppet 1: ‘‘My parents fight a lot’’; Puppet 2: ‘‘My parents don’t fight a lot. How about your parents?’’) Puppet interviews elicit self-report information that may not emerge naturally in laboratory settings. Young children feel more comfortable expressing their perceptions of their lives and their feeling states to puppets rather than to unfamiliar clinicians. Another method that has been shown to be very useful with young children is the introduction of story stems that the child is asked to complete. Specifically, the child is introduced to characters in the story, shown a series of props, and then the interviewer will narrate the beginning of a story while using the props (e.g., ‘‘Johnny and his friend Tommy are playing soccer. Johnny’s little brother walks up to them and says: ‘Can I play?’ ’’). The child is then asked to ‘‘Show me and tell me what happens next.’’ Coding systems have been developed that focus on the coherence of children’s narratives, their representations of adults as positive or negative socialization agents, and their use of coping strategies. These codes are associated

with a range of children’s social–emotional and problem behavior outcomes. Puppet interviews and story stems conducted with children as young as 3 or 4 years have been shown to be reliable and valid assessment instruments. Although these new child interviewing techniques appear promising in their ability to provide valuable information about child social–emotional and behavioral functioning in both the family and school context, doubts about reliance on child reports (noted above) remain. Observational Techniques: Semistructured Diagnostic Tools and Parent–Child Interactions One promising avenue in the evaluation of children’s social–emotional functioning that can be used to supplement questionnaires and interviews is the development of semistructured observational diagnostic tools. Observational assessments are currently available to evaluate autism spectrum disorders and disruptive behavior disorders in young children. The assessments involve a variety of ‘presses’ designed to elicit behaviors relevant to a particular diagnosis (e.g., autism, oppositional defiant disorder) that might not be commonly observed in an evaluation session where the setting and examiner are unfamiliar to the child. For example, to address oppositionality, frustration is elicited by having children attempt to use a broken toy without the child knowing that the toy is broken. Though useful in identifying behaviors symptomatic of particular disorders, these instruments are quite specialized. In other words, observational techniques that use presses are most relevant when the evaluator has targeted a particular diagnostic category. Given the centrality of parents in young children’s lives, observing parent–child interactions proves vital to the assessment of children’s social–emotional development. A number of laboratory paradigms exist with which to evaluate parent–child interactions, including separation/ reunion, feeding, free play, and structured tasks (e.g., building a tower or completing a puzzle). Segments typically last a couple of minutes and the interactions are videotaped and later coded using standardized coding systems that evaluate child behavior, parent behavior, and parent–child interaction quality. Consistent with interview, rating scale, and questionnaire data, observational methods vary along a continuum of structure and the level of inference required to evaluate the constructs of interest. In addition, observational data add the dimension of time, and decisions must be made regarding the timeframe of the analysis (e.g., continuous vs. time or event sampling). The unit of analysis in terms of a micro-analytic or macro-analytic focus must also be considered. Such decisions will be driven by the constructs under study. Use of a standardized protocol and coding scheme allows evaluators to assess child behavior and parent–child


relationships free from reporter biases. In this sense, observational techniques are more objective than questionnaires or interviews, which rely on information from parents who will vary in their perception of child behavior problems. Though observational techniques avoid parent subjectivity and biases, coding schemes and decision making are inherently subjective and culturally biased. Thus, it is important to acknowledge the intrinsic subjectivity of all evaluation techniques, including observations. One complement to observational ratings is to involve the parent in viewing the videotape to capture their perceptions of their child’s behavior in the observational paradigm, as well as their perceptions of themselves in the parenting role. Selecting segments of the interaction and viewing these with the parent can help to engage them in ‘wondering along’ about who this child is for them, who he/she may remind them of, and how they are interpreting their child’s behavior. This can both allow the parent(s) to be part of the assessment process and help to inform our understanding of their responses or difficulty responding to their child’s needs. In addition to the difficulties involved in creating an objective coding scheme, observational techniques have other drawbacks as well. Observations are only able to capture a snapshot of the child’s behavior and quality of the parent–child relationship at one point in time. Thus, unlike parent reports, observational techniques may be less able to put the observed behaviors into context developmentally. Laboratory observations also do not provide contextual information about the antecedents or consequences of behaviors in everyday life. Situational-specific behaviors (i.e., problems that only occur while at preschool) may not be exhibited or may be displayed differently during observational assessments. Observations are also more expensive to employ than questionnaires and interviews due to time needed to train staff, administer the paradigm, and code the videotapes. Summary: Assessment Techniques Clinicians and researchers evaluating children’s social– emotional development can choose from an array of assessment techniques. These tools vary with respect to who provides information about the child, the method of assessment employed (e.g., questionnaire, interview, or observation), the timeframe that is covered (e.g., last 2 weeks, last year, lifetime), and the type of information that is gathered. Given the spectrum of assessment tools and the pros and cons of each, the most comprehensive approach to child assessment involves the use of multiple techniques that gather information from various respondents. Multimethod, multi-informant assessment approaches are especially important for the evaluation of young children due to young children’s inability to provide self-reports and the embedded nature of children’s development in their caregiving contexts.

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Evaluating Assessment Techniques Regardless of the assessment approach taken, the psychometric properties of the instruments should be evaluated. With respect to reliability, the more structured the assessment format, the easier it is to obtain adequate test–retest and inter-rater reliability coefficients. Similarly, the lower the inference level required to make ratings (either for the informant or the evaluator), the greater the probability that adequate reliability can be obtained. With respect to validity, an assessment’s underlying traits or constructs should be confirmed using factor analytic or item response theory methods within a developmental framework to ensure that the measure has the same structure and measures the same traits/constructs over development. In addition, because it is rare to obtain appropriate within ethnic group reliability and validity data, investigators who are working with minority populations are encouraged to report internal consistency statistics when presenting findings. It is not appropriate to assume that the internal consistency or factor structure obtained in a dominant culture population will be comparable when a scale is employed with ethnic/racial minority groups. Although an assessment tool may be a reliable and valid measure of an underlying construct or behavior, there is still an issue of how useful it might be for a given diagnostic or classification purpose (e.g., meets criteria for oppositional defiant disorder, is peer rejected, has a relationship disturbance that warrants intervention). The measures of sensitivity (proportion of a sample found to fall within a diagnostic category) and specificity (proportion of a sample not falling within a diagnostic category) help to determine how well any test can be used for a specific diagnostic purpose. Specificity should be high for assessment tools designed to aid specific diagnoses (e.g., structured clinical interviews, structured observational diagnostic tools). However, for assessment tools aimed at screening large samples and identifying atrisk individuals regardless of their diagnostic status, it becomes more challenging to maintain a balance whereby a sufficient proportion of children with problems are detected while maintaining an acceptable rate of false positives. If the scoring threshold is too high, then too few true ‘cases’ (e.g., meets criteria for a psychiatric disorder) will screen positive and the screener will have low sensitivity. Yet, the screener will likely have high ‘specificity’, meaning it will identify a low proportion of ‘noncases’ as screen positives. In contrast, if the threshold is set too low, sensitivity will be high, but specificity will be low, potentially flooding the service system with unnecessary costs for assessing false positives. Also of concern is the problem of misclassification and its impact on the child and family being evaluated. Thus, it is important to achieve a balance between identifying a sufficient

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proportion of ‘cases’ to effectively improve early detection, while minimizing false positives. It is therefore necessary to document that assessment tools are sufficiently sensitive to clinically significant social–emotional/behavioral problems (detecting a minimum 80% of cases), yet maintain false positive rates that are low enough (20% or lower) that service systems are not overwhelmed unnecessarily. Additionally, one should not expect any test to have stable sensitivity and specificity for a particular diagnostic decision across the developmental spectrum, especially with diagnostic conditions that might have different base rates at different ages (e.g., speech disorders). Psychometric concepts are frequently given only passing attention in clinical practice or research, when time and ease of administration are often the first priorities, but conceptual issues, such as a test’s factor structure, are critical considerations for assessing the development of an individual or group. A developmentally informed comprehensive perspective on psychological assessment can only be achieved with a basic understanding of psychometric and methodological issues.

Conclusion: Remaining Gaps and Future Directions The range of assessment techniques available to clinicians and researchers evaluating children’s social–emotional development has increased dramatically over the past 10–15 years. The versatility and quality of these methods will continue to grow as more questionnaires and rating scales become available with appropriate normative information, and as clinical interview methods and observational paradigms are standardized. Several challenges to the assessment of children’s social–emotional development persist and warrant consideration in future research. A major existing difficulty is determining appropriate methods for integrating data across different methods and sources. Data integration is further complicated when multiple informants provide conflicting information. However, conflicting data are often informative and contribute an added dimension to the assessment, especially in terms of understanding the systems in which the individual functions. As informants may have access to different samples of behavior in multiple settings, conflicting information may reflect true variability in current functioning. On the other hand, conflicting information may be a function of observer or interviewer biases. Additional research on how best to synthesize information from multiple sources is clearly needed. A current challenge to assessment that is in the process of being addressed is the lack of normative data. Several large-scale, longitudinal, epidemiological studies are

currently underway and their findings will be critical to disentangling the continuities and discontinuities in normative and atypical development. Large, representative samples also permit cross-group validation, which will allow much needed examinations of the cultural, racial, and/or ethnic appropriateness of assessments. Sadly, at this point in time, very few psychological tests, scales, or interview assessments have undergone such scrutiny, even for the largest racial/ethnic groups within the US population. A potentially complicated issue related to culture is that of assessing multilingual individuals. It is inadequate to employ a measure that has been translated into the target population or client’s native language because the translation may not be appropriate for the population under study or the family seeking treatment. Differences in language or contextual understanding of behaviors and emotions must be examined and efforts made to minimize miscommunication. Furthermore, translation and backtranslation do not guarantee that the psychometric properties of the instrument will remain stable across cultural, racial, or ethnic groups. Thus, researchers and clinicians must evaluate the cultural and linguistic appropriateness of assessment techniques being used and work toward the development of more suitable measures. The role of race, ethnicity, and culture in the assessment of young children’s social–emotional development should be a central focus of future work given the increasing diversity of the US population and prior neglect of these issues within the field of child development and assessment. Research initiatives designed to improve assessment techniques for diverse populations are therefore critical. Increased awareness of parents’ understanding of child behavior will be vital to these initiatives. Since assessment is linked to diagnostic and treatment decisions, advances in cultural conceptualizations of assessment have the ability to encourage culturally sensitive diagnostic guidelines and treatment recommendations. Additionally, during assessments investigators and clinicians can take a more proactive role by inquiring about parents’ experiences with and preferences for treatment. Given the emerging body of work documenting psychopathology among very young children and the increasing number of assessment instruments available, more effort should be made to increase widespread assessment of children’s social–emotional behavioral development. Screening and diagnostic measures remain under-utilized even though measures of social–emotional development have proven reliable and valid and behavioral screening has been introduced successfully into a number of settings, including the primary care pediatric office. Reluctance to screen is in part due to continued resistance to acknowledge psychopathology in young children, knowledge barriers about the seriousness of early


emerging psychopathology, resource limits regarding the availability of appropriate mental health services for young children and their families, short-term costs, and lack of trained professional evaluators. As child assessments become more widespread, the need for trained professionals knowledgeable in assessment techniques for young children will only increase. Training should cover basic knowledge about social–emotional developmental expectations of young children, as well as skills for working with young children and their families in an assessment context. For example, evaluators should be trained to spot the toddler who has trouble waiting and find ways to respectively engage both the parent and the young child and to move quickly through the assessment process. However, lack of available referral services remains the largest barrier to screening. That the overwhelming majority of children whose parents report social–emotional/ behavioral problems do not receive services highlights the need for enhanced screening and intervention efforts. Multigated or multistage screening procedures offer a cost-effective means for screening large groups of children. The first step in the process involves utilizing a short and relatively inexpensive screening assessment tool to identify children at elevated risk. Pediatric visits are an ideal venue for such first-stage screening. Children who are identified as at elevated risk can then be referred for a second, more comprehensive screening that might involve a longer parent report instrument about the child’s behavior, the parent’s degree of concern about the behaviors, and the presence of any impairment as a function of the child’s social–emotional behaviors. The meaning of the child’s behavior and cultural considerations are central foci of the comprehensive second-stage assessment. Depending on available resources, the third stage of screening could involve observations, collateral informants, and/or referral for more intensive diagnostic evaluation. Ideally, this third-stage evaluation would be conducted at a site that can also provide intervention services. Routine social–emotional screening and followup assessments, especially in a primary care pediatric setting may play an important role in ensuring that the needs of young children with early-emerging difficulties are addressed. Research documenting the prevalence of child psychopathology and the persistence of early behavior problems may provide the thrust necessary to create systemic changes in the assessment, diagnosis, and treatment of very young children exhibiting social–emotional and behavior problems. The availability of assessment tools can bolster this research and improve studies that focus on the clinical efficacy and effectiveness of screening, prevention, and early intervention programs designed to promote positive mental health. Ideally, such studies would encourage the implementation of the assessment

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and prevention practices being evaluated, as well as the training of professionals who have the competence to both assess and treat young children and their families. Thus, in helping to document the prevalence and consequences of early emerging psychopathology, as well as the benefits of early identification and intervention, high-quality assessment techniques have the potential to improve mental healthcare systems for very young children. Children and families currently underserved by current healthcare and mental healthcare systems, who also happen to be the most vulnerable in terms of being exposed to multiple contextual risk factors, may gain the most from this line of assessment research. See also: Social and Emotional Development Theories.

Suggested Readings Canino G, Costello EJ, and Angold A (1999) Assessing functional impairment for child mental health services research: A review of measures. Journal of Mental Health Serivces 1: 93–108. Carter AS, Briggs-Gowan MJ, and Davis N (2004) Assessment of young children’s social–emotional development and psychopathology: Recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry 45: 109–134. Carter AS, Marakovitz SE, and Sparrow SS (2006) Comprehensive psychological assessment: A developmental psychopathology approach for clinical and applied research. In: Cicchetti D and Cohen DJ (eds.) Developmental Psychopathology Vol. 1: Theory and Method, 2nd edn, pp. 181–210. Hoboken, NJ: Wiley. Clark R, Paulson A, and Conlin S (1993) Assessment of Developmental Status and Parent–Infant Relationships. In: Zeanah CH (ed.) Handbook of Infant Mental Health, 2nd edn, pp. 191–209. New York: Guildford Press. Clark R, Tluczek A, and Gallagher K (2004) Assessment of Parent-child Relational Disturbances. In: Del Carmen-Wiggins R and Carter AS (eds.) Handbook of Infant,Toddler, and Preschool Mental Health Assessment, pp. 25–60. New York: Oxford University Press. Crowell J and Fleischmann MA (1993) Use of structured research procedure in clinical assessments of infants. In: Zeanah CH (ed.) Handbook of Infant Mental Health, 2nd edn, pp. 210–221. New York: Guilford Press. Del Carmen-Wiggins R and Carter AS (eds.) (2004) Handbook of Infant, Toddler, and Preschool Mental Health Assessment. New York: Oxford University Press. Glascoe FP (2000) Early detection of developmental and behavioral problems. Pediatric Review 21: 272–280. Task Force on Research Diagnostic Criteria: Infancy Preschool (2003) Research diagnostic criteria for infants and preschool children: The process and empirical support. Journal of the American Academy of Child and Adolescent Psychiatry 42: 1504–1512. Weston DR, Thomas JM, Barnard KE, et al. (2003) DC: 0–3 Assessment Protocol Project: Defining a comprehensive information set to support DC: 0–3 diagnostic formulation. Infant Mental Health Journal 24: 410–427.

Relevant Website http://www.zerotothree.org – Zero to Three, National Center for Infants, Toddlers and Families.

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Socialization

Socialization R D Parke, M S Leidy, T J Schofield, M A Miller, and K L Morris, University of California, Riverside, Riverside, CA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Co-parenting – The patterns of cooperative or noncooperative alliances that mothers and fathers assume in their parenting roles. Family systems theory – The view that various subsystems such as the parent–child dyad, sibling, co-parenting, and marital units are interdependent. Socialization – The process by which an individual’s standards, skills, motives, attitudes, and behaviors change to conform to those regarded as desirable and appropriate for his or her present and future role in any particular society.

Introduction Socialization is the process by which infants and children acquire the standards, skills, motives, attitudes, and behaviors that are appropriate for a particular society and culture. Currently, ecological systems theory is the central framework for understanding socialization. According to this perspective, many agents play a role in the socialization process including families, peers, media, neighborhoods, schools, and religious institutions. Within families, various subsystems are recognized, including the parent–child dyad, the co-parenting, marital and sibling subsystems as well as the family unit itself. Families, in turn, are embedded in a variety of extrafamilial socialization systems (e.g., peers and schools) and they operate together with families rather than independently. A variety of factors such as child characteristics including genetic differences, personal parental resources, contextual factors, and ethnicity modify the operation of these socialization influences.

Socialization in Infancy and Childhood Socialization is the process whereby an individual’s standards, skills, motives, attitudes, and behaviors change to conform to those regarded as desirable and appropriate for his or her present and future role in any particular society. Many agents play a role in the socialization process including families, peers, neighborhoods, the mass media, schools, and religious institutions. It is assumed

that these various agents function together rather than independently. Families have been recognized as an early pervasive and highly influential context for socialization. Infants and children are dependent on parents for nurturance and support from an early age, which accounts, in part, for their prominence as a socialization agent. We next consider peers, mass media, and neighborhood socialization influences. In this article, we will focus on parents, as well as sibling, co-parenting, and marital subsystems as contexts for socialization. Next, we will examine the determinants of parental socialization strategies. Finally, we examine the socialization roles of a variety of extrafamilial influences (e.g., peers, media).

Contemporary Perspectives on Socialization Several themes are evident in current theoretical approaches to socialization. First, the rise of systems theory has transformed the study of socialization from a parent–child focus to an emphasis on the family as a social system. To understand fully the nature of family relationships, it is necessary to recognize the interdependence among the roles and functions of all family members. Second, it is being increasingly recognized that families are best viewed as social systems. Consequently, to understand the behavior of one member of a family, the complementary behaviors of other members also need to be recognized and assessed. For example, as men’s roles in families shift, changes in women’s roles in families must also be monitored. Third, different units of analysis are necessary in order to understand families. While the individual level – child, mother, and father – remains a useful and necessary level of analysis, recognition of relationships among family members as units of analysis is necessary. The marital relationship, the co-parental relationship, the mother–child, the father–child relationship, and the sibling–sibling relationship require separate analysis. Finally, the family as a unit that is somewhat independent of the individual or dyads within the family requires recognition. Fourth, contemporary work on socialization recognizes the importance of considering the wide range of forms that families assume in our society. While our focus will be largely on intact, two parent families, many children are raised in a variety of nontraditional family structures

Socialization

including single parent households, same gender parent families, extended families in which grandparents or another relative are the primary caregivers, families formed through the assistance of new reproductive technologies, and adoptive families. Many children are also reared in stepparent or divorced families with varying custody arrangements. While care needs to be taken in generalizing from research on socialization of children in traditional family arrangements to other family forms, many of the issues that we address in this article are relevant for understanding socialization in other family structures as well. A fifth conceptual shift is from unidirectional to transactional models of relationships among family members. There have been various phases in the conceptual thinking in this domain. In place of the unilateral model, a bilateral model has emerged as the dominant paradigm for guiding research in the parent–child relationship domain. In contrast to the unilateral model, the direction of causality between parents and children is bidirectional, equal agency on the part of parents is assumed, and power relations are characterized by ‘interdependent asymmetry’. Sixth, under the influence of Urie Bronfenbrenner’s ecological theory, recognition is being given to the embeddedness of families within a variety of other social systems, including both formal and informal support systems as well as the cultures in which they exist. These include a wide range of extrafamilial influences such as extended families, informal community ties such as friends and neighbors, work sites, as well as educational, religious, medical, and other social institutions. A further shift over the last two decades is the challenge to the universality of our theories of parent–child relationships as well as peer relationships. This challenge takes a variety of forms. First, as cross-cultural work has accumulated, it has become evident that generalizations from a single culture (e.g., American) may, in fact, not be valid in other cultural contexts. Second, studies of social class differences in socialization challenged the generality of findings even within one cultural or national context. Currently, there is an increased awareness of the importance of both recognizing and studying variations in socialization strategies in other cultures as well as across ethnic groups within our own culture. An eighth and closely related theme involves the recognition of the importance of the historical time period in which the family and peer relationships are taking place. Historical time periods provide the social conditions for individual and family transitions: examples include the 1930s (the Great Depression) or the 1980s (Farm Belt Depression). Across these historical time periods, family interaction may, in fact, be quite different due to the unique conditions of the particular era. Ninth, in order to understand the nature of parent– child relationships within families, a multilevel and

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dynamic approach is required. Multiple levels of analysis are necessary in order to capture the individual, dyadic, and family unit aspects of operation within the family itself as well as to reflect the embeddedness of families within a variety of extrafamilial social systems. The dynamic quality reflects the multiple developmental trajectories that warrant consideration in understanding the nature of families in infancy and childhood. Distinctions among different developmental trajectories, as well as social change and historical period effects, are important because these different forms of change do not always harmonize. For example, a family event such as the birth of a child may have more effects on a man who has just begun a career than on one who has advanced to a stable occupational position. Moreover, individual and family developmental trajectories are embedded within both the social conditions and the values of the historical time in which they exist. The role of parents as socialization agents is responsive to such fluctuations. Tenth, a major change in the study of parent–child relationships, is the renewed interest in the role of biological factors in shaping this dyadic relationship. The recent work on genetics has produced not only a more sophisticated understanding of the potential role that genetics can play in the onset of certain behaviors, but in the unfolding of behavior across development. Specifically, there is more interest in genotype by environment interactions by which the impact of a particular gene will depend on the specific environment to which the child is exposed (see section titled ‘Child characteristics’). Moreover, Robert Plomin’s reformulation of genetic questions has led to studies of the effects of nonshared family environment on children’s development. A second focus is found in studies of hormones and behavior especially during infancy and adolescence. Third, the increased use of psychophysiological assessments as well as brain imaging techniques with families represents a further instance of how biological processes are changing studies of parent–child relationships. Fourth, the resurgence of interest in the use of evolutionary approaches to the study of families is producing new and provocative hypotheses and research directions. It is not simply that there is more recognition of biological markers and individual differences among infants and children in genetic and biological predispositions such as variations in temperament that has shifted. Our views of the parent–infant dyad have moved from a static to a dynamic and mutually influential one in which we recognize that infants are ‘biologically prepared’ to play an active role in their own socialization. New appreciation of infants’ perceptual-cognitive competence by which they show early responsiveness to a variety of social stimuli, such as human faces and voices, as well as human odors, suggests clear evidence of preparedness for social interaction. In addition, through a variety of signaling systems, such as crying and

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smiling in the early months of life, as well as crawling and walking in later infancy, the infant can control to some degree the actions of their caregivers (see our discussion of attachment theory below). In short, infants clearly share the work of socialization with their caregivers through their own biologically based readiness to respond to social cues and to become active social partners. Finally, affect is increasingly viewed as a central family process. Under the guidance of such researchers as Suzanne Denham, Nancy Eisenberg, and Carolyn Saarni, the study of affect has assumed a variety of forms including the development of emotion regulation, the development of emotional expression and understanding, as well as the role of emotion in the enactment of the parenting role. Cognition is viewed as central to socialization as well. As Jacqueline Goodnow has reminded us, the ways in which parents perceive, organize, and understand their children’s behaviors is important for appreciating how parent–child relationships are regulated and change. In current work on parent–child relationships there is the recognition that cognitive and affective processes are interdependent, mutually influencing each other.

Quantitative and Qualitative Assessments of Mother and Father Involvement In spite of current shifts in cultural attitudes concerning the appropriateness and desirability of shared roles and equal levels of participation in routine caregiving and interaction for mothers and fathers, the changes are modest in the majority of intact families. Fathers spend less time with their infants, children, and adolescents than mothers not only in the US but also in other countries such as the UK, Australia, France, and Belgium. Fathers participate less than mothers in caregiving but spend a greater percentage of the time available for interaction in play activities than mothers do. The quality of play across mothers and fathers differs too. With infants and toddlers, fathers play more physically arousing games than mothers. In contrast, mothers play more conventional motor games or toy-mediated activities, and are more verbal and didactic, although fathers in several other cultures, such as Sweden, India, and Central Africa, do not show this physical play style. As children develop, fathers become more involved in physical/outdoor play interactions and fixing things around the house and garden, where mothers are more actively involved in caregiving and household tasks, in schoolwork, reading, playing with toys, and helping with arts and crafts. In adolescence, the quality of maternal and paternal involvement continues to differ. Just as in earlier developmental periods mothers and fathers may complement each other and provide models that reflect the tasks of adolescence-connectedness and separateness. Recent

evidence suggests that fathers may help adolescents develop their own sense of identity and autonomy by being more ‘peer-like’ and more playful (joking and teasing) which is likely to promote more equal and egalitarian exchanges. Why do mothers and fathers play differently? Both biological and environmental factors probably play a role. Experience with infants, the amount of time spent with infants, the usual kinds of responsibilities that a parent assumes – all of these factors influence the parents’ style of play. The fact that fathers spend less time with infants and children than mothers may contribute as well. Fathers may use their distinctive arousing style as a way to increase their salience in spite of more limited time. Biological factors cannot be ignored in light of the fact that male monkeys show the same rough and tumble physical style of play as American human fathers. Perhaps predisposing biological differences between males and females may play a role in the play patterns of mothers and fathers. At the same time, the cross-cultural data underscore the ways in which cultural and environmental contexts shape play patterns of mothers and fathers and remind us of the high degree of plasticity of human social behaviors.

Assessing Parent–Child Interaction: Three Approaches to Socialization Three approaches to understanding the impact of parent–child interactions on children’s socialization outcomes have been utilized: (1) a typological approach which focuses on styles of child-rearing practices; (2) an attachment approach to parent–child relationships; and (3) a social interaction approach which focuses on the nature of the interchanges between parent and child. The Typological Approach The most influential typology has been offered by Diana Baumrind who distinguished between three types of parental child-rearing typologies: authoritative, authoritarian, and permissive. Authoritative parents were not intrusive and did permit their children considerable freedom within reasonable limits, but were firm and willing to impose restrictions in areas in which they had greater knowledge or insight. In general, high warmth and moderate restrictiveness were associated with the development of self-esteem, adaptability, and social competence. In contrast, the authoritarian parents were rigid, powerassertive, harsh, and unresponsive to the children’s needs. This results in the unhappy, conflicted, neurotic behavior often found in these children. Finally, in spite of the permissive parents’ reasonably affectionate relationship with their children, their excessively lax and inconsistent discipline, and encouragement of the free expression of their

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children’s impulses were associated with the development of uncontrolled, impulsive behavior in their children. Baumrind has followed these types of parents and their children from the preschool period through adolescence. She found that authoritative parenting continued to be associated with positive outcomes for adolescents as with younger children and that responsive, firm parent– child relationships were especially important in the development of competence in sons. Moreover, authoritarian child rearing had more negative long-term outcomes for boys than for girls. Eleanor Maccoby and John Martin extended the Baumrind typology and included a fourth type of parenting style which is characterized by neglect and lack of involvement. These are disengaged parents who are motivated to do whatever is necessary to minimize the costs in time and effort of interaction with the child. In infants such a lack of parental involvement is associated with disruptions in attachment; in older children it is associated with impulsivity, aggression, noncompliance, and low self-esteem. This typology approach has been challenged on several fronts. First, questions remain concerning the processes that contribute to the relative effectiveness of these different styles. Second, it is unclear whether parenting styles are, in part, in response to the child’s behavior. Placing the typology work in a transactional framework would argue that children with certain temperaments and/or behavioral characteristics would determine the nature of the parental style. A third concern is the universality of the typological scheme. Recent studies have raised serious questions about the generalizability of these styles across either socioeconomic status (SES) or ethnic/cultural groups. In lower SES families, parents are more likely to use an authoritarian as opposed to an authoritative style but this style is often an adaptation to the ecological conditions such as increased danger and threat that may characterize the lives of poor families. A second challenge to the presumed universal advantage of authoritative child-rearing styles comes from crossethnic studies. In Ruth Chao’s study of Chinese families, authoritarian styles of child rearing are more common and some have argued that the application of these stylistic categories to Chinese parents may be ‘ethnocentric and misleading’ since these child-rearing types represent an American perspective emphasizing an individualistic view of childhood socialization and development. Contextual and cultural considerations need to be given more attention in typological approaches to child rearing. The Attachment Theory Approach to Parent–Child Relationships Attachment theory, developed originally by John Bowlby, offers organizing principles for understanding various aspects of relationships. The comprehensive theory has

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guided researchers in diverse areas of psychology including social, clinical, and developmental psychology. As Alan Sroufe, Byron Egeland, and colleagues have shown, securely and insecurely attached youngsters developed very different social and emotional patterns. At 4–5 years of age, teachers rated securely attached children as more socially competent and socially skilled and as having more friends than other children. Moreover, their classmates considered them more popular than others. At 8 and 12 years of age, the securely attached children continued to be rated as more socially competent, more peer oriented and less dependent on adults. Moreover, they were more likely to develop close friendships than their less securely attached peers. At age 19 years, the socioemotional functioning of those adolescents with a history of secure attachment was rated higher as well. In comparison with peers who had a history of insecure attachment, these young adults were more likely to have close family relationships, long-term friendships, sustained romantic involvement, higher self-confidence, and greater determination regarding personal goals. Just as John Bowlby argued, the links between attachment and social outcomes are forged by children’s internal working models. In a longitudinal study, Alan Sroufe and colleagues assessed children’s cognitive working models of relationships at various times throughout childhood and adolescence. For example, in the preschool years, these researchers evaluated children’s relationship expectations, attitudes, and feelings. Securely attached children’s relationship models were characterized by expectations of empathy between play partners, a high expectation of sharing during play, and constructive approaches to conflict resolution (e.g., take turns, seek adult acceptance, get another toy). During adolescence (age 12 years) securely attached children construed their friendships as close, emotionally connected, and skilled in conflict resolution. These investigators showed that cognitive working models and social behavior mutually influence each other across time. In other words, cognitive representations in the preschool period predict social behavior in middle childhood; in turn, the representations in middle childhood predict social behavior at 12 years of age, and these cognitive models predict social outcomes at 19 years of age. Moreover, across time, social behavior at one point predicts later cognitive representations. For example, social behavior in middle childhood is related to a child’s cognitive working models in early adolescence. Together, these studies illustrate the interplay among attachment, cognitive understanding, and children’s social outcomes. Clearly, the attachment approach to parent–child relationships has been an important theoretical framework. What is the current status of this theory? First, this approach continues to evolve and has been successfully applied to other relationships beyond the parent– child dyad, including dating and marital relationships.

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Second, as the longitudinal studies of attachment mature there is increasing examination of cross-time and crossgenerational linkages. These studies provide evidence for both continuity and discontinuity and underscore the dynamic and changing nature of attachment relationships in response to shifting socioemotional experiences. Third, more attention to mechanisms that account for the longterm effects of early infant–parent attachment, such as emotional antecedents and cognitive factors, are evident. These efforts will help reconcile this approach and the social interaction approach that we review in the next section. Fourth, cross-cultural examination of the generalizability of attachment patterns is yielding new insights concerning how culture-specific experiences shape the nature of dominant attachment patterns in different cultures. Fifth, recognition of the fact that infant–parent attachment is most profitably viewed from a family systems perspective is needed in order to more fully appreciate the ways in which mother, father, and sibling attachment patterns coordinate with each other in affecting children’s developmental outcomes. The Parent–Child Interactional Approach Research in this tradition is based on the assumption that face-to-face interaction with parents may provide the opportunity to learn, rehearse, and refine social skills that are common to successful social interaction with other social partners. The style of the interaction between parent and child is linked to a variety of social outcomes including aggression, achievement, and moral development. Parents who are responsive, warm, and engaging are more likely to have children who are more socially competent. In contrast, parents who are hostile and controlling have children who experience more difficulty with age mates. Moreover, these findings are evident in the preschool period, middle childhood, and adolescence. Although there is an overlap between mothers and fathers, fathers make a unique and independent contribution to their children’s social development. Although father involvement is quantitatively less than mother involvement, fathers have an important impact on their offspring’s development. Both quality and quantity of parent–child interaction are important predictors of cognitive and social development. This approach is especially useful for understanding socialization processes. In fact, within this tradition, a variety of processes have been suggested as mediators between parent–child interaction patterns and children’s social and cognitive outcomes including emotional encoding and decoding, emotional regulatory skills, cognitive representations, attributions and beliefs, problem-solving skills, and attentional regulatory abilities. As in the case of the attachment model, this approach is profitably cast in a family systems framework to understand how mothers’

and fathers’ unique styles of interaction combine to alter children’s socialization outcomes. Finally, more work on how parent–child interaction patterns change across development and especially how parent and child power shifts toward more equality and mutual influence and a shared understanding of the relationship is needed.

Alternative Socialization Pathways Parental Instruction, Advice Giving, and Consultation Learning about relationships through interaction with parents can be viewed as an indirect pathway since the goal is often not explicitly to influence children’s social relationships with extrafamilial partners such as peers. In contrast, parents may influence children’s relationships directly in their role as a direct instructor, educator, or advisor. In this role, parents may explicitly set out to educate their children concerning appropriate ways of initiating and maintaining social relationships and learning social and moral rules. As Alan Russell has found the quality of advice that mothers provided their children prior to entry into an ongoing play dyad varied as a function of children’s sociometric status. Mothers of well-accepted children were more specific and helpful in the quality of advice that they provided. In contrast, mothers of poorly accepted children provided relatively ineffective kinds of verbal guidance, such as ‘have fun’ or ‘stay out of trouble’. The advice was too general to be of value to the children in their subsequent interactions. As children develop, the forms of management shift from direct involvement or supervision of the ongoing activities of children and their peers to a less public form of management, involving advice or consultation concerning appropriate ways of handling social problems. Parents as Managers of Children’s Socialization Opportunities Parents influence their children’s social relationships not only through their direct interactions with their children, but also function as managers of their children’s social lives and serve as regulators of opportunities for social contact with extrafamilial social partners. This parental role is of theoretical importance in light of the recent claims by Judith Harris that parents’ impact on children’s development is limited and peer group level processes account for major socialization outcomes. In contrast to this view, we conceptualize the parental management of access to peers as a further pathway through which parents influence their children’s development. From infancy through middle childhood, mothers are more likely to

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assume the managerial role than fathers. In infancy, this means setting boundaries for play, taking the child to the doctor, or arranging daycare. In middle childhood, it was found that mothers continue to assume more managerial responsibility (e.g., directing the child to have a bath, to eat a meal, or to put away toys).

Beyond the Parent–Child Dyad: The Sibling, Co-Parenting, and Marital Subsystems as Contributors to Children’s Socialization Children’s experiences in families extend beyond their interactions with parents. Evidence suggests that children’s understanding of relationships is also shaped through their active participation in other family subsystems (e.g., child–sibling) as well as through exposure to the interactions of other dyadic subsystems (e.g., co-parenting subsystem; marital relationship). The Sibling Subsystem Siblings play a critical role in the socialization of children. Most children are likely to spend more time in direct interaction with siblings than parents and this array of interactions between siblings have been found to be typified by greater emotional intensity than the behavioral exchanges that characterize other relationships. As Judy Dunn has noted, sibling relationships contribute to children’s socialization in a number of significant ways. Through their interactions with siblings, children develop specific interaction patterns and social understanding skills that generalize to relationships with other children. Relationships with siblings may also provide a context in which children can practice the skills and interaction styles that have been learned from parents or others. Older siblings function as tutors, managers, or supervisors for their younger siblings. Also paralleling the indirect influence that the observation of parent–parent interaction has on children, a second avenue of influence on children’s development is their observation of parents interacting with siblings. These interactions may serve as an important context in which children deal with issues of differential treatment and learn about complex social emotions such as rivalry and jealousy. The Co-Parenting Subsystem Recently there has been an increasing focus on co-parenting in recognition that mothers and fathers operate as a parenting team as well as individual parents. Much of the research about co-parenting is based upon Salvador Minuchin’s structural family theory. James McHale has

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identified a variety of forms that co-parenting alliances can assume, including antagonistic and adult-centered or hostile-competitive co-parenting, a pattern marked by significant imbalance or parenting discrepancy in levels of parental engagement with the child, and a pattern reflecting cooperation, warmth, cohesion, and child centeredness or high family harmony. These patterns have been observed across a range of studies with infants, preschoolers, and school age children and in both European American and African American families. Of course, the family unit expands past a triadic (mother–father–child) unit when a second child is involved. Looking beyond the triadic level of interaction, research on co-parenting suggests that the co-parenting system may undergo radical modification when there are two or more children in the family. Studies of two-child families support that each parent engages with one child at a time, and that the four members of the family varied in interactions and amount of unity depending on outside influences such as siblings’ gender, age differences, and temperament. Moreover families do not stop at the nuclear unit, and the extended family in which the nuclear unit is embedded has unique influence, context, and consequence, as does the society and culture in which the entire family exists. Co-parenting accounts for unique variance in child measures and clearly needs to be distinguished from traditional parent–child and marital-level processes. Less is known about the processes that control these various patterns of co-parenting, but recent work on gate-keeping that focuses on ways in which couples facilitate or hinder the involvement of their partner’s interactions with their children is promising. The similarities and differences of the co-parenting relationship among both intact and nonintact (divorced and single-parent) families are only poorly understood. The Marital or Partner–Partner Subsystem Considerable evidence indicates that marital functioning is related to children’s short-term coping and long-term adjustment. Children exposed to marital or partner–partner discord are likely to have poorer quality of interpersonal relationships, including internalizing and externalizing behavior problems, and changes in cognitions, emotions, and physiology. Two alternatives, but not mutually exclusive models, have been proposed to account for the impact of marital relations on children’s developmental outcomes. One theoretical framework conceptualizes marital discord as an indirect influence on children’s adjustment that operates through its effect on family functioning and the quality of parenting. A second model focuses on the direct effects of witnessed marital conflict on children’s outcomes rather than on the indirect effects. Both of these models have received empirical support.

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The Family Unit as a Contributor to Children’s Socialization Parent–child, marital, and sibling influences are clearly the most well-researched aspects of family socialization. However, consideration of these units of analysis alone is insufficient because they fail to recognize the family unit itself as a separate and identifiable level of analysis. Consistent with a systems theory perspective, the properties, functions, and effects of the family unit cannot necessarily be inferred from these smaller units of analysis. The family as a unit changes across development in response to changes in the individual members, life circumstances, and scheduled and unscheduled transitions. Families develop distinct climates, styles of responding to events, identities and distinct boundaries, which provide differing socialization contexts for the developing child. Several investigators have argued that the family regulates the child’s development through a range of processes, including myths, stories, and rituals. Recent evidence suggests the potential importance of these family level processes for understanding socialization in the family. Myths refer to beliefs that influence family process, provide continuity across generation, and are generally not open to discussion or debate. Family myths influence mate selection and marital satisfaction. Individuals can set aside destructive family myths by marrying a person with different and perhaps a healthier history of family myths. To date, there is little direct evidence of the impact of family myths on children’s development. Family stories have received more attention as vehicles for socialization of young children. Family of origin experiences may be transmitted across generations through stories and shared memories, and shape contemporary interaction between family members. Barbara Fiese has provided a useful framework for studying family stories by focusing on three narrative dimensions: (1) narrative coherence, (2) narrative styles, and (3) relationship beliefs that characterize the form that the content of family stories assumes. This approach yielded important insights into child functioning attitudes toward open vs. closed adoption, marital satisfaction, and diagnosis of depression. Stories are related to family interaction patterns and are linked to children’s social competence as well. Rituals have been recognized for decades as an important aspect of family life, but only in the last decade has the socialization function of rituals and routines become apparent. As Fiese suggested, routines typically involve instrumental communication in conveying information that is ‘what needs to be done’. Rituals, in contrast, involve symbolic communication and convey this is ‘who we are as a group’. Failure to attend an important family event, such as a wedding, often indicates a shift in family alliances and definitions of who is in or out of the family. Family routines are associated with better child health

and better behavioral regulation in intact families. Similarly, routines serve a protective function and are linked to better adjustment for both parents and children in single-parent, divorced, and remarried households. Rituals, serve a protective function such that children who came from families who were able to preserve family rituals, such as holidays and routines, were less likely to become alcoholic adults. Other studies report that families who attach more meaning to their rituals have adolescents who are higher in self-esteem. In sum, routines and rituals are a powerful index of family functioning and may serve as a protective socialization influence on the child.

Determinants of Family Socialization Strategies One of the major advances in the field has been recognition of the importance of understanding the determinants of parenting behavior. Jay Belsky proposed a three-domain model of the determinants of parenting, which included characteristics of the child, personal resources of the parents, and contextual sources of stress and support (i.e., social capital) which has been an influential guide to this issue. Child Characteristics Child characteristics take two forms: universal predispositions that are shared by all children and individual differences in particular characteristics. Infants are biologically prepared for social, cognitive, and perceptual challenges and these prepared responses play a significant role in facilitating children’s adaptation to their environment. Under the influence of recent advances in behavior genetics, there is increasing recognition of the role of individual differences in temperament on parenting behavior. Although debates about the relative contributions of genetic and experiential factors to the emergence of individual differences in temperament continue, temperament clearly is a determinant of parental socialization tactics. Children who are more difficult may elicit increasingly coercive strategies from parents. In contrast, fearful children may respond optimally to subtle parental socialization strategies such as reasoning or re-direction rather than harsh, punitive, or coercive tactics. Infants with difficult temperaments elicit more arousal and distress from caregivers than less difficult infants. The impact of these individual differences on parental socialization behavior is not independent of environmental conditions. As Susan Crockenberg has shown, the impact of a difficult infant temperament on the parent–infant attachment relationship varied as a function of the degree of social support available to the mother, which underscores the potential modifiability of temperament-based influences.

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Other characteristics, in addition to temperament, have been examined, including activity level, social responsiveness, and compliance level. In general, the more active, less responsive, and more noncompliant child elicits more negative parenting and more negative parental arousal and affect. More recently, under the guidance of scholars such as Robert Plomin, Michael Rutter, and their colleagues, gene–environment interaction models for understanding the interplay between genetics and child-rearing contexts have gained prominence in our theories of socialization. In such research, specified genetic variations in combination with particular environmental circumstances can reveal associations with child outcomes. With respect to adverse outcomes, such genetic variations can be thought of as susceptibility factors whose impact depends on the type of environments to which the child is exposed during socialization. For example, Avshalom Caspi and colleagues found that men with a variant of a normal but low active gene that is associated with inhibition of aggression (MAO-A ), and who were exposed to severe abuse were more violent as adults than individuals exposed to the same abuse but had a more active aggression inhibitory gene. Similarly, Marian Bakermans-Kranenburg and Mariunus Van IJzendoorn from the Netherlands recently found that maternal insensitivity was associated with externalizing (oppositional, aggressive) behavior but only in the presence of a specific gene (seven repeat DRD4 polymorphism), a part of the dopaminergic system. As these studies illustrate, contemporary researchers emphasize a model of ‘gene environment interplay’ as a framework for understanding development in which both behavioral predispositions, such as temperament and specific genes, interact with parenting strategies in determining socialization outcomes.

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adequate theory of socialization. The concept of social capital is useful for understanding the links between families and the wider set of community institutions. According to James Coleman, social capital is both the flow of information and the sharing of norms and values that serve to facilitate and constrain the actions of people who interact in a community’s social structures (e.g., schools, religious institutions, or business enterprises). Recognition of the embeddedness of families in a set of broader social systems such as community and culture is only a first step. The next task is to articulate ways in which these other levels of social organization affect family functioning and explore the way in which these influence processes take place. Social capital can be either positive or negative, since a high degree of connectedness with community resources is not necessarily positive. In addition, the relationship between communities and families is bidirectional and varies across development. Moreover, the influence of support systems on families may either be direct or indirect in its effects. Finally, both availability and utilization need to be separately considered. While the availability of social capital is potentially valuable to families, especially in times of stress, families may have friends, relatives, and neighbors available, but fail to utilize these members of their informal social network in times of stress or crises or even on a day-to-day basis. Socioeconomic Status

A variety of studies support the prediction that personal resources – conceptualized as knowledge, ability, and motivation to be a responsible caregiver – alter parenting behaviors. Particularly striking are recent studies of how parental psychopathology, such as depression, will alter parenting behavior. When interacting with their infants, depressed mothers show flat affect and provide less contingent stimulation than nondepressed mothers; in turn, their infants showed less attentiveness, more fussiness, and lower activity levels. Differences are particularly evident when depression is protracted and not merely transient.

There is a long history of research concerning the links between SES and/or social class and parenting beliefs and practices. In contrast to traditional assumptions that SES is a static state, SES is a dynamic concept. Over the course of childhood and adolescence, families change social class and change is greatest in the youngest ages. Over 50% of American children change social class prior to entering school. In spite of the controversies surrounding this variable, there are SES differences in parental socialization practices and beliefs. Lower SES parents are more authoritarian and more punitive and controlling than higher SES families. Second, there are more SES differences on language measures than on nonverbal measures with higher SES mothers being more verbal than low SES mothers. Some SES differences are independent of race and poverty. In China, where there are relatively small differences in income across groups who vary in terms of education, less educated parents used more imperatives with their toddlers than better-educated mothers. Similarly, studies of cognitive socialization found clear SES differences in AfricanAmerican lower class and middle class families.

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Ethnicity

Recognition of the role of the community and community agents as modifiers of family interaction is necessary for an

Recent cross-cultural and intracultural theories have emphasized the importance of socialization goals, values,

Personal Parental Resources

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and beliefs as organizing principles for understanding cultural variations. In contrast to the older cultural deficit models of socialization, the more recent models emphasize how ecological demands shape values and goals. In the past, cultural deficit models were popular explanations for the socialization and child outcome differences observed between ethnic minorities and Euro-Americans. The focus on ethnic minority families has shifted away from majority–minority differences in developmental outcomes and more toward an understanding of the adaptive strategies ethnic minorities develop in response to both majority and minority cultural influences on their development. The parents’ individual history of interaction with the larger sociocultural context, including their awareness of their ethnic group’s history within the larger society, affect the manner in which they socialize their children. An important dimension of socialization in ethnic minority families is teaching children how to interact effectively in dual cultural contexts; the context of their ethnic group and the context of the larger Euro-American society. Scholars, such as Raymond Buriel and Cynthia Garcia-Coll, have adopted an ecological orientation to explain the diverse environmental influences that contribute to the socialization of ethnic minority children. They conceptualize the socialization of ethnic minority children in terms of the interconnectedness between the status of ethnic minority families, adaptive strategies, socialization goals, and child outcomes. Emerging out of the adaptive strategies of adults are the socialization goals that they endeavor to inculcate in children to help them meet the ecological challenges they will face as ethnic minorities in a class and race conscious society. Ethnic pride and interdependence are two important socialization goals that enable ethnic minority children to function competently as members of both their minority culture and the larger society. Research needs to take into account the acculturation level of parents and children in recent immigrant families and the effects it has on family processes and child outcomes. Intergenerational differences in acculturation can create role strains between parents and children that have implications for child rearing styles, disciplinary practices, and overall parent–child relations. Together with acculturation, recognition of biculturalism as both an adaptation strategy and socialization goal is important. The effects of prejudice and discrimination on ethnic minorities, in such areas as social and emotional development, ethnic identity, and achievement motivation, deserve more attention. Language development research should also give greater attention to second language acquisition (usually English) and bilingualism and its relation to cognitive development and school achievement. More attention must also be given to the role of ethnic minority fathers, grandparents, and extended family members in the socialization of children.

The Impact of Social Change on Socialization Families are not static but dynamic and are continuously confronted by challenges, changes, and opportunities. A number of society-wide changes have produced a variety of shifts in the nature of family relationships. Fertility rates and family size have decreased, the percentage of women in the workforce has increased, the timing of onset of parenthood has shifted, divorce rates as well as rates of remarriage and stepfamily formation have risen, and the number of single parent families has increased. These social trends provide an opportunity to explore how families adapt and change in response to these shifting circumstances and represent ‘natural experiments’ in family coping and adaptation. Moreover, they challenge our traditional assumptions that families can be studied at a single point in historical time since the historical contexts are constantly shifting. Our task is to establish how socialization processes operate similarly or differently under varying historical circumstances. In both the US and other parts of the world, a variety of changes, including the timing of parenthood, increases in women’s employment, and increases in rates of divorce and remarriage, have taken place. These social changes can have a major impact on children’s socialization. For example, some divorce experts such as Mavis Hetherington suggest that approximately 25% of children in divorced and stepparent families are at risk for developmental problems, in part, as a result of changes in socialization practices accompanying these shifts in family structure. However, the majority of children adapt and function well in a variety of family arrangements including divorced-single parent families and stepfamily households. To date, societal changes, such as shifts in the timing of parenting, work participation, or divorce, have been treated relatively independently, but, in fact, these events co-occur rather than operate in any singular fashion. Multivariate designs which capture the simultaneous impact of multiple events on family socialization strategies are necessary.

Extrafamilial Socialization Influences Peers Peers, in addition to parents, play important socialization roles. Peers play a central role in children’s socialization, beginning in infancy. Especially in view of the growing number of infants and children who spend time in out of home child-care, the role of peers as socialization agents has assumed major importance. From the first year of life infants are responsive to peers and by the second year engage in mutually responsive social exchanges. Learning to interact in a socially skilled manner with peers is a central task of early socialization. Children with different

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temperaments or with cold, unresponsive parents or who have developed insecure infant–parent attachment have more difficulty interacting in a harmonious way with their peers. Of importance is the fact that toddlers with poorly developed social skills are more likely to be disliked and rejected by their peers. In turn, children with this history of poor peer relationships are more likely to experience academic failure as well as socioemotional problems (i.e., loneliness, depression, externalizing behaviors) in the elementary school years and in adolescence. Clearly, peers are an important part in the socialization saga. However, peers and parents do not make independent socialization contributions; instead, these two sets of socialization agents are best viewed as independent and mutually influential. For example, parental interaction patterns, advice giving, and monitoring play central roles in the nature and quality of children’s peer relationships. Similarly, children develop attitudes, norms, and values as a consequence of their extrafamilial peer relationships that, in turn, can modify the nature of their relationships with their parents and siblings in either a positive or negative way. Although it is clear that peers play an increasingly important role as children develop, family values and control strategies continue to play an important role in shaping children’s ties with peers. Mass Media In our increasingly technological era, the mass media in the form of television, movies, computer-based educational programs, and video games play a role in infant and child socialization. Even in infancy, parents expose their offspring to videotapes, television programs, and other forms of mass media that is facilitated by the fact that a large percentage of infants and toddlers have a television and/or video player in their rooms. Some types of media exposure are clearly beneficial, such as educational programs (e.g., Sesame Street and Mr. Rogers) can increase young children’s cognitive development as well as their prosocial behavior. In contrast, there is abundant evidence that violent cartoons and programs watched by children can have detrimental socialization effects including desensitization to witnessed violence, greater acceptance of aggression as a solution to social problems and, for some children, an increase in aggressive behavior. Moreover, the impact of a high diet of violent television exposure has long-lasting effects; first grade children who watch a great deal of violent programs have more antisocial and unlawful behavior in early adulthood. As in the case of viewing aggressive television, violent video and computer games have been found to produce similar negative effects such as increased aggression. Again, parents play a major role in their regulation of access to mass media including the amount of exposure and the types of programs that children watch. Moreover,

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parents can help children better understand television plots and programs (i.e., highlight negative consequences of violent actions) that, in turn, can reduce the negative effects of exposure. Often parents fail to exercise this regulatory responsibility. Neighborhoods as Socialization Contexts Neighborhoods are important socialization contexts as well. Children who grow up in poor and dangerous neighborhoods have more academic and social problems. High-risk neighborhoods expose children to violence, limit their access to safe play spaces and often encourage aggressive strategies in order to function effectively in these contexts. Moreover, as children develop, they are prone to more negative peer influence (i.e., gangs) and lawlessness (drug use; drug dealing; vandalism). The impact of the quality of neighborhoods is illustrated by studies in which children change neighborhoods; those that move to higher quality neighborhoods improve in both achievement and social behavior, while those who move to poorer-quality neighborhoods show declines in academic and social outcomes. Nonexperimental studies show these patterns but experimental policy-based planned shifts in neighborhood quality show short-term but not long-term effects. This suggests that ‘neighborhoods’ can be viewed as an additional level of socialization influence. Again it is critical to underscore that ‘neighborhood effects’ are often achieved through changes in parenting behaviors in response to aspects of neighborhood, such as perceived dangerousness, or through the types of peers and/or peer related activities afforded by the neighborhood. Schools Parents choose not only neighborhoods but also, for middleclass families, the type and quality of day care and elementary schools that their children will attend. These choices make a difference to children’s later development. As studies of child care have shown, the quality of and, to some extent, the amount of time in care are linked to children’s cognitive and social development. Higher quality of child care is associated often with higher cognitive functioning. Social behavior, despite the opportunity to have increased peer contact, is less consistently linked with day care quality. Some evidence suggests that children who are in day care for more than 40 h per week may show some increases in aggression. As children develop, parents select neighborhoods as a function of the quality of the schools that are available. However, these choices are limited by social class and economic resources and are mainly available to middle-class families. Moreover, the ability to choose is not inconsequential because exercising the ability to choose a school has been linked to adolescent academic outcomes. As a reminder that children can play a role in the process

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of school choice, there is some evidence that children’s behavior in school – their successes and failures in both social and academic domains – influence the nature of the parent–child relationship. Children’s positive and negative experiences at school during the day alter the nature of the parent–child interaction in the home after school. School choice is not the only way in which families and schools are linked. The extent to which parents are involved in school-related activities (e.g., parent–teacher associations or school conferences) is positively related to children’s academic outcomes. Practices of partnerships between parents and schools decline across child development. Parents of children in elementary school are more likely to volunteer, attend parent–teacher conferences, and supervise children’s homework. In recognition of adolescents’ need for autonomy and independence, parental involvement decreases in high school, but young adolescents still want their families to support their learning and activities at home. Even older adolescents endorse parent involvement in school, but in different ways than in earlier school grades. These developmental changes can be interpreted as evidence of the child’s role in shaping the form that the parent–school partnership will assume at different points in the child’s educational career. Religious Organizations Parental facilitation of children’s involvement in religious institutions is another potentially important way which parents socialize their children. It is important to distinguish between the issue of involvement in religious institutions and religious beliefs because these two aspects of religion may have partially independent effects on family functioning and child outcomes. In their book, Children of the Land, Glen Elder and Rand Conger argue that church involvement is a family affair. When both parents attended church on a regular basis, children were more likely to be in involved in religious organizations. Similarly, actively involved grandparents tend to have actively involved grandchildren. Church attendance involved more than contact with a broadened network of adults who share similar family and religious values; it also involved exposure to a network of age-mates with common beliefs and values. Involvement in church activities was associated with higher endorsement of not only church but also school, good grades, and – especially for boys – community activities. For those who were less involved in religious activities, athletics, and school were given high priority. Religiously involved youth perceived their friends to be less likely to encourage deviant activities, viewed their friends and themselves as less involved in deviance, and were less likely to see friends that their parents disapproved of. Religious involvement in the eighth grade was predictive of competence by the 12th grade in grades and peer success. Moreover, adolescents

who become more religiously involved by the end of high school tend to rank higher on a variety of competence dimensions – from academic and peer success to selfconfidence and relations with parents. A reciprocal influence model best accounted for those findings. Although the primary flow of influence moved from religious activity and socialization to individual competence in achievement, some adolescents who were successful academically and socially, and became more involved in religious activities, further enhanced achievement. Similarly, it is likely that both parents and children are active players in the process of involvement in religious activities. Although parents – through their own involvement and through their introduction of the child to religious beliefs and functions – play an important initial role, children, and especially adolescents, themselves are central agents in choosing to continue their regular participation in religious institutions. Finally, parental religiousness (frequency of church attendance and importance of religion) is associated with better child adjustment as well. Specifically higher maternal and paternal religiousness is associated with less externalizing problems among 9- to 12-year-olds. The effects were mediated by family cohesiveness and lower marital conflict. However, the relative importance of beliefs or involvement in organized religious activities in accounting for these effects is unclear.

Summary Socialization is a multiply determined process; while families have traditionally been viewed as central socialization agents, we argue that it is important to recognize the roles of social agents such as peers, neighborhoods, schools, religious institutions, and the mass media in this process. A fuller understanding of socialization will come from more attention to the interplay among these diverse agents and how biological, including genetic factors as well as cultural and ethnic backgrounds, influence socialization practices and outcomes. See also: Attachment; Discipline and Compliance; Family Influences; Friends and Peers; Marital Relationship; Parenting Styles and their Effects; Routines; Siblings and Sibling Rivalry; Social and Emotional Development Theories; Social Interaction; Television: Uses and Effects; Temperament.

Suggested Readings Bugental DB and Grusec JE (2006) Socialization processes. In: Damon W, Lerner RM, and Eisenberg N (eds.) Handbook of Child Psychology: Vol. 3. Social, Emotional, and Personality Development, 6th edn., pp. 366–428. New York: Wiley.

Stress and Coping Damon W and Lerner RM (eds.) (2006) Handbook of Child Psychology: Vol. 3. Social, Emotional, and Personality Development, 6th edn. New York: Wiley. Grusec J and Ungerer J (2003) Effective socialization as problem solving and the role of parenting cognitions. In: Kuczynski L (ed.) Handbook of Dynamics in Parent–Child Relations, pp. 211–228. Thousand Oaks, CA: Sage Publications. Kuczynski L (ed.) (2003) Handbook of Dynamics in Parent–Child Relations. Thousand Oaks, CA: Sage Publications. Ladd G (2005) Children’s Peer Relations and Social Competence. New Haven, CT: Yale Univesity Press.

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Parke RD (2004) Development in the family. Annual Review of Psychology 55: 365–400. Parke RD and Buriel R (2006) Socialization in the family: Ecological and ethnic perspectives. In: Damon W, Lerner RM, and Eisenberg N (eds.) Handbook of Child Psychology: Vol. 3. Social, Emotional, and Personality Development, 6th edn., pp. 429–504. New York: Wiley. Parke RD, Simpkins S, McDowell D, et al. (2002) Relative contribution of families and peers to children’s social development. In: Smith PK and Hart CH (eds.) Blackwell Handbook of Childhood Social Development, pp. 156–178. Oxford, UK: Blackwell.

Stress and Coping E M Cummings and C D Kouros, University of Notre Dame, Notre Dame, IN, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Attachment theory – A psychological theory focusing on the emotional social bond between a primary caregiver and child, including the functioning of this emotional bond in children’s coping with everyday stressors, including separation. Attachment patterns are assessed by examining how infants use their caregiver as a secure base from which to explore, as well as infants’ pattern of responses to being separated from a primary caregiver in an unfamiliar setting. Cognitive appraisal – The process of monitoring and evaluating a specific person–environment interaction with respect to the individuals’ well-being and goals. Coping – This is an often complex, multidimensional process by which infants regulate emotion, behavior, cognition, physiology, and/or the environment when faced with a stressful event. Coping efficacy – This refers to a child’s belief that his or her coping strategy will be successful. Coping efficacy affects children’s decisions about their responses in the face of stress. Emotion-focused coping – Coping responses aimed at regulating or minimizing the negative emotions elicited by stress. Emotional security theory – Theoretical framework for understanding the effects of stressful family processes on children’s adjustment. Notably, this theory posits that marital conflict is a stressor that affects infants by threatening their emotional security. Threats to the infant’s emotional security motivate and organize their coping responses, for

example, emotional and behavioral regulatory responses. Problem-focused coping – Coping responses aimed at managing, changing or regulating the source of stress. Stress – A wide range of adverse stimuli (physical or mental) that disrupt normal functioning of an individual and elicit a physiological and/or psychological response. Temperament – Individual differences in emotional and behavioral reactivity that is evident from early on in life and consistent over time and across situations. Temperament has a biological basis with genetic origins. At the same time, temperament can be influenced and modified by early experiences.

Introduction Stress is an inevitable and normal part of everyday life. How individuals cope with stress has strong implications for their current as well as future well-being and adjustment. While most people deal with stress with no adverse consequences, children exposed to chronic stress or who do not have effective coping responses may be at risk for mental and physical health problems. Stressful events elicit both physiological and psychological responses and the coping strategies children use in the face of stress lead to patterns of behavior that are predictive of developmental trajectories of adjustment and maladjustment. Thus, the stressors encountered by infants and the coping mechanisms used by infants may have lasting implications

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for coping with stress later in life, and ultimately, the way individuals develop. A strength of infancy research on stress and coping is the emphasis on a biopsychosocial perspective of stress and coping. Thus, research has emphasized the impact of stress on multiple aspects of infant’s physiological and psychological responding, as well as the importance of social context for the impact of stress on infants. That is, social context is seen as affecting children’s exposure to stress, how they react to stress, and their ability to employ and access various coping strategies, including the availability of parents, caregivers, or others in a position to help the infant. Moreover, the role of individual differences and biological dispositions in stress and coping is emphasized through the systematic study of the construct of temperament. Stress and coping research is perhaps unusual in that in the past 20 years or so a high level of consensus has been reached with regard to a particular definition and conceptual model for the nature of stress and coping. Richard Lazarus and Susan Folkman define stress as ‘‘a particular relationship between the person and environment that is appraised by the person as taxing or exceeding his or her resources or endangering his or her well-being.’’ Coping is conceptualized as a dynamic process, that is, ‘‘constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.’’ In other words, coping is what the infant does to manage the demands of a stressful situation. Additionally, coping is conceptualized as often a multidimensional process that extends over time and is highly sensitive to context (e.g., the availability of a caregiver). The way an infant copes with stress may vary widely depending on the context and coping responses may change over time in response to a specific context. When coping is defined in this way, it follows that coping for infants may include emotional and social responses in observable behavior, or physiological responses of heart rate, blood pressure, and other such domains. Responding may also be extended in time, so that it becomes important for the coping researcher to observe or record infant responses over a pertinent time course. In addition, it follows that it is important to be concerned with the meaning and interpretation of coherent patterns of responding, that is, strategies or higher-order coping styles (e.g., infant attachment patterns), not just isolated response domains, which can give a limited if not distorted picture of response processes. There are many different types of stressors that infants and children face during childhood, as well as a wide range of possible coping responses that change throughout development. This article presents a brief overview of historical perspectives on stress and coping, which includes physiological responses to stress, and current views on psychological processes for stress and coping models in infancy and early childhood. An in-depth discussion of stress and coping

is provided for two significant themes in childhood research: attachment patterns and exposure to interparental conflict. In particular, attachment theory and the emotional security theory (EST) are presented as important frameworks for understanding how children’s coping with stress can account for the associations between exposure to stress and children’s adjustment. An example of an individual differences approach is provided in terms of the construct of temperament.

Historical Perspective on Stress and Coping Early views of stress and coping focused primarily on a person’s physiological response to stress. The study of physiological responses of stress and coping has a distinguished and long history. In the early 1930s, the biopsychologist Walter Cannon used the term stress to describe challenges and disturbances to homeostasis, that is, the ability for an individual to maintain internal equilibrium by making adjustments to physiological processes. In an influential article in 1936, Hans Selye used the term stress to refer to any demand made upon the body; however he focused specifically on the physiological reactions to such demands. Selye described three stages of a General Adaptation Syndrome to explain how stress affected physical health. The first stage is the Alarm Stage which is an immediate physiological response to stress that prepared the body to channel resources to immediate muscular needs. In the process, immune functioning, the digestive system, and other responses could be suppressed, leaving the individual more vulnerable to illness and other negative outcomes. In the second stage, Resistance, the individual acclimated to the stressful situation allowing the individual to adapt to stressful conditions. However, over time, the third stage, Exhaustion, may take place, in which due to prolonged suppression of the immune system, the body is no longer able to handle the stress and begins to break down. In the years since these early conceptualizations and definitions of stress, psychological responses to stress remain recognized as pertinent to understanding the nature of stress. Notably, stress refers to a wide range of adverse stimuli (physical or mental) that may disrupt the normal functioning of an individual and elicit significant physiological and/or psychological responses.

Conceptualizations and Definitions Regarding Physiological Responses to Stress The responses of infants and young children to stress may be informative with regard to the impact of stress on multiple dimensions of physiological functioning. Notably, the body’s physiological response to stress can be

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sophisticated and complex. The stress response may prepare the individual to act in order to escape, avoid, or deal with the stressor or prepare the body for potential injury. The physiological response of the individual may function to take energy away from parts of the body where it is not immediately needed (e.g., digestive system) and move this energy to, as well as create energy for, other parts of the body that need it to deal with stress (e.g., large muscles). Stressful events activate the sympathetic nervous system (SNS), which is a branch of the autonomic nervous system, and the hypothalamic–pituitary–adrenal axis (HPA axis). The parasympathetic nervous system (PNS), another branch of the autonomic nervous system, is also activated to assist the individual in resting and recovery. In the early 1900s, Walter Cannon introduced the concept of ‘fight or flight’ response to describe the response of the SNS to threats to the individual in general. The SNS is partly responsible for regulating the body to maintain homeostasis. Specifically, activity of the SNS stimulates the adrenal medulla (the inner core of the adrenal glands), which are located above the kidneys, to secrete catecholamines, including epinephrine (adrenaline) and norepinephrine (noradrenaline). SNS activation diverts blood and energy away from processes such as digestion and the immune system to large muscles and processes necessary to immediately respond to the stress. As a result, heart rate and blood pressure increase, perspiration increases, and hearing and vision become more acute. Because of these responses, one may experience dry mouth, sweating, dilated pupils, and insomnia in response to stress. A standard and noninvasive approach to measuring SNS reactivity is skin conductance, typically measured by attaching electrodes to the first and second fingers of the child’s nondominant hand. Skin conductance refers to the electrodermal activity (electric impulses on the surface of the skin) resulting from activity of sweat glands that are innervated solely by the SNS. Thus, skin conductance is an unbiased marker of SNS activity. Another, newer approach for measuring SNS activity is to examine changes in pre-ejection period (PEP) in response to stress. PEP is a measure of cardiac contractibility; that is, it is a measure of the time interval between blood entering and exiting the heart. The shorter the time period, the more active the heart is and the more quickly blood is being pumped out to the body, reflecting greater physiological arousal. Additionally, stress activates the HPA axis, which affects almost every organ and tissue of the body, as well as the brain. An illustration of this process is depicted in Figure 1. Specifically, the hypothalamus stimulates the anterior pituitary gland to secrete the adrenocorticotropic hormone (ACTH). ACTH travels through the blood to the adrenal cortex (outer layers of the adrenal gland) to stimulate the release of the hormone cortisol, which is released in the bloodstream. Among its effects, the release of cortisol increases blood pressure and blood sugar levels, and suppresses

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Hypothalamus Releasing factor

Anterior pituitary

ACTH (through blood)

Adrenal cortex

Cortisol

Figure 1 Illustration of the activation of the HPA axis in response to stress. From Biological Psychology 6th edition by Kalat. 1998. Reprinted with permission of Wadsworth, a division of Thomsan Learning. (ACTH), adrenocorticotropic harmone.

immune system functioning. A relatively easy and noninvasive measurement of cortisol is the use of salivary samples. Cortisol is also easily assayed in the blood and urine. The newborn brain is biologically prepared to respond to certain types of stressors that threaten homeostasis, such as pain, bright lights, cold, heat, loud noises, and hunger. Newborns are alert to these types of physiological stressors and their autonomic nervous system responds. For example, a commonly studied stressor in newborn infants is pain via heel stick procedures. A heel stick involves pricking the newborn’s heel in order to draw blood, and is used as a screening test before babies leave the hospital after birth. Research has found that the heel stick procedure is stressful for infants, as evidenced by activation of the HPA axis, an increase in cortisol, and increased crying. By 3 months of age, as the HPA axis matures and develops, cortisol response to these physiological stressors are not as intense.

Psychological Processes of Stress and Coping in Infancy and Childhood While physiological responses play a critical role in coping with various stressors and may describe stress and coping response for newborns, current perspectives and research highlight the increasing importance of psychological processes as infants get older. Specifically, cognitive appraisals further articulate stress and coping as a

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process that may be pertinent to understanding stress and coping in infancy and childhood, and also toward advancing the study of links between stress and coping processes in older children and their possible origins in infancy and toddlerhood. As individuals get older, cognitive appraisal is increasingly emphasized in the study of stress and coping. Individuals are continuously monitoring their environment in relation to their well-being and a hierarchy of goals. Two levels of appraisal are often differentiated: primary and secondary. Primary appraisals are evaluations of the personal significance of a person– environment encounter. If the individual evaluates that there is no harm to their well-being, the situation is appraised as irrelevant. However, if the person–environment interaction is appraised as harming, threatening, or challenging the well-being of the individual, the situation is appraised as stressful. Finally, if the outcome of a specific person–environment relationship is perceived as preserving or enhancing the individual’s well-being, the situation is appraised as benign-positive. Primary appraisals are influenced by a person’s beliefs about himself or herself and the world, as well as their beliefs about the resources available to him or her for coping, such as level of problem-solving skills and financial resources. Notably, individual differences in these beliefs may lead one person to appraise a situation as stressful, whereas another person may appraise the same situation as irrelevant. Given that a situation or event is appraised as stressful, a secondary appraisal is made in which the individual evaluates his or her options for coping. Such appraisals include an assessment of what coping options are available, how likely a particular coping option will work, and whether the individual will be successful in applying that particular coping strategy. For example, infants and toddlers from high-conflict homes are more likely to appraise conflict as threatening to their well-being (primary appraisal) and decide the most effective option for coping is to intervene in their parents’ conflicts (secondary appraisal), either by distracting the parents from their conflicts or attempting to comfort parents. Together, primary and secondary appraisals influence the type and intensity of emotional responses to stress and influence an individual’s coping response. Cognitive appraisals are seen as continuously occurring and are not necessarily a conscious process. Another issue is how to categorize coping responses. In this regard, two types of coping responses are generally recognized, problem-focused coping and emotion-focused coping, which have influenced many contemporary models of stress and coping. Problem-focused coping is aimed at resolving the stressful event or situation and may include seeking information, generating solutions, and taking action to change the stressful person–environment interaction. For example, even infants as young as 1 year of age may attempt

to intervene in their parents conflicts with behaviors such as comforting or distracting parents. Emotion-focused coping is directed at minimizing the negative emotions elicited by the stressful situation and may include expressing emotions, seeking support from others, selective attention, or avoiding the source of stress. For example, infants may cover their ears or leave the room when exposed to interparental conflicts. In some cases, emotion-focused coping can lead to a reappraisal of the situation as not stressful. Some response strategies may incorporate both problem-focused and emotion-focused coping, thus these two forms of coping are not mutually exclusive. Moreover, these categories are not exhaustive of the different ways in which an individual may cope with a stressful event. Coping responses have also been categorized in terms of those aimed at primary control as opposed to responses aimed at secondary control. Primary control refers to responses toward gaining personal control over, or influencing, the stressful situation or regulating one’s own emotional reaction. Secondary control, on the other hand, refers to responses aimed at adapting and fitting in with the stressful situation. This includes accepting the situation or reappraising the stressful conditions as nonstressful. Another common distinction among coping behaviors is engagement vs. disengagement. Engagement consists of responses aimed at the stressor or one’s own negative emotions and thoughts (e.g., generating solutions), whereas disengagement reflects responses in which the individual withdraws or avoids the stressor or his or her own emotions and thoughts. Cognitive appraisals emerge as a key element in psychological perspectives on stress and coping. However, there is considerable variability in the use and effectiveness of cognitive appraisals among infants compared to young children. Infant and child models of stress and coping are derived from adult models and as such, perspectives on infant stress and coping imply that cognitive appraisals are also a critical element in stress and coping responses among this age group. However, there is a lack of empirical research testing the role of cognitive appraisals in stress and coping processes with infants and young children. Instead, research is focused on specific child responses to specific stressors, with little attention given to the processes underlying stress and coping responses among infants and young children. Thus, the study of coping in infancy and early childhood has lagged behind research with adults with regard to the construct of cognitive appraisal. However, there have been important efforts toward modifying the conceptualization of coping for the study of infants and children. For example, Nancy Eisenberg, Richard Fabes, and colleagues propose that coping is a component of self-regulation, or more specifically, emotion-regulation. They posit that children are constantly regulating their behavior and emotions. Thus, coping is seen as the process of children regulating their behavior and emotions when

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faced with stress, motivated by the presence or expectation of negative emotional arousal. Eisenberg and colleagues outline three aims of coping among infants and children. First, coping may be concerned with children’s regulation of their internal negative emotional experience and emotion-related physiological responses, including cognitive strategies such as cognitive restructuring of events (e.g., ‘This stressful event isn’t so bad’), redirecting one’s attention, approaching or withdrawing from the stressful stimulus and seeking comfort from others. Second, coping may be concerned with regulation of the behaviors associated with the experienced emotion. Third, coping may take the form of efforts to regulate the emotion-eliciting context, including modifying the source of emotional arousal, such as active approach behavior, but can also include behaviors such as seeking support. Bruce Compas and colleagues conceptualize coping as a component of children’s broader self-regulation processes. They define coping as conscious, volitional efforts by children to regulate emotion, behavior, cognition, physiology, and the environment when faced with a stressful event. Coping strategies are a function of the biological, social, cognitive, and emotional development of the individual. Although Eisenberg and colleagues allow for unconscious efforts to be classified as coping mechanisms, Compas and colleagues define only conscious, volitional responses as coping. They note this distinction allows for more precise and useful definitions of coping, excluding certain regulatory processes during stress, such as innate reflexes and automatic responses. Finally, another significant construct often included in assessing stress and coping in infants and young children is coping efficacy. Coping efficacy refers to a child’s belief that his or her coping strategy will be successful. Coping efficacy affects children’s decision about their responses in the face of stress. Coping efficacy may be influenced by previous experiences such that children may feel more competent and confident using responses that have been successful in the past. Infants and children with low coping efficacy may feel they have limited options in the face of stress and therefore may experience elevated stress responses. Evidence for Cognitive Appraisals among Infants and Young Children Studies on infant brain and cognitive development in other domains provide some evidence for the use of cognitive appraisals in infants and young children. While newborn stress responses are considered to be reflexes and automatic, by 8–12 weeks, these newborn responses become less frequent as the brainstem begins to develop. At this time, there is evidence of more advanced cognitive abilities, including increased attention. Among researchers, there is controversy regarding whether young infants

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possess complex cognitive structures. However, there is increasing evidence that by 7 months, infants have developed advanced cognitive functions, which correspond to the further development of the prefrontal cortex and other brain regions. One of the most critical cognitive abilities at this age relevant to stress and coping is the retrieval of schemata for past events and developed working memory abilities. That is, newborns are biologically equipped to perceive and create representations of the world. With increased experiences, infants begin to develop expectations of the world, objects, and people. Thus, infants develop schema, or organized mental representations of knowledge and expectations, about the world, people, and events. By 7 months of age, infants can access these schema and hold them in their working memory (short-term memory that temporarily stores and holds information). The implication of this is that infants are able to appraise new situations in relation to their expectations, or schema. If this new information cannot be assimilated into these schema, infants may appraise the situation as stressful. For example, infants around this age who encounter unfamiliar situations or interactions that violate their expectations show fear responses and may show avoidance or crying responses. Individual differences in these fear responses result partly as a function of whether or not infants believe they can control the unfamiliar event. Thus, research on infant brain and cognitive development suggest that infants starting at around 7 months possess the cognitive capabilities to appraise events as stressful. Infants’ use of social referencing around 12 months also suggests that young infants are capable of cognitive appraisals. Social referencing refers to infants seeking information during a novel or ambiguous event by looking at the emotional reaction of another person (frequently a primary caregiver) to regulate their own behavior. Social referencing, and more generally eye gaze perception, is thought to serve as a means for infants to appraise (or reappraise) situations as stressful or not and guide infants regulation in the face of stress. At the same time, it is quite difficult to assess stress and coping processes in infancy and therefore, this theme is often overlooked. While research in cognitive development suggests that infants possess the capabilities to cognitively appraise situations and events, whether these processes are at work in the context of stress and coping remains important questions for future research.

Common Themes in Stress and Coping Research in Infancy and Early Childhood Although there is no consensus on the precise processes at work, various themes identify a stress and coping perspective on child development, including infancy and early

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childhood. First, coping is seen as a complex, multidimensional process, including a wide range of responses that can occur cognitively, emotionally, behaviorally, physiologically, socially, or in any combination of the above. Additionally, coping may be influenced by both characteristics of the infant (e.g., temperament) and the environment (e.g., the availability of a parent). Second, coping is not a static response, but rather a dynamic, changing process. Coping is also context specific; an infant does not respond to all stress in the same way. An infant may use various different strategies or combinations of strategies during the course of a stressful event. Even given the same stressor, an infant may employ different coping strategies over time. Third and relatedly, coping is a developmental process; coping responses change depending on one’s age and the socioemotional and cognitive abilities of the individual. Accordingly, coping responses among infants may differ from the responses among 3-year-olds, even in the context of the same stressor. For example, infants typically seek proximity or contact from parents in unfamiliar laboratory contexts, whereas 3-year-olds are more likely to use distance interaction strategies, such as talking to the mother or keeping track of her whereabouts visually. Additionally, what constitutes a stressful event or situation may change with age or development. For example, an infant may be highly distressed by separation from the mother in day care whereas a 3-year-old may show little, if any, visible distress. Fourth, the function of coping is to limit, control, minimize, or eliminate stress, including changing the stressful environment or changing one’s own negative arousal or cognitions about the stressful event (e.g., cognitive restructuring, distracting yourself by refocusing your attention). A response that aims to eliminate stress or a stressful situation is still considered a coping response Table 1

regardless of whether it was a successful strategy. That is, although coping efficacy is an important construct with regard to stress and coping among infants and young children, the effectiveness of a response does not factor into definitions of coping.

Stress and Coping in Infancy through Early Childhood Coping with stress is an important developmental task in infancy that has implications for children’s future wellbeing. Since the newborn infant possesses limited coping strategies, there is often reliance on the caregiver to help alleviate particular stressors. Caregiver–infant interactions serve to immediately soothe the infant and also foster the development of infants’ positive representations of the world, which influence later coping responses. As children undergo rapid growth in cognitive, emotional, social, and physical developmental domains during the first year of life, the coping strategies of children become more differentiated and complex. As children get older they rely less on their caregiver for comfort and are able to engage in self-soothing coping responses and more complex cognitive problem-solving strategies. Although longitudinal studies examining within person change in coping responses during development from infancy to later childhood are a gap, cross-sectional studies provide an overview of some common coping strategies utilized by infants and children in the face of stress. Considerable individual differences are evident in infants’ reactivity to stress and their responding to caregiver or self-initiated coping behaviors. Some commonly observed coping responses among infants are presented in Table 1.

Summary of observed infant coping responses to stress

Signals to elicit caregiver help

Caregiver soothing responses

Body postures Crying Eye contact Fussing Facial expressions (e.g., grimacing) Gesturing

Baby massage Holding Non-nutritive sucking (thumb/pacifier) Rocking Smiling Sucrose Vocalizations

Infant initiated coping Self-soothing Non-nutritive sucking (thumb/pacifier) Clasping hands Body rubbing Use of security object (e.g., blanket, toy) Distraction Gaze aversion Closing eyes Turning head Playing with toy Looking/playing with hands Vocalizing distress Seeking proximity to caregiver/attachment behaviors Cognitive restructuring/reappraisal (e.g., changing thoughts or behavior given cues from social referencing) Anticipatory coping behaviors

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Types of Stressors in Infancy and Early Childhood Although infants early in life cannot use language to let us know they are feeling stressed, physiological and behavioral responses indicate that infants do experience stress. Responses that indicate infants are stressed include increased cortisol levels and heart rate, crying and grimacing, and movements such as arching the back or turning the head. Older infants evidence distress by decreasing exploration and seeking proximity to a caregiver. Additionally, infants exposed to stress may show disruptions in their sleeping and eating patterns and may be more prone to becoming sick. However, a confound in research is that it is sometimes difficult to distinguish between stress and coping responses among infants. For example, crying is a sign that an infant is stressed; however, it can also be a coping response with the function of eliciting caregiver help. Moreover, some situations and interactions may be stressful for infants, even if they do not exhibit behavioral signs of distress. There are many different events and interactions that are stressful for infants, as well as great individual variability in the types of situations that induce stress. Some of these stressors are physiological stressors, which can include events that cause discomfort or bodily pain. These include stressors such as being hungry or tired, having a wet diaper, cold or hot temperatures, physical exams, being weighed and handled, inoculation and heel stick procedures, changes in routines, and maternal separation. Also, loud noises, bright lights, or overstimulation may be stressful experiences for infants. These stressors are common among newborn and young infants. Other stressors are psychological stressors. These types of stressors include certain person–environment interactions or interpersonal interactions. Environmental stressors are changes in the infant’s physical environment, including changes in a child’s routine or being in an unfamiliar environment (e.g., doctor’s office) or exposed to unfamiliar objects. Interpersonal stressors include interactions with others that induce stress. Among infants as young as 1–3 months, certain types of interactions that include inappropriate levels of stimulation, even with familiar adults can be distressing. For example, studies using a still-face paradigm, in which mothers are instructed to present a still face to their infants and not respond to them, suggest that infants are particularly distressed by these interactions. In contrast, overstimulation, such as intrusive play which can include getting very close to an infant’s face or repeatedly presenting the infant with toys can also be distressing. Essentially, when the level of stimulation does not match the level of stimulation an infant is expecting or desires, the interaction can be distressing. Other types of interpersonal stressors that emerge around 7–8 months of age include interactions with unfamiliar people or separation from a primary caregiver. There is

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considerable individual variability in how infants respond to these interpersonal stressors. For example, infant responses when exposed to unfamiliar people may depend on the physical characteristics and behavior of the person, as well as if the environment is unfamiliar as well. The types of events that are stressful for infants and children change over time. For example, exposure to strangers is not stressful to a 1-month-old baby; however, this same experience is quite stressful for children at around 7–8 months. For older infants, events that interfere with their goals and desires are distressing, such as having a favorite toy taken away. Infant stress can be assessed both through physiological (e.g., cortisol) and behavioral (e.g., crying, facial expression) responses. However, behavioral and physiological indices of stress do not necessarily show similar results and each response may serve a different function. For example, an infant may cry during a physical exam (behavioral index of stress), but not show elevated cortisol levels (physiological index of stress). Therefore, there is no gold standard or best method for assessing the level of stress experienced by infants. Given these factors, using multiple indices of stress is optimal. Caregivers Responses to Infant Stress Newborn and young infants have limited coping response. Caregivers’ responses to stress are one of the important ways that young infants cope with stress. Thus, infants, in the early part of life, heavily rely on their caregiver to help alleviate their stress. Moreover, the caregivers’ responses to their infant’s signals of stress are critical to their child’s physiological and socioemotional development. For example, young infants show increased cortisol levels when exposed to mild stressors, such as routine physical exams. Over the first year of life, cortisol reactivity decreases such that mild stressors no longer activate cortisol release. However, there is a hypersensitive period early in life in which the caregiving environment can significantly impact the activation, and development, of the HPA system and the developing brain. While the caregiver of an infant certainly can include fathers, the majority of research in this area involves the mother–child relationship. Mother–child, or caregiver– child, interactions during times of stress have long-lasting implications for infants’ socioemotional development, which has been especially well-documented on studies of mother– infant attachment and behaviors associated with the attachment relationship. Specifically, sensitivity and responsiveness of the mother to her infant’s needs is especially important in shaping the infants’ attachment security, including internal working models of herself as worthy of support and love and the world as a positive environment. Infant crying and fussing signals to and motivates caregivers to respond to the source of their baby’s stress.

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Interestingly, maternal responsiveness to infant cries is associated with decreased crying over the first year of life. As infants become older, they are able to more actively seek the support of their caregiver through eye contact, gesturing, vocalizations, and seeking proximity to their caregiver. Caregivers’ responsiveness and sensitivity to their infants’ stress responses are critical for their socio-emotional development, and especially the development of a secure attachment, which can buffer children from the effects of stress. Early in infancy, caregivers play an especially active and important role in paying attention to when their infant is stressed and helping their infant cope with this stress, including soothing. Substantial research has been concerned with the effectiveness of maternal soothing behaviors. The effectiveness of soothing behaviors applied by fathers remains a question for future research. One method with empirical support for soothing is the use of sucrose. Specifically, sucrose has been found to serve as an analgesic and reduce infant crying, especially among newborns. Caregivers may also soothe their infants with massage. Tiffany Field and colleagues have conducted extensive research on infant massage therapy. Infant massage consists of stroking motions for about 15 min in length. Non-nutritive sucking, through the use of a pacifier has also been shown to be effective in reducing infant crying. Maternal soothing behaviors can include both proximal and distal responses. Proximal behaviors include actions in which the mother has direct contact with the infant, such as rubbing the infant’s back or the use of massage. Distal behaviors include responses such as vocalizations (e.g., ‘It’s okay, baby’) and smiling. By attending to their infants’ signs of distress and soothing them, caregivers can help infants learn how to cope effectively and regulate themselves during times of stress. Thus, caregivers’ responses to infant stress serve two functions: (1) to immediately soothe and calm the infant; and (2) to help the infant develop a repertoire of effective strategies to cope with future stress. Coping Responses in Infancy While there is heavy reliance on caregivers, the newborn infant possesses coping mechanisms to deal with stress. While these responses are limited at first, they become differentiated and complex as the infant develops. Physiological coping appears in newborn infants and is an unconscious and automatic process. That is, the newborn is capable of regulating physiological changes that occur as a result of stress in order to regain homeostasis within a short period of time. Reflexes, such as sucking and particular body movements, also characterize coping processes in newborn and young infants. However, as mentioned previously, the caregiving environment influences infants’ physiological coping with stress.

Infants also engage in psychological coping strategies. The primary coping strategies frequently observed among newborns include emotion-focused and self-soothing strategies, such as head or gaze aversion, looking at hands or clasping hands, body rubbing, non-nutritive sucking (e.g., pacifier, thumb-sucking), and signals to elicit help from a caregiver (e.g., crying, fussing). Psychological coping strategies, however, become more prominent around 3 months of age. By 3 months, infants’ coping strategies include responses in which they withdraw from the environment, such as averting their gaze or closing their eyes, or responses in which they interact with the environment, such as distracting themselves with an object. However, while infants have a number of coping strategies available to them, which one they actually choose depends on a number of factors, including their motor capabilities, temperament, level of distress, and caregiver signals. From 3 to about 9 months, the number of coping behaviors increases and the frequency with which infants use multiple coping responses also increases. Infant coping skills become further developed as their motor abilities and skills become more sophisticated. For example, as infants begin to crawl, they can seek proximity to their caregiver and as infants’ reach and grasp abilities develop, in addition to their visual development, they are able to use objects to help self-soothe. They can pick up objects, use them in new ways, and observe the textures and various features of a toy. Essentially, this is a form of self-distracting. Coping Responses in Early Childhood Compared to newborns and younger infants, the coping responses of older infants, in general, are more differentiated. Older infants use more self-soothing and problem-focused coping strategies as their motor, language, and cognitive skills develop in comparison to younger infants who rely primarily on the caregiver or tactics such as gaze aversion. However, older infants still seek their caregiver in times of stress. As their awareness of different arousal states increases and they gain an understanding that their caregiver has an effect on their arousal, infants more actively seek support from their caregiver. They also begin to display communicative behaviors, such as seeking eye contact. Children are able to use language to vocalize their distress, as well as nonverbal behaviors, such as pointing and gesturing. During early childhood, the use of crying decreases and the use of strategies requiring cognitive processing increase. By around 12 months of age, the emergence of problem-solving strategies is evident. For example, older infants can leave a stressful situation or physical act to remove a stressor (e.g., remove an obstacle to a favorite toy). Additionally, children have the ability to talk about their emotions. Older infants also engage in anticipatory

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coping responses. That is, given their experiences, they can prepare themselves for imminent stressors (e.g., doctor’s visit). For example, children may develop a preference for a particular object, such as a security blanket, that they seek in times of stress to help them self-soothe. Links between Stress and Coping and the Well-Being of Infants and Young Children Adversity, stress, and exposure to risk do not lead directly to developmental disorders or health-related problems in infants. The development of disorder or health-related problems is assumed to reflect a series of micro-social processes that occur interactively over time, typically reflecting gradual adaptations by individuals to circumstances. Even a stressor that has relatively immediate health-related consequences does so by inducing complex patterns of change at a micro-social level; that is, specificity and multidimensional characterization of response processes remain important to the possibility of causal explanation. Thus, stress and coping processes, responses, and styles that occur in specific biopsychosocial contexts account for relations between risk factors on the one hand, and adjustment or health-related outcomes on the other. The stress and coping perspective has proved to be useful for advancing a process-oriented study of infant development. That is, this perspective advances a notion of functioning and development in terms of complex processes of responses unfolding over time. Thus, this approach has fostered moving the discipline of infancy research beyond simply the identification of associations between predictors (e.g., stressor) and outcomes, and conceptualizations of infant functioning in terms of static notions of global outcomes or diagnostic classifications. Rather than focusing on infant coping in terms of something the infant ‘has’, the stress and coping perspective fosters the study of an individual’s dynamic, constantly changing adaptations to situations and contexts of family, day care, or other settings. This approach stresses how children adapt to an ever-changing and constantly flowing pattern of events. Change, for good or ill, occurs gradually and in terms of multiple and multidimensional responses to challenges, exigencies or demands of daily life. Although traumatic events may sometimes have disproportionate effects (e.g., loss of a parent, long-term separation from a parent), regardless of the rate of change, it is still the case that change is micro-social and, ultimately, involves highly specific patterns of intra- and extraorganismic interactions. While stress is an inevitable part of life, effectively responding and coping with stress is important for successful development. Exposure to certain types of stress can be a risk factor for later psychopathology. Studies of these links support the importance and significance of stress and coping for understanding the course of infant

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and early child development. The coping responses used by infants and their caregiver have been linked with both concurrent and later child outcomes. With regard to physiological development, Megan Gunnar and colleagues have shown how stress can affect the neurobiology of infants. Whereas a majority of studies on the neurobiological effects of stress have been conducted with laboratory mammals (e.g., rats), studies with human infants have examined links between how infants and young children cope with family stress and later adjustment, including studies of temperament and attachment and later development. In the specific context of marital conflict, heightened negative emotional reactivity and arousal, withdrawal, direct intervention, and aggressive responding have been linked with later externalizing and internalizing problems. Externalizing problems refers to behaviors such as aggression, delinquency, and hyperactivity. Internalizing problems refer to behaviors such as anxiety, depression, somatic complaints, and withdrawal. Notably, although certain coping responses may be linked with poor outcomes later in life, these responses may also be adaptive for children in the short term. That is, these responses can help infants and children immediately deal with the current stressor. However, over time, these coping responses may develop into a pattern of behavior that is inappropriate in other settings or situations, becoming maladaptive. For example, non-nutritive sucking is an effective coping strategy for infants, decreasing infant crying. As children become older, non-nutritive sucking, either thumb or pacifier, may be maladaptive in that children do not learn to vocalize their distress or learn active problem-solving strategies to cope. Additionally, in certain cultures thumb-sucking or the use of a pacifier may be socially unacceptable. Some levels of stress may actually be beneficial for young children and in some contexts may enhance development. Exposure to stress allows children to develop a set of coping strategies and through experience children learn which strategies are effective. However, exposure to severe forms of stress, such as child neglect or physical aggression, or chronic levels of even mild stress pose a significant risk for children’s developmental outcomes, especially when the child has not developed effective coping strategies. A point meriting emphasis is that relations between risk factors, stress and coping processes, and psychological and physical health may change significantly during development. For example, the infants’ use of parents as attachment figures or for exploration of the social or physical environment is different in important ways from the way adolescents use parents as attachment figures. However, there may be important continuities and similarities between infancy and later periods of development. For example, attachment security is clearly important for the adjustment and

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well-being of both infants and adolescents. However, age, per se, is not necessarily the best index of period of development. In other words, since aging itself is a process, periods of development may be better conceptualized in terms of processes of biopsychosocial functioning rather than chronological age.

Current Research on Stress and Coping among Infants and Young Children There is limited research on theoretical perspectives of stress and coping in infants, and most research is stressor specific. Below current knowledge on two common areas in the stress and coping literature in which there is substantial conceptual development are reviewed, along with theoretical frameworks for understanding stress and coping processes and children’s development and adjustment. First, infant attachment patterns as a working model for dealing with stress is reviewed. Next, children’s exposure to marital conflict is discussed and the EST is presented as a theoretical framework for understanding children’s coping with family stress. Infant Coping and Attachment The exact coping response a caregiver or infant uses is, of course, dependent on various factors, including the particular context or stressor. Therefore, an extensive review of infant coping responses is difficult without considering the specific stressor eliciting responses from infants. We have considered stress responses among infants, effective responses among caregivers for alleviating infant stress, and coping responses observed by infants and young children. Next, we discuss children’s coping responses to maternal separation (or separation from a primary caregiver) and the role of attachment in infant stress and coping. Mother–infant attachment is not only an indication of the mother–children relationship, but attachment behaviors are activated during times of stress. Thus, understanding children’s attachment provides a window from which to explore children’s coping responses to stressful events and situations. Historical overview of infant attachment research

The theoretical framework for attachment was developed by John Bowlby and Mary Ainsworth. Bowlby posited that infants had an evolutionary drive to attach to their caregivers and that attachment was necessary for infants’ survival. Moreover, Bowlby posited that infants were active, competent, and self-motivated to form an attachment with their caregiver. His position, however, ran counter to the popular position among psychoanalysts who considered infant attachment important solely because caregivers provided food and nourishment.

Bowlby proposed that attachment was more than just a function of meeting infants’ biological needs, such as feeding, and that the security and comfort provided by caregivers was critical to the development of an organism. Bowlby’s position was consistent with Harry Harlow’s seminal study with rhesus monkeys in 1958. Specifically, Harlow found that when given the choice between a wire surrogate mother (constructed mother-figure made of wire) with a feeding nipple and a cloth surrogate mother, infant rhesus monkeys preferred the cloth ‘mother’ and used this surrogate as a means of comfort when scared or stressed. This study underscored the idea that mothers could provide a source of comfort for their infants during times of stress. Bowlby proposed four stages of attachment. In the first stage, when infants are between 0 and 3 months old, infants do not differentiate among individuals and do not seem to be attached to one particular person. Thus, their signals when stressed are not directed toward any particular person. Their main goal is to preserve homeostasis. When stressed, infants in this stage cope by signaling distress primarily by crying, thereby promoting proximity and contact with a caregiver. Additionally, sucking responses help soothe infants in this stage. The second stage occurs approximately between 3 and 6 months. In this stage, infants prefer to be with a select group of people, primarily the caregiver. Infants in this stage utilize more self-comforting coping responses, such as non-nutritive sucking. Infants in this stage also begin to understand that their caregiver is a source of safety and comfort and signals of distress are directed to one or more discriminated caregivers. Thus, infants in this stage are seeking proximity and contact with a particular person(s). By the third stage, which occurs between 6 and 12 months, infants have formed an attachment with a primary caregiver (e.g., mother) and perhaps a secondary caregiver (e.g., father). During this time, the use of transitional objects (e.g., toy, security blanket) is an effective means of coping with stress. Additionally, the child is able to use the caregiver as a secure base to explore the world. In times of stress, infants can use their locomotion skills to actively seek proximity and contact with their caregiver. Bowlby also described a fourth stage characterized by goal-corrected behavior which occurred later in life (at about age 3 years), in which the child is able to understand the mental state of her caregiver and adjust her behavior. Bowlby’s model of attachment was not constrained to infancy; rather, it takes a lifespan developmental perspective. A key component of Bowlby’s model of infant attachment is the development of an internal working model concerning the self and others in relation to the self. Bowlby posited that through her interactions with the world and her caregiver, the infant begins to develop expectations about the caregiver’s availability and responsiveness, as well as her own deservingness for care. This internal working model is

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partly responsible for individual differences in attachment styles. Moreover, attachment reflects information regarding the infants’ current state (stressed vs. nonstressed), the state of the environment, and the availability of the caregiver. Ainsworth’s work on attachment provided empirical support for Bowlby’s theory, and marked an important new direction for empirical study of infants’ socioemotional development. Attachment patterns and coping with stress

Ainsworth noted three distinct attachment styles: labeled secure, insecure-ambivalent, and insecure-avoidant. Attachment patterns are measured by observing children’s responses to being separated from their caregiver (i.e., a stressor), in an assessment called the Strange Situation. Secure children feel comfortable exploring the unfamiliar room while their mother is present, effectively using the mother as a source of security in a stressful context. For example, these children might explore a new toy in the room, but they also turn around to interact with their mothers by showing them the toy. They are distressed by being separated from their mothers, but are quickly soothed and comforted during the reunion phase when their mothers return. Ambivalent children, however, are fearful of the unfamiliar situation and clingy with their mothers from the beginning. They are relatively more distressed (e.g., cry more) during the separation period and are not quickly comforted by their mother’s return (e.g., continue to cry). Insecure-avoidant children appear independent and generally do not interact with their mothers, evidenced by little conversation with the parent, physical drifting and orienting the face and body away from the mother. They do not appear distressed when separated from their mothers and often do not react when reunited with their mothers, sometimes snubbing the mother. In 1990, Mary Main and Judith Soloman added a fourth category, labeled disorganized/disoriented. These infants were highly aroused and distressed while being separated from their caregiver and appear to have no coherent coping strategy for dealing with the stressful situation. However, researchers have noted the difficulty in examining stress and coping responses of children when separated from a caregiver or any other stressful situation. For example, is it the case that insecure-avoidant children are not stressed by being separated from their mothers, or could it be the case that they are stressed but cope with the situation by distracting themselves or using avoidant coping strategies? Therefore, some have argued that differences in attachment behavior could indicate differences in appraisal of the situation (stressful vs. not stressful) or differences in children’s abilities to cope effectively. Ainsworth had also conducted home observations with families and noted associations between infants’ attachment behavior and mothers’ parenting behavior. Specifically,

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securely attached infants had mothers who were responsive to their children’s needs; whereas insecurely attached infants had mothers who were unresponsive, intrusive, or inconsistent in their caregiving behavior. The link between caregiving patterns and infant attachment provided support for Bowlby’s notions of the effects of these early experiences on infants developing internal working models of self and the world, including caregivers. That is, infants whose mothers are neglectful and ignore their child seemingly develop a representation of the world in which the caregiver is seen as unreliable. Nonetheless, even insecure attachments can be seen as adaptive in the short term. For these children, it is adaptive to be more independent. Similarly, for mothers who are inconsistent in their caregiving, it is adaptive for ambivalent children to cry a lot in order to gain their mothers’ attention and have their needs met. Attachment security, coping, and later development

Alan Sroufe and colleagues at the University of Minnesota provided further empirical support for the attachment categories observed by Ainsworth, based on longitudinal study. Empirical findings from his studies have shown that securely attached children in infancy are better problemsolvers at age 2 years. These children are less frustrated by challenging tasks and appropriately use their mother for help. Insecure children, however, are easily frustrated by difficult tasks and are not as good at problem-solving. Moreover, insecure attachment has been linked with poor academic achievement and ratings of unpopularity in school by both teachers and peers. Grazyna Kochanska and colleagues have found that insecure attachment is related to displays of more negative, and less positive, emotions and the inability to delay gratification. Moreover, Gunnar and colleagues have noted that insecure attachment is related to increased production of cortisol during stressful events that can have potentially harmful consequences for children’s neurological development. Increased cortisol is also related to inabilities to concentrate and lack of impulse control, which may affect coping responses. Thus, whereas an insecure attachment style is adaptive for infants in the short-term, the potential negative consequences of these attachment behaviors may make them maladaptive for socioemotional functioning and coping responses across the life span. Coping with Exposure to Marital Conflict in Infancy and Early Childhood Infants and young children are not only affected by events and situations that directly involve them, but can become stressed by seeing other family members that are stressed. Family processes and the relationship among other family members have been implicated as important factors shaping children’s developmental trajectories. For example,

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interparental conflict is a risk factor for children’s broader adjustment, linked with both internalizing and externalizing problems, as well as social, academic, and physiological functioning (e.g., sleep). Highlighting the significance of marital conflict as a stressor in early childhood, marital disagreements are inevitable and children are likely exposed to conflict on virtually an everyday basis. Moreover, exposure to marital conflict is stressful for children, and children’s coping responses to conflict mediate over time the effect of conflict on children’s development. Although popular belief is that infants are too young to understand and be affected by marital interactions, empirical studies have shown that infants as young as 6 months can distinguish between interadult anger and other emotions, and respond differently depending on the emotional tone of the interaction. Infants and children exposed to marital conflict show signs of increased negative emotional arousal and facial expressions of distress, cry, and distressed body movements, such as freezing (remaining motionless for an extended period of time) or covering their ears. Some children may verbalize their discomfort or leave the interaction or distract themselves by playing with a toy and refocusing their attention. Children as young as 12 months may become involved in interparental conflicts as a mediator in order to try and resolve and stop their parents’ dispute. Somatic responses when exposed to interparental conflict include increased heart rate and systolic blood pressure and elevated skin conductance compared to baseline levels. However, as with other stressors, there are individual differences in children’s appraisals of marital conflict as a stressful event and their responses to cope with exposure

to conflict. There is also great variability in children’s outcomes associated with marital conflict. Why are some children distressed by marital conflict while others appear unaffected? And why do some children respond to conflict by withdrawing (e.g., hiding in their rooms), while other children, for example, respond aggressively (e.g., misbehaving to distract their parents). With regard to these issues, EST, proposed by Patrick Davies and E. Mark Cummings, provides bases for understanding children’s regulatory processes in response to marital conflict (see Figure 2). EST has also been recently extended to apply to other family processes in addition to marital conflict that may be stressful for children (e.g., parental depression, parental drinking problems). Theoretical model of children’s coping responses to family stress: Emotional Security Theory

The EST has roots in attachment theory and posits that children’s responses to marital conflict serve the function of preserving or regaining a higher-order goal of emotional security within the family. Thus, children appraise marital conflict in terms of the implications the interaction has for their felt security and safety within the family system. For example, marital conflict that is negative in nature (i.e., negative emotional displays, destructive conflict tactics) is more likely to threaten a child’s sense of security and thus more likely to be stressful for children compared to a marital disagreement that is positive in nature (i.e., calm discussion of each person’s perspective, working together toward a resolution). Therefore, not all marital conflict is distressing for children; rather, destructive interparental conflict that affects the well-being and

Goal: Preserving emotional security Response: 1. Affect regulation 2. Behavioral regulation 3. Cognitive regulation

Stress: Exposure to marital conflict 1. Intense negative emotions 2. Destructive tactics 3. Discordant/unresolved endings

Outcome: Child psychological Maladjustment

Figure 2 EST: theoretical model of the effects of marital conflict on infant and child outcomes.

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security of the child and family is stressful. This type of interaction elicits the most pronounced activation of regulatory response systems. EST is a developmental theory that assumes the child’s emotional security can be enhanced or undermined by the quality of family relations over time. EST also emphasizes the transactional process between a child and the family system in predicting children’s outcomes. That is, children’s development is a dynamic interaction between the child and his or her environment that is continuously changing. Under this framework, marital conflict is not simply an environmental stressor that impacts children’s development; rather, marital conflict has effects on children depending on children’s prior exposure to marital conflict and the characteristics of any ongoing conflict, with children’s coping processes among the processes accounting for the dynamic interaction between the child and family context. Thus, preserving emotional security is a critical goal for children, organizing their responses to marital conflict and other stressful family processes. Children’s coping responses have been implicated as a possible pathway by which marital conflict relates to children’s broader adjustment. The global construct of emotional security can be measured in terms of specific regulatory processes. One regulatory process is children’s emotional reactivity to interparental disagreements, which may include physiological reactions. When disagreements are perceived as threatening, children may react with fear, anger, or sadness. Characteristics of the disagreement and children’s history of exposure to conflict both influence the form, intensity, and duration of these emotions. Another regulatory process is children’s behavioral reactions. Insecure children may attempt to intervene directly in the marital disagreement as a mediator, or become involved indirectly by trying to distract their parents from the argument at hand. Alternatively, children may withdraw from the interaction, removing themselves from the immediate environmental stressor in order to avoid exposure to destructive conflict. They may also become highly dysregulated in the context of emotional arousal and threats to emotional security such that no effective coping strategies are exhibited (e.g., freezing). In sum, marital disagreements that threaten children’s emotional security are stressful for children, motivating and organizing their specific coping responses in order to maintain or reinstate a sense of security. While some of these coping responses are effective and adaptive in the short-term, certain responses (e.g., misbehaving) may generalize into patterns of behavior that are inappropriate in other settings or situations (e.g., classroom), thereby potentially becoming a maladaptive coping strategy for the future and contributing to the development of adjustment problems later in life. A useful analogy for thinking about regulatory processes in the service of emotional security is to think

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about emotional security as a bridge between the child and the world. When the marital relationship is functioning well, it serves as a secure base, a structurally sound bridge, supporting the child’s exploration and relationship with others. When destructive conflict erodes the bridge, children become hesitant to move forward and lack confidence, or may move forward in a dysregulated way, unable to find appropriate footing within themselves or in interactions with others.

Individual Differences in Infant Stress and Coping: Temperament Why are some infants more vulnerable to stress than other infants? And why do some infants cry during stress while other infants distract themselves with a toy? Child temperament has been implicated as one of the many factors (e.g., cognitive and motor skills) that may account for individual differences in infants’ and children’s responses to stress. Temperament has been defined as individual differences in emotional and behavioral reactivity that is evident from early on in life. Moreover, temperamental traits are consistent over time and across situations, and, therefore, stable over time. It is posited that temperament has a biological basis with genetic origins, however it is acknowledged that temperament can also be influenced and modified by early experiences. One of the first studies dealing with infant temperament was the New York Longitudinal Study, which was conducted by Alexander Thomas and Stella Chess in 1956. During this study, they observed great individual differences in infant behavior and identified nine temperamental traits. These nine temperamental traits were clustered into three categories characterizing children: easy, difficult, and slow-to-warm up. Studies on infant and child temperament also frequently use the categories behaviorally inhibited and behaviorally uninhibited to characterize children. Temperament, thus, affects what is stressful for infants and may facilitate or hinder responses to stress, including initial physiological responses to stress. For example, children high in attentional control may be better able to use coping skills involving distraction or shifting one’s attention. Infants with high negative emotionality may have a tendency toward feeling anxious or threatened; therefore, they may be more likely to find novel situations stressful, be less receptive to soothing strategies, and find it more difficult to implement emotion-focused coping strategies compared to infants with high positive emotionality. Studies on temperament and coping pioneered by Jerome Kagan and colleagues have found that behaviorally inhibited children are high in reactivity and therefore have a lower threshold for stress and a slower recovery

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time from stress, and exhibit elevated cortisol responses to stress. Inhibited temperament is related to the use of avoidance or withdrawal as coping mechanisms. Uninhibited children, in contrast, are low in reactivity and more likely to use approach-oriented coping strategies. Temperament is also related to attachment style such that inhibited children are more likely to be insecurely attached. However, an important concept in temperament research is goodness of fit. That is, although research has demonstrated associations between temperament and specific developmental outcomes, ultimately it is the match between infant temperament and the caregiving environment that influences children’s development. For example, whereas behaviorally inhibited children are more reactive to stressful events and interactions, having a responsive caregiver to help aid the infant in coping effectively and self-soothe can buffer children from any negative developmental outcomes.

as reflexes and physiological regulatory abilities; however, the primary coping skills among young infants are signals for caregiver responses. Caregivers play a pivotal role in soothing their infants, as well as helping infants learn effective strategies to cope with stress. As the infants grow older, they are able take a more active role in coping with stress and their repertoire of responses grows and becomes more sophisticated. Additionally, with experience young children learn which strategies are effective. Stress is an inevitable part of life, yet most children do develop a repertoire of effective coping strategies and develop without any adverse consequences. See also: Attachment; Crying; Risk and Resilience; SelfRegulatory Processes; Separation and Stranger Anxiety; Temperament.

Suggested Readings Summary and Future Directions Stress and coping research is challenging to conduct with infants and young children who cannot directly tell us how they feeling or what they are thinking. Understandably, currently models of stress and coping in infancy are based on adult models. These models elucidate the processes that may be at work during times of stress and the mechanisms underlying exposure to certain risk and stress and later development. However, future research is needed to enhance and better articulate these models for infants and young children. For example, more evidence for children’s cognitive appraisals during stress would help strengthen current models of stress and coping, or provide direction for modifying models to more accurately capture the processes at work for young infants. While the precise processes underlying infants’ coping with stress need refining and further development, studies show that coping is a complex, multidimensional process that is constantly changing as infants develop more sophisticated motor, cognitive, emotional, and social skills. Newborn infants possess some abilities to deal with stress, such

Compas BE, Connor-Smith JK, Saltzman H, Thomsen AH, and Wadsworth ME (2001) Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and research. Psychological Bulletin 127(1): 87–127. Cummings EM, Greene AL, and Karraker KH (eds.) (1991) Life-Span Developmental Psychology: Perspectives on Stress and Coping. Hillsdale, NJ: Lawrence Erlbaum Associates. Davies PT and Cummings EM (1994) Marital conflict and child adjustment: An emotional security hypothesis. Psychological Bulletin 116(3): 387–411. Field TM, McCabe PM, and Schneiderman N (eds.) (1992) Stress and Coping in Infancy and Childhood. Hillsdale, NJ: Lawrence Erlbaum Associates. Gunnar MR (2006) Social regulation of stress in early child development. In: McCartney K (ed.) Blackwell Handbook of Early Childhood Development, pp. 106–125. Malden, MA: Blackwell Publishing. Gross JJ (ed.) (2007) Handbook of Emotion Regulation. New York: Guilford Press. Kalat JW (1998) Biological Psychology, 6th edn. Belmont, CA: Thompson Brooks/Cole Publishing Co. Kopp CB (1989) Regulation of distress and negative emotions: A developmental view. Developmental Psychology 25(3): 343–354. Lazarus RS and Folkman S (1984) Stress, Appraisal, and Coping. New York: Springer. Lewis M and Worobey J (eds.) (1989) Infant Stress and Coping. San Francisco: Jossey-Bass. Wolchik SA and Sandler IN (eds.) (1997) Handbook of Children’s Coping: Linking Theory and Intervention. New York: Plenum.

T Television: Uses and Effects J P Murray and A D Murray, Kansas State University, Manhattan, KS, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Attention deficit hyperactivity disorder (ADHD) – A biologically based psychological disorder that is characterized by restlessness, impulsivity, inattention and distractedness. Autism (or autism spectrum disorders) – A developmental disorder characterized by deficiencies in language and communication, social interaction skills, and the presence of repetitive behaviors and obsessive-compulsive disorder (OCD) interests. Formal features – Production features of television and other screen media programs such as pace, film angles and cuts, sounds, voices (male, female, child), frequency of scene changes, temporal integration. Mirror neurons – Areas of the brain that are responsive to – and ‘mirror’ – the observed physical actions of others; first discovered in the 1990s by Giacomo Rizzolatti when studying primate brains. Moderate discrepancy hypothesis – The notion that young viewers will attend to visual portrayals that are moderately novel, moderately complex and somewhat surprising in the context of the viewer’s experience (see traveling lens model). Screen media/screen time – A general category of a range of media involving visual stimulation, including computer games, CD material, television, and video. Also, the amount of time spent with such media is described as ‘screen time’. Traveling lens model – A model for describing the factors that enhance or diminish children’s attention to screen media; factors such as novelty, complexity, consistency, integration, and repetitive versus unpredictability. Trigger hypothesis – The notion that viewing television, video, or DVDs extensively during infancy may trigger the onset of autism in vulnerable children.

Introduction The history of research and policy discussions concerning media and early childhood is largely a history of research on television and children. Indeed, the concern about the impact of television on the cognitive development and social behavior of children began in the 1950s in the US and was initially focused on social behavior, particularly the impact of media violence. By the mid- to late-1960s, there was a developing concern about the role that media (i.e., television) could play in facilitating or retarding cognitive development. The landmark research in this latter area was the research designed to establish and evaluate ‘Sesame Street’, and other programs for preschool children. However, by the 1990s and the first decade of the twenty-first century, concerns about young children and media had broadened to include computers, video games, and other forms of electronic screen media or interactive toys. As a result of research and public discussion of children and media, legislators and scientific and professional associations began to suggest the need to formulate public policy and parental recommendations. These were designed to monitor and curb some of the negative effects of media, while encouraging patterns of use that enhance the positive effects of media in the lives of young children. The negative effects of screen media were associated with excessive amounts of time spent with media and the harmful effects of particular content such as violence or advertising. The concerns about excessive time spent on media focused on the fact that screen time might take time away from other important activities of childhood such as imaginative play or interaction with other children as well as time spent with parents, being read to and playing, or exploring their expanding social world. So too, the concerns about specific content such as violence, sexuality, and social role portrayals became important. In addition, advertising for unhealthy food products that may lead to disordered food preferences and eating

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patterns that encourage unhealthy lifestyles were a major concern. Finally, it has been suggested, by some psychologists and pediatricians, that extensive viewing leads to reduced attention span or increased hyperactivity and, in some recent speculative research by a team of economists, that early television viewing can facilitate the induction of Autism in young children. In response to these concerns, various professional and scientific organizations, such as the American Psychological Association, the National Association for the Education of Young Children and the American Academy of Pediatrics – including one of its most important advocates for children’s television, Berry Brazelton – have issued policy statements and recommendations about screen media effects such as violence, early childhood learning needs, and children’s social development and obesity. Early in the twenty-first century, the American Academy of Pediatrics issued an advisory to its members entitled, ‘Children, Adolescents and Television Policy Statement’, in which it recommended zero screen time for infants under the age of 2 years and only 1–2 h of quality educational media per day for those beyond 2 years of age. This is a fairly ‘lean’ diet for infants and young children and far below the levels that we know, from studies such as those conducted by the Kaiser Family Foundation, these youngsters consume in their typical daily lives. Why would major professional organizations concerned with the health and well-being of young children adopt such stringent recommendations? How have scientists studied these issues over the past 50 years of research? What do we know about the patterns of use and the effects of television and other media on the development of young children? How can screen media (television, video games, internet information, interactive toys, and CD-rom or video educational material) be used to enhance the learning and lives of infants and young children?

Research Approaches and Concerns The research history is best described in terms of the nature of the methodological approaches used: correlational, experimental (laboratory and field), and cross-lagged panel studies. Each of these methodologies will be discussed within an historical context, and the ways in which government and public concerns over the years have set the agenda for social science research. Setting the Agenda Concern about the influence of televised violence as an issue in the US began as early as the start of this new medium. The first Congressional hearings were held in the US in the early 1950s. At these early hearings,

developmental psychologist Eleanor Maccoby and sociologist Paul Lazarsfeld presented testimony that relied upon some early studies of violence in films, such as the 1933 report, Boys, Movies and City Streets, to outline a necessary program of research on the issue of televised violence and its effects on children. As the 1960s progressed, concern in the US about violence in the streets and the assassinations of President John F. Kennedy, Dr. Martin Luther King, Jr., and Robert Kennedy, stimulated continuing interest in media violence. In response, several major government commissions and scientific and professional review committees were established to summarize the research evidence and public policy issues regarding the role of television violence in salving or savaging young viewers. Across five decades, six principal government and professional commissions and review panels – the 1969 National Commission on the Causes and Prevention of Violence; the 1972 Surgeon General’s Scientific Advisory Committee on Television and Social Behavior; the 1982 National Institute of Mental Health Television and Behavior Project; the 1982 Group for the Advancement of Psychiatry, Child and Television Drama Review; the 1992 American Psychological Association Task Force on Television and Society; and the 2002 Surgeon General’s report on Youth Violence – have been central to setting the agenda for research and public discussion. In 1982, the National Institute of Mental Health (NIMH) published a 10 year follow up of the 1972 Surgeon General’s study. The two-volume report, collectively titled, Television and Behavior: Ten Years of Scientific Progress and Implications for the Eighties, provided a reminder of the breadth and depth of knowledge that had accumulated on the issue of televised violence. In this regard, the NIMH staff and consultants concluded: After 10 more years of research, the consensus among most of the research community is that violence on television does lead to aggressive behavior by children and teenagers who watch the programs. This conclusion is based on laboratory experiments and on field studies. Not all children become aggressive, of course, but the correlations between violence and aggression are positive. In magnitude, television violence is as strongly correlated with aggressive behavior as any other behavioral variable that has been measured. In 1986, the American Psychological Association (APA) empanelled a Task Force on Television and Society to review the research and professional concerns about the impact of television on children and adults. The nine psychologists assigned to this committee undertook reviews of relevant research, conducted interviews with television industry and public policy professionals, and discussed concerns with representatives of government regulatory agencies and public interest organizations. The final report, entitled Big World, Small Screen: The Role of Television in


American Society, published in 1992, included the following observation about television violence: American television has been violent for many years. Over the past 20 years, the rate of violence on prime time evening television has remained at about five to six incidents per hour, whereas the rate on children’s Saturday morning programs is typically 20–25 acts per hour. There is clear evidence that television violence can cause aggressive behavior and can cultivate values favoring the use of aggression to resolve conflicts. Clearly, both the federal government and the medical establishment had identified media violence as a problem worthy of extensive inquiry. It is not surprising that the social science researchers took up the topic as well. Early Correlational (Survey) Studies The early studies of television’s influence began almost simultaneously in England, the US, and Canada in the mid-1950s. They were designed to take advantage of the regulated introduction of the new medium in order to examine its impact in those early years. In England, a group of researchers at the London School of Economics and Political Science, under the direction of Hilde Himmelweit, began the first study of children’s television viewing patterns while television was still relatively new. (At the time, there were only three million television sets installed in the 15 million households in England.) Although proposed by the Audience Research Department of the British Broadcasting Corporation (BBC), the study was conducted by independent researchers. Begun in 1955, the study was published in a 1958 report, Television and the Child: An Empirical Study of the Effect of Television on the Young. The American and Canadian study was conducted by Wilbur Schramm and his colleagues at Stanford University. Begun in 1957, the study was published in a 1961 report, Television in the Lives of Our Children. These studies, both correlational in that they compared television viewers and nonviewers in a real-world setting (as opposed to manipulating viewing in a laboratory), provided very important benchmarks for understanding the broad and general effects of television on children. With regard to aggression, these correlational studies did not support an association. Himmelweit and colleagues ‘‘did not find that the viewers were any more aggressive or maladjusted than the controls,’’ and concluded that ‘‘television is unlikely to cause aggressive behaviour, although it could precipitate it in those few children who are emotionally disturbed. There was little support for the view that programmes of violence are beneficial; we found that they aroused aggression as often as they discharged it’’. The conclusions of Schramm, Lyle, and Parker have become something of a mantra, and go a long way toward also summarizing (or foreshadowing) the findings of 50 years of research:

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For ‘some’ children under ‘some’ conditions ‘some’ television is harmful. For ‘other’ children under the same conditions, or for the same children under ‘other’ conditions, it may be beneficial. For ‘most’ children under ‘most’ conditions, ‘most’ television is probably neither particularly harmful nor particularly beneficial.

Yet they also concluded that those Canadian and American children studied who had high exposure to television and low exposure to print media were more aggressive than those with the reverse pattern. Thus, the early correlational studies identified some areas of concern about television violence and set the stage for more focused investigations. The demonstration of a relationship between viewing and aggressive behavior in daily life circumstances is a logical precursor to studies of the causal role that televised violence may play in promoting aggressive behavior. The correlational studies that followed the Himmelweit and Schramm reports found consistent patterns of significant correlations between the number of hours of television viewed (or the frequency of viewing violent programs) and various measures of aggressive attitudes or behavior. Correlational Panel Studies While correlational studies can show us that there is a relationship between viewing media violence and behavior and/or beliefs, they do not address the issue of cause and effect. Although authors might interpret correlational data to provide evidence of cause and effect, they cannot say for sure in which direction the relationship goes. For example, might naturally aggressive children/teens be more drawn to violent media? And yet, there are some special-case correlational studies in which ‘intimations of causation’ can be derived from the fact that these studies were conducted over several time periods. Three of these special surveys and ‘panel’ studies (so named because the same panel of respondents are studied at various points in time) have been highly influential – a 1978 retrospective survey of viewing and current behavior, funded by the private television network CBS; a 1982 panel study, funded by the private television network NBC; and another panel study, funded by the Surgeon General’s Committee and NIMH from 1969 to 1986. The 1978 CBS study was conducted by William Belson in England with 1565 youths who were a representative sample of 13–17-year-old males living in London. This retrospective survey looked at the history of viewing violent programs that had been broadcast over 12 years in England and related that to the behavior of the boys during the previous 6 months. The boys were interviewed concerning the extent of their exposure to a selection of violent television programs (broadcast during the period

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1959 through 1971 and rated by members of the BBC viewing panel for level of violence) as well as each boy’s level of violent behavior as determined by his report of how often he had been involved in any of 53 categories of violence over the previous 6 months. The degree of seriousness of the acts reported by the boys ranged from only slightly violent aggravation, such as taunting, to more serious and very violent behavior such as: ‘‘I tried to force a girl to have sexual intercourse with me’’; ‘‘I bashed a boy’s head against a wall’’; ‘‘I burned a boy on the chest with a cigarette while my mates held him down’’; and ‘‘I threatened to kill my father.’’ Approximately 50% of the 1565 boys were not involved in any violent acts during the 6-month period. However, of those who were involved in violence, 188 (12%) were involved in 10 or more acts during the 6-month period. When Belson compared the behavior of boys who had higher exposure to televised violence to those who had lower exposure (and had been matched on a wide variety of possible contributing factors), he found that the high-violence viewers were more involved in serious interpersonal violence. The NBC study (published in 1982), undertaken by Ronald Milavsky and his colleagues, was conducted over a 3-year period from May 1970 to December 1973 in two cities, Fort Worth and Minneapolis. Interviews were conducted with samples of second- to sixth-grade boys and girls and a special sample of teenage boys. In the elementary school sample, the information on television viewing and measures of aggression was collected in six time periods over the 3 years. The aggression measure consisted of peer ratings of aggressive behavior. In the teenage sample there were five waves of interviews over the 3 years and the aggression measures were self-report rather than peer-reported aggression. The results showed that there were small but clear causal effects of viewing violence in the samples of boys and that these effects grew in strength over the 3 years of the repeated measures during the study period. Finally, one of the longest panel studies, 22 years, is the work of Leonard Eron and his colleagues. In the initial studies, conducted for the Surgeon General’s investigation of televised violence, the researchers were able to document the long-term effects of violence viewing by studying children over a 10-year period from age 8 to 18. At these two time periods, the youngsters were interviewed about their program preferences and information was collected from peer ratings of aggressive behavior. The violence levels of their preferred televised programs and other media and measures of aggression across these two time periods suggested the possibility that early television violence viewing was one factor in producing later aggressive behavior. In particular, the findings for 211 boys followed in this longitudinal study demonstrated that televised violence at age 8 years was significantly related to aggression at age 8 years; and the 8-year old violent

television preferences were significantly related to aggression at age 18; but televised violence preferences at age 18 years were not related to aggressive behavior at the earlier time period, age 8. When other possible variables, such as parenting practices and discipline style, were controlled it was still clear that early media violence could be part of the cause of later aggressive behavior. Furthermore, in a 1984 follow-up study, when these young men were now age 30, the authors found a significant correlation between televised violence levels at age 8 years and serious interpersonal criminal behavior (e.g., assault, murder, child abuse, spouse abuse, rape) at age 30 years. Thus, it seems clear that a correlation between television violence and aggression can be established from diverse studies. And, some special cases of longitudinal correlational studies (described as cross-lagged/panel studies) can lead to intimations of causation. However, the issue of causation is best assessed in experimental designs that allow for random assignment of subjects to various treatment conditions or, in the case of field studies, take advantage of naturally occurring variations in television viewing experiences. Early Experimental Studies The earliest experimental studies on the effects of media violence on young people emerged in the 1960s, and have proved to be so influential (and even controversial) that they are still cited today. These initial experiments were conducted by Albert Bandura, at Stanford University, who studied preschool age children, and Leonard Berkowitz, at the University of Wisconsin, who worked with college-age youth. In both instances, the studies were experimental in design, which meant that subjects were randomly assigned to various viewing experiences, enabling the researchers to apply the results of this manipulated viewing to address the issue of causal relationships between viewing and behavior. The early Bandura studies, such as ‘Transmission of aggression through imitation of aggressive models or Imitation of film-mediated aggressive models’, were set within a social learning paradigm and were designed to identify the processes governing the ways that children learn by observing and imitating the behavior of others. In this context, therefore, the studies used stimulus films (videotape was not generally available) back projected on a simulated television screen. Immediately following the viewing period, the behavior of the children was observed and recorded in a playroom setting. The children who have viewed the model beating a inflated clown (the Bobo doll, hence the generic reference to ‘Bobo-Doll-Studies’) were more likely to attack the similar toy in the playroom and imitated the voices and words used by the model in the film. Despite the structured nature of these studies, Bandura’s research was central to the debate about the influence of media violence.


Moreover, the work of Berkowitz and his colleagues, such as ‘Effects of film violence on inhibitions against subsequent aggression’, studied the aggressive behavior of youth and young adults following the viewing of segments of violent films, such as a Kirk Douglas boxing film, ‘The Champion’. The demonstration of increased willingness to use aggression against others following viewing, further fueled the debate about the influence of media violence. While the studies of Bandura and Berkowitz set the stage, later experimental studies have employed both the structured, laboratory-based settings as well as more naturalistic settings in schools and communities. For example, one of the earlier studies in this genre, assessed the effects of viewing segments of a violent television program, ‘The Untouchables’, on the aggressive behavior of 5–9-year-old boys and girls. In this study, the children viewed either ‘The Untouchables’ or a neutral, but active, track race. Following viewing, the child was placed in a playroom setting in which he or she could help or hurt another child who was ostensibly playing a game in another room. The subject could help the other child by pressing a button that would make the game easier to play and allow the other child to win more points. Similarly, the child could hurt the other child by pressing a button that would make the game very difficult to play and hence lose points. The results indicated that youngsters who had viewed the violent program manifested a greater willingness to hurt the other child than youngsters who had watched the neutral program. Moreover, an elaboration of this study by Paul Ekman and colleagues included the recording of the facial expressions of these children while they were watching the television violence. In this instance, the children, whose facial expressions indicated interest or pleasure while watching televised violence, were more willing to hurt the other child than the youngsters whose facial expressions indicated disinterest or displeasure while watching televised violence. Thus, this set of studies identified some potential moderating variables in the violence-viewing/aggressive-behavior equation. Other early experiments by researchers using physiological measures of arousal (e.g., GSR – known as galvanic skin response, a measure of sweating on the palms of the hand – and heart rate and respiration changes) while watching violent cartoons found that children were emotionally responsive even to cartoon violence. So too, other studies found that exposure to even one violent cartoon led to increased aggression in the structured playroom settings. Furthermore, studies by Ronald Drabman and his colleagues showed that children who view violent television programs became desensitized to violence and were more willing to tolerate aggressive behavior in others. Moreover, studies with emotionally disturbed children in the 1990s by Tom Grimes and his colleagues found that these youngsters may be more vulnerable to the influence of televised violence. For example, Grimes

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found that 8–12-year-olds who were diagnosed as having either attention-deficit-hyperactivity disorder, oppositional defiant disorder, or conduct disorder, manifested less emotional concern for victims and were more willing to accept violence as justified than a matched group of children who did not have these disorders – the beginnings of concerns about hyperactivity and attention deficit hyperactivity disorder (ADHD) which will be seen in more recent studies on autism and neurological deficits. All of these experimental studies described above were conducted in fairly structured laboratory or playroom settings where the display of aggression or emotional arousal or desensitization were relatively contiguous to the viewing of televised violence. However, questions remain about what might happen in more naturalistic settings or field studies of violence viewing and aggressive behavior. One early study that assessed these issues was the 1973 work of Aletha Huston Stein and Lynette Friedrich-Cofer in which they assessed the impact of viewing aggressive versus prosocial television programs on the behavior of preschoolers in their normal childcare settings. In this study, the preschoolers were assigned to view a diet of either Batman and Superman cartoons, or Mister Rogers’ Neighborhood, or neutral programming that contained neither aggressive nor prosocial material (i.e., special travel stories for preschoolers). The ‘diet’ consisted of 12 30-min episodes that were viewed 30-min per day, 3 days per week, for 4 weeks. The researchers observed the children in the classroom and on the playground for 3 weeks prior to the start of the viewing period, to establish a baseline for the amount of aggression or prosocial behavior, and continued to observe the children during the 4 weeks of viewing and for an additional 2 weeks. The results were that children who were initially more aggressive and had viewed the diet of Batman and Superman cartoons were more active in the classroom and on the playground, played more roughly with toys, and got into more aggressive encounters. Conversely, youngsters from lower income families who had viewed the Mister Roger’s diet increased their prosocial helping behavior. One suggestion from this early field study is that viewing aggressive program content can lead to changes in aggressive behavior, while the opposite is also true for prosocial programming. Moreover, these changes were demonstrated in a relatively short viewing period (12 30-min sessions) and in the context of other viewing that took place outside of the classroom setting. Other field studies have used restricted populations such as boys in detention centers or secure residential settings. In one such study, published in 1971 and conducted for NBC, Seymour Feshbach and his colleague presented preadolescent and adolescent males in a security facility with a diet of aggressive or nonaggressive television programs over a 6-week period and measured their daily aggressive behavior. They found that the youngsters who watched the nonaggressive programs

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were more aggressive than the other group. However, this study was criticized on methodological grounds relating to the selection of subjects and the assignment of viewing conditions and a subsequent replication failed to duplicate the findings. Moreover, a later study conducted by Leonard Berkowitz and his colleagues, using aggressive or nonaggressive films presented to adolescent males living in minimum-security institutions, did demonstrate increases in both verbal and physical interpersonal aggression among the teens viewing the aggressive diet. Another approach to field studies involved the assessment of the effects of naturally occurring differences in the television exposure available to children in communities with or without television or communities with differing television content. In the 1970s, John Murray and Susan Kippax were able to study the introduction of television in a rural community in Australia, in contrast to two similar communities that had differing experiences with television. In a second set of studies by Tannis Macbeth and her colleagues, the research team studied the introduction of television in a rural Canadian community, in contrast to two similar communities with differing television experience. In general, the results of both the Australian and Canadian studies converge in showing that the introduction of television had a major influence on restructuring the social lives of children in these rural communities. In this regard, both studies found that television displaced other media use and involvement in various social activities – a finding not dissimilar to the earlier studies of children in England by Himmelweit or the US and Canada by Schramm. However, with regard to the effects of televised violence, these newer field studies provide stronger evidence of negative influence, in differing but complementary ways. Murray and Kippax found changes in perceptions of the seriousness and prevalence of crime among children in the town exposed to higher levels of television violence, while Macbeth found increases in aggression among children following the introduction of television in the town. Given the range of research approaches identified over the past 50 years, what can be said about the influences of media on very young viewers? What are the patterns of use and the effects on the youngest viewers?

Patterns of Use Studies of American households consistently demonstrate that television, since its inception 50 years ago, has been a major feature of daily activities and, increasingly in recent years, computers, video games, and other electronic entertainment are woven into the fabric of family life. A 2004 report by the Kaiser Family Foundation, noted that babies 6 months to 3 years of age spend an average of over 1 h per day watching television and about threequarters of an hour using other screen media (computers,

video games, and other video/CD material). Children between the ages of 4 and 6 show similar patterns, with other screen media increasing to about 1 h per day. In addition to these patterns of use, the recent expansion of the production of television programs, videos, and CDs for infants, such as ‘Teletubbies or Baby Einstein’ and related programming, have raised questions about the impact and appropriateness of such material for very young viewers. A result that was confirmed in a 2007 report by Ellen Wartella and colleagues. Studies conducted in Australia by the Australian Broadcasting Authority, as well as studies in the Netherlands and the US, have documented the widespread use of screen media by infants and toddlers. The media environment, children living in industrialized nations experience, is both rich and varied, even accounting for the differences in social and economic conditions across various groups within those countries. For example, a study conducted in 2000 by the Annenberg Public Policy Center in the US, which was a national interview survey of 1235 parents of 2–17-year-olds and interviews with 416 youngsters ages 8–16 years, found that homes with children under the age of 17 years contained a wide range of media: 98% of the households had at least one television set, 97% had a VCR, 78% subscribed to basic cable television services – with 31% subscribing to premium cable (with its expanded programming for children, along with more adult programming), 70% owned a computer, 68% owned video games, and 52% of households had access to online services connecting to the Internet. In a related study by the Kaiser Family Foundation in 2003, which was a survey of 1065 parents of children birth to 6 years, it was found that children under 6 years were spending approximately 2 h per day with screen media (including television, computer use and video games – with 48% using a computer and 30% playing video games). And, among the 4–6-year-olds who used the computer and video games, they did so for an average of 1 h per day. In the Australian study of 157 families in Sydney – which was a longitudinal tracking of children at ages 4 months, 12 months, and 30 months – they found that infants were exposed to 44 min of television per day at age 4 months, 62 min per day at 12 months, and 84 min per day at 30 months. So too, a study using a nationally representative sample of the parents of American children, ages birth to 12 years, found that children aged 2 and younger watched an average of 10 h and 45 min of television each week, while the same report, in a longitudinal study of 240 children from low-income families, found that total television viewing increased from 19.2 to 20.8 h per week between the ages of 3–5 years. Thus, it seems clear that screen media, particularly television, occupy a significant portion of the daily activities of infants, toddlers, and young children. The next question is how do children come to understand and process the


images that they are viewing and does this viewing and media interaction have any positive and negative effects on these youngsters?

Viewing Processes We know that children begin viewing television and video material in infancy, and are exposed to significant amounts of this electronic storytelling throughout their earliest years. Therefore, the process of viewing has received some research attention in recent years. For example, in the Netherlands researchers investigated the attention patterns of 50, 6- to 58-month-olds while they viewed segments of Sesame Street, Teletubbies, the Lion King, and news clips, in their own homes. The authors hypothesized that attention to the screen material should be maximized when the content was congruent – but slightly discrepant – with the infant’s developmental needs and interests, related to familiarity with the topic and content. This approach posited the ‘moderate-discrepancy’ view, which states that children pay most attention to television content that is only moderately discrepant from their existing knowledge and capabilities. In this study, ‘salient’ content features (such as loud noise, bright or fast visual changes in the display) attracted the attention of the youngest viewers. The authors report that these features also attracted the attention of the older viewers but, in addition to the salient content, the older children were also attracted to the nonsalient content features such as moderate action by the characters, letters and numbers, and meaningful dialogue. The authors noted that this shift from salient to nonsalient content started between 1.5 and 2.5 years. This is a particularly interesting finding because it tracks closely the long-known theoretical formulations of Jean Piaget concerning the use of symbols in the transition from sensorimotor to preoperational stages of cognitive development. Related to this finding, recent research on mirror neurons (areas of the brain that respond to the observed behavior or emotions of others by showing identical patterns of brain activation as that occurring in the other person – hence mirroring the other person’s experience) and the development of language, by Michael Arbib and Giacomo Rizzolati, suggest that the ability to imitate the physical actions of others – controlled by the mirror neurons – may be the neurological basis of the development of language, a notion first raised in the mid-twentieth century by both Jean Piaget and Lev Vygotsky in their descriptions of language as ‘internalized actions’. On a broader scale, we are beginning to see that these internalized actions, drawn from observations of others in the child’s environment, may control both thought and behavior in the infant and young child. In other studies, a program of research on attention and comprehension by John Wright and Aletha Huston has

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provided an outline of the sequence of shifts in attention and comprehension during the early years of viewing. In this program of research, the authors followed the viewing patterns of 240 children from low-income families in a large city in the Midwestern area of the US, for 3 years, in two cohorts, from ages 2 to 5 years and 4 to 7 years. The authors found shifts in the types of programs viewed by preschoolers and early school years – a shift from less cognitively demanding to more demanding program content (with cognitive demand measured by the redundancy of scenes and characters – easier – and the amount of temporal integration required to understand the scene and storyline – harder). Building on the earlier work of Dan Anderson and colleagues, who demonstrated that children attended to content that was comprehensible even when it was not presented with salient features, Huston and her colleagues outlined a clear pattern of shifts in attention based on children’s understanding of the production conventions associated with particular media content. In this instance, the authors proposed that children quickly learn the ‘formal features’ of programs that are ‘child-friendly’ and easily understood – the formal features of such programs include, for example, child and female voices as a prominent content feature. As a result of these studies, the authors developed the notion that young children ‘sample’ the television content to determine whether the program is child-oriented and potentially interesting and understandable. This stimulus sampling model suggested that initial brief attention to the screen will increase if the child recognizes that the material is ‘appropriate’ for their interests. This notion was elaborated into the concept of the Traveling Lens Model of attention and comprehension in children’s viewing patterns, which is outlined in Figure 1. Thus, the arousal of interest and attention will be highest if the stimulus material is perceived as falling between the poles of familiar versus novel; simple versus complex; redundant versus inconsistent; repetitive versus unpredictable; and expected versus surprising. Hence, children attend most to scenes that are moderately novel, of intermediate complexity, somewhat regular, somewhat ordered, and recognizable.

Effects of Viewing So, what are the implications of this extensive use of screen media in infancy and early childhood, coupled with the changing patterns of attention and comprehension throughout the early years of viewing? Most of the concern about this early viewing and screen time has focused on the lack of interactivity between the infant and toddler and his or her caregiver. As the American Academy of Pediatrics, noted, the most important activities and interactions in infancy are those social, face-to-face, interactions that establish the basis for

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Resultant effects of increasing age and viewing experience on location of curve

Incomprehensibility

Effects of learning and cognitive development

Effects of familiarization and habituation

Arousal of interest and attention

Boredom

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Low Stimulus perceived as: Familiar…………………… Moderately novel……………..………..Novel Simple……………….of Intermediate complexity………………Complex Wholistic……………………...Integratable…………………..Incongruous Redundant………………..Somewhat regular……………….Inconsistent Repetitive………………….Partially ordered……….…..…Unpredictable Expected………………………Recognizable………………….Surprising Figure 1 The traveling lens model of children’s attention to television content. Source: Huston AC, Bickham DS, Lee JH, and Wright JC (2007) From attention to comprehension: How children watch and learn from television. In: Pecora N, Murray JP, and Wartella EA (eds.) Children and Television: Fifty Years of Research, p. 52. Mahwah, NJ: Lawrence Erlbaum Associates.

interpersonal relationships. Television and video viewing tends to be more solitary, although there are newer videos, such as that developed by Sesame Workshop (‘Sesame Beginnings: Beginning Together’; a DVD for 6 months and up) that encourages parental involvement in the viewing experience by explicitly designing ‘co-viewing’ tasks for caregiver and infant. However, other concerns have been raised about the early viewing experience and the effects on later development. Marie Evans Schmidt and Dan Anderson, in the Pecora, Murray, and Wartella book (Children and Television; Fifty Years of Research), review the evidence for and against such viewing by noting the positive gains from viewing specific educational programming versus the tradeoffs concerning lost interpersonal interaction and the charges that such viewing leads to reduced attention span or intellectual and physical passivity. As the authors note: ‘‘To us it is clear that most of the effects of television on cognitive development and academic achievement stem from the particular content viewed. There is little question but that educational television programs teach, and that this teaching has beneficial short- and long-term consequences for schooling. These consequences are due not only to academic content and skills learned from the programs, but also from the social teaching of impulse and aggression control. Most of the negative effects of television stem from entertainment programs, particularly those with violent content. The negative effects include reading displacement in the early elementary years and modeling of aggression, restlessness and impulsivity.’’

With regard to the development of behaviors that are incompatible with smooth progress in social and intellectual development, it is the issue of the fostering of restlessness, impulsivity, and disrupted attentional processes that has sparked the most concern. For example, Dimitri Christakis and his colleagues, in a study of 1345 children, found that an extra hour of daily television viewing at ages 1 and 3 years led to a 10% higher probability that children would exhibit behaviors consistent with a diagnosis of ADHD by age 7 years. Also, a 2007 report by Carlin Miller and colleagues in the Journal of Pediatric Psychology, confirms the risk of attentional problems in preschool children who engaged in extensive television viewing. Moreover, in a 2007 report in the Journal of Pediatrics, Fredrick Zimmerman and his colleagues found that every hour of daily veiwing of ‘baby videos’ such as ‘Baby Einstein’ was associated with a 17% ‘decrease’ in scores on a standard language development assesement. Following on this research, a team of economists led by Michael Waldman at Cornell University explored the possibility that extensive television viewing in infancy and early childhood might serve as a ‘trigger’ for the development of autism in young children. This is a highly controversial proposition, but the authors provide interesting statistical analyses showing correlations between autism rates at the county level in California, Oregon, Washington, and Pennsylvania and variables that should be correlated with early childhood television viewing. Using the US Bureau of Labor Statistics study of the ‘American Time Use Survey’ they first show that television viewing by


children under age 3 years is positively related to the amount of precipitation in the environment. They then examine county level autism rates in California, Oregon, and Washington (which have varying levels of precipitation), and show that autism diagnosis rates are positively related to precipitation – as the television-as-trigger hypothesis would suggest. In a second test of the hypothesis, the authors compared cohorts of children in California and Pennsylvania who were born between 1972 and 1989 and found that the county-level autism rates were significantly related to the percentage of households who subscribed to cable television even after controlling for the trend increase in cable percentages during the time period (which was spreading rapidly through those areas during that 1972–89 time period). Thus, the authors conclude that the findings from their ‘natural experiments’ are sufficiently suggestive of the television-as-trigger hypothesis that more direct testing is warranted. Naturally, there is much discussion about the speculative and complex trail of correlations outlined in the Waldman et al. study of autism and early television viewing. However, there is evidence discussed earlier by Schmidt and Anderson and Christakis and his colleagues, suggesting that both the content (violent, high-action programs) and the amount of time spent viewing television in early years can lead to increases in impulsivity and disorders of attention. Furthermore, the speculations

about the relationship of viewing and hyperactivity, as a neurological problem of focus and attention that relates to autism, may be supported in the recent reports of longitudinal studies of the effects of extensive television viewing in the development of attention and learning difficulties during adolescence, in a 2007 report by Jeffrey Johnson and his colleagues. Also, brainmapping studies by John Murray and Mario Liotti and their colleagues, of older children (8–12 years), demonstrated that there are unique patterns of brain activations associated with viewing violence. Indeed, in looking at the brain scans of the youngsters while they were viewing video violence there was evidence that they were attempting to imitate the violent boxing actions through activation of the prefrontal cortex – premotor cortex in the right hemisphere (see Figure 2, area PF9/6) suggesting the role of mirror neurons in affecting the thought and behavior of young viewers. And, descriptions of the behavioral manifestations of autism note that one of the striking characteristics of children at high-risk for autism (children who have older siblings who are autistic) is their failure of ‘disengagement of visual attention’ such as their inability to ‘break attentional contact’ with the television screen when viewing. Clearly more research is needed in this area, but this highlights some of the concerns about excessive amounts of ‘screen time’ and the potential influence on infants and young children.

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Figure 2 A brain scan from functional magnetic resonance imaging showing mirror neurons active in the prefrontal cortex – the right hemisphere premotor Area (PF-9/6; PF-9). Source: Murray JP, Liotti M, and Ingmundson PT, et al. (2006) Children’s brain activations while viewing televised violence revealed by fMR1. Media Psychology 8(1): 25–37 (see color plate 2).

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So too, on a more positive note, Anderson and his colleagues, in a 2001 report in the Monographs of the Society for Research in Child Development, reported on their longitudinal study of the impact of educational programs such as ‘Sesame Street’. Their findings show that ‘Sesame Street’ viewing at age 5 years not only prepared children for preschool and early school years but also predicted better High School grades in English, math, and science. Thus, there are both positive and negative outcomes from early experience with screen media. However, the cautious response to questions about the effects of television and other screen media in infancy and early childhood is to limit the amount of exposure to these media and to very carefully monitor the content of the program material by emphasizing planned educational programming and maintaining parental interaction in the young child’s viewing experience. As many psychologists and pediatricians have noted, it is the ‘human interaction factor’ and not technology, that most advances the intellectual and social development of infants and young children. See also: Anger and Aggression; Autism Spectrum Disorders.

Suggested Readings Anderson DR, Huston AC, Schmitt K, Linebarger DL, and Wright JC (2001) Early childhood television viewing and adolescent behavior: The recontact study. Monographs of the Society for Research in Child Development 66 (Serial No. 264). Arbib MA (2002) Towards a neuroscience of the person. In: Russell RJ, Murphy N, Meyering TC, and Arbib MA (eds.) Neuroscience and the Person: Scientific Perspectives on Divine Action. Citta del Vaticano: Libreria Editrice Vaticana.

Arbib MA and Rizzolatti G (1997) Neural expectations: A possible evolutionary path from manual skills to language. Communication and Cognition 29: 393–424. Brazelton TB (1992) Touchpoints: Your Child’s Emotional and Behavioral Development. New York: Perseus Publishing. Christakis DA, Zimmermann FJ, DiGiuseppe DL, and McCarty CA (2004) Early television exposure and subsequent attentional problems in children. Pediatrics 113(4): 708–713. Fisch SM and Truglio RT (2001) ‘‘G’’ is for Growing: Thirty Years of Research on Children and Sesame Street. Mahwah, NJ: Lawrence Erlbaum Associates. Huston AC, Bickham DS, Lee JH, and Wright JC (2007) From attention to comprehension: How children watch and learn from television. In: Pecora N, Murray JP, and Wartella EA (eds.) Children and Television: Fifty Years of Research, p. 52. Mahwah, NJ: Lawrence Erlbaum Associates. Johnson JG, Cohen P, Kasen S, and Brook JS (2007) Extensive television viewing and the development of attention and learning difficulties during adolescence. Archives of Pediatric Adolescent Medicine 161: 480–486. Miller CJ, Marks DJ, Miller SR, et al. (2007) Brief report: Television viewing and risk for attention problems in preschool children. Journal of Pediatric Psychology 32(4): 448–452. Murray JP (2007) Children and Television: Using TV Sensibly – A Guide for Parents and Teachers. San Antonio, TX: Mind Science Foundation. (available online at www.mindscience.org/ murray_research.html). Murray JP, Liotti M, Ingmundson PT, et al. (2006) Children’s brain activations while viewing televised violence revealed by fMRI. Media Psychology 8(1): 25–37. Pecora N, Murray JP, and Wartella EA (2007) Children and Television: Fifty Years of Research. Mahwah, NJ: Lawrence Erlbaum Associates. Phillips H (2007) Mind-altering media. New Scientist 33–37. Vandewater EA, Rideout VJ, Wartella EA, Huang X, Lee JH, and Shim M (2007) Digital childhood: Electronic media and technology use among infants, toddlers and preschoolers. Pediatrics 119(5): 1006–1015. Waldman M, Nicholson S, and Adilov N (2006) Does Television Cause Autism? (Working Paper No. 12632). Cambridge, MA: National Bureau of Economic Research. Zimmerman FJ, Christakis DA, and Meltzoff AN (2007) Associations between media viewing and language development in children under age 2 years. Pediatrics (in press).

Temperament M K Rothbart, University of Oregon, Eugene, OR, USA M A Gartstein, Washington State University, Pullman, WA, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Constitutional – Factors related to the biological make-up of the individual. Cortisol – A corticosteroid hormone produced by the adrenal cortex that is involved in responses to stress; it increases blood pressure, blood sugar levels, and suppresses the immune system.

Executive attention – Attentional control in situations that require conflict, overcoming habitual responses, action planning, error detection and compensation, and dealing with novel, difficult, or dangerous conditions. These capacities are seen to underlie temperamental effortful control. Hemispheric asymmetry – The brain’s left hemisphere has been associated with approach and

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positive affect, the right hemisphere with negative affect and avoidance processes. Heritability – The proportion of variation in a population attributable to genetic variation among individuals, as opposed to environmental factors. Heritability analyses estimate the relative contributions of genetic and nongenetic factors to the total phenotypic variability in a trait. Individual differences – Variability among individuals in the expression of specific characteristics such as temperament traits. Psychopathology – The study of mental distress, problem behaviors, and major difficulties in adjustment indicative of mental illness or psychological impairment. Surgency – A personality attribute associated with dominance, self-confidence, competitiveness, outgoing, extroverted, and decisive actions. Surgency involves patterns of behavior that are generally exhibited in reward-oriented situations and in the social context, also presumably rewarding to individuals with high levels of this characteristic.

Introduction When you ask a friend about the origins of their adult personality, they will likely talk about what happened to them in childhood, with the parent playing a major role. The tendency to turn to parents as causal influences is consistent with the tabula rasa approach to infancy, viewing infants as molded by socializing agents into functional adults. More recent efforts to understand the origins of personality, however, have expanded to include ‘child effects’, those effects on development that can be attributed to the individual child. Temperament has emerged as a key mechanism in child effects, with characteristics observed early in life predicting later personality, behavioral and emotional patterns, adjustment, and the presence and severity of clinically significant symptoms. The study of temperament has a long history, with only relatively recent attention to the development of these attributes. Individual differences in temperament were described in the fourfold typology of the Greco-Roman physician, Vindician, which persisted throughout the middle ages and the Renaissance. Early in the twentieth century, major schools in Europe contributed to temperament research. In the UK, studies of individual differences in temperament and personality were carried out using adults’ self-reports, which yielded several factors, or broad dimensions, including introversion–extraversion, emotional stability–instability (later called by Eysenck,

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‘neuroticism’), and volition or will. Jeffrey Gray later revised this model, proposing individual differences in behavioral activation and inhibition, as well as tendencies to fight and flight. Perhaps the single most influential investigation of children’s temperament was conducted in the US. The New York Longitudinal Study (NYLS) conducted by Alexander Thomas, Stella Chess, and colleagues formed the basis for much of the recent research on temperament in children. Thomas and Chess identified nine dimensions of temperament: activity, approach/withdrawal, threshold, mood, intensity, rhythmicity, adaptability, distractibility, and attention span/persistence. They also described ‘difficult temperament’ as including low rhythmicity, high withdrawal, slow adaptation, high frequency of negative mood, and intense reactions. The ‘easy temperament’ category, on the other hand, was described as including regular eating, sleeping, elimination cycles, a positive approach response to new situations, along with frustration tolerance, whereas ‘slow-to-warm-up children’ were characterized as showing negative responses when exposed to new situations, but slowly accepting these with repeated exposure. Alexander Thomas and Stella Chess also introduced the concept of goodness-of-fit, which is the degree of match between the child’s characteristics and the parent’s demands or expectations. They proposed that in order to understand how certain children demonstrate positive adjustment, while others show behavioral problems and symptoms of psychopathology, the ‘goodness-of-fit’ between child temperament, intellectual ability, and environmental factors (parenting in particular) need to be considered. The basic thesis is that a good match leads to more positive adjustment, whereas a poor fit between child temperament, other characteristics, parental demands, and expectations leads to problematic outcomes. These ideas paved the way for a variety of investigations addressing early appearing individual differences, some of which have led to significant revisions in the NYLS list of temperament dimensions.

Conceptual Definitions of Temperament Mary Rothbart and Douglas Derryberry defined temperament as constitutionally based individual differences in emotional, motor and attentional reactivity, and selfregulation, demonstrating consistency across situations and relative stability over time. The term constitutional stresses the connection between temperament and biology. Over the long history of study, individual differences in temperament have been linked to the constitution of the organism as it was understood at the time. Reactivity refers to the latency, rise time, intensity, and duration of response to stimulation. Self-regulation refers to

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processes serving to modulate reactivity; these include behavioral approach, withdrawal, inhibition, and executive attention. This definition of temperament has been appealing to researchers because it can be applied to temperament observed in infancy, childhood, and adulthood, whereas other approaches have focused on applications to adults, or other developmental periods (e.g., the newborn period). Other approaches to the study of temperament include the work of Jerome Kagan, who adapted temperamental characteristics of fear and surgency into temperamental categories, assigning children to inhibited and uninhibited extreme groups. Inhibited children can also be described as shy, cautious, fearful, and motorically tense. Uninhibited children tend to be social and outgoing (extraverted) in novel situations, and do not show as much motor restraint. Kagan and colleagues have reported a number of physiological differences between inhibited and uninhibited youngsters in the first 5 years of life. These include higher, more stable heart rates, and higher levels of cortisol for inhibited children, and they see the classification system as reflecting underlying biological differences. A number of unresolved issues, however, include the stability of classification, variability within the two groups, and specific patterns of physiological response. Arnold Buss and Robert Plomin have applied two criteria, early appearance and heritability, as defining properties of temperamental traits. They identify emotionality, activity, and sociability as the three key dimensions of temperament, conceptualized as stable, with little change evidenced over time. They exclude traits that fail to persist into adulthood, such as rhythmicity (the degree of regularity in sleeping and eating patterns). While heritability plays a key role in their conceptualization of temperament, Buss and Plomin note that environmental forces can act upon the individual to promote change. Hill Goldsmith and Joseph Campos propose that the basic emotions are the core of temperament, describing individual differences in temperament as the likelihood of experiencing and expressing the primary emotions, and in the frequency of emotional experience. Their emotions include anger, sadness, fear, joy, pleasure, disgust, interest, and surprise. Goldsmith and Campos note the importance of both the expressive and receptive aspects of individual differences in social interactions; that is, in children’s ability to express emotions and to recognize, decode, and understand the emotional expressions of others. Although a number of theorists have their own distinctive definitions, fundamental points of consensus regarding the nature of temperament have been identified. First, temperament refers to a set of traits. Studies of temperament, therefore, typically involve a variety of dimensions (i.e., fear, sadness, arousal level, activity level, etc.) rather than a single construct. Temperament

constructs also consist of behavioral predispositions, rather than direct links to behavioral outcomes. Temperament does not provide a complete ‘formula’ for behavior; rather it provides a framework within which observed tendencies can be interpreted and behavior predicted. Temperament serves as a mechanism to explain how individuals contribute to their own social–emotional development in a given environmental context. A third common emphasis is the belief that temperament is biologically based and relatively stable across time and situations. In the course of development, however, links between temperament and its manifestations become much more complex. Thus, infancy has been traditionally considered the developmental period during which temperament can be interpreted most directly. A fourth and final commonality is the assumption that temperament refers to a quality that varies among individuals, with different temperament predispositions leading children to experience the same events in a different way. Dimensions of Temperament: Structural Definitions Research addressing the structure of temperament has most frequently relied on caregiver reports (often using paper-and-pencil questionnaires) allowing study of relations among dimensions, as done in the NYLS. More recently, individual differences have been examined broadly in terms of general characteristics, and narrowly, identifying fine-grained attributes and taking advantage of the caregiver’s extensive observations of the child. Studies have identified higher-order temperament constructs, such as negative emotionality, positive emotionality/ extraversion, and effortful control/regulatory capacity, which in turn consist of sets of more fine-grained temperament attributes. Whereas negative emotionality typically consists of related dimensions of sadness, anger, irritability, and fear, positive emotionality/extraversion typically consists of approach, smiling and laughter, activity level, and sociability. Early in life, regulatory capacity reflects orienting and self-soothing; later in life, effortful control reflects the ability to inhibit a dominant response in order to perform a subdominant response, and includes perceptual sensitivity and attentional control. In addition to the research outlined above, recent work with parent-report instruments has led to revisions of the list of temperament dimensions originally identified in the NYLS. Responses to questions or items on questionnaires allow an examination of the clustering of these items via factor analysis (a statistical technique used to determine the extent of clustering and the degree of homogeneity within and across the clusters of items). The use of this approach has not provided support for the original NYLS dimensions; instead, recent studies

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provide evidence for a smaller number of relatively independent temperament characteristics seen in early childhood. For instance, instead of supporting bipolar scales such as approach vs. withdrawal, withdrawal items, along with items from adaptability and other fearrelated items, tend to cluster together in a fear or inhibition/withdrawal factor. Approach items, in contrast, tend to cluster with positive affect items from the mood scale to form a positive affect/approach factor. In the assessment of negative emotionality, fear tends to be differentiated from irritability or frustration. Other factors extracted more closely resemble the NYLS dimensions of activity level, persistence or duration of orienting, and rhythmicity, but rhythmicity tends to be a more minor factor containing few items. Threshold as a factor has been found in an extremely limited context in one instrument only, and ‘intensity’ does not emerge in the factor structure of the instruments, because of its lack of generalizability across different kinds of response. Dimensions of temperament in the revised list seem to correspond more to specific affective-motivational processes than to overall styles of behavior. For instance, infant behaviors that reflect positive emotionality include smiling, laughing, and approaching novel stimuli. Positive emotionality is frequently used interchangeably with the term surgency or extraversion, which reflects behaviors described as outgoing, enthusiastic, alert, and active. Individuals higher in positive affect also have the tendency to be engaged with, rather than disengaged from, their environment. Extraversion/ surgency in infancy is now thought of as a developmental precursor to the personality dimension of extraversion evaluated in older children and adults. In research on 3–12-month-old infants, a negative emotionality factor has also been found, consisting of irritability, fear, sadness, anger, frustration, and discomfort. Negative emotionality has been linked to the personality trait of neuroticism observed later in childhood and adulthood. There has been occasional debate as to whether positive and negative emotionality reflect two different constructs or are opposite poles on one dimension of emotionality. Evidence suggests, however, that these constructs are related, but distinct. That is, positive and negative affectivity ratings are largely nonoverlapping, although low to moderate associations between negative and positive emotionality have also been reported. Activity level (i.e., the degree to which infants engage in physical movement) is another early emerging temperamental characteristic. Although it has been measured at various stages of development, there is some question as to whether it is a unique construct or if it appears as an aspect of positive or negative emotionality. For example, Escalona noted that newborns tend to engage in more motor activity when in a negative rather than in a positive state. However, later in infancy, higher

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levels of activity become associated more with positive emotionality, in the context of exploration, play, or approaching novel objects. The regulation-oriented dimension of temperament emerges in early infancy and undergoes rapid development throughout childhood. In infancy, this factor has been labeled as orienting capacity/regulation and includes attributes associated with attentional duration of orienting, positive affect, and soothing. Interestingly, the infancy orienting/regulation factor includes the low-intensity pleasure scale, addressing the child’s ability to enjoy calm pleasant activities (e.g., looking at pictures). This relation is consistent with the findings reported for effortful control in the preschool period. Despite this similarity, there are considerable differences in the characteristics related to self-regulation in infancy and later in childhood, and these reflect significant developmental shifts in related attentional processes. For example, inhibitory control, a central component of effortful control for toddlers and preschoolers, does not come ‘online’ in the first year of life (e.g., infants are not able to engage in a delay following instructions). So-called higher-order attentional skills contributing to inhibitory control scale have been linked to the development of the executive attention system, exerting its influence toward the end of the first year of life and continuing to develop throughout childhood. The immaturity of infant control of attention often necessitates external (i.e., caregiver) involvement in regulatory functions, and the child characteristics of soothability and cuddliness also contribute to the orienting/regulatory domain of temperament in infancy. As children develop, self-regulatory skills becoming more proficient at effortful control, adult interventions aimed at regulating behavioral and emotional reactions become less prominent, and the child is said to have developed self-control. Effortful control is a regulatory aspect of temperament that is responsible for suppression of a dominant response in favor of performing a subdominant response. Effortful control serves to override a prepotent response as well as to initiate and/or maintain an alternative behavioral or emotional response. Effortful control is also involved in the ability to shift attention and to voluntarily alter one’s focus from one location to another. Currently, it is believed that effortful control emerges in the late infancy/ toddler period, coinciding with rapid development of executive attentional mechanisms in the brain. Executive attention, a brain network involving prefrontal cortex and anterior cingulate as well as basal ganglia, appears to be a process underlying effortful control. Effortful control includes focused attention, perceptual sensitivity, inhibitory control, and low intensity pleasure. Given the range of abilities in which effortful control plays an important role, it is not surprising that effortful control has been found to relate to the development of conscience and

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aggression. Effortful control is also a protective factor for the development of problems, promoting the child’s obedience to parental rules.

Assessment of Temperament in Early Childhood: How Do We Measure Temperament? Temperament assessments in early childhood often rely on structured observations of temperament-related behavior or information collected from the caregiver. Observational measures of newborns and young infants include assessments of reactivity to multiple modes of stimulation, whereas observations of older infants, toddlers, and preschoolers also permit evaluation of attention-based regulatory capacity. Observations of young children are frequently carried out in the laboratory, following a structured set of procedures; however, such observations can also be conducted in the child’s home or the hospital. Caregiver report methodology consists of asking parents, or other care providers, questions about the frequency of behaviors related to child temperament characteristics. A variety of questionnaires, based on caregivers’ observations, have been developed for this purpose, providing researchers with tools for assessing temperament from birth into the preschool period and beyond. At least three major goals have been pursued in the assessment of temperament in early childhood. One has been to measure individual differences in reactivity and self-regulation under controlled conditions, typically through observation in a laboratory setting. More recently, it has involved the development of laboratory marker tasks, tests that assess variability in children’s behavior in the laboratory that has been associated in adult imaging studies with the activation of specific brain regions or networks. A second goal has been to identify the structure of temperament via parental responses to paper-andpencil questionnaires addressing multiple child attributes. Information provided by caregivers is sometimes presented together with data from additional sources (e.g., home observations or other temperament measures) because caregiver report possesses both unique strengths and potential weaknesses, as do other methods (elaborated on in the next section). The third goal has been to adapt temperament measures to clinical uses. Clinical adaptations have included the informal use of questionnaires or observations in clinical diagnosis and treatment, as well as a means to encourage parents to pay attention to their children’s behavior patterns. Measures of temperament have also been used in studies of the development of behavior problems, and have been linked to adjustment in adulthood. Measures developed for the assessment of temperament in

early childhood have not yet achieved the measurement qualities necessary for predicting future problems for specific individuals, but they have been helpful in our general understanding of the development of behavior problems. Recent studies have begun to include physiological measures such as assessments of children’s vagal tone, cortisol levels, and hemispheric asymmetry, yielding results of interest in relation to caregiver reports and observations of children’s temperament-related behavior. The use of these methods along with other temperament assessment approaches (e.g., caregiver-report) may allow validation of each method, and provide valuable information regarding the processes involved in the development of temperamental individual differences. Consistent patterns of findings across different measurement modalities would also provide conclusive validation for each of the approaches involved. The use of physiological tools in concert with behavioral measures provides an added benefit of allowing researchers to identify mechanisms underlying individual differences in temperament. Confidence in Measures of Temperament: Reliability and Validity Researchers of temperament development in early childhood have traditionally been very concerned about possible sources of error in their measurement. These so-called sources of error include any contributors to the temperament rating other than the indications of child temperament themselves. For instance, researchers often worry that social desirability, or the tendency to answer questions in a manner consistent with perceived social expectations, will lead parents to inflate their ratings of child positive emotionality (e.g., smiling/laughter). Although this concern is typically voiced in relation to caregiver-report, potential effects of sources of error (e.g., effects of the laboratory environment on the child’s behavior) extend to observational measures as well. Error affects the reliability and validity of the assessments. Reliability refers to the consistency of a particular measure across time, raters, or items, whereas validity represents the extent to which the estimate accurately reflects the temperament attribute under investigation. Not surprisingly, low levels of reliability and validity lead to decreased confidence in the measures of temperament, and a problem for a meaningful interpretation of findings. Each approach described above has a set of potential sources of error as well as distinctive strengths, and these are discussed in turn. Sources of error that can affect observation-based indices include those related to characteristics of the rater, effects of the measure on child behaviors, and interactions between rater characteristics and child behavior (e.g., subtle differences in the

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experimenters’ reactions to infants in distress, with more soothing behavior directed toward these children relative to nondistressed participants). In caregiver report, error may occur due to an inability of the caregiver to understand items and instructions, lack of knowledge of the child’s behavior and its meaning, lack of knowledge of the behavior of other youngsters to whom the child is compared, and the accuracy of caregivers’ memory of events involving the child. These concerns can be partially addressed by careful pretesting of items, asking only about recently occurring events, and inquiring about concrete child behaviors, rather than asking the parent to make abstract or comparative judgments. A second set of problems includes the extent to which caregivers’ responses are driven by their own state or clinical disorder, or response sets such as social desirability. In our review of research relating maternal characteristics to their reports of infant temperament, the two sets of variables are related, but the degree of this association is low to moderate, and could be related, at least in part, to genetic inheritance. In the laboratory, concerns about the observer also apply, but these are moderated by the possibility of carrying out detailed coding of videotapes, rather than doing all of the coding as the behavior occurs. In video analysis, multiple behaviors can be coded. Work may be done by multiple coders, and strict controls on reliability are possible. In all approaches, there are problems with detecting ambiguous reactions of the child. Concerns with sources of error in laboratory observations also include the effects of the novel laboratory environment and/or experimenters. For instance, the lack of familiarity in this environment may lead children to behave in a more fearful manner, especially as the development of the behavioral inhibition system accelerates toward the end of the first year of life. The latter may pose no problem in the assessment of fear/behavioral inhibition; however, these effects are likely to adversely impact the ratings of positive affectivity, serving to attenuate reactivity. Despite the ongoing efforts to improve our assessment tools, enhancing their reliability and validity and decreasing the influence of different sources of error, research with existing measures has already lead to an increased understanding of temperament development in early childhood.

Development of Temperament in Early Childhood (Birth–5 years) Although Arnold Buss and Robert Plomin argued that temperament measures must show both early appearance and long-term stability, developmental changes in temperament-related processes have been found throughout

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childhood and beyond, and at no time are these changes as rapid as in the first year of life. Expressions of temperament differ greatly in the newborn, the 3-month-old, and the 12-month-old, and develop further into the toddler and preschool periods. In fact, it is not possible to measure all of the temperament attributes across all developmental periods in early childhood because the developmental emergence of particular primary emotions and attentional processes varies across early childhood. Moreover, because some emotions and attentional processes regulate other emotions and actions, the time of onset of these control dimensions has important implications for other temperamental characteristics. Early Infancy (Birth–3 Months) During early infancy, smiling and laughter are emerging as part of a positive affectivity dimension, and motor activity comes to be linked to infants’ positive as well as negative affect displays. In addition, infants by 2 months are demonstrating anger/frustration when their actions no longer control an interesting outcome. Infants during this period also often show a high susceptibility to distress to overstimulation and colic. Cindy Stifter has found, however, that measures of colic during this period are not predictive of later measures of temperament. Colic is generally defined as uncontrollable, extended crying in an infant who is otherwise healthy and well-fed. That is, although every infant cries, babies who cry for more than 3 h a day, 3–4 days a week, are identified as having colic. In general, this condition appears at around 2–4 weeks of age and can last for 3 months, or longer in some cases. In addition, measures of distress proneness during this early period do not consistently predict to later measures of the negative emotions. Infancy (4–12 Months) Whereas earlier distress signals may not often be easily identified as being associated with specific emotional reactions, such differentiation is achieved during this developmental period. Fear and irritability, for example, are becoming increasingly differentiated during this period, with behavioral inhibition (fear) being increasingly associated with novel and/or unpredictable experiences. Susan Calkins and colleagues have noted that high motor activity and positive affect at 4 months is associated with bold behavior in later childhood. At 4–5 months, infants’ motor capacities allow them to reach for and grasp objects, and rapid (short latency) grasp of objects is positively related to smiling and laughter, suggesting that a neurobehavioral system underlying approach, or reward-oriented tendencies, can be assessed during this period. Later, by 9–10 months, behavioral inhibition will

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come to exercise a good deal of control over approach. Infants at 4–6 months also tend to be quite tractable and interested in the stimuli presented in the laboratory. The period of 4–6 months may thus be especially appropriate for the study of early approach and attention. Behavioral inhibition and other aspects of fear are developing late in the first year (between 9 and 12 months of age), and coming to modulate infants’ approach responses. By this time, the novelty of the laboratory can suppress positive affect and approach for infants, to a greater degree for some infants than for others. It nevertheless continues to be important to consider approach tendencies separately from fear responses in the assessment of temperament. This can be done by observing approach of the infant at the earlier period of 4–6 months, and/or by assessing older infants’ reactions under both novel and challenging, and familiar conditions. Toddler/Preschool Period (1–5 Years of Age) Temperamental characteristics are not all in place at the end of the first year. Positive emotionality becomes increasingly stable later in infancy, with most of surgency/extraversion’s associated characteristics identifiable by toddlerhood. Although changes in negative emotionality during infancy have been reported, considerable stability is noted by the toddler period. Development of the executive attention system during the toddler and preschool periods is particularly important for effortful control, planning, and the ability to inhibit or delay action and expression. The development of effortful control is closely linked with advances in a variety of attentional skills, which provide the basis for emerging self-regulation. Development of the executive attention system during the toddler and preschool periods is particularly significant, with important implications for effortful control, including increasing abilities to plan and inhibit or delay action and expression, providing children with opportunities for more flexible control of emotion and action. Researchers have developed ‘marker tasks’, known to activate a given brain region, and adapt these for use with children. Michael Posner, Mary Rothbart, and Gina Gerardi-Caulton, for example, have developed a promising spatial conflict task, in which the child must respond to a spatially conflicting stimulus by inhibiting the dominant response and executing a subdominant response. Children sit in front of two response keys, one located to the child’s left and one to the right. Each key displays a picture, and on every trial a picture identical to one member of the pair appears on either the left or right side of the screen. The spatial conflict occurs when the picture appears on the side of the screen opposite of the correct (i.e., matching) response key, since the dominant response is to press the key that is compatible in terms of its location.

Remarkably, between 2 and 4 years of age, children progress from an almost complete inability to carry out this type of task to relatively good performance. Whereas 24-month-old children tended to perseverate on a single response, at 36 months, children performed with considerable accuracy. Similar to adults, the 36-month-olds responded more slowly and with reduced accuracy to incompatible trials. Youngsters who performed well were also described by their parents as more skilled at temperamental attentional shifting and focusing, less impulsive, and less prone to frustration reactions. Another important aspect of executive attention, the detection and correction of errors, can also be evaluated via the spatial conflict task, wherein longer reaction times (RTs) following incorrect trials interpreted as slowing down associated with error detection/correction. Such longer RTs were observed for 30- and 36-month-old children, whereas no evidence of slowing following an error was found at 24 months. Although precursors of effortful control are not yet well understood, recent evidence suggests that development of this set of attributes is rooted in earlier temperament. For example, there is evidence that infant orienting/regulatory capacity is related to toddler effortful control, which in turn predicts effortful control in the preschool period. Thus, there appears to be an indirect stability of the underlying regulatory dimension of temperament. The relationship of surgency and effortful control, however, changes as a function of age, with infant surgency and positive emotionality predicting higher levels of effortful control in toddlers, but toddler and preschool surgency associated with lower effortful control. Gender Differences in Early Temperament Although a number of gender differences have been reported for older children and adults, few have been found for children younger than 1 year of age. Differences in infancy have been limited to activity level and fear/ behavioral inhibition, with higher activity level and approach for boys, and girls exhibiting greater hesitation in approaching novel objects. Darren Campbell and Warren Eaton applied meta-analytic procedures that enabled them to summarize results across 46 studies of activity level in infancy, demonstrating small, but reliable gender differences. Gender differences in approachwithdrawal have also been reported for cross-cultural samples, with parents rating males higher in their levels of approach. Fearfulness differences between male and female infants have also been reported, with girls receiving higher scores. There is also evidence suggesting that girls exhibit higher levels of regulation-related skills in early childhood. Grazyna Kochanska, for example, demonstrated that girls exhibited higher levels of inhibitory control, an important component of effortful control, on laboratory tasks, and caregiver report.

Temperament

From Temperament to Personality Research addressing dimensions of temperament in early childhood also suggests possible links with studies of adult personality. For example, investigations of children’s temperament frequently reveals broad factors that are consistent with the ‘Big Three’ and ‘Big Five’ factors reported in research with adults. There remain, however, important differences between concepts of temperament and personality. First, temperament traits emerge in infancy and early childhood, while personality characteristics are generally thought of as emerging later in development. Second, personality includes many more characteristics than does temperament, including self-concept, attitudes, expectations, and preferred coping strategies. Personality develops out of the early temperament traits in conjunction with the child’s experiences. Infants’ and young children’s temperament provides the building blocks of personality, but additional personality characteristics will develop with maturation and experience. For instance, individual differences in positive emotion at 6 months of age are related to differences in approach tendencies, sensation seeking, activity level, and lack of shyness later in childhood. Preschool children who exhibit strong approach tendencies often become adolescents who tend to be impulsive and ineffective in the social context. Children who show the highest levels of inhibition of approach in infancy tend to be more fearful and shy later in childhood, although not all those inhibited as infants continue to demonstrate inhibition. Temperament includes individual differences in emotional processing and the evaluation of experience, so that a particular stimulus provides different emotional experiences for children who vary in temperament. Thus, temperamental dispositions can serve as biasing factors on the development of attitudes, expectations, and the nature of social learning, further contributing to the development of personality. Temperament contributes directly to social–emotional and personality development, and interacts with parenting, family, and other environmental variables, which in turn affect the development of children. Sandra Scarr and Kathleen McCartney have described ‘niche picking’, where individual differences in temperament contribute to children’s selection of their own environments. This selection can be seen in children’s adaptations to preschool. Nonshy children show effects of stress associated with their rapid approach to a new setting at the beginning of the year, but these reactions decrease over time. Shy children do not show stress initially, likely because they are avoiding potentially stressful interactions. However, over time the more shy children begin involvement, and then show effects of stress. Interactions between temperament and attachment have important implications for social–emotional development. Attachment refers to the child’s thoughts, feelings,

487

and behaviors in relation to important others, most often the caregiver. Attachment security is generally assessed by observing the child’s reactions during a ‘strange situation’ procedure, designed for children between 10 and 24 months of age, largely on the basis of work by Mary Ainsworth. The strange situation consists of several episodes that involve brief separations from the parent, and the entrance of an unfamiliar experimenter. The stress of the situation is gradually increased in order to intensify attachment behaviors (e.g., crying, approaching, and clinging). As stress increases, the child should also decrease his/her affiliation with the experimenter. Children who show distress during separation from their parents attempt to search for them, and readily approach them when reunited are classified as securely attached. Attachment security assessed through the strange situation procedure is associated with the caregiver’s sensitivity and responsiveness to the infant. Insecure or anxious attachment patterns are classified as resistant, avoidant, or disorganized. Infants classified as resistant are likely to show a great deal of distress when separated from caregivers. However, upon reunion, these children tend to actively resist contact with the parent (sometimes angrily). Avoidant infants, on the other hand, are less likely to be distressed during the separation, despite the fact that their heart rates are elevated, relative to other classification groups. A child classified as belonging to the avoidant attachment category appears to regard the stranger in much the same way as the parent. The disorganized classification has been added more recently, and can be applied in situations when infants present with atypical behaviors (e.g., disorientation), making classification into one of the more traditional categories difficult to achieve. Child temperament appears to have two associations with attachment security. First, temperamental characteristics, such as fear or approach, influence the attachment classification. For example, a child low in fear is likely to appear to be less securely attached because she or he may not react to the presence of a stranger as a stressor. Thus, a child who is not fearful may not attempt to gain comfort from the mother upon reuniting with her. Second, temperament during the first year of life appears to influence the relationship with the primary caregiver, contributing to the caregiver’s behavior and subsequent development of the child’s attachment security. Although not all studies have provided consistent support for these relationships, numerous significant associations between temperament and attachment measures have been found. Children higher in negative reactivity and distress to limitations have been described as exhibiting lower levels of attachment security. Irritable newborns were also found by Dymph van den Boom to be more likely to later exhibit insecure attachment than newborns who were not irritable. One interpretation of this finding is that infant irritability prevents mothers from acting in a

488

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sensitive/responsive manner, so that they may not use effective soothing techniques. A larger sample of irritable infants and their mothers took part in an intervention study where half the parents were trained in parenting skills, prompt soothing, and positive interaction when the infant was not in distress. This intervention resulted in greater maternal responsiveness, infant sociability, selfsoothing, and higher levels of exploratory behavior. In addition, more of the infants were categorized as securely attached. Another important interaction between child temperament and socialization involves mutual influences of temperamental characteristics and the quality of parenting on the children’s adjustment. Children with temperamental attributes, including negative affectivity, appear to be more likely to experience ineffective parenting practices (e.g., harsh and inconsistent discipline). The quality of parenting may in turn be related to children’s development of behavior problems. Children’s temperament also affects the development of coercive family processes, interactions characterized by escalating aversive behaviors, in which children and parents engage in progressively more and more noxious actions directed toward each other. The child’s refusal to follow the parents’ requests and their tendencies toward frustration and aggression are also more likely to occur when the child has lower regulatory capacity. In turn, this contributes to ineffective discipline practices (e.g., harsh punishment, inconsistent enforcement of rules), which subsequently lead to child conduct difficulties. Children with challenging temperamental characteristics may also be at risk for insufficient and/or ineffective guidance and instruction from the parent. Youngsters described as ‘difficult’ in fact received more cognitive assistance and disapproval from their mothers during a problem-solving task, and these mothers showed greater involvement in more challenging aspects of the task. These behaviors are not ideal for guiding children through a problem-solving task. According to Lev Vygotsky, optimal strategies involve providing the child with structure during problem solving (e.g., reminding the child of the rules, providing suggestions regarding possible approaches to the problem), but allowing the child to discover strategies independently, and take on greater responsibility in the activity as she or he gains more skill. This kind of guidance ultimately promotes further development of self-regulation, and may be limited or lacking for children with temperament profiles perceived as difficult by caregivers. Certain dimensions of temperament may also interact with each other (i.e., modify each others’ influence), working in tandem to contribute to children’s adjustment. For instance, children classified as ‘unsocial’ and ‘poor emotion regulators’ in temperament ratings were described as more aimless and anxious during play, and exhibited

higher levels of behavior problems including social withdrawal, anxiety/depression, and frequent complaints about aches and pains, by their mothers. Relations between fearful behavioral inhibition and approach tendencies have been described by Douglas Derryberry and Mary Rothbart. A relatively fearless child with strong approach tendencies may respond impulsively, and is likely to focus on rewarding, rather than punishing, aspects of the experience. Alternatively, children who are strong in approach, but also have strong fear tendencies are more likely to inhibit impulsive behaviors, and to appreciate rewards and punishments more equally in a given situation. Thus, fear motivation may play an adaptive role in regulating approach behaviors and may also lead to lower levels of aggression. Effortful control may also influence the way in which negative emotionality, approach, and aggression are related to each other. Children with effective effortful control can be expected to show little aggression, even when they are experiencing high levels of approach and negative emotionality. Thus, effective effortful control can be expected to prevent the expression of excessive levels of approach and negative emotionality associated with aggressive behavior.

Temperament Risk and Protective Factors: Symptoms of Psychopathology and Competence in Early Childhood Psychopathology in childhood (e.g., depression, conduct problems, and ADHD) is associated with significant costs to society and frequently precedes psychological difficulties in adulthood. Identification of risk and protective factors (contributors linked with either escalation of difficulties or those associated with resilience in the face of stressors), especially those present early in life, could help in intervention and prevention efforts, resulting in considerable reductions of costs to society. Although considerable attention was originally given to some risk factors, such as economic factors, parent psychopathology and parenting, only recently have contributions of child temperament started to receive more widespread attention. Table 1 summarizes most of the recent investigations addressing temperament in early childhood, with a considerable number of studies linking child characteristics and environmental factors (e.g., parenting) to later positive and negative outcomes for youngsters. In these studies, early negative emotionality has been linked with broad behavioral and emotional difficulties, often referred to externalizing (associated with ‘actingout’, or undercontrolled behavior and emotions) and internalizing (or overcontrolled behavioral/emotional expressions) problems later in childhood. There is also evidence of specificity of risk, with temperamental

Temperament

Table 1

489

Research (1995–2006) addressing temperament and behavior problems in early childhood (0–5 years of age) Sample description (N; age range; characteristics)

Authors

Constructs assessed

Abrams S (2005)

Infant temperament, maternal temperament, parental stress level Maternal trait anxiety, life event stress and depression, infant temperament Resistance to control restrictive parenting externalizing behavior

65; 6–12 months

Infant temperament does not correspond to maternal temperament characteristics to a significant degree.

970; third trimester of pregnancy – 6 months postpartum

Maternal trait anxiety is predictive of ‘difficult’ infant temperament, independent of concurrent depression, and key risk factors.

168; 6, 13, 24 months

Attentional persistence, negative emotionality social competence, problem behavior, and school readiness Negative emotionality, parenting during toddler years, externalizing behaviors, inhibition Negative emotionality in infancy, early intervention

1038; 1–36 months

Stronger links between temperamental resistance to control and externalizing behavior for parents low on control, in comparison to parents who were more restrictive. High negative emotionality associated with low social competence when attentional persistence was poor. High negative emotionality related to high levels of school readiness at high levels of attentional persistence. Negative mothering predicted higher externalizing scores, less negative fathering, and more positive fathering forecast more inhibition at age 3 years.

Austin M et al. (2005)

Bates JE and Pettit GS (1998)

Belsky J et al. (2001)

Belsky J et al. (1998)

Blair C (2002)

Calkins S and Fox NA (2002)

Calkins S (2002)

Conway AM (2005)

Coplan RJ et al. (2005)

Crockenberg SC and Leerkes EM (2005)

Crockenberg SC and Leerkes EM (2006)

Self-regulatory processes, personality, and behavioral adjustment Frustration distress, aggression/venting, defiance, and maternal interactive style Maternal sensitivity, infant negative emotionality, emotion regulation, attentional control Maternal state and trait anxiety, infant temperament

Quantity and type of nonparental care, infant temperament, internalizing and externalizing problems Infant regulatory behaviors, infant reactivity to novelty, maternal behavior, and anxious infant behavior

125; 27–37 months; males

985; 12–36 months; low birth weight, preterm

81; 4–14 months

Major findings

With early intervention, infants with higher levels of negative emotionality at 12 months had a twofold decrease in the occurrence of behavior problems, and fourfold decrease in the occurrence of high-risk profiles at age 3 years. Links between behavioral inhibition and frustration tolerance, and physiological, attentional, and emotional regulatory development.

73; 18–24 months

Aggressive ‘venting’ behavior at 24 months predicted by interaction of early child aversive behavior and low maternal positive guidance.

181; 7 and 33 months

Maternal sensitivity and infant negative affect at 7 months predicted later emotion regulation flexibility; maternal sensitivity and child negative affect at 33 months related to emotional resilience.

60; third trimester of pregnancy to 3 months postpartum

Maternal trait anxiety predicted infant distress to novelty and limitations, and difficulty soothing. Antenatal state anxiety predicted less infant positive affect and lower attention-span. Postnatal state anxiety related to infant activity level and distress to limitations. Long hours in nonparental care associated with externalizing problems for children easily frustrated as infants, and internalizing symptoms for children highly distressed in response to novelty as infants.

64; 6–30 months

64; 6–30 months

Infant regulatory behaviors moderated associations between reactivity to novelty and anxious behavior at 30 months. High reactivity to novelty, with withdrawal and poor attention control, predicted anxiety when mothers were less engaged or less sensitive. Continued

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Table 1

Temperament

(Continued) Sample description (N; age range; characteristics)

Authors

Constructs assessed

De Rosnay M et al. (2006)

Maternal social anxiety, infant-stranger interactions

24; 12–24 months

Diener ML and Kim D (2004)

Child self-regulation, child temperament, maternal separation anxiety, social competence in preschool Attentional control, positive affectivity, language acquisition

110; 24–56 months

Dixon WE Jr. and Smith P (2000)

Gerardi-Caulton G (2000)

Spatial conflict, self-regulation, negative affectivity

Ghera MM et al. (2006)

Infant soothability, negative infant temperament, maternal sensitivity Aggression, empathy

Gill K et al. (2003) Gutteling BM et al. (2005)

Study 1: 40; 13, 20 months Study 2: 47; 7–21 months 68; 24–36 months

56; 4–9 months

474; 2 years

Prenatal stress, toddler temperament, and problem behavior Stability of early feeding problems, infant temperament, maternal sensitivity Variations in maternal caregiving behavior (MCB)

103; prenatal– 27 months; nulliparous women 115; 10 month–2 years

Harden B et al. (2000)

Internalizing problems parental psychopathology child temperament

155; 4.1 years; children enrolled in Head Start

Huizink, AC et al. (2002)

Maternal prenatal stress and infant temperament Utility of the behavioral style observational system (BSOS) vs. material ratings Difficult temperament (12–24 months), aggression (12–24 months), noncompliance (12–24 months), internalizing problems (36, 60 months), externalizing problems (36, 60 months)

170; 2) 3–8 months; nulliparous women

Hagekull B et al. (1997)

Hane AA and Fox NA (2006)

Karp J et al. (2004)

Keenan K et al. (1998)

185; 4–9 months

160; 12–72 months

104; 1–5 years; low income families

Major findings Following a socially anxious mother–stranger interaction, infants significantly more fearful and avoidant with a stranger than following a normal mother–stranger interaction; high-fear infants were more avoidant in the socially anxious condition than low-fear infants. Child age, temperament, self-regulation, and maternal characteristics predicted social competence in preschool.

Attentional control and positive affectivity predicted language production and comprehension.

Children responded slower and less accurately when location and identity were in conflict. Ability to resolve conflict was linked to individual differences in effortful control and negative emotionality. Infant negative emotionality and maternal sensitivity positively related at higher levels of infant soothability; negatively related when maternal ratings of infant soothability were low. Aggressive children showed more behaviors indicative of empathy than nonaggressive children. Increased levels of maternal prenatal stress associated with difficult temperament and behavioral problems in toddlers. Less sensitive mothers with less manageable infants reported more feeding refusal behaviors.

Infants with low-quality MCB showed more fearfulness, less positive joint attention, and greater right frontal electroencephalogram (EEG) asymmetry than infants with high-quality MCB. Externalizing behavior associated with child internalizing behavior, parental psychopathology, child temperament, family environment and exposure to community violence. Children with externalizing behavior had specific social problem-solving skill deficits. Increased maternal prenatal stress associated with temperamental variation of young infants. Observational measures and maternal ratings alone not sufficient to assess children’s temperament; evaluations of children’s temperament should include both observational measures and maternal ratings. Evidence for continuity of emotional and behavioral problems; support for early differentiation between internalizing and externalizing problems accounting for early difficult temperament.

Continued

Temperament

Table 1

491

(Continued) Sample description (N; age range; characteristics)

Authors

Constructs assessed

Kivijarvi M et al. (2005)

Maternal sensitivity behavior (MSB) and infant temperament

56; 3–12 months; Finnish dyads

Kochanska G and Knaack A (2003)

Effortful control

106; 22–45 months

Kochanska G et al. (1997)

Inhibitory control and conscience development Effortful control

83; 2.5–5 years

Kochanska G et al. (2000) Leerkes EM and Crockenberg SC (2003)

Leve LD et al. (2001)

Little C and Carter AS (2005)

Maxted AE et al. (2005)

Maziade M et al. (1998)

NICHD Early Child Care Research Network (2004)

Park S et al. (1997)

Pauli-Pott U et al. (2004)

Maternal remembered childhood care, prenatal depression, sensitivity, and concordance between maternal reports of temperament and temperament observed in the laboratory (distress to novelty, distress to limitations). Maternal sensitivity, infant temperament, pleasure in parenting, marital happiness Infant emotional reactivity, infant emotion regulation, maternal–infant emotional availability Infant colic, maternal depression, infant, parent, and family difficulties Infant temperament, attitudes to discipline, stressful events, clinical status at an older age Affect dysregulation within mother–child relationship, cognitive and socioemotional problems Infant temperament, parenting, and child inhibition Caregiver depression/ anxiety, caregiver social support, caregiver sensitivity, infant emotionality, infant withdrawal/fear

106; 22, 33 months

90; 6 months; primiparous mothers

99; mean age 5 months; adopted infants

45; 12 months; low income

93; 2 months

358; 4.7 years

1364; 1–54 months

125; 12–36 months; first born males 101; 4–12 months; first born infants

Major findings Moderate temperament stability during first year; MSB related to infant temperament characteristics at 3, 6, and 12 months. Gender differences in temperament evident at 6 and 12 months. Effortful control mediated the reported relations between maternal power assertion and impaired conscience development in children, even when child management difficulty was controlled. Strong links found between inhibitory control and measures of children’s conscience at early school age, with girls outperforming boys. Greater effortful control at 22 months linked to more regulated anger; at 33 months linked to more regulated anger and joy and to stronger restraint. Higher concordance between maternal reports and behavior observation of Distress to Novelty when mothers reported having needs met as a child and low prenatal depressive symptoms. Distress to Limitations higher when mothers less sensitive during observational tasks.

Parents who rated infants as showing more distress to limitations reported less pleasure in routine parenting, mediated by marital happiness for fathers. Mothers reported less pleasure in parenting with infants perceived as more fearful. Maternal hostility significantly associated with infant difficulty in regulating distress during an emotion challenge and in postchallenge conditions, over and above the impact of emotional reactivity. More severe depressive symptoms in mothers related to fussy/difficult infant temperament, more parenting stress, lower parental self-esteem, and more familyfunctioning problems. Extremely difficult temperament had no strong direct association with clinical outcomes at 4 years, temperament assessed at 4 years, family attitudes to discipline, and stressful events were related. Affective dysregulation associated with less maternal sensitivity and stimulation, maternal depressive symptoms, and lower income over first 36 months. Affect-dysregulation linked to cognitive, social and emotional problems at 54 months. Supportive parenting and high negativity with low positivity in infancy predicted high inhibition. Caregiver characteristics predicted negative emotionality and withdrawal/fear, but not positive emotionality.

Continued

492

Temperament

Table 1

(Continued)

Authors

Constructs assessed

Pesonen A et al. (2005)

Gestational age, gestational weight, parental ratings of temperament Parental stress and perceived infant temperament Extraversion/surgency, negative affectivity, and effortful control

Raikkonen K et al. (2006) Rothbart MK et al. (2001)

Sample description (N; age range; characteristics) 152; 6 months

292 families/584 parents; 6 months 262; 3–7 years

Rothbart MK et al. (2003)

Effortful control

192; 18–36 months

Rubin KH et al. (2002)

Inhibited temperament parenting style, and stability of behavioral inhibition Conflict-aggression, emotion and behavior, dysregulation, parenting, externalizing problems Emotional regulation and social interaction

Time 1: 108; time 2: 88; 25–51 months



Shaw DS et al. (1997)

Sokolowski M (2006)

Vaughan AE (2005)

Wachs T and Kohnstamm G (2002)

Negative emotionality, attachment, life experiences, childrearing disagreements, parenting daily hassles, and internalizing problems Marriage, spousal personality, parental expectations for temperament, life stress, continuity of parental sensitivity Temperament (sociability, selfregulation), joint attention, social competence, externalizing and internalizing problems Maternal rating of child shyness, temperament characteristics, social behavior

104; 2–4 years

96; 4 years

86; 12–60 months; lowincome families

Major findings Infants born small for gestational age were rated by both parents as significantly more fearful and negatively reactive compared to infants born appropriate for gestational age. The more stress one parent reported, the more negatively tuned were the parents’ reports of their own functioning, and their perceptions of the infant. Factor analyses reliably recovered a three-factor solution indicating three broad dimensions of temperament: extraversion/surgency, negative affectivity, and effortful control, which also appeared reliably in ratings of children in other cultures. Performance on marker tasks designed to address attentional mechanisms underlying effortful control related to aspects of effortful control and negative affect at an older age. Toddler inhibition predicted socially reticent behavior at preschool age; maternal behaviors (intrusive control and derision) moderated the relation between toddler peer inhibition and social reticence. Emotional and behavioral dysregulation at 2 independently predicted externalizing problems at 4 years; relation between conflict-aggression at 2 years and externalizing problems at 4 years strongest for toddlers with high levels of maternal negativity.

Emotional dysregulation associated with psychological maladaptation; the association was modified depending on the degree to which children engage in social interaction. Negative emotionality, disorganized attachment, negative life events, and exposure to child-rearing disagreements and parenting hassles related to the development of preschool age internalizing problems.

30; third trimester of pregnancy, 3.5 months, 12 months

Marital adjustment and parental personality moderated child temperament and parenting behaviors. Change and stability in mother–infant relationship related to multiple factors; change and stability in father–infant relationship mostly related to maternal personality.

65; 24–30 months

Response to Joint Attention (RJA), self-regulation, and social fearfulness negatively related to externalizing behavior at 30 months. RJA and self-regulation negatively predicted intemalizing behavior at 30 months. RJA and self-regulation positively predicted social competence at 30 months.

570 families; 3.5–4.5 years

Social maturity mediated the influence of temperament on children’s adjustment to kindergarten.

Continued

Temperament

Table 1

493

(Continued)

Authors

Constructs assessed

Warren S and Simmens SJ

Difficult temperament, maternal sensitivity, symptoms of anxiety, and depression

Sample description (N; age range; characteristics) 1226; 1–36 months

anger/frustration associated with externalizing problems, and fear and sadness aspects of negative affectivity predicting internalizing difficulties. For example, results of the Bloomington longitudinal study (BLS), conducted by John Bates and colleagues, indicated that resistance to control (associated with frequent and intense anger and frustration) predicted externalizing problems later, especially when parents exhibited lower levels of control. More recently, Susan Crockenberg showed that higher levels of frustrations in infancy were associated with externalizing difficulties, whereas greater distress to novelty was associated with internalizing symptoms, for children experiencing long hours in nonparental care. Other factors appear to be important in shaping the impact of early negative emotionality on later childhood outcomes. For example, infant negative emotionality in the context of greater maternal sensitivity, and higher levels of infant soothability, were not associated with adverse effects on child social–emotional development. Research conducted by Susan Warren also pointed to the importance of maternal sensitivity in the context of predicting internalizing type difficulties, wherein children identified as having more difficult temperament were significantly more likely to show decreased anxiety/depressive symptoms, if their mothers had been more sensitive. Interestingly, this effect was further qualified by gender, with boys showing a greater protective impact of maternal sensitivity on lowering the levels of anxiety and depression. The link between positive emotion and psychopathology has only recently been investigated in childhood, and studies addressing positive emotionality in early childhood have not been widespread. Investigations with older children and adolescents have generally provided results consistent with findings in the adult literature, that is, low positive emotion is associated with increases in depressive symptoms. Although there is some debate as to whether activity level is an independent temperament construct or is part of the higher order constructs of negative or positive emotionality, research has demonstrated links between activity level and behavioral difficulties. Most frequently, higher levels

Major findings Children with more difficult temperament were more likely to show decreased anxiety/depressive symptoms if their mothers had been more sensitive. Temperamentally difficult boys with more sensitive mothers were significantly more likely to show decreased symptoms of anxiety and depression, compared to girls.

of activity have been associated with externalizing difficulties (e.g., aggression, hyperactivity, inattention, conduct problems, and impulsivity). A number of studies have also examined the role of regulatory capacity/effortful control in the development of behavioral and emotional difficulties in early childhood. Effortful control has emerged as an important contributor to both internalizing and externalizing difficulties in childhood, with lower levels of effortful control contributing to increasing the level of risk for such problems and higher effortful control playing a protective role. Even earlier manifestations of self-regulation have been linked with preschool symptoms of psychopathology by Crockenberg. Infant regulatory behaviors were found to moderate the relationship between reactivity to novelty and later anxious behavior, with high reactivity to novelty with poor attention control predicting later anxiety, especially when the mothers were rated as less engaged or sensitive. The majority of studies have examined temperament characteristics in an effort to explain the onset or maintenance of childhood psychopathology. However, some have addressed the role of temperament in the development of competence. Recently, Jay Belsky and colleagues showed that high levels of child negative emotionality predicted more advanced school readiness, but only when children also demonstrated high levels of attentional persistence. In another study conducted by Marissa Diener, child temperament, self-regulation in particular, along with maternal characteristics, predicted social competence in preschool; fewer prosocial behaviors were demonstrated by children at increased risk related to these factors. Wally Dixon and colleagues’ investigation also demonstrated that attentional control and positive affectivity predicted language production and comprehension in early childhood. Connections between temperament attributes and the development and maintenance of childhood psychopathology are still being investigated, and already intervention efforts are underway, taking advantage of the available information. Understanding early precursors of developmental psychopathology and behavior problems

494

Temperament

has enabled researchers to target youngsters demonstrating characteristics linked with risk for later difficulties (e.g., frequent/severe negative emotionality, irritability), preventing the manifestation and/or escalation of such problematic patterns of behavior. Similar to van den Boom is intervention for highly irritable infants, leading to increased attachment security. Clancy Blair recently demonstrated that with early intervention, infants with higher levels of negative emotionality at 12 months had a twofold decrease in the occurrence of behavior problems, and fourfold decrease in the occurrence of high-risk profiles at age 3 years, relative to children not participating in treatment. Preventative efforts have also been advocated, for example, providing all parents of newborn infants with information regarding early developmental milestones, in order to prevent child abuse and neglect.

Conclusions The study of temperament in early childhood has a recent but exciting history, with interest in this area continuing to grow. There have also been a number of advances in our understanding of the basic temperament attributes and their development in the first 5 years of life. Some researchers have focused on theoretical definitions, providing guidance for others in formulating hypotheses regarding the structure of temperament, that is, relationships between different domains or characteristics. This work had a direct impact on the development of measurement tools available for the study of temperament in development, with parent-report questionnaires developed and revised on the basis of theoretical advances. Most recently, a widely used parent-report instrument examining infant temperament has been revised to include items that address early manifestations of regulatory capacity. Another important area of study involves attempts to explain and predict the development of various temperament attributes. This research is especially important in early childhood, given the rapid developmental changes that occur during this period. Interestingly, a number of developmental changes in temperament attributes can be linked with changes in other areas of maturation. For instance, higher levels of activity and approach reported for older children may stem, at least in part, from increased capacities for locomotion. Increases in anger/ frustration may also be related to frustrations of the goals of locomotion, as well as to emerging cognitive skills, including goal directed thinking and working memory, allowing goals to be kept in mind, and creating greater potential for frustration. Infants developing these capacities are more likely to show distress when unable to grasp desired objects, or when a caregiver removes a desired object.

The development of the brain’s executive attention system supports the rapid increases in Effortful Control during the toddler and preschool years. Increases in attention are also due, in part, to advances in comprehension and language development. As children are better able to understand their environment, this increased appreciation of their surroundings helps them to sustain attention for longer periods of time. The emergence and development of language also contribute to further advances in impulse control, which in turn are related directly to increases in sustained attention. The evaluation of how temperament and its development are related to other domains of social–emotional functioning and later psychopathology represents another important area of study. The study of early temperament, and its links to later adjustment or behavioral/emotional problems, is of particular importance given the potential for application of findings. A more precise understanding of early appearing temperament underpinnings of later difficulties may enable clinical psychologists to formulate more effective prevention and early intervention approaches, capitalizing on this information. If future research confirms the importance of infant regulatory capacity in shaping later attention-based regulation (e.g., effortful control), interventions aimed at facilitating the development of these early attentional skills that have already shown some progress could be implemented. See also: Abuse, Neglect, and Maltreatment of Infants; Attachment; Birth Order; Crying; Discipline and Compliance; Emotion Regulation; Empathy and Prosocial Behavior; Family Influences; Fear and Wariness; Humor; Independence/Dependence; Mental Health, Infant; Parenting Styles and their Effects; Postpartum Depression, Effects on Infant; Risk and Resilience; SelfRegulatory Processes; Separation and Stranger Anxiety; Shyness; Siblings and Sibling Rivalry; Social and Emotional Development Theories; Socialization; Stress and Coping; Twins.

Suggested Readings Gerardi-Caulton G (2000) Sensitivity to spatial conflict and the development of self-regulation in children 24–36 months of age. Developmental Science 4: 397–404. Kagan J (1994) Galen’s Prophecy: Temperament in Human Nature. New York: Basic Books. Posner MI and Rothbart MK (1998) Attention, self-regulation, and consciousness. Philosophical Transactions of the Royal Society of London B(353): 1915–1927. Rothbart MK and Bates JE (2006) Temperament. In: Damon W, Lerner R, and Eisenberg N (eds.) Handbook of Child Psychology: Vol. 3. Social, Emotional, and Personality Development, 6th edn., pp. 99–166. New York: Wiley. Rothbart MK and Derryberry D (1981) Development of individual differences in temperament. In: Lamb ME and Brown AL (eds.)

Theory of Mind Advances in Developmental Psychology, vol. 1, pp. 37–86. Hillsdale, NJ: Erlbaum. Rothbart MK and Posner MI (2007) Educating the Human Brain. Washington, DC: APA. Stifter CA and Braungart J (1992) Infant colic: A transient condition with no apparent effects. Journal of Applied Developmental Psychology 13: 447–462.

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Thomas A, Chess S, Birch HG, Hertzig ME, and Korn S (1963) Behavioral Individuality in Early Childhood. New York: New York University Press. Van den Boom DC (1994) The influence of temperament and mothering on attachment and exploration: An experimental manipulation of sensitive responsiveness among lower-class mothers with irritable infants. Erratum. Child Development 65: 1457–1477.

Theory of Mind J W Astington and L A Dack, University of Toronto, Toronto, ON, Canada ã 2008 Elsevier Inc. All rights reserved.

Glossary

Simulation theory – The theoretical explanation of theory-of-mind development that proposes that mental-state concepts are derived from children’s own direct experience of such states. The theory says that children can understand other people’s behavior through a process like pretence. They can imagine having the beliefs and desires that the other person has, and imagine what they themselves would do if they possessed those imagined beliefs and desires. Theory of mind – People’s understanding of themselves and others as psychological beings, whose beliefs, desires, intentions, and emotions differ. Theory of mind underlies the ability to understand human behavior, as people explain their own actions, as well as attempt to interpret and predict other people’s actions, by considering mental states. Theory–theory – The theoretical explanation of theory-of-mind development that proposes that children’s theory of mind develops via a process of theory construction and change, analogous to construction and change in scientific theorizing. With this view, children construct a theory about the mind, whereby their concepts of mental states are abstract and unobservable theoretical postulates used to explain and predict observable human behavior.

False-belief task – An experimental task that assesses young children’s ability to attribute beliefs to others. Children are given different information about a situation – for example, an object is moved from one place to another, witnessed by child but not other, or a familiar container has some unexpected content seen by child but not other. Children are asked what the other will do, or think, or say. About 4 years of age they respond correctly by attributing to the other a belief that is different from their own, and false from their point of view. Intentional causation – The idea that intentions are fulfilled only if a person’s intention causes the action that brings about the outcome, despite the fact that one’s desires may be fulfilled, however, the outcome is achieved. Interpretive diversity – The understanding that two people may make different interpretations of the same external stimulus and that both interpretations may be legitimate. Metarepresentational understanding – The ability to represent one’s own and another person’s different relationships to the same situation. Children who pass false-belief tasks demonstrate such metarepresentation, as they understand that another person will act on the basis of his or her mental representation, even when this is a misrepresentation of the actual situation in the world as represented by the child.

Introduction

Modularity theory – The theoretical explanation of theory-of-mind development that proposes that theory of mind depends on maturation of a particular brain structure – an innate cognitive theory-of-mind module. While experience might be required as a trigger, the module will not be modified in differential ways by different experiences.

Theory-of-mind research investigates children’s understanding of people as mental beings, who have beliefs, desires, emotions, and intentions, and whose actions and interactions can be interpreted and explained by taking account of these mental states. Children’s understanding of mental life was first investigated by Jean Piaget early in the last century and it has been of interest to psychologists

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ever since, for example, in studies of perspective taking and metacognition. However, recent years have seen an explosion of research in the area and given it a new name: theory of mind.

What is a Theory of Mind? Developmental psychologists often refer to children’s theories of different domains – for example, physics or biology – by which they mean that children have an integrated set of concepts underlying their understanding of how things work in a particular domain. The characteristics of theories in general and theory of mind in particular are shown in Table 1. Theory of Mind Children’s theory of mind underlies their ability to understand human behavior. It is called a theory of mind rather than a theory of behavior because much of people’s behavior depends on what goes on in their minds. We explain our own actions by referring to our beliefs, desires, and other mental states, and we attempt to interpret and predict other people’s actions by considering their mental states. Such mentalistic explanations, interpretations, and predictions of human behavior are fundamental to social interaction. Theory of mind is therefore an important part of social understanding or social cognition. The term theory of mind might seem to portray children as little psychologists or philosophers but this is not what is intended – children do not hold the theory explicitly as a psychologist or philosopher would. They cannot articulate their theory of mind, but rather we have to infer it from what they say and do in naturalistic and experimental situations. Both are required because the natural setting shows the child’s abilities as an interacting participant within the social world, whereas the experimental setting allows for more control, in order to reveal the precise level of the child’s own understanding.

Table 1

Characteristics of theories and theory of mind

Theories

Theory of mind

Make ontological distinctions and define a domain Coherent set of inter-related concepts Underlie explanations and predictions within the domain Change in light of counterevidence to predictions

Distinguishes between mental and real and defines mental world Concepts of mental states: belief, desire, intention, emotion, etc. Explains, predicts, and interprets human behavior Changes and develops throughout childhood, especially early childhood

However, the fact that theory of mind is inferred from behavior leads to the vexing question of whether the child ‘has’ a theory of mind in a first-person sense or whether it is merely a third-person ascription. That is, is theory of mind a psychologically real structure underlying the child’s behavior or is it merely a way of describing the child’s behavior – as if it were guided by a theory of mind? It may be that only verbal self-ascription can provide unequivocal evidence for theory of mind in a first-person sense but this is not possible for preverbal children or nonhuman primates. It is worth noting that the term first entered the developmental literature after it had been applied to nonhuman primates in a landmark article by David Premack and Guy Woodruff entitled, ‘Does the chimpanzee have a theory of mind?’ These researchers reported that they had shown a chimpanzee videotapes, in which a man was faced with a problem (e.g., trying to get bananas that were hung out of his reach) and the animal then had to choose between two photographs, one of which depicted the solution to the problem (e.g., the man standing on a box). The animal chose the correct photograph significantly more often than the other one. The researchers claimed that this demonstrated that chimpanzees have a theory of mind, which they defined as a system of inferences about mental states that can be used to make predictions about behavior (e.g., the man ‘wants’ bananas and so he will stand on a box to get them). The focus of Premack and Woodruff ’s study was on the animal’s recognition of the man’s desire or intention. However, other researchers’ commentaries on the article made it clear that the critical inference revealing theory of mind is the attribution of belief – in particular, in a case where observer and observed have different beliefs about a situation. Only in this case can one be certain that the observer is actually attributing a mental state to the observed and not merely responding as he himself (or she herself ) would do in the same situation. Understanding False Belief The commentaries on Premack and Woodruff ’s article led two Austrian psychologists, Heinz Wimmer and Josef Perner, to develop the ‘false-belief task’, which assesses whether children have a theory of mind in the Premack and Woodruff sense. That is, it shows whether a child can make inferences about mental states, in order to predict behavior. In the task, children are told a story that the experimenter acts out with toy figures and props. A character in the story has a false belief about a situation and the child has to predict what that character will do (see Table 2). At the end of the story children are asked a question about the character’s subsequent action, which in this example is: ‘Where will Maxi look for the chocolate?’

Theory of Mind Table 2

Example of a ‘false-belief’ story

Mother returns from a shopping trip with some chocolate. Her little boy, Maxi, puts the chocolate away in the cupboard. Then he goes outside to play. Mother takes the chocolate from the cupboard and uses some to make a cake. Then she puts the remaining chocolate away in a drawer, not in the cupboard, and goes upstairs. Maxi then comes back inside, hungry and wanting some chocolate.

They are also asked where he put it and where it is now. Numerous studies have shown that children of about 4 years of age and older say that Maxi will look where he put it, in the cupboard. However, younger children say that he will look in the drawer where the chocolate now is, even though they remember where he put it at the beginning of the story. The catch is that children have to recognize that the story character’s belief about the location of the chocolate is different from their own. That is to say, this is one of those cases where the observer (the child) and the observed (Maxi, the boy in the story) have different beliefs about a situation. Children can respond correctly only by attributing to the boy a belief that is different from their own, and false from their point of view. They further have to recognize that the boy’s belief is what guides his actions, even though it is false. This simple demonstration reveals a most important aspect of theory of mind. Children who can correctly predict that the boy would look for the chocolate in the cupboard understand that people act not on the basis of the way things actually are in the world but on the basis of the way they ‘think’ that they are. That is, successful performance on the false-belief task demonstrates an understanding of the idea that people’s relationship to the world is mediated by their mental representation of it. Children who pass the false-belief task understand that the world is represented in mind and that people act on the basis of their mental representation even when this is a misrepresentation of the actual situation in the world. To be precise, they are capable of ‘metarepresentation’ – that is, they not only represent a situation but they can also represent their own and another person’s different relationships to this situation. Expressing it this way draws on a philosophical work on the representational theory of mental states, which has informed research on children’s theory of mind and which is briefly described in the following section. Mental Representation Mental states such as beliefs and desires are representations that mediate our activity in the world. They are also referred to as ‘intentional’ states, not with the everyday meaning of ‘deliberate’ or ‘on purpose’ but with a

Table 3

497

Examples of intentional states

Attitude (type of mental state)

Propositional content (what it is about)

Believe Want Intend

Chocolate is in cupboard Eat some chocolate Open the cupboard

Table 4

Two basic types of intentional state

Beliefs

Desires and intentions

True or false Caused by events in the world Changed to fit the world: ‘mind-to-world’ direction of fit

Fulfilled or unfulfilled Bring about changes in the world World has to change to fit them: ‘world-to-mind’ direction of fit

technical meaning from the philosophical literature: ‘aboutness’. Intentional states are always ‘about’ something. One does not just have a belief, for example, but rather one has a belief about something – this is the content, or propositional content, of the intentional state. Such states are often described as attitudes to propositions. That is, a person has a certain attitude toward the propositional content – such as holding it to be true or wanting it to happen – and this attitude denotes what type of mental state it is, as shown in Table 3. A person can hold different attitudes to the same propositional content, resulting in different mental states. For example, the boy can ‘believe’ the chocolate is in the cupboard, ‘hope’ the chocolate is in the cupboard, ‘want’ the chocolate to be in the cupboard, and so on. Beliefs and Desires: Truth and Fulfillment There is obviously a difference between believing something to be true and wanting something to be the case, even when the propositional content of the belief and the desire are the same. This difference is due to a difference in the nature of the representational relation. There are two basic types of relation, characterized by truth/falsity or by fulfillment/unfulfillment, as shown in Table 4. Belief-type states are true or false, whereas desire-type states are fulfilled or unfulfilled. If the propositional content of a belief corresponds to the way things actually are in the world, then the belief is true. If it does not correspond, then it is false. If it is false, it can be made true by changing the belief – by making the mind fit the world. This is described as a mind-to-world ‘direction of fit’. Desires (and also intentions) are different from beliefs because they are neither true nor false. They are fulfilled or unfulfilled. If the propositional content of a desire does not correspond to the way things actually are in the world,

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then the desire is unfulfilled. However, it cannot be fulfilled by changing the desire. In order to fulfill the desire, things in the world have to change to fit the representation that is held in mind. That is, desires and intentions have a world-to-mind direction of fit. Predicting and Explaining Behavior As mentioned, theory of mind is used to explain and predict human behavior. The basic premise is that actions are produced by desire and belief in combination (Figure 1). That is, people act to fulfill their desires in light of their beliefs. This is why false beliefs lead to misguided actions. If a person’s belief and desire are known, one can predict how the person will act (as in the false-belief task). Alternatively, if the desire is known, a misguided action can be explained by attributing a false belief to the person. In fact, intentions are mediators between desires and actions. If someone desires something they may form an intention to obtain it, which causes them to act in a way that will lead to fulfillment of the desire (Figure 2). That is, a desired outcome can be achieved through the action of a person whose intention causes the action. Actually, desires may be fulfilled however the outcome is achieved (the dotted line in Figure 2) but, importantly, intentions are fulfilled only if the person’s intention

+

Belief

Desire

Action Figure 1 The basic premise of theory of mind.

Belief

+

causes the action that brings about the outcome. This is known as intentional causation. Development of Theory of Mind The ability to explain and predict human behavior using concepts of false belief and intentional causation typically develops toward the end of the preschool years. However, children’s first awareness of mental life begins much earlier. There is, indeed, no single moment when children acquire a theory of mind. On the contrary, their understanding changes and develops from infancy on into the school years, so that perhaps it would be better to refer to children’s theories (rather than theory) of mind. Table 5 highlights the major development occuring at each of the stages which are described in the following sections. Social Perception in Infancy When Premack and Woodruff asked, ‘‘Does the chimpanzee have a theory of mind?’’ they took it for granted that human beings do. Their definition of theory of mind – a system of inferences about mental states that can be used to make predictions about behavior – was taken up by developmental psychologists and the question became: ‘‘When does the child acquire a theory of mind?’’ Inge Bretherton and colleagues gave one of the first answers, arguing that infants’ ability to engage in intentional communication implies that they have a theory of mind, at least an implicit and rudimentary one. However, most theory-of-mind research during the 1980s focused on preschool children’s success on the false-belief task as providing evidence for theory of mind. It is only more recently that there has been much investigation of developments during the infancy period that may underlie theory of mind. This is now a burgeoning area of research. It is obvious that even young infants ‘have’ beliefs, desires, and intentions (e.g., they become upset when their desires are frustrated or show surprise when their expectations are unrealized) but this is different from having ‘awareness’ of belief, desire, and intention, and attributing such states to others. It is the latter that is Table 5

Desire

Intention

Action Outcome Figure 2 Intended actions are means to desired outcomes.

Development of theory of mind

Period

Age range

Major development

Infancy

Birth–18 months

Social perception

Toddler and early preschool Preschool

18-month-olds to 3-year-olds

Mental-state awareness

4- and 5-year-olds

Metarepresentation

School age

6 years onwards

Recursion and Interpretation

Theory of Mind

theory of mind, and it is debatable whether theory of mind in this sense is developed during infancy. However, infants do have some important precursors to theory of mind. From birth, infants are interested in other people and prefer social over nonsocial stimuli. They attend to human faces and voices more than to nonhuman sights and sounds and they can soon discriminate the mother’s face and voice from those of others. Infants can also imitate human facial movements from very early in life. Even newborns can imitate – for example, by protruding their tongue in response to an adult’s tongue protrusion. Infants only see the other’s face and only feel their own response yet, in some way, they can connect the visible bodily actions of the other with their own internal state, thus demonstrating that they can match their own actions to those of another individual. This ability – referred to as ‘cross-modal matching’ – shows that infants can make a connection between self and other, at least at some primitive level, which is important because the similarity between self and other is at the heart of theory of mind. Infants soon begin to participate in social interactions with those around them. Around 2 months of age they start to interact by smiling and vocalizing (e.g., cooing and, later, babbling). At first these interactions are dyadic, in that only two participants – infant and adult – are involved. However, around 9 months of age triadic interactions appear, in which both participants are focused on the same object. For example, the infant and adult may engage in turn-taking with a toy, continuously switching their focus between each other and the toy. Such ‘joint attention’, which is the ability to coordinate attention with others by following gaze or pointing gestures, is a major feature of infant social behavior. It is more than just looking at the same thing but involves mutual awareness (at some level) that both are engaged with the same object. Between 9 and 12 months of age, infants develop the ability to follow an adult’s eye gaze or an adult’s point even to objects not in their line of sight. Also, if the adult points or gazes and there is no evident object of attention, the infant will look to the adult, as if checking back. Likewise, when infants point, they will look toward the adult as well as toward the object to monitor the other’s attention. At this stage infants also begin to engage in social referencing, in which they look to an adult (often their mother) when they are unsure how to react in an ambiguous situation and then respond in accord with her positive or negative emotional expression. Social referencing is triadic, in that infants are able to respond to their mother’s reaction to an object. Dishabituation experiments, in which infants look longer at a novel stimulus than one seen earlier, are used to demonstrate their sensitivity to mental states. Findings show that infants can distinguish between agents (that have goals) and inanimate objects (that do not). They are more sensitive to the goals of an action than to the

Table 6

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Theory of mind in infancy

Social perception in infancy, from birth to 8 months of age Characteristic behaviors and abilities Imitation Dyadic smiling and vocalizing Joint attention: Follow other’s pointing and gaze Direct other’s attention with point and gaze Social referencing Discriminate animates from inanimates Discriminate goals from movements Sensitive to agents knowledge state

physical movements involved. They understand actions as goal-directed and linked to perceptions/emotions. They are also more sensitive to interruptions in action that occur before a goal is achieved than to interruptions occurring as the goal is achieved. They also respond differentially based on knowledge states of the agent. In sum, infants have many abilities relevant to social understanding (see Table 6). These early developing behaviors may be referred to as social perception, social intuition, person perception, intersubjectivity, or even ‘early’ or ‘implicit’ theory of mind – but, the latter is controversial. Although there is general agreement on the behavioral findings, there is much disagreement over their interpretation. The debate centers on whether the appropriate level of analysis is behavioral or mental. That is, some researchers maintain that infants are merely able to detect statistical regularities in behavior, whereas others claim that infants understand the subjective nature of psychological experience – that is, they are aware of other people as intentional agents, whose behavior is governed by goals and perceptions. Yet other researchers argue that this is a false dichotomy and that interpersonal perception only later splits into separable bodily and mental aspects. Although this debate is not yet resolved, it is clear that infants display behaviors that are relevant to theory of mind. Certainly, social perception is not supplanted by later-developing aspects of theory of mind but rather it continues to exist and underpins the complexities of social understanding right on into adulthood. Mental-State Awareness in Toddlers and Young Preschoolers Important changes come at about 18 months of age, when children clearly begin to show awareness of the subjective nature of psychological experience. This depends on their ability to think about more than what is directly perceived. Although infants think about things in the world, they do not think of alternative possible worlds. Around the middle of the second year, children can think and talk

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about absent and hypothetical situations. This is seen in Piagetian sensorimotor stage 6 behaviors, such as, finding invisibly displaced objects, and solving problems by insight. It is also revealed as language develops – toddlers can talk about past and future events and things out of sight or only imagined. For example, a child building a tower out of blocks may say ‘uh-oh’ as the tower collapses. This use of ‘uh-oh’ indicates the discrepancy between what the child imagined would happen and what actually happened. What is important is that the child is able to think of the hypothetical and compare it with the reality. The ability to imagine a possible alternative reality is also seen – perhaps best seen – in young children’s pretend play, which begins to develop at about 18 months of age. Through pretend play (e.g., pretending that a banana is a telephone), toddlers show that they can distinguish between the object – the banana – and thoughts about the object – the banana as a telephone. The ability to distinguish between objects and thoughts about them can also be demonstrated in experimental tasks. For example, 3-year-olds can tell the difference between a boy who is thinking about a cookie, and a boy who has got a cookie. That is, they know which boy can see, touch, share, or eat the cookie. They know that people’s thoughts are private, they cannot be seen or touched, and sometimes, as mental images, for example, they can be made to come and go at will. Toddlers’ awareness of the subjective nature of psychological experience is also seen in their recognition of people’s intentions and desires. For example, 18-month-olds can use the direction of a speaker’s gaze to infer the referent of a novel word. When adults are labeling objects, they understand that the word the adult is using refers to the object the adult is currently looking at, not the one they themselves happen to be looking at. That is, children of this age clearly attribute communicative intentions to the other person. They can also recognize intention in an adult’s behavior. For example, if 18-month-old infants watch an individual attempt to perform a task but fail (e.g., attempt to push a button with a stick, but miss the button) and are then given the opportunity to handle the objects themselves, they will demonstrate the intended task, rather than imitate the way in which the other person failed (i.e., the infant will push the button with the stick). That is, they are aware of what someone wants to achieve. Also at this age, children can recognize that there may be a difference between what they want and what another person wants. For example, if an experimenter shows pleasure toward one food and disgust toward the other, 18-month-old infants understand that they should give her the one toward which she showed pleasure, even if they themselves prefer the other food. Three-year-olds are able to reason more explicitly about desires and emotions. For example, if they are told what a story character wants, they are able to predict what the character will do

to fulfill this desire. Further, they can predict the character’s emotion based on whether or not the desire is fulfilled. That is, they understand that people will feel happy when they get what they want and will feel sad when they do not. During this period children also begin to show some understanding of how people get to know things. For example, 2-year-olds know that in showing something, they have to orient it toward the person. Two-year-olds also take account of people’s knowledge states when asking others for assistance, in that they will give more information to someone who is ignorant about the situation. Three-year-olds understand that if an object is hidden inside a box, only those who have looked inside the box will know what is inside. A developing awareness of mental states is seen in children’s language too. Around 2 years of age, children start to talk about what people ‘want’ and ‘like’ and ‘feel’. They produce explicit contrasts – distinguishing between what they want and what another person wants, or between what they wanted and what they got or what happened. Toddlers also talk about emotions, using terms like ‘happy, sad, mad’, and so on. When they are 3 years of age they also talk about what people ‘think’ and ‘know’. In sum, it is clear that 3-year-olds are aware of the subjective nature of psychological experience (see Table 7). They know that there is a difference between thoughts in the mind and things in the world; they are aware of people’s wants, feelings, perceptions, and knowledge; and they use mental-state terms in their talk. There is more to theory of mind, however, than being aware of mental states and reasoning about action based on desire. As mentioned earlier, mental states are representations that mediate our activity in the world. The two basic types of mental state – desires and beliefs – differ in the nature of the representational relation. Desire-type states are characterized by fulfillment/unfulfillment, whereas belief-type states are characterized by truth/falsity. Three-year-olds understand that people act to fulfill their desires and they are able to use information about a person’s desire to explain or predict actions or emotions. However, 3-year-olds do not understand truth and falsity; therefore, they cannot take into account that people act to

Table 7

Theory of mind in toddler and early preschool period

Mental-state awarness, 18-month-olds to 3-year-olds Characteristic behaviors and abilities Distinguish between mental and real Pretend play Aware of intentions, desires, and emotions Desire-based reasoning Aware of perception and knowledge acquisition Use mental-state terms

Theory of Mind

fulfill their desires in light of their beliefs even when they are mistaken (recall 3-year-olds’ failure on the false-belief task described in an earlier section). Metarepresentational Ability in Older Preschoolers Understanding truth and falsity and taking false beliefs into account in predicting action depend on the development of metarepresentational understanding. This is the understanding that people’s beliefs, desires, and intentions are mental representations that mediate their actions in the world and their interactions with others in the world. Children with this understanding think of beliefs, desires, and intentions as representations that are produced by the mind as a result of certain experiences and that effect actions in the world in certain specific ways. They have the ability to represent their own and another person’s different relationships to the same situation – as clearly demonstrated in successful performance on the falsebelief task. Children’s understanding of false belief is undoubtedly the most striking and most studied aspect of their theory of mind. As described earlier, this research began in the early 1980s with the task devised by Heinz Wimmer and Josef Perner, in which a story is acted out for children. A character in the story is off the scene when an object that he has left in one location is moved to a different place. The character therefore has a false belief about the object’s location. When he returns to the scene, children are asked where he will look for the object or where he thinks it is. By 4 or 5 years of age, children recognize that the character’s representation of the situation is different from their own and they can predict the character’s action based on his false belief. One criticism of this ‘change-of-location’ false-belief task is that children have to follow a complicated story narrative and have to attribute beliefs to dolls. Researchers attempted to make false belief easier for 3-year-olds, by letting children actually experience a false belief themselves, and then asking them about another person’s belief in the same situation. For example, they showed children a familiar candy box, all closed up, and then let them find out that it contained pencils, not candy. Then they put the pencils back and asked what another person, who had not seen inside the box, would think was inside it. Most 3-year-olds claimed that the other person would think there were pencils in the box but by 4 or 5 years of age children realized that the other person would think as they themselves had done, that it had candy inside. That is, they could represent and distinguish between their own and another’s different relationships to the same situation. The traditional Piagetian explanation of 3-year-olds’ failure on this ‘unexpected-contents’ false-belief task is

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that such young children are egocentric and thus cannot understand that other people may have beliefs different from their own. However, 3-year-olds’ lack of understanding is more profound. In this experiment, children were also asked what they themselves had thought was in the box before it was opened. Three-year-olds found it as difficult to remember their own previous false belief as to predict the other person’s false belief. They could not metarepresent, that is, they could not represent themselves as representing both the past and the present situations and see that what was true for them in the past was false for them in the present. Children’s performance on these types of false-belief task is an extremely robust, much-replicated finding. In fact, a recent meta-analysis determined that there were no age differences in children’s ability to attribute false beliefs to others or to themselves in the past. In addition, children’s success did not differ based on the experimental procedures used, for example, the changein-location-story task or the unexpected-contents-box task. These meta-analytic findings support the argument that there is a genuine conceptual change – that is, the development of metarepresentational understanding – underlying performance on different types of false-belief task. The development of metarepresentational understanding is associated with the development of a number of other behaviors and abilities. False-belief task performance correlates with children’s recognition of the relative certainty implied by use of the term ‘know’ over ‘think’ or ‘guess’. In addition, since deception is the intentional creation of false beliefs, once children understand false belief, they are able to understand deception and to act deceptively or to tell lies. Some researchers claim that there is evidence for deception and lying earlier, before children understand false belief, but this is controversial. It may be that younger children act intentionally in ways that affect others’ beliefs even though that may not be their motive in so acting – rather, they may just want to affect what the other person will do. Metarepresentational ability also underlies children’s understanding of the distinction between appearance and reality. For example, children are shown a piece of painted sponge that looks just like a rock, and then they squeeze it and discover that it is really a sponge. Once they know it is a sponge, 3-year-olds say that it looks like a sponge, but by 4 or 5 years of age children understand that its appearance is misleading – it looks like a rock but it is really a sponge. At this age children also come to understand aspects of knowledge acquisition. They realize that information comes from different sources, that is, beliefs are derived from perception (e.g., feeling or seeing) or from communication (e.g., being told). They can remember the source of their own information and they remember, if they have

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just learned something new, that they did not know it previously. By 4 or 5 years of age, children also understand that different sensory modalities yield different kinds of information, for example, seeing gives information about color, whereas touching gives information about texture. The development of metarepresentational ability also allows for a new understanding of desire and intention. Recall that intentions are mediators between desires and actions – although a desire may be fulfilled however the outcome is achieved, intentions are fulfilled only if the person’s intention causes the action that brings about the outcome (intentional causation). As discussed earlier, toddlers have some understanding of desire and intention but they may think of both as mental states that motivate actions and outcomes, without distinguishing between the two types of state. Metarepresentational ability allows them to differentiate between desire and intention and to recognize cases of fortuitous success – in which the desire is satisfied even though the intention is unfulfilled. This ability also allows children to understand cases where two people’s desires are in conflict, that is, situations where the satisfaction of one person’s desire necessarily means that the other person’s desire is not satisfied. Emotional understanding continues to develop in 4- and 5-year-olds. In particular, toward the end of this period, children can make belief-based emotion attributions, for which they have to assess whether characters believe their desires will be fulfilled, not simply whether the desires will be fulfilled. Children also come to understand the distinction between appearance and reality in the emotional realm. For instance, they recognize that people might feign happiness even when they are sad, for example, because their desires are unfulfilled. In sum, the development of metarepresentational ability in the later preschool period underlies a range of new behaviors and abilities that become apparent during this period (see Table 8). Once metarepresentation is clearly established, children reach a new level of understanding of social interactions – including surprises, secrets, tricks, and lies. Of course, there are further developments in social cognition after the preschool years, which can be construed as further Table 8

Theory of mind in older preschool period

Metarepresentational ability, 4- and 5-year-olds Characteristic behaviors and abilities Understand false belief in self and others Understand deception Distinguish appearance and reality Understand aspects of knowledge acquisition Distinguish between desire and intention Understand intentional causation Understand belief-based emotions

development in theory of mind, although research on social cognition during the school-age years has been less specifically focused on theory of mind. Recursive and Interpretive Abilities in School-age Children One of the main developments in theory of mind at the beginning of the school years is an understanding of mental-state recursion, that is, the embedding of one mental state in another (e.g., ‘Mother thinks that Maxi thinks that the chocolate is in the cupboard’). Children become aware that people have beliefs, not just about the world, but about the content of others’ minds (e.g., about others’ beliefs) and, like people’s beliefs about the world, these too may be different or wrong. Such beliefs about beliefs are referred to as second-order beliefs. Tasks designed to assess children’s second-order false-belief understanding show that it develops by about 7 years of age. Somewhat earlier, children acquire the ability to understand second-order representations involving desires and intentions, such as understanding that someone wants to make another person believe something. Somewhat later, children acquire the ability to deal with third-order representations involving beliefs, desires, intentions, and emotions (e.g., ‘Mother wants Maxi to think that she intended to hide the chocolate’ or ‘Mother thinks that Maxi wants her to know that he could not find the chocolate’). Such recursive ability underlies the more mature understanding and use of complex language, particularly indirect speech acts, such as irony and metaphor, that develop during the school-age years. In indirect speech there is a distinction between what a person means and what their words appear to mean; that is, what is actually said is not really what is meant. In verbal irony, for example, someone says something that is false but does not intend the listener to believe it to be true, but rather to recognize the falsity and interpret the statement as funny or sarcastic. Likewise, metaphors are not intended as statements to be literally interpreted but are used to create poetic images. Children’s understanding of irony and metaphor begins to develop during the early school years, although it takes some years to reach maturity. The ability to comprehend recursive mental states also underlies an increasing sensitivity to the interpersonal dynamics of social situations. For example, during the early school years children come to understand ‘white lies’ where something untrue is said to protect a person’s feelings. They also recognize when someone has produced a ‘faux pas’ and unintentionally revealed secret information or created hurt feelings. As well, they can invent or select persuasive strategies, which require the manipulation of a person’s mental states in order to

Theory of Mind

get them to believe or do something. Children’s use of language during the school-age years also reflects their more sophisticated understanding of the mind, as children begin to comprehend and produce more complex mental-state terms, such as ‘interpret’, ‘infer’, ‘doubt’, and many more. Other developments in the early school years involve increasing understanding of knowledge acquisition and of the mind as an active interpreter of information. For example, around 7 years of age children recognize interpretive diversity, that is, they understand that even given the same external stimulus, two people may make legitimate but different interpretations of it, which requires more than understanding the possibility of true vs. false beliefs. Also by age 7 years, children come to understand the role of inference in knowledge acquisition and to recognize ambiguity and referential opacity. Children of this age also have a simple understanding of evidence for belief and can distinguish between the cause of a phenomenon and a person’s reason for believing it. This allows them to engage in scientific reasoning by evaluating evidence. Understanding the mind as an interpreter of information is related to understanding the dynamic nature of mental activity. Until the early school years, children are unaware of the stream of consciousness that fills the waking mind and they are not able to introspect about their own thinking. Preschool children can report the content of their mental states – but without recognizing that it is produced by the mind’s activity. Participation in formal school activities may facilitate children’s introspective abilities. Indeed, the investigation of a number of metacognitive abilities that are demonstrated in school tasks, such as metamemory and comprehension monitoring, began during the 1970s, before the explosion of research into children’s theory of mind. Undeniably, although such metacognitive abilities, as well as the social cognitive abilities described earlier in this section, can be interpreted in the framework of children’s theory of mind, it is fair to say that much of the research predates the theory-of-mind field and even now is conducted somewhat independently of it (Table 9).

Table 9

Theory of mind in school-age children

Recursive and interpretive abilities, 6 years and older Characteristic behaviors and abilities Understand second- and higher-order mental states Recognize interpretive diversity Understand indirect speech, for example, irony and metaphor Aware of white lies, faux pas, and persuasion Use and comprehend complex mental-state terms Understand inference, ambiguity, referential opacity Aware of stream of consciousness, introspect

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Differences in Development The preceding section provides an overview of typical development of theory of mind from infancy through the early school years. Although approximate age norms are given, there are marked individual differences in typical development. In addition, there are variations in development in atypical populations. Furthermore, the overview is derived from research conducted primarily with samples of middle-class, Western children – however, theoryof-mind development may not be universally the same across cultures. Therefore we need to consider individual differences in typical development, diverse atypical developments, and cultural differences in theory of mind. Individual Differences The main focus of research so far has been on examining factors, both within the child and in the child’s environment, that are associated with the development of false-belief understanding, which some children achieve soon after they are 3 years of age and others not until age 5 years. A number of factors, such as executive functioning, language ability, and social competence, are correlated with the understanding of false belief – both contemporaneously and across time in longitudinal studies. The causal or consequential nature of such earlier or later correlates is a matter of some debate, requiring careful consideration. Executive functioning. Executive functions are selfregulatory cognitive processes, such as inhibition, planning, resistance to interference, and control of attention and motor responses. During the years from 3 to 5, children’s performance on executive function tasks is correlated with their performance on false-belief tasks. This may be because executive function tasks require suppression of a habitual response in favor of a new response and, likewise, in standard false-belief tasks children must resist making the more salient (incorrect) response. This suggests that there are executive functioning demands embedded within falsebelief tasks. However, most researchers believe that the relation between theory of mind and executive function extends beyond the fact that false-belief tasks require inhibition. Some argue that executive functioning is actually required for children to develop a theory of mind, in that children must be able to control their own representations of the world before understanding others’ representations. Others argue that the relation is in the opposite direction, in that children must understand mental states before they are able to control their own actions. Yet a third group propose that the relation between theory of mind and executive function is due to the acquisition of the general ability to reason about complex problems relating to selective attention. In turn, this ability improves performance on both false-belief and executive function tasks.

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Fantasy and pretense. Pretend play is a context in which children can simulate feelings and desires they do not currently hold and imagine states of the world that do not currently exist. Researchers argue that pretend play encourages theory-of-mind development and this is supported by data showing that preschoolers who score higher on theory-of-mind tasks engage in more fantasy and pretense. There is also evidence that acting out roles in pretend play precedes and supports false-belief understanding, whereas explicit assignment of roles and plans for joint action in pretend play follow and result from false-belief understanding. Language ability. It is well established that there is a strong relation between language ability and theoryof-mind development that is independent of age. In 9- to 15-month olds, joint attention behaviors are correlated with language production and comprehension and may be instrumental in language development at this stage. Subsequently, many studies have shown relations between false-belief understanding and various language skills, including general language, receptive vocabulary, semantics, and syntax. Moreover, it is likely that there is a causal relation involved such that children’s linguistic development supports their theory-of-mind development at this later stage. Longitudinal studies show that changes in children’s false-belief understanding are predicted by their language competence but the reciprocal relation (i.e., prediction of language development by false-belief test scores) is much weaker. It is not likely that the verbal requirements of false-belief tasks can alone explain these findings since the correlations are found for a wide range of theory-of-mind measures, some less verbal than others. The role of language in the development of theory of mind is complex, reflecting the multifaceted nature of language, which includes pragmatics, semantics, and syntax. Pragmatic ability allows children to participate in communicative exchanges, where they hear mental terms used in complex syntactic structures. From this experience they acquire awareness of different points of view, concepts of mental states, and mastery of the syntax for representing false beliefs. Both the social environment that provides this input and the child’s own cognitive resources that make use of it are needed for the child’s theory of mind to develop. Family environment. A number of studies show that the kind of conversational experiences that children have is related to theory-of-mind development. In particular, children whose mothers use more mental terms in their conversations acquire false-belief understanding at an earlier age than children whose mothers use fewer such terms, even when the children’s own language ability is taken into account. However, it is certainly possible that it is not the use of mental-state terms in particular that is important for children’s understanding of the mind, but rather, that use of mental-state terms is an easily

countable measure that is likely to be found in mothers who also tend to introduce varying points of view into conversations with their children. In addition, both parenting style and disciplinary strategy are associated with children’s false-belief understanding. As might be expected, children whose parents explain and discuss, rather than only punish unacceptable behavior, score more highly on false-belief tasks. Children from larger families develop false-belief understanding sooner. Perhaps this is because they have more experience of tricks, jokes, and teasing among their siblings, or perhaps because they are more exposed to talk about thoughts and wants as parents try to settle disputes among the children. Other studies have shown a similar effect for children who interact with more adults and who interact with older children including both siblings and peers. The relation between family size and performance on theory-of-mind tasks is stronger in the case of children with poorer language skills. This means that children with poor linguistic competence can acquire an understanding of false belief through social interaction with siblings in their home. Evidence from the attachment literature also demonstrates the importance of the family environment and parenting style to theory-of-mind development. Children who are classified as having secure maternal attachments in infancy develop false-belief understanding at an earlier age than children with less secure attachments. Some researchers argue that mothers’ ‘mind-mindedness’, that is, their propensity to treat their infants as individuals with minds, is an important factor in determining attachment security, as well as underlying their children’s developing awareness of other minds. Social competence. One might expect that children’s developing theory of mind would be related to their social competence – that is, children’s awareness of others’ mental states should have consequences for their relationships with others and for their social behavior in general. And indeed, research shows that individual differences in false-belief understanding are associated with actual differences in behavior in the social world. These behaviors are: communication abilities, as seen in more connected and more informative conversation; imaginative abilities, as seen in more frequent and more sophisticated pretend play; ability to resolve conflicts and to maintain harmony and intimacy in friendships; teacher ratings of global social competence; happiness in school; and peer-rated empathy and popularity. Importantly, in most if not all cases, the relations with false-belief understanding are independent of age and language ability. Conversely, preschoolers who are rejected by their peers and who do not have stable friendships tend to perform more poorly on theory-of-mind tasks. However, the directionality of this finding is not known. It is possible that these children’s low scores on theory-of-mind tasks

Theory of Mind

are due to their limited opportunities to engage in pretend play and the use of shared mental states with other children. On the other hand, it is possible that these children’s lack of social understanding weakens their ability to develop friendships and gain acceptance from peers. Either way, children with a better understanding of false belief tend to be more successful in their social relationships. However, theory-of-mind understanding is also related to children’s antisocial behavior. For example, children who are bullies have sophisticated theory-of-mind abilities and the skill of manipulating other people’s beliefs. As well, children who show a highly developed understanding of mental states tend to be better at lying. These paradoxical findings of the effects of theory of mind on social behavior have led some researchers to suggest that the concept of theory of mind be separated into ‘nice theory of mind’ (prosocial behavior requiring theory of mind) and ‘nasty theory of mind’ (antisocial behavior requiring theory of mind). In fact, research has suggested that these truly are distinct cognitive abilities. Yet the consequences of theory-of-mind development are perhaps most striking in their absence, suggested by studies of atypically developing populations.

Atypical Development Autism. Children with autism show impairments in communication and social interaction. Because of these deficits, there has been intensive investigation of theoryof-mind development in autism. Although autism is not usually diagnosed until after 2 years of age, children at risk for autism do not show the typical joint attention behaviors of late infancy and do not engage in pretend play. Later in the preschool years, they do show some understanding of others’ desires, although their ability lags behind that of typically developing children. Most striking, though, is their difficulty in understanding other people’s beliefs, as shown in their performance on the false-belief task. Only about 20% of children with autism succeed on standard false-belief tasks. This finding has been replicated numerous times in many different studies. Children with autism also tend to fail theory-of-mind tasks that require deception and have difficulty understanding belief-based emotions. As in typical development, autistic children’s falsebelief understanding is predicted by their language ability, perhaps to an even greater degree than for typically developing children. Notably, children with autism require far higher verbal mental age to pass false-belief tasks than typically developing children do. Some researchers suggest that high levels of language ability allow these children to pass false-belief tasks by working around their lack of intuitive social understanding.

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However, even with high levels of language ability, few individuals with autism develop the ability to understand second-order false beliefs and they have particular difficulty with nonliteral language use, such as sarcasm, irony, white lies, and metaphor. One thing that is clear is that the difficulty that children with autism have in passing theory-of-mind tasks is not due to a lack of intelligence. Evidence for this comes from the fact that children with Down syndrome tend to be successful on false-belief tasks, despite the fact that their intelligence scores are, on average, significantly lower than those of individuals with autism. Sensory impairments. Theory-of-mind development in children who are deaf differs depending on their family environment. Deaf children with hearing parents are delayed in their false-belief understanding, whereas deaf children with deaf parents are not. This is because, even though both groups of children engage in social interaction, the children with hearing parents are delayed in their acquisition of sign language, which again shows the important role of language in theory-of-mind development. Deaf children whose language development is delayed fail false-belief tasks even though the tasks are adapted to their mode of communication and they completely understand the basic story facts in the task. Furthermore, they find nonverbal theory-of-mind tasks just as difficult and their performance on such tasks is predicted by their level of language development. Children who are blind cannot see facial expressions and gestures and tend to have delayed language development. These children too show delays in theory-of-mind development, particularly in understanding false belief. There are also studies indicating deviations from typical theory-of-mind development in children with cerebral palsy, Williams syndrome, and fragile X syndrome. Behavior problems. A few studies have examined theoryof-mind development in children with behavior problems but the findings are somewhat inconsistent, with some studies suggesting a mix of enhanced and impaired performance on theory-of-mind tasks in ‘hard to manage’ preschoolers and others describing no deficit in theoryof-mind competence in school-age children with attention deficit hyperactivity disorder (ADHD). Cultural Differences Theory-of-mind development has been investigated primarily in middle-class children in North America, Europe, and Australasia. Most researchers assume that it is a universal development, or at least that there is a universal core to theory of mind that is acquired in the early years. In support of this idea, research shows that Chinese and Japanese children’s theory-of-mind development is quite similar to that of Western children, with slight variations in timing and perhaps more emphasis on

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social roles in the explanation of behavior. However, these children are also generally from middle-class, literate cultures. There are a few studies of children in unschooled, nonliterate populations, such as Baka and Mofu of Cameroon, Tolai and Tainae of New Guinea, Quechua of Peru, and Mopan Maya children in Central America. The findings from these studies are somewhat contradictory – some indicating development comparable to that in Western children, and others indicating delays or differences in development. However, cross-cultural research, in which tasks like false-belief tasks are adapted for local use, may not be the best way to investigate cultural diversity in theory of mind. Western theory of mind, which explains and predicts behavior by imputing mental states to self and others, underlies the design of such tasks. Yet other cultures may have quite different conceptions of mind, or the concept of mind may not exist in every culture. That is to say, there could be ways of interpreting social behavior that do not necessarily rely on theory of mind. It is possible that theory of mind is not universal and not all cultures explain and predict behavior as people do in Western society. This issue could be effectively addressed by collaborations among developmental psychologists and anthropologists. Furthermore, evidence provided by ethologists and comparative psychologists is also relevant here. If nonhuman primates were shown to possess theory of mind, then it would be more likely that theory of mind is universal in the human species – at least its basic core, even if there is cultural diversity in its further development. As mentioned, research on children’s theory of mind was initiated by reports of theory of mind in the chimpanzee. In more recent years, however, the issue has been highly controversial. Although most researchers agree that chimpanzees do not understand false belief, there is disagreement over whether they do understand simpler psychological processes, such as seeing, or whether they are simply able to detect statistical regularities in behavior without any awareness of mental states or ability to reason about mental states. Importantly, these debates – concerning the universality of theory of mind in humans, and whether theory of mind is a unique cognitive specialization in humans – inform ongoing debate on how to explain theory-ofmind development.

characteristics of theory of mind described in the first section of this article are associated with one particular explanation, one that gives a literal interpretation to the term ‘theory of mind’. The proposal is that children’s theory of mind develops via a process of theory construction and change, analogous to construction and change in scientific theorizing. That is, the theory says that children construct a theory about the mind, which has led to this view being referred to as the ‘theory–theory’ (see Table 10). On this view, children’s concepts of mental states are abstract and unobservable theoretical postulates used to explain and predict observable human behavior. The concepts are coherent and interdependent, and the theory can interpret a wide range of evidence using a few concepts and laws. The theory is not static but is reorganized over time when faced with counter-evidence to its predictions. A somewhat similar explanation is provided by ‘simulation theory’ (see Table 10). However, on this view, mental-state concepts are derived from children’s own direct experience of such states and are not postulated in some process of abstract theorizing. The theory says that children are intuitively aware of their own mental states and can understand other people’s behavior by a process of simulation, using their abilities for pretence that develop early in the preschool years. Children can imagine having the beliefs and desires that the other person has, and imagine what they themselves would do if they possessed those imagined beliefs and desires. Another explanation is provided by ‘modularity theory’. On this view, theory-of-mind development depends on maturation of a particular brain structure – an innate cognitive theory-of-mind module. Like theory – theory, modularity theory regards children’s concepts of mental states as abstract theoretical entities, organized into causal laws that can be used to interpret a wide range of evidence. However, the theory is not acquired

Table 10 development

Theoretical

Theory of mind is defined as an integrated set of mentalstate concepts underlying the interpretation of human social activity that develops gradually from infancy onwards. Various competing theories have been put forward to explain how this development comes about. The

of

theory-of-mind

Theories

Characteristics

Theory–theory

Children construct theory of mind through a process of theorizing Children simulate others’ experience based on their own Theory of mind depends on maturation of an innate cognitive theory-of-mind module Theory of mind is collaboratively constructed in linguistically mediated social interaction Theory-of-mind development depends on domain-general developments, for example, in executive functions

Simulation theory

Explanations of Theory-of-Mind Development

explanations

Modularity (nativist) theory Socialconstructivist theories Domain-general theories

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through any process of ‘theorizing’, but rather the theoryof-mind module is innate and matures. The module constrains development in a precise way – the theory is not subject to revision based on experience. Although experience might be required as a trigger, the module will not be modified in differential ways by different experiences, which predicts that the acquisition of a theory of mind will be a universal human achievement. These three views – that posit theory construction, simulation, or an innate module – all focus on theory of mind as an individual cognitive achievement in which children construct or employ a conceptual structure – the theory of mind. An alternative view gives social factors a much greater role in theory-of-mind development. ‘Social constructivist theories’ assert that theory of mind is embodied in the folk ways and speech practices of a culture and theory of mind develops as children participate in interaction and dialogue with more knowledgeable members of the culture. Importantly, social constructivist views are not passive enculturation explanations that allow the child no active role. Rather they recognize the contribution both of the child and of the social environment, arguing that children’s understanding of mind is collaboratively constructed in linguistically mediated social interaction. Against the aforementioned four views, other researchers argue that children do not develop a domain-specific theory about the mind. Rather, theory-of-mind development is a reflection of domain-general changes in cognitive processes, such as executive function, working memory, or reasoning abilities (Table 10). Evidence for and against each of the proposed theories is hotly debated and there is no overall consensus clearly supporting one theory over all the others. The same empirical evidence is used to support different theories and, furthermore, evidence that some researchers use to refute a particular theory is dismissed by others as not relevant. Indeed, some researchers maintain that the differences between some of the theories (e.g., theory-theory and simulation theory) are philosophical differences that cannot be refuted by empirical evidence. Many researchers argue that the striking absence of theory-of-mind abilities in children with autism occurs because of impairment in the theory-of-mind module, which is taken as evidence in support of modularity theory. However, cultural variation in theory of mind speaks against modularity theory and in favor of social constructivist theories. Researchers generally agree that

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domain-general resources are needed for successful performance on theory-of-mind tasks but the origin of domainspecific mental-state concepts still requires explanation. In recent years, substantial attention has been paid to the role that the brain plays in theory-of-mind reasoning, with an attempt to isolate brain regions that are specific to this ability. However, most of this research has focused on adult participants, making it difficult to draw conclusions about how theory of mind develops. The limited research conducted with young children has attempted to examine the relationship between functional brain development and theory-of-mind development. Findings suggest that the neural systems associated with children’s ability to reason about mental states (i.e., theory-of-mind reasoning) are independent of those associated with other kinds of reasoning (e.g., reasoning about reality). There is also evidence to suggest that it is the frontal lobes in particular that are required for theory-of-mind reasoning, and that this may be lateralized to the left hemisphere of the brain. Given the recent rise in interest in cognitive neuroscience research, significant future work in this area is to be expected and this may inform the debate over theoretical explanations of theory-of-mind development. See also: Autism Spectrum Disorders; Empathy and Prosocial Behavior; Friends and Peers; Imitation and Modeling; Pragmatic Development; Social Interaction.

Suggested Readings Astington JW (1993) The Child’s Discovery of the Mind. Cambridge, MA: Harvard University Press. Astington JW and Baird JA (eds.) (2005) Why Language Matters for Theory of Mind. New York: Oxford University Press. Baron-Cohen S (1995) Mindblindness: An Essay on Autism and Theory of Mind. Cambridge, MA: Bradford Books/MIT Press. Carpendale J and Lewis C (2006) How Children Develop Social Understanding. Oxford: Blackwell. Carruthers P and Smith PK (eds.) (1996) Theories of Theories of Mind. Cambridge, UK: Cambridge University Press. Malle BF and Hodges SD (eds.) (2005) Other Minds: How Humans Bridge the Divide between Self and Others. New York: Guilford Press. Moore C (2006) The Development of Commonsense Psychology. Mahwah, NJ: Erlbaum. Perner J (1991) Understanding the Representational Mind. Cambridge, MA: Bradford/MIT Press. Tomasello M (1999) The Cultural Origins of Human Cognition. Cambridge, MA: Harvard University Press. Wellman HM (1990) The Child’s Theory of Mind. Cambridge, MA: Bradford/MIT Press.

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Twins

Twins L F DiLalla, P Y Mullineaux, and K K Elam, Southern Illinois University School of Medicine, Carbondale, IL, USA ã 2008 Elsevier Inc. All rights reserved.

Glossary Conjoined twins – When an egg divides, leading to monozygotic twinning, but the division occurs late in development and therefore is incomplete, the two resulting embryos may not completely separate, leading to partial fusion, or conjoined twins. Twins may be joined physically at different places and to different extents, and we are not certain what causes this. Gene–environment (GE) correlation – Genes and environment can be correlated three different ways. Passive GE correlation happens when both genes and environment come from the parents and thus are correlated. Reactive GE correlation happens when people in the environment react to something genetically influenced in the child, making the child’s genes and subsequent environment correlated. Active GE correlation occurs when a child chooses an environment partly because of his or her genetic make-up. Heritability – The extent to which genetic make-up influences behavior is called heritability. Genetic influences on behavior are indirect via proteins that are coded for by genes and that have effects on the brain. Heritability is a statistic that is specific to the population for which it is calculated. The comparison between monozygotic (MZ) and dizygotic (DZ) twins can be used to calculate the heritability of a particular behavior. Twin research – Twins are a wonderful natural experiment because MZ and DZ twins can be compared to provide information about the extent to which genes influence behavior. MZ twins share 100% of their genes, whereas DZ twins share approximately 50% of their genes. Therefore, if MZ twins are more similar to each other on a particular behavior than DZ twins are to each other, then genetic influences can be assumed to be important for influencing that behavior. Twins – Twins are children who are conceived at the same time from the same mother. There are two types of twins: MZ, when one egg is fertilized by one sperm and then the zygote splits in two, forming two genetic copies, and DZ, when two separate eggs are fertilized by two separate sperm, resulting in two siblings who share approximately 50% of their genetic material.

Introduction Twins occur when two fetuses share the same uterus during a pregnancy. Overall, twins occur in approximately 1 in 32 births in the US. When this happens, resources must be shared during development in the uterus. This causes most twins to be born prematurely and with a lower birth weight than normal infants. Single births have a gestation period of approximately 40 weeks, whereas twin births normally range from 34 to 36 weeks. Twins are usually born in quick succession and are often kept for observation due to low birth weight and increased possibility of complications found in multiple births. Two basic types of twinning can occur (monozygotic (MZ) and dizygotic (DZ)) depending on the number of eggs (zygotes) that are fertilized during pregnancy. MZ twins, sometimes known as identical twins, are the result of a single egg that is fertilized during conception that then splits into separate embryos. MZ twins, therefore, are 100% genetically the same because they result from a single fertilized egg. This causes them to look very similar and to be the same sex. (There are rare exceptions to this, however, as noted below.) After they split, these separate embryos develop into two fetuses that share the uterus during pregnancy. MZ twins may share the same amnion (the inner fetal membrane that contains the amniotic fluid) and placenta (the organ joining the mother and fetus that allows transfer of oxygen and nutrients to the fetus and waste from the fetus), or just share the same placenta. MZ twins occur in about 1 in 250 of all births. Dizygotic twins, sometimes called fraternal twins, develop when two eggs are released at about the same time and both become fertilized. These eggs then develop into two separate fetuses. Because DZ twins are a result of two different eggs, they are as genetically similar as siblings and they share on average 50% of their genes. Opposite sex twins can occur in fraternal pairs because different sperm fertilize the two eggs, and sex is determined by whether the sperm carries an X or a Y chromosome. Thus, DZ twins do not necessarily look alike and may have differing features as well as similar ones. Dizygotic twins occur in about 1 in 36 of all births. Since the 1990s, multiple births, especially dizygotic, have become more common as a result of infertility treatments, although multiple births may also occur naturally. In addition, certain maternal factors such as higher maternal age and race may contribute to multiple births.

Twins

509

Per 1000 live births

70 60

40+

50

35−39

40

30−35

30

30−34

20

20−24

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