Growth and Development

Cognitive and Moral Developmental Theories

Many theories have been devised to
study the development of children

• Intellectual development: Jean Piaget

• Moral development: Jean Piaget and

Lawrence Kohlberg

• Emotional development: Erik H Erikson

• Psychosexual development: Sigmund Freud

• Spiritual development: James W Fowler

Psychosocial Theory- Erik
[Link]
Psychosexual Theory –
Sigmund Freud
 Piaget’s
Cognitive
Development
Theory - 1969
 Introduction
• Children are born with inherited potentialities
for thorough intellectual growth.

• Development of potential occurs through

interaction with environment.

• The age related changes in mental activities

are called “cognitive development”.

• The term “cognition” means “understanding”.

Contd….Introduction
• It refers to mental development that
includes not only intelligence but also
complementary processes as perceiving,
recognizing, recalling and interpreting
information as well as all forms of
reasoning.

• According to him, thinking of normal child

is not a simpler version of thinking of
adults.
• Thinking is based on different understanding
of reality.

• It slowly changes according to maturation

and experiences.

• According to Piaget, children proceed

through the stages of mental activity in an
orderly and sequential manner.

• Children learn through assimilation and

accommodation
The sequences of cognitive changes are
divided into 4 periods according to
chronological age, as:

Sensorimotor (birth to 2 years)

Pre- operational thought ( 2 to 6 years)
Concrete operations (6 to 12 years)
Formal operations (12 to 15+ years)
 Concept – Piaget’s Cognitive
Theory
• According to Piaget, the baby is in the
sensorimotor stage between birth to 2
years.

• During the sensorimotor stage, the child

understands his world through sensory
organs and through his motor abilities.

• He used several terms schema, assimilation,

accommodation, equilibrium to describe
cognitive development
Contd…Concept
• Piaget believed intellectual growth followed
an orderly progression based on the child’s
maturational level, experiences with
physical objects, interactions with
caregivers, other adults and peer.

• This sensorimotor stage has six substages.

 SENSORIMOTOR (Birth to 2
years)
• At the beginning of his/ her life, the child is
concerned only with satisfying basic needs
and comforts.

• As the sense of differentiation occurs, with

increasing mobility and awareness, the
mental system is expanded.
Contd….Introduction

• The child develops a greater

understanding regarding objects within
external environment and their effects
upon him/her.

• Knowledge is gained regarding the ability

to manipulate objects and experiences
within the environment
Three important events takes place during
the sensorimotor stage:
1. Separating of the infant’s self from other
persons, such as the mother or objects in the
environment.

2. Perceiving the concept of object permanency

or constancy – that people and things
continue to exist even though they cannot be
seen.

3. Using symbol to think of a situation or an

object, such as toy, without its being present
in the immediate environment.
The sensorimotor stage is composed of 6 sub
stages: first 4 stages comes under infancy and
the remaining two in toddler stages – which are
as follows:

Sub – Stage I: Use of Reflexes (birth to 1 month):

• Reflexes are voluntary responses to certain

stimuli.

• The common reflexive activity during this stage

are sucking, swallowing, rooting, grasping and
crying.
Sub – stage II: Primary circular reaction
(1 to 4 months)

• This sub stage marks the beginning of

voluntary action replacing reflexive behavior.

• Infants indulge in investigating his body

parts.

• Investigation includes sucking his own

thumb and grasping his foot.
• After their palmer reflexes fade between 2
and 3 months, infants voluntarily grasp
objects.

• Sucking the thumb becomes a deliberate

act and when finally learned, a new
organized scheme is introduced that
involves coordination of movements. These
activities are done in a repetitive way and
Piaget calls it “circular reaction”
 Sub – stage III: Secondary circular
reaction (4 to 8 months)

• During this stage, the baby reaches out for

objects other than his own body.

• Eye – hand coordination and coordination

between large muscles and finger muscles of
the body.

• These reaching out responses are called

“secondary circular reactions” -
secondary because they are intentional.
Contd…Sub – Stage III
• Events that occur by accident in the
environment are repeated by infants if they
produce interesting results.

• The phenomenon called “Object

Permanence” begins to appear – meaning
the ability to represent an object, whether or
not it is actually present.
Sub – stage IV: Co-ordination of secondary schemas
and their application to new situations / goal
oriented behavior
(8 to 12 months)

• Concept of object permanence advances and increased

motor capabilities promote exploration of environment.

• They discover that hidden objects does not mean that

it is gone forever. This makes for the development of
intellectual reasoning.
Contd….
• They begin to associate symbols with events
(saying bye – bye).

• Infants learn begins to perceive a

relationship between cause and effect.

• Common behaviors manifested are active

searching for hidden objects, comprehends
meaning of words and simple commands
and try to be away from parents to explore
the surroundings.
 Sub – stage V: Tertiary circular reactions /
experimentation (12 to 18 months)

• Develop increased concept of object

permanence. They begin to experiment
actively with things to discover how various
actions will affect an object.

• Breaking play things to see what is inside,

inserting objects into nostrils, ears etc are
examples of experimentation. These
reactions are called “tertiary circular
reaction.”
Contd….
• The child differentiates himself separately
from the environment and shows curiosity
about the environment.

• Gains comfort from parents voice even if the

parents is not visible.
Sub – stage VI: Problem solving and mental
combination (18 months to 24 months)

• The child is able to solve problems by

mental combinations of signs, symbols or
images.

• Object permanence fully develops.

• Child is able to remember objects for a

brief when they are removed from sight.
Contd…
• Child imitates others and engages on making
believe plays.

• Elementary logic is found in child’s

responses.

• Ego centrism is another typical feature –

attitude like mine is mine and yours is also
mine.
 II. Pre- operational thought
(2 to 6 years)

• The representational abilities become more

sophisticated and capable to communicate
their needs with language.

• They become social beings but child does

not understand the use of symbols and
basic operations hence the name pre-
operational stage.
This phase consist of 2 sub-stages:
1. Pre – conceptional stage (2 – 4 years)
2. Intuitive stage (4 – 6 years)

Pre – conceptual phase (2 to 4 years)

• This is a transient period which bridges the

self – satisfying behavior of infancy and
rudimentary social behavior of latency.

• This is period of beginning symbolization in

thinking.
• The baby is only capable of making concept
of a single object and not a class of objects.

• The child views every object or situation as

single instances and will not understand the
dimensionality of objects.

• The child cannot think in terms of

operations.

• Pre – conceptual thought is extremely

concrete and egocentric (child’s persistent
self- centredness)
• Egocentrism is a major hindrance to
cognitive development.

• With egocentrism, the child is unaware of

others perspectives.

• The pre – schooler do not realize that other

people see things from a different view
point..
 Intuitive phase (4 to 7 years)
• Egocentric thought begins to give away to
social pressure and the child beings to
accommodate others (cognitive egocentrism).

• The pre-schooler’s thinking is static and focus

at one feature at a time. They are unable to
combine various features of an object. This is
centration.

• Child is unable to decentre and his perceptual

evaluation is not developed.
• Piaget also used the transductive reasoning
(a child proceeds from particular to
particular centring on one salient aspects of
an event and ignoring other aspects.)

There are two forms of transductive

thinking ; namely – juxtaposition and
syncretism.
• In juxtaposition, he described indiscriminate
relationship

• In syncretism, the child fails to relate

various observations into a consistent.
• At this stage, the children group items with
similarity

• From 2 to 4 years, the child lacks speech

and the egocentric speech which the child
repeatedly uses in his communication with
others.

• With age 4 to 6 years, language becomes

socialized speech (you, she , he ) are added
in conversations
• The child exchanges ideas with other
persons, which helps in socialization
process.

• There is beginning of thoughts and the

child thinks internally by using words and
signs.

• There is internalization of action and

actions become more symbolic rather than
perceptual motor
Common forms of imaginary experiences in
childhood are:

• Day dreaming Exaggeration

• Imaginary friends Dreams

• Imaginary illness Creativity

• Animism
• Ordering / Seriation: School age children are
able to arrange things or concrete objects
according to their size and relationships to
other things. Ordering allows them to solve an
abstract problem when it deals with concrete
objects.

• Classification: Children are increasingly able

to classify objects in a more computer manner
than they could during the pre-school years
• Thinking and Reasoning: They can solve
problems because they can manipulate symbols.
Their mental ability permits them to carry on
converse and reverse processes. School children
can think problems through, a new world of logical
operations opens before them.

• Time: During the school age period, children think

not only of the present but also of the past and
future

• Egocentrism decreases, the ability to cooperate in

interactions with other children increases, and
understanding and acceptance of established rules
grow.
 IV. Formal operations (12 to 15+ years)

• At this stage, the individuals is able to think

and reason in abstract terms.

• Individuals can solve problems that require

purely abstract thinking in a flexible
manner.

• He/ she can make and test hypothesis using

logical and orderly problem solving.
• Adolescents can utilize “Hypothetical
deductive reasoning”, they may reject
authority if they are not satisfied with the
rationale and logic.

• Current situations and reflections of the

future are idealized and a degree of
egocentrism returns during this stage

• Formal operations, however, enables the

individual to distinguish between the real and
the ideal
 Reference / Bibliography

 Sharma Rimple- “Essentials of Pediatric Nursing for BSc. and

[Link]. Nursing students”; 1st edition; Jaypeee Brothers Medical
Publishers (P) Ltd; page no:68-70
• Yadav Manoj –“ A textbook of Child Health Nursing and
Procedure”; 1st edition; [Link] and Company (Medical
Publish); page no: 126-128
• Clement I-“ Psychosocial Foundation of Nursing”; 1st edition;
Jaypee Brothers Medical Publishers (P) ltd; page no:89-95
• T.M Assuma Devi – “Textbook of Pediatric Nursing”; 1st
edition ;Reed Elsevier India Pvt Limited; page no: 65-68
• Townsend Mary C-“ Psychiatric Mental Health Nursing”; 7th
edition; Jaypee Brothers Medical Publisher (P).ltd; Page no: 33-
41
• Marlow Dorothy R and Redding Barbara A – “Marlow’s
Textbook of Pediatric Nursing”; 1st edition; Reed Elsevier India
Pvt Limited; Page no:110 – 111