Posted: April 12th, 2022

The Importance of Play

Unit 2.1 Discussion: The Importance of Play

Discuss why play is so important to the development of a child. What are possible outcomes for a child who does not learn how to play? Tell us if play is important to you as an adult and how you integrate play into your life.
In response to your peers, engage openly and respectfully comment on their perspective.
Unit 2
Infancy and Childhood

Readings and Resources
Readings and Resources
eBook:
Zastrow, C., Kirst-Ashman, K.K. & Hessenauer, S.L. (2019). Empowerment series: Understanding human behavior and the social environment (11th Ed.). Cengage Learning.

• Chapter 2: Biological Development in Infancy and Childhood
• Chapter 3: Psychological Development in Infancy and Childhood
• Chapter 4: Social Development in Infancy and Childhood
Articles, Websites, and Videos:
Erik Erikson is a well-known Psychologist and Psychoanalyst known who devoted his work to understanding the psychosocial development of individuals. This video explains the 8 stages of psychosocial development and reviews Erikson’s beliefs on how all of us move through these stages in our lifespan. https://youtu.be/04wbdxzkvYU

Doesn’t everyone like to play with children? Do we understand the multiple benefits of play? In this video, play is examined emphasizing how it supports responsive relationships, strengthens core life skills and reduces sources of stress for young children. https://youtu.be/pjoyBZYk2zI

A child’s temperament can affect many aspects of their lives. This video examines the three major temperament styles of children, including descriptions of their behaviors, and identifies which parenting style is the best for a particular child and their temperament. https://youtu.be/uDNmTn2s8_w

Chapter 2 Biological Development in Infancy and Childhood
Chapter Introduction

Camille Tokerud/Taxi/Getty Images
Learning Objectives
This chapter will help prepare students to

EP 6a
EP 7b
EP 8b
• LO 1 Describe the dynamics of human reproduction (including conception, the diagnosis of pregnancy, fetal development, prenatal influences and assessment, problem pregnancies, and the birth process)
• LO 2 Explain typical developmental milestones for infants and children
• LO 3 Examine the abortion controversy (in addition to the impacts of social and economic forces)
• LO 4 Explain infertility (including the causes, the psychological reactions to infertility, the treatment of infertility, the assessment process, alternatives available to infertile couples, and social work roles concerning infertility)
Juanita lovingly watched her 1-year-old Enrico as he lay in his crib playing with his toes. Enrico was her first child, and Juanita was very proud of him. She was bothered, however, that he could not sit up by himself. Living next door was a baby about Enrico’s age, whose name was Teresa. Not only could she sit up by herself, but she could crawl, stand alone, and was even starting to walk. Juanita thought it was odd that the two children could be so different and have such different personalities. That must be the reason, she thought. Enrico was just an easygoing child. Perhaps he was also a bit stubborn. Juanita decided that she wouldn’t worry about it. In a few weeks, Enrico would probably start to sit up.
Knowledge of typical human development is critical in order to understand and monitor the progress of children as they grow. In this example, Enrico was indeed showing some developmental lags. He was in need of an Assessment to determine his physical and psychological status so that he might receive help.
A Perspective
The attainment of typical developmental milestones has a direct impact on the client. Biological, psychological, and social development systems operate together to affect behavior. This chapter will explore some of the major aspects of infancy and childhood that social workers must understand in order to provide information to clients and make appropriate assessments of client behavior.
2-1Describe the Dynamics of Human Reproduction
LO 1
Chuck and Christine had mixed emotions about the pregnancy. It had been an accident. They were both in their mid-30s and already had a vivacious 4-year-old daughter named Hope. Although Hope had been a joy to both of them, she had also placed serious restrictions on their lifestyle. They were looking forward to her beginning school. Christine had begun to work part-time and was planning to go full-time as soon as Hope turned 5.
Now all that had changed. To complicate the matter, Chuck, a university professor, had just received an exciting job offer in Hong Kong—the opportunity of a lifetime. They had always dreamed of spending time overseas.
The unexpected pregnancy provided Chuck and Christine with quite a jolt. Should they terminate the pregnancy and go on with their lives in exotic Hong Kong? Should they have the baby overseas? Questions concerning foreign prenatal care, health conditions, and health facilities flooded their thoughts. Would it be safer to remain in the United States and turn down this golden opportunity? Christine was 35. Her reproductive clock was ticking away. Soon risk factors concerning having a healthy, normal baby would begin to skyrocket. This might be their last chance to have a second child. Chuck and Christine did some serious soul-searching and fact-searching to arrive at their decision.
Yes, they would have the baby. Once the decision had been made, they were filled with relief and joy. They also decided to take the job in Hong Kong. They would use the knowledge they had about prenatal care, birth, and infancy to maximize the chance of having a healthy, normal baby. They concluded that this baby was a blessing who would improve, not impair, the quality of their lives.
The decision to have children is a serious one. Ideally, a couple should examine all alternatives. Children can be wonderful. Family life can bring pleasurable activities, pride, and fullness to life. On the other hand, children can cause stress. They demand attention, time, and effort and can be expensive to care for. Information about conception, pregnancy, birth, and child rearing can only help people make better, more effective decisions.
2-1aConception
Sperm meets egg; a child is conceived. But in actuality, it is not quite that simple. Many couples who strongly desire to have children have difficulty conceiving. Many others whose last desire is to conceive do so with ease. Some amount of chance is involved.
Conception refers to the act of becoming pregnant. Sperm need to be deposited in the vagina near the time of ovulation. Ovulation involves the ovary’s release of a mature egg into the body cavity near the end of one of the fallopian tubes. Fingerlike projections called fimbriae at the end of the fallopian tube draw the egg into the tube. From there, the egg is gently moved along inside the tube by tiny hairlike extensions called cilia. Fertilization actually occurs in the third of the fallopian tube nearest the ovary.
If a sperm has gotten that far, conception may occur. After ejaculation, the discharge of semen by the penis, the sperm travels up into the uterus and through the fallopian tube to meet the egg. Sperm are equipped with a tail that can lash back and forth, propelling them forward. The typical ejaculate, an amount of approximately one teaspoon, usually contains 200 to 400 million sperm; however, only 1 in 1,000 of these will ever make it to the area immediately surrounding the egg (Rathus, Nevid, & Fichner-Rathus, 2014). Unlike females, who are born with a finite number of eggs, males continually produce new sperm. Fertilization is therefore quite competitive. It is also hazardous. The majority of these sperm don’t get very far (Hyde & DeLamater, 2017; Rathus et al., 2014). Many spill out of the vagina, drawn by gravity. Others are killed by the acidity of the vagina. Still others swim up the wrong fallopian tube, meaning the one without the egg. Only about 2,000 sperm make it up the right tube. By the time a sperm reaches the egg, it has swum a distance 3,000 times its own length; an equivalent swim for a human being would be more than 3 miles (Hyde & DeLamater, 2017).
Although sperm are healthiest and most likely to fertilize an egg during the first 24 hours after ejaculation, they may survive up to 72 hours in a woman’s reproductive tract; an egg’s peak fertility is within the first 8 to 12 hours after ovulation, although it may remain viable for fertilization for up to 24 hours, and some may remain viable for up to five days (Greenberg, Bruess, & Oswalt, 2017; Newman & Newman, 2015). Therefore, sexual intercourse should ideally occur not more than five days before or one day after ovulation for fertilization to take place (Yarber & Sayad, 2016).
In the fallopian tube, the egg apparently secretes a chemical substance that attracts sperm. The actual fertilization process involves sperm reaching the egg, secreting an enzyme, and depositing it on the egg. This enzyme helps dissolve a gelatinous layer surrounding the egg and allows for the penetration of a sperm. After one sperm has penetrated the barrier, the gelatinous layer undergoes a physical change, thus preventing other sperm from entering it.
Fertilization occurs during the exact moment the egg and sperm combine. Eggs that are not fertilized by sperm simply disintegrate. The genetic material in the egg and sperm combine to form a single cell called a zygote.
Eggs contain an X chromosome. Sperm may contain either an X or a Y chromosome. Eggs fertilized by a sperm with an X chromosome will result in a female; those fertilized by sperm with a Y chromosome will result in a male.
The single-celled zygote begins a cell division process in which the cell divides to form two cells, then four, then eight, and so on. Within a week, the new mass of cells, called a blastocyst, attaches itself to the lining of the uterus. If attachment does not occur, the newly formed blastocyst is simply expelled. From the point of attachment until eight weeks of gestation, the conceptus, or product of conception, is called an embryo. From eight weeks until birth, it is referred to as a fetus. Gestation refers to the period of time from conception to birth.
2-1bDiagnosis of Pregnancy
Pregnancy can be diagnosed by using laboratory tests, by observing the mother’s physical symptoms, or by performing a physical examination. Early symptoms of pregnancy can include increase in basal body temperature that lasts for up to 3 weeks, breast tenderness, feelings of fatigue, and nausea (Hyde & DeLamater, 2017). Many women first become aware of the pregnancy when they miss a menstrual period. However, women also can miss periods as a result of stress, illness, or worry about possible pregnancy. Some pregnant women will even continue to menstruate for a month or even more. Therefore, lab tests are often needed to confirm a pregnancy. Such lab tests are 98 to 99 percent accurate and can be performed at a Planned Parenthood agency, a medical clinic, or a physician’s office (Hyde & DeLamater, 2017; Rathus et al., 2014).
Most pregnancy tests work by detecting human chorionic gonadotropin (HCG) in a woman’s urine or blood. HCG is a hormone secreted by the placenta (the tissue structure that nurtures a developing embryo). Laboratory tests can detect HCG as early as eight days after conception (Greenberg et al., 2014).
The use of home pregnancy tests (HPTs) has become quite common. Like some laboratory tests, they measure HCG levels in urine. They are very convenient, relatively inexpensive and can be used as early as the first day a menstrual period was supposed to start. However, they are more likely to be accurate if administered after more time has passed.
Most HPTs function in a similar fashion. The user holds a stick in the urine stream or collects urine in a cup and dips the stick into it. Most tests have a results window indicating whether a woman is pregnant or not. Most tests also stress retaking the test a few days or a week later to confirm its accuracy.
Because HCG increases as the pregnancy progresses, HPTs become more accurate as time goes on. “Many home pregnancy tests claim to be 99 percent accurate on the day you miss your period. Although research suggests that most home pregnancy tests don’t consistently spot pregnancy this early, home pregnancy tests are considered reliable when used according to package instructions one week after a missed period” (Mayo Clinic, 2013c).
Although HPTs can be highly accurate, there is room for error. If instructions are not followed perfectly, results can be faulty. For instance, exposure to sunlight, accidental vibrations, using an unclean container to collect urine, or examining results too early or too late all can end in an erroneous diagnosis. False negatives (i.e., showing that a woman is not pregnant when she really is) are more common than false positives (i.e., showing that a woman is pregnant when she really is not). Regardless, it is suggested that a woman confirm the results either by waiting a week and administering another HPT or by having a laboratory diagnosis performed. Early knowledge of pregnancy is important either to begin early health care or to make a decision about terminating a pregnancy.
2-1cFetal Development during Pregnancy
An average human pregnancy lasts about 266 days after conception (Papalia & Martorell, 2015). However, there is a great amount of variability in the length of pregnancies among mothers. It is most easily conceptualized in terms of trimesters, or three periods of three months each. Each trimester is characterized by certain aspects of fetal development.
The First Trimester
The first trimester is sometimes considered the most critical. Because of the embryo’s rapid differentiation and development of tissue, the embryo is exceptionally vulnerable to the mother’s intake of noxious substances and to aspects of the mother’s health.
By the end of the first month, a primitive heart and digestive system have developed. The basic initiation of a brain and nervous system is also apparent. Small buds that will eventually become arms and legs are appearing. In general, development starts with the brain and continues down through the body. For example, the feet are the last to develop. In the first month, the embryo bears little resemblance to a baby because its organs have just begun to differentiate.
The embryo begins to resemble human form more closely during the second month. Internal organs become more complex. Facial features including eyes, nose, and mouth begin to become identifiable. The 2-month-old embryo is less than an inch long and weighs about one-third of an ounce.
The third month involves the formation of arms, hands, legs, and feet. Fingernails, hair follicles, and eyelids develop. All the basic organs have appeared, although they are still underdeveloped. By the end of the third month, bones begin to replace cartilage. Fetal movement is frequently detected at this time.
During the first trimester, the mother experiences various symptoms. This is primarily due to the tremendous increase in the amount of hormones her body is producing. Symptoms frequently include tiredness, breast enlargement and tenderness, frequent urination, and food cravings. Some women experience nausea, referred to as morning sickness.
It might be noted that these symptoms resemble those often cited by women when first taking birth control pills. In effect, the pill, by introducing natural or artificial hormones that resemble those of pregnancy, tricks the body into thinking it is pregnant, thus preventing ovulation. The pill as a form of contraception is discussed more thoroughly in Chapter 6.
The Second Trimester
Fetal development continues during the second trimester. Toes and fingers separate. Skin, fingerprints, hair, and eyes develop. A fairly regular heartbeat emerges. The fetus begins to sleep and wake at regular times. Its thumb may be inserted into its mouth.
For the mother, most of the unappealing symptoms of the first trimester subside. She is more likely to feel the fetus’s vigorous movement. Her abdomen expands significantly. Some women suffer edema, or water retention, which results in swollen hands, face, ankles, or feet.
The Third Trimester
The third trimester involves completing the development of the fetus. Fatty tissue forms underneath the skin, filling out the fetus’s human form. Internal organs complete their development and become ready to function. The brain and nervous system become completely developed.
An important concept that becomes relevant during the sixth and seventh months of gestation is viability. This refers to the ability of the fetus to survive on its own if separated from its mother. Although a fetus reaches viability by about the middle of the second trimester, many infants born at 22–25 weeks “do not survive, even with intensive medical care, and many of those who do experience chronic health or neurological problems” (Sigelman & Rider, 2012, p. 100).
The viability issue becomes especially critical in the context of abortion. The question involves the ethics of aborting a fetus that, with external medical help, might be able to survive. This issue underscores the importance of obtaining an abortion early in the pregnancy when that is the chosen course of action.
For the mother, the third trimester may be a time of some discomfort. The uterus expands, and the mother’s abdomen becomes large and heavy. The additional weight frequently stresses muscles and skeleton, often resulting in backaches or muscle cramps. The size of the uterus may exert pressure on other organs, causing discomfort. Some of the added weight can be attributed to the baby itself, amniotic fluid, and the placenta. Other normal weight increases include those of the uterus, blood, and breasts as part of the body’s natural adaptation to pregnancy.
Pregnancy Apps
Many women now use technology as a way to get advice about their pregnancy and parenting. Mobile apps, such as “BabyBump Pregnancy,” “My Pregnancy & Baby Today,” “WebMD Pregnancy,” and “Parenting Tips,” help parents by providing information on subjects such as tracking your period, what to expect during your pregnancy, what your baby looks like in the womb (complete with pictures and photos), fetal development information, tips on how to have a healthy pregnancy, questions to ask at doctors’ appointments, contraction timing, and much more. For those who want up-to-date advice or information, an app might be a source of information to look into. It is important to note, however, that these apps should not be used as a substitute for the prenatal care given by a medical professional, especially for women with at-risk pregnancies.
2-1dPrenatal Influences
Numerous factors can influence the health and development of the fetus. These include the expectant mother’s nutrition, drugs and medication, alcohol consumption, smoking habits, age, stress, and a number of other factors.
Nutrition
A pregnant woman is indeed eating for two. In the past, pregnant women were afraid of gaining too much weight. But a woman should usually gain 25 to 35 pounds during her pregnancy (Berk, 2013; Kail & Cavenaugh, 2013; Sigelman & Rider, 2012). She typically requires 300 to 500 additional calories daily to adequately nurture the fetus (Papalia & Martorell, 2015).
The optimal weight gain depends on the woman’s height and her weight prior to pregnancy. For example, a woman who is underweight before pregnancy might require a greater weight gain to maintain a healthy pregnancy.
Being underweight or overweight poses risks to the fetus. Too little weight gain due to malnutrition can result in low infant birth weight, increased risk of mental or motor impairment, and a higher risk of infant mortality (Berk, 2013; Newman & Newman, 2015). Being overweight either before or during pregnancy can increase the risk of miscarriage and other complications during pregnancy and birth (Chu et al., 2008), in addition to birth defects (Stothard, Tenant, Bell, & Rankin, 2009).
Not only does a pregnant woman need to eat more, but the quality of food also needs careful monitoring and attention. It is especially important for pregnant women to get enough protein, iron, calcium, and folic acid (a B vitamin), in addition to other vitamins and minerals (Berk, 2013; Kail & Cavenaugh, 2013). As Hyde and DeLamater (2017) explain,
Protein is important for building new tissues. Folic acid is also important for growth; symptoms of folic acid deficiency are anemia [low red blood cell count] and fatigue. A pregnant woman needs much more iron than usual, because the fetus draws off iron for itself from the blood that circulates to the placenta. Muscle cramps, nerve pains, uterine ligament pains, sleeplessness, and irritability may all be symptoms of a calcium deficiency. (p. 127)
Drugs and Medication
Because the effects of many drugs on the fetus are unclear, pregnant women are cautioned to be wary of drug use. Drugs may cross the placenta and enter the bloodstream of the fetus. Any drugs should be taken only after consultation with a physician. The effects of such drugs usually depend on the amount taken and the gestation stage during which they are taken. This is especially true for the first trimester, when the embryo is very vulnerable.
Teratogens are substances, including drugs, that cause malformations in the fetus. Certain drugs can cause malformations of certain body parts or organs. The so-called thalidomide babies of the early 1960s provide a tragic example of the potential effects of drugs. Thalidomide, a type of tranquilizer used to ease morning sickness, was found to produce either flipper-like appendages in place of arms or legs, or no arms or legs at all.
A variety of prescription drugs can produce teratogenic effects. These include antibiotics such as tetracycline and streptomycin, Accutane (an acne drug), and some antidepressants (Rathus et al., 2014; Santrock, 2016). Generally speaking, women should avoid taking drugs or medications during pregnancy and while breastfeeding unless such medication is absolutely necessary.
Even nonprescription, over-the-counter drugs such as Aspirin (acetylsalicylic acid) or caffeine should be consumed with caution (Santrock, 2016). Aspirin can cause bleeding problems in the fetus (Steinberg et al., 2011a). Coffee, tea, colas, and chocolate all contain caffeine. The research findings concerning the effects of caffeine on a fetus have been mixed (Maslova, Bhattacharya, Lin, & Michels, 2010; Minnes, Lang, & Singer, 2011; Rathus, 2014a). However, some research results have revealed a greater risk of low birth weight (Rathus, 2014a; Santrock, 2016). Even vitamins should be consumed with care and only under a physician’s supervision (Rathus et al., 2014; Steinberg et al., 2011a). An expectant mother’s best bet is to be cautious.
Ethical Question 2.1

EP 1
1. Should a pregnant woman who consumes alcohol or illegal drugs that damage her child be punished as a criminal? Should her child be taken from her? If so, with whom should the child be placed?
Alcohol
Alcohol consumption during pregnancy can have grave effects on a fetus. The condition is termed fetal alcohol syndrome (FAS). Babies of women who were heavy drinkers during pregnancy have “unusual facial characteristics [including widely spaced eyes, short nose, and thin upper lip], small head and body size, congenital heart defects, defective joints, and intellectual and behavioral impairment” (Yarber & Sayad, 2016, p. 370). Effects stretch into childhood and even adulthood. They include difficulties in paying attention, hyperactivity, lower-than-normal intelligence, and significant difficulties in adjustment and social interaction (Shaffer & Kipp, 2010). The severity of defects increases with the amount of alcohol consumed during pregnancy (Shaffer & Kipp, 2010). However, there is evidence that even more moderate alcohol consumption, such as one or two drinks a day, can harm the fetus (Rathus et al., 2014; Shaffer & Kipp, 2010; Steinberg et al., 2011a). Fetal alcohol effects (FAE) is a condition that manifests relatively less severe (yet still significant) problems, presumably resulting from lower levels of alcohol consumption during pregnancy.
2-1eDrugs of Abuse
Illegal drugs, such as cocaine (a powerful stimulant) and heroin (an opioid), can cause significant problems during a pregnancy (Newman & Newman, 2015). Both of these substances can cause infertility, problems with the placenta resulting in the fetus not receiving enough food or oxygen, preterm labor, or death of the fetus via miscarriage or stillborn birth. Babies may be premature, or have low birth weight, heart defects, birth defects, or infections such as hepatitis or AIDS (March of Dimes, 2013). A significant problem is when the baby develops Neonatal Abstinence Syndrome (NAS). In NAS, the baby is born addicted to the addictive drugs the mother used during her pregnancy and goes through withdrawal at birth. These babies have a tendency to have lower birth weights, breathing problems, sleep difficulties, seizures, and birth defects, and may require a longer stay in the hospital. Signs and symptoms of NAS include body shakes, seizures, excessive crying, trouble sleeping, fever, inability to gain weight, and overall fussiness. All of these symptoms may need to be treated with medications, fluids, or higher-calorie feedings (March of Dimes, 2015).
Marijuana may also cause problems during a pregnancy (Papalia & Martorell, 2015). Studies link marijuana use with premature birth, low birth weight, increased chance of stillbirth, withdrawal symptoms in the baby, and problems with brain development (March of Dimes, 2016). Ingredients in marijuana can also pass to a child during breastfeeding; therefore, it is recommended that breastfeeding moms refrain from marijuana use (March of Dimes, 2016).
Note, however, that it is difficult to separate out the direct effects of specific drugs because of the numerous other factors involved (e.g., an impoverished environment or use of other potentially harmful substances by the mother).
Smoking
Numerous studies associate smoking with low birth weight, preterm births, breathing difficulties, fetal death, and crib death (Rathus, 2014a; Santrock, 2016; Shaffer & Kipp, 2010; Yarber & Sayad, 2013). Even secondhand smoke is thought to pose a danger to the fetus (Rathus, 2014a). Some research found a relationship between a mother’s smoking during pregnancy and a child having behavioral and emotional problems when the child reaches school age (Papalia & Martorell, 2017; Rathus, 2014a).
Studies have also found that a father’s smoking during pregnancy may affect the health of the child (Hyde & DeLamater, 2017).
Age
The pregnant woman’s age may affect both the woman and the child. Women “between ages 16 and 35 tend to provide a better uterine environment for the developing fetus and to give birth with fewer complications than do women under 16 or over 35” (Newman & Newman, 2015, p. 118). Women aged 35 and older account for more than 16 percent of all births in the United States (U.S. Census Bureau, 2011). For example, although a woman who is aged 16 to 34 has a very low risk of having a baby with Down syndrome, the likelihood increases to about 1 in 30 births once the mother reaches the age of 45 (Yarber & Sayad, 2016). It is thought that a contributing factor to Down syndrome is deterioration of the female’s egg or the male’s sperm as people age (Newman & Newman, 2015). Mothers aged 40 and over “are also at slightly higher risk for maternal death, premature delivery, cesarean sections, and low-birth-weight babies (London, 2004). As women age, chronic illnesses such as high blood pressure and diabetes may also present pregnancy- and birth-related complications” (Yarber & Sayad, 2013, p. 375).
Teen mothers account for about 24 births per 1,000 females in the United States in 2014 (LOC, 2016). Their infants have twice the mortality rates of infants born to mothers in their 20s (Santrock, 2016). Their infants are more likely to be underweight and experience a greater risk of health problems and disabilities (Papalia & Martorell, 2015). Problems are often due to an immature reproductive system, inadequate nutrition, poor or no prenatal care, and poverty (Santrock, 2016; Smithbattle, 2007).
Maternal Stress
Maternal stress is another factor that can affect fetal development (Kail & Cavenaugh, 2014; Rathus, 2014a). Bjorklund and Blasi (2014) explain:
Women who experience high levels of stress during pregnancy are more apt to have premature births and low-weight babies (Mulder [et al.], 2002). It is important to note that stress is not some phantom effect but quite real in its physical effects; it causes decreased nutrients and oxygen to the fetus and weakens the mother’s immune system, making the fetus more vulnerable as well. Stress in the mother can cause hormone imbalances in the placenta. In addition, women with high levels of stress are more apt to engage in behaviors that are harmful to the fetus, such as tobacco and alcohol use. (pp. 108–109)
Other Factors
Other factors have been found to affect prenatal and postnatal development. For example, lower income level and socioeconomic class can pose health risks to any mother and her fetus (Newman & Newman, 2015). Illness during pregnancy may damage the developing fetus. Rubella (German measles) can cause physical or mental disabilities in the fetus if a woman contracts it during the first three months of pregnancy (Yarber & Sayad, 2016). Prevention of rubella is possible by vaccination; however, this should not be done during pregnancy because it can harm the fetus.
Sexually transmitted infections (STIs) may also be transmitted from mother to newborn in the womb, during birth, or afterward. Pregnant women should be tested for “chlamydia, gonorrhea, hepatitis B, HIV, and syphilis” (described in Chapter 6; Yarber & Sayad, 2016, p. 371). Transmission can often be prevented or infants treated successfully. For example, acquired immune deficiency syndrome (AIDS), which is transmitted by the human immunodeficiency virus (HIV), can infect a fetus through the placenta; it can also infect an infant at birth if there is contact with the mother’s blood, or through breast milk. However, administration of certain drugs, such as azidothymidine (AZT), to the mother during pregnancy and to the infant after birth, in addition to performing a cesarean section (surgical removal of the infant from the womb), has radically decreased mother-to-infant HIV transmission rates in the United States (Santrock, 2016).
2-1fPrenatal Assessment
Tests are available to determine whether a developing fetus has any of a variety of defects. These tests include ultrasound sonography, fetal MRI, amniocentesis, chorionic villus sampling, and maternal blood tests.
“The development of brain imaging techniques has led to increasing use of fetal MRI to diagnose fetal malformations” (Schmid et al., 2011). “MRI (magnetic resonance imaging) uses a powerful magnet and radio images to generate detailed images of the body’s organs and structures” (Santrock, 2016, p. 61). Ultrasound sonography is generally the first and much more common option for fetal screening because it is cost effective and safe. However, when a clearer image or more information is required to provide an accurate diagnosis and effective treatment planning, an MRI can be used. Frequently, ultrasound sonography will identify a potential abnormality and a subsequent MRI will offer a more comprehensive, clearer picture of what’s involved (Mangione et al., 2011). “Among the fetal malformations that fetal MRI may be able to detect better than ultrasound sonography are certain central nervous system, chest, gastrointestinal, genital/urinary, and placental abnormalities” (Nemec et al., 2011; Triulzi, Managaro, & Volpe, 2011; Amini, Wikstrom, Ahlstrom, & Axelsson, 2011; Santrock, 2016, p. 61).
Amniocentesis involves the insertion of a needle through the abdominal wall and into the uterus to obtain amniotic fluid for determination of fetal gender or chromosomal abnormalities. The amniotic fluid contains fetal cells that can be analyzed for a variety of birth defects including Down syndrome, muscular dystrophy, and spina bifida. The gender of the fetus can also be determined. Amniocentesis is recommended if a woman has had a baby with a birth defect, may be a genetic carrier of such a defect, or is over age 35. A disadvantage of amniocentesis is that the test is usually performed about the 16th or 17th week of pregnancy (Charlesworth, 2014). Results are available in about 2 weeks after that (Santrock, 2016). If a serious problem is discovered, people don’t have much time to decide whether to terminate the pregnancy. Another danger is a small risk of miscarriage (Rathus, 2014a; Santrock, 2016).
Chorionic villus sampling (CVS) is another method of diagnosing defects in a developing fetus. It involves the insertion of a thin plastic tube through the vagina or a needle through the abdomen into the uterus. A sample of the chorionic villi (tiny fingerlike projections on the membrane that surrounds the fetus) is taken for analysis of potential genetic irregularities (National Institutes of Health [NIH], 2014). It can be performed between the 10th and 12th weeks of pregnancy, with results received within about two weeks (NIH, 2014). An advantage of CVS is that it can be done earlier in the pregnancy than amniocentesis. Couples may have a different perspective on whether to abort or keep a defective fetus at this early stage of the pregnancy. A disadvantage of CVS, as with amniocentesis, is an increased risk of miscarriage (Charlesworth, 2014; NIH, 2014; Rathus, 2014a).
Maternal blood tests done between the 16th and 18th weeks of gestation can detect a variety of conditions (Santrock, 2016). For instance, the amount of a substance called alpha-fetoprotein (AFP) can be measured. High levels of AFP forewarn about abnormalities of the brain and spinal cord. Testing AFP levels can also detect Down syndrome. Ultrasound sonography or amniocentesis can then be used to verify the presence of such congenital conditions.
A physician and pregnant mother examine an ultrasound of the fetus

Monkey Business Images/ Shutterstock.com
In addition to a pregnant woman’s behavior and condition, numerous other variables in the macro environment and in a woman’s personal situation also directly affect the fetal condition. Highlight 2.1 discusses how social workers can help pregnant women access and maximize the use of prenatal care.
Highlight 2.1
Social Workers Can Help Women in Getting Prenatal Care: Implications for Practice
Prenatal care is considered vital “because it provides social workers and other health professionals with opportunities to identify pregnant women who are at risk of premature or low-weight births, and to deliver the medical, nutritional, educational, or psychosocial interventions that can promote positive pregnancy outcomes” (Perloff and Jeffee, 1999, p. 117). Early prenatal care is especially significant because of the developing fetus’s vulnerability. It is important not to assume that all women’s knowledge about prenatal care and easy access to such care is equal.
Barriers to obtaining prenatal care may include a number of factors. Women may be struggling with numerous other life issues (e.g., poverty, stress, and demands on their time for other things). Clinics and services may not be readily available and easy for them to reach. Pregnant women may experience difficulties in getting transportation for services or be struggling with other work and child-care demands. They may distrust the health-care system generally. They may have had previous bad experiences with respect to other health-care issues. They may have faced long waiting periods, crowded conditions, and inconvenient hours while trying to get services (Sable & Kelly, 2008).
There are several implications for social work practice. First, workers can help women navigate a complex health-care system, making certain they have ready access to available insurance and Medicaid payments. Second, practitioners can advocate with clinics to improve their internal environments. Providing child care, magazines, comfortable furniture, and refreshments can significantly improve the clinic experience. Third, workers can Help pregnant women “in gaining access to clinic resources (for example, appointments, laboratory tests, and educational seminars) through regular, ongoing contact with clients” (Cook, Selig, Wedge, & Baube, 1999, p. 136). Fourth, practitioners can “develop innovative service delivery models,” including screening women during their initial visit to identify those at greatest risk, mailing or calling reminders of clinic appointments, and participating in community outreach (p. 136). Outreach might entail conducting door-to-door case-finding of pregnant women to expedite early initiation of prenatal care. This could involve sharing information about risks posed without care, benefits of care, and the availability of services.
2-1gProblem Pregnancies
In addition to factors that can affect virtually any pregnancy, other problems can develop under certain circumstances. These problems include ectopic pregnancies, toxemia, and Rh incompatibility. Spontaneous abortions also happen periodically.
Ectopic Pregnancy
When a fertilized egg begins to develop somewhere other than in the uterus, it is called an ectopic pregnancy or tubal pregnancy. In most cases, the egg becomes implanted in the fallopian tube. Much more rarely, the egg is implanted outside the uterus somewhere in the abdomen.
Ectopic pregnancies most often occur because of a blockage in the fallopian tube. The current rate of ectopic pregnancy has increased dramatically from what it was 30 years ago (Hyde & DeLamater, 2014). This may be attributed partially to increasing rates of STIs that result in scar tissue (Hyde & DeLamater, 2017). Others have hypothesized that this increase in ectopic pregnancies may be due to the increased use of fertility drugs and escalating external stresses in the environment (Kelly, 2008).
Ectopic pregnancies in the fallopian tubes “may spontaneously abort and be released into the abdominal cavity, or the embryo and placenta may continue to expand, stretching the tube until it ruptures” (Hyde & DeLamater, 2017, p. 140). In the latter case, surgical removal is necessary to save the mother’s life.
Toxemia
Toxemia (also called preeclampsia) is an abnormal condition involving a form of blood poisoning. Carroll (2013b) explains:
In the last 2 to 3 months of pregnancy, 6% to 7% of women experience toxemia … or preeclampsia. Symptoms include rapid weight gain, fluid retention, an increase in blood pressure [hypertension], and protein in the urine. If toxemia is allowed to progress, it can result in eclampsia, which involves convulsions, coma, and in approximately 15% of cases, death…. Overall, [African American] … women are at higher risk for eclampsia than White or Hispanic women … (p. 319; emphasis in original)
Concept Summary
Problem Pregnancies
Ectopic pregnancy: The circumstance when a fertilized egg becomes implanted and begins to develop somewhere other than the uterus (usually in a fallopian tube).
Toxemia: A pregnant woman’s abnormal condition involving a form of blood poisoning that results in rapid weight gain, fluid retention, hypertension, and protein in the urine.
Rh incompatibility: The condition when a mother and fetus have opposite Rh factors (positive versus negative), resulting in the mother’s blood forming antibodies against the fetus’s incompatible blood.
Spontaneous abortion: The termination of a pregnancy due to natural causes before the fetus is capable of surviving on its own.
Rh Incompatibility
People’s red blood cells differ in their surface structures and can be classified in different ways (Santrock, 2016). One way of distinguishing blood type involves categorizing it as either A, B, O, or AB. Another way to differentiate blood cells involves the Rh factor, which is positive if the red blood cells carry the marker or negative if they don’t (Santrock, 2016). If the mother has Rh-negative blood and the father has Rh-positive blood, the fetus may also have Rh-positive blood. This results in Rh incompatibility between the mother’s and fetus’s blood, and the mother’s body forms antibodies in defense against the fetus’s incompatible blood. Problem pregnancies and a range of defects in the fetus may result. Problems are less likely to occur in the first pregnancy than in later ones, because antibodies have not yet had the chance to form. The consequence to an affected fetus can be intellectual disability, anemia, or death.
Fortunately, Rh incompatibility can be dealt with successfully. The mother is injected with a serum, RhoGAM, that prevents the development of future Rh-negative sensitivity. This must be administered within 72 hours after the first child’s birth or after a first abortion. In those cases where Rh sensitivity already exists, the newborn infant or even the fetus within the uterus can be given a blood transfusion.
Spontaneous Abortion
A spontaneous abortion or miscarriage is the termination of a pregnancy due to natural causes before the fetus is capable of surviving on its own. About 20 to 25 percent of all diagnosed pregnancies result in a spontaneous abortion; however, about 50 percent of non-diagnosed pregnancies are terminated by a spontaneous abortion (Hyde & DeLamater, 2017). Thus, a woman may not even be aware of the pregnancy when the miscarriage occurs. Sometimes it is perceived as an extremely heavy menstrual period. The vast majority of miscarriages occur within the first trimester, with only a small minority occurring during the second or third trimester.
Most frequently, spontaneous abortions occur as a result of a defective fetus or some physical problem of the expectant mother. The body for some reason knows that the fetus is defective or that conditions are not right, and expels the fetus. Maternal problems may include a uterus that is “too small, too weak, or abnormally shaped, … maternal stress, nutritional deficiencies, excessive vitamin A, drug exposure, or pelvic infection” (Carroll, 2013b, p. 318). Some evidence indicates that faulty sperm may also be to blame (Carrell et al., 2003).
2-1hThe Birth Process
The birth process involves three stages: early labor and active labor, the birth of the baby, and delivery of the placenta.
There are three phases of the first stage of labor: early labor, active labor, and the transition phase. Early labor is the longest phase, lasting from 8 to 12 hours (American Pregnancy Association, 2015). Contractions may come every 5–30 minutes, lasting about 30–45 seconds each time (American Pregnancy Association, 2015). As the woman moves through early labor, contractions will increase in frequency and duration. During early labor, the cervix will begin to dilate and contractions start. The woman may experience a bloody mucus discharge (the mucus plug that has been sealing the opening of the uterus is discharged) and lower back pain that will not go away (back labor); and her “water” (amniotic sac) may break (American Pregnancy Association, 2015).
For women who have health complications, such as hypertension or preeclampsia, a baby whose health may be in danger (lack of oxygen), or whose amniotic sac has ruptured but whose labor has not started, labor may be induced. Labor may be induced by starting medications, such as oxytocin and prostaglandin; by artificially rupturing the amniotic sac for those who have not experienced this yet; or by nipple stimulation to increase oxytocin production, which may trigger labor (American Pregnancy Association, 2015). More and more women are choosing to induce labor as a means of “scheduling” their pregnancies; however, doctors encourage women to keep the baby in the uterus as long as medically possible.
In addition, some women experience Braxton Hicks contractions during early labor, referred to as “false labor.” This occurs when the uterus tightens for a period of 30 seconds to 2 minutes. Unlike true labor, Braxton Hicks contractions do not grow longer, stronger, or closer together. It is important for a woman to talk to her doctor about her contractions to verify the type of contractions she is experiencing.
The second phase of early labor, active labor, lasts from 3–5 hours, during which time contractions feel stronger and last longer. It is important that the woman head to the hospital or contact the midwife during this process if she has not done so already.
Local anesthesia or an epidural (spinal anesthesia) may also be given to aid in reducing any pain during the labor process. Typically, women make a plan about having a baby naturally (without medications) or with anesthesia prior to going into labor; however, it is not uncommon for a woman to change her mind about the use or non-use of an anesthesia once labor has begun. During the final phase, the transition, the cervix will dilate to 8–10 cm. This tends to be the hardest phase, but lasts the shortest amount of time (from 30 minutes to 2 hours). Contractions are long, strong, and intense (occurring every 30 seconds to 2 minutes and lasting about 60–90 seconds) (American Pregnancy Association, 2015). In addition, the woman might experience nausea, hot flashes, or chills, and have a strong urge to push. During the second stage of transition, the birth of the baby occurs. The second stage can last from 20 minutes to 2 hours (American Pregnancy Association, 2015). The woman will be encouraged to push between contractions to help the baby move through the birth canal. The cervix is fully dilated, allowing the baby to move through the vagina. The baby’s head will eventually appear, called “crowning,” at which time the woman is told not to push any longer.
After the baby completely emerges, the umbilical cord, which still attaches the baby to its mother, is clamped and severed about three inches from the baby’s body. Because there are no nerve endings in the cord, this does not hurt. The small section of cord remaining on the infant gradually dries up and simply falls off.
At times, an episiotomy (making an incision in the perineum, away from the vagina) might be needed to help deliver the baby. This may occur when the baby’s head is too large for the vaginal opening, the baby is in distress, the perineum has not stretched enough, the baby is in a breech position, or the mother is unable to control her pushing (American Pregnancy Association, 2015). It is important to note that episiotomy rates are on the decline (American Congress of Obstetricians and Gynecologists, 2016). The American Congress of Obstetricians and Gynecologists recommends that physicians avoid performing routine episiotomies, using them only when needed for safety reasons (American Congress of Obstetricians and Gynecologists, 2016).
The last stage of labor, the afterbirth, involves the body contracting in order to remove the placenta from the uterine wall. This can take from 5 to 30 minutes (American Pregnancy Association, 2015).
Birth Positions
The majority of babies are born with their heads emerging first. Referred to as a vertex presentation, this is considered the normal birth position and most often requires no Helpance with instruments. Figure 2.1 depicts various birth positions.
The birth process is an amazing experience.

Blend Images – ERproductions Ltd/Brand X Pictures/Getty Images
Figure 2.1Forms of Birth Presentation

In 1 in 25 deliveries, babies are born in a breech presentation (Santrock, 2016, p. 101). Here, the buttocks and feet appear first and the head last as the baby is born. This type of birth may merit more careful attention. Often a cesarean section is performed (Santrock, 2016). A cesarean section, or C-section, is a surgical procedure in which the baby is removed by making an incision in the abdomen through the uterus. Cesarean sections account for over 32 percent of all births in the United States (CDC, 2015).
Note that more cesarean sections are carried out in the United States than in any other nation (Santrock, 2013). Cesarean sections are necessary when the baby is in a difficult prenatal position, when the baby’s head is too large to maneuver out of the uterus and vagina, when fetal distress is detected, or when the labor has been extremely long and exhausting. Today it is usually safe with only minimal risks to the mother or infant. The mother’s recovery, however, will be longer because the incisions must heal.
A common recommendation following a cesarean delivery is that all future deliveries be done via a cesarean delivery. Despite this, many women whose first child was born through a cesarean birth want to explore a VBAC (vaginal birth after cesarean). Physicians are concerned about risks associated with VBAC procedures, but due to recent studies showing risks being low, it has been determined that a trial of labor can be attempted for most women (Papalia & Martorell, 2015).
Finally, about 1 percent of babies are born with a transverse presentation (Dacey, Travers, & Fiore, 2009). Here the baby lies crossways in the uterus. During birth, a hand or arm usually emerges first in the vagina. As such positions also merit special attention, a cesarean section is typically performed (Santrock, 2016).
In the United States, 98.8 percent of all births occur in hospital settings, and a doctor is usually present (Martin et al., 2012). However, it’s quite a different scene throughout much of the world, where home births and midwifery (the practice of having a person who is not a physician Help a mother in childbirth) are much more common. Although midwives are present for only 8.1 percent of births in the United States (American College of Nurse-Midwives, 2012), this reflects a significant increase from the less than 1 percent evident in 1975 (Martin et al., 2005).
Families also have the option of hiring a doula. A doula is a hired, trained professional who provides emotional and physical support to a woman and her partner during her entire pregnancy, from pregnancy to the postpartum period. A doula’s main role is to provide support during the labor and delivery; however, it is important to note that a doula is not a medical professional. Research has shown that support from a doula might be associated with decreased use of pain medication, decreased length of labor, and a decrease in negative childbirth experiences during the labor process (MFMER, 2016).
Natural Childbirth
In natural childbirth, the emphasis is on education for the parents, especially the mother. The intent is to maximize her understanding of the process and to minimize her fear of the unknown. Natural childbirth also emphasizes relaxation techniques. Mothers are encouraged to tune in to their normal body processes and learn to consciously relax when under stress. They are taught to breathe correctly and to facilitate the birth process by bearing down in an appropriate manner. The Lamaze method is currently popular in the United States, although other methods are also available. Most “emphasize education, relaxation and breathing exercises, and support” in addition to the partner’s role as a labor coach (Santrock, 2016, p. 107).
Many women prefer natural childbirth because it allows them to experience and enjoy the birth to the greatest extent possible. When done correctly, pain is minimized. Anesthetics are usually avoided so that maximum feeling can be attained. It allows the mother to remain conscious throughout the birth process.
Newborn Assessment
Birth is a traumatic process that is experienced more easily by some newborns, often referred to as neonates, and with more difficulty by others. Assessment scales have been developed to assess an infant’s condition at birth. The sooner any problems can be attended to, the greater the chance of having the infant be normal and healthy. Two such scales are the Apgar and the Brazelton.
In 1953, Virginia Apgar developed a scale, commonly known as the Apgar scale, that assesses the following five variables (note the acronym):
1. Appearance: Skin color (ranging from bluish-gray to good color everywhere).
2. Pulse: Heart rate (ranging from no heart rate to at least 100 beats per minute).
3. Grimace: Reflex response (ranging from no response while the airways are being suctioned to active grimacing, pulling away, and coughing).
4. Activity: Muscle tone (ranging from limpness to active motion).
5. Respiration: Breathing (ranging from not breathing to normal breathing and strong crying) (Apgar, 1958; Berk, 2013; Steinberg et al., 2011a).
Each of these five variables is given a score of 0 to 2. Assessment of these signs usually occurs twice—at one minute and at five minutes after birth. A maximum total score of 10 is possible. Scores of 7 through 10 indicate a normal, healthy infant. Scores of 4 through 6 suggest that some caution be taken and that the infant be carefully observed. Scores of 4 or below warn that problems are apparent. In these cases, the infant needs immediate emergency care.
A second scale used to assess the health of a newborn infant is the Brazelton (1973) Neonatal Behavioral Assessment Scale. Whereas the Apgar scale addresses the gross or basic condition of an infant immediately after birth, the Brazelton assesses more extensively the functioning of the central nervous system and behavioral responses of a newborn. Usually administered 24 to 36 hours after birth, the scale focuses on finer distinctions of behavior. It includes a range of 28 behavioral items and 18 reflex items that evaluate such dimensions as motor system control, activity level, sucking reflex, responsiveness while awake or sleeping, and attentiveness to the external environment (Brazelton Institute, 2005). Extremely low scores can indicate brain damage or a brain condition that, given time, may eventually heal (Santrock, 2013).
Birth Defects
Birth defects refer to any kind of disfigurement or abnormality present at birth. Birth defects are much more likely to characterize fetuses that are miscarried. It should be noted that the term “birth defects” carries negative undertones, and that the term does not reflect the many abilities and talents of those affected by these problems. A consensus has not been reached as to a more appropriate term. Miscarriage provides a means for the body to prevent seriously impaired or abnormal births. The specific types of birth defects are probably infinite; however, some tend to occur with greater frequency.
Down syndrome is a disorder involving an extra chromosome that results in various degrees of intellectual disability. Accompanying physical characteristics include a broad, short skull; widely spaced eyes with an extra fold of skin over the eyelids; a round, flattened face; a flattened nose; a protruding tongue; shortened limbs; and defective heart, eyes, and ears. We’ve already noted that a woman’s chances of bearing a child with Down syndrome increase significantly with her age.
Spina bifida is a condition in which the spinal column has not fused shut and consequently some nerves remain exposed. Surgery immediately after birth closes the spinal column. Muscle weakness or paralysis and difficulties with bladder and bowel control often accompany tins condition. Frequently occurring along with spina bifida is hydrocephalus, in which an abnormal amount of spinal fluid accumulates in the skull, possibly resulting in skull enlargement and brain atrophy. Spina bifida has a prevalence rate of 3.49 per 10,000 births (Centers for Disease Control [CDC], 2011).
Low-Birth-Weight and Preterm Infants
Low birth weight and preterm status (prematurity) pose grave problems for newborns. Low birth weight is defined as 5 pounds 8 ounces or less; “about 1 in every 12 babies in the United States is born with low birth weight” (March of Dimes, 2014). Primary causes for low birth weight are premature birth and fetal growth restriction (i.e., being small for gestational age due to any of a number of reasons); other maternal factors increasing risk for low birth weight include chronic health conditions (such as those involving high blood pressure, diabetes, or lung and kidney problems), some infections (especially those involving the uterus), troubles with the placenta (resulting in inadequate nutrients provided to the fetus), inadequate weight gain during pregnancy, and the pregnant mother’s behavior and experience (e.g., smoking, drinking, poor nutrition, chronic maternal health problems, and lack of access to adequate resources) (March of Dimes, 2014).
Preterm or premature babies, born before the 37th week of gestation, often experience low birth weight.
A full-term pregnancy is considered to last between 37 and 42 weeks, with most babies being born at about 40 weeks; about 1 in 10 of all babies born in the United States are preterm (CDC, 2015). Premature infants tend to weigh less because they haven’t had the necessary time to develop. Risk factors for premature birth include having born a prior premature baby, being part of a multiple birth scenario, and uterine or cervical abnormalities (CDC, 2013d). Other risk factors resemble those involved in infants having a low birth weight (CDC, 2015).
Both low birth weight and preterm status place infants at higher risk for a range of problems (CDC, 2013d; March of Dimes, 2014). However, note that most low-birth-weight babies eventually function normally (Santrock, 2013; Wilson- Costello et al., 2007; Xiong et al., 2007). The earlier infants are born and the lower their birth weight, the greater their potential for developmental delays and long-term disabilities (CDC, 2015; Santrock, 2016).
Due to modern technology and care, low-birth-weight babies are much more likely to survive than they were in the past. Yet, early on, they are also more likely to experience problems involving breathing, bleeding, heart problems, intestinal difficulties, and potential loss of vision (March of Dimes, 2014). There is some indication that by school age, low-birth-weight children are more likely to experience learning and attention difficulties or breathing problems such as asthma (Anderson et al., 2011; Berk, 2013; Santo, Portuguez, & Nunes, 2009; Santrock, 2016). Increasing evidence indicates that low-birth-weight infants have greater difficulties socializing as adults (Berk, 2013; Moster, Lie, & Markestad, 2008). Be aware, however, that it is difficult to distinguish the direct effects of low birth weight from the effects of other variables such as an impoverished or abusive environment. Highlight 2.2 addresses the circumstances of low-birth-weight infants internationally.
Highlight 2.2
An International Perspective on Low-Birth-Weight Infants
Santrock (2013) reflects on the circumstances of low-birth-weight infants in various countries around the world:
The incidence of low birth weight varies considerably from country to country. In some countries, such as India and Sudan, where poverty is rampant and the health and nutrition of mothers are poor, the percentage of low birth weight babies reaches as high as 31 percent … In the United States, there has been an increase in low birth weight infants in the last two decades. The U.S. low birth weight rate of 8.2 percent in 2007 is considerably higher than that of many other developed countries (Hamilton et al., 2009). For example, only 4 percent of infants born in Sweden, Finland, Norway, and Korea are low birth weight, and only 5 percent of those born in New Zealand, Australia, and France are low birth weight.
The causes of low birth weight also vary (Mortensen et al., 2009). In the developing world low birth weight stems mainly from the mother’s poor health and nutrition (Christian, 2009). For example, diarrhea and malaria, which are common in developing countries, can impair fetal growth if the mother becomes affected while she is pregnant. In developed countries, cigarette smoking dining pregnancy is the leading cause of low birth weight (Fertig, 2010). In both developed and developing countries, adolescents who give birth when their bodies are not fully matured are at risk of having low birth weight babies (Malamitsi-Puchner & Boutsikou, 2006). In the United States, the increase in the number of low birth weight infants is due to such factors as the use of drugs, poor nutrition, multiple births, reproductive technologies, and improved technology and prenatal care, resulting in a higher survival rate of high-risk babies (Chen et al., 2007). Nonetheless, poverty still is a major factor in preterm birth in the United States… (p. 121)
Social work roles that are used to help pregnant women bear healthy infants might include that of a broker to help women get the resources they need. These resources include access to good nutrition and prenatal care. If such resources are unavailable, especially to poor women, social workers might need to advocate on the women’s behalf. Funding sources and services might need to be developed.
Treatment for low-birth-weight babies includes immediate medical attention to meet their special needs and provision of educational and counseling support. Group counseling for parents and weekly home visits to teach parents how to care for their children, play with them, and provide stimulation to develop cognitive, verbal, and social skills also appear to be helpful. 2-2Early Functioning of the Neonate
The average full-term newborn weighs about pounds and is approximately 20 inches long (most weigh from to 10 pounds, and measure from 18 to 22 inches long). Girls tend to weigh a bit less and to be shorter than boys. Many parents may be surprised at the sight of their newborn, who does not resemble the cute, pudgy, smiling, gurgling baby typically shown in television commercials. Rather, the baby is probably tiny and wrinkled with a disproportionate body and squinting eyes. Newborns need time to adjust to the shock of being born. Meanwhile, they continue to achieve various milestones in development. They gain more and more control over their muscles and are increasingly better able to think and respond.
First, newborn babies generally spend much time sleeping, although the time spent decreases as the baby grows older. Second, babies tend to respond in very generalized ways. They cannot make clear distinctions among various types of stimuli, nor can they control their reactions in a precise manner. Any type of stimulation tends to produce a generalized flurry of movement throughout the entire body.
Several reflexes that characterize newborns should be present in normal neonates. First, there is the sucking reflex. This obviously facilitates babies’ ability to take in food. Related to this is a second basic reflex, rooting. Normal babies will automatically move their heads and begin a sucking motion with their mouths whenever touched even lightly on the lips or cheeks beside the lips. The rooting reflex refers to this automatic movement toward a stimulus.
A third important reflex is the Moro reflex, or startle reflex. Whenever infants hear a sudden loud noise, they automatically react by extending their arms and legs, spreading their fingers, and throwing their heads back. The purpose of this reflex is unknown, and it seems to disappear after a few months of life.
Five additional reflexes are the stepping reflex, the grasping reflex, the Babinski reflex, the swimming reflex, and the tonic neck reflex. The stepping reflex involves infants’ natural tendency to lift a leg when held in an upright position with feet barely touching a surface. In a way, it resembles the beginning motions involved in walking. The grasping reflex refers to a newborn’s tendency to grasp and hold objects such as sticks or fingers when placed in the palms of their hands. The Babinski reflex involves the stretching, fanning movement of the toes whenever the infant is stroked on the bottom of the foot. The swimming reflex involves infants making swimming motions when they’re placed face down in water. Finally, the tonic neck reflex is the infant’s turning of the head to one side when laid down on its back, the extension of the arm and leg on the side it’s facing, and the flexing of the opposite limbs. Sometimes, this is referred to as the “fencer” pose as it resembles just that.
2-3Explain Typical Developmental Milestones for Infants and Children
LO 2
As infants grow and develop, their growth follows certain patterns and principles. At each stage of development, people are physically and mentally capable of performing certain types of tasks. Human development is the continuous process of growth and change, involving physical, mental, emotional, and social characteristics, that occurs over a lifespan. Human development is predictable in that the same basic changes occur sequentially for everyone. However, enough variation exists to produce individuals with unique attributes and experiences.
Four major concepts are involved in understanding the process of human development:
• (1)
growth as a continuous, orderly process,
• (2)
specific characteristics of different age levels,
• (3)
the importance of individual differences, and
• (4)
the effects of both heredity and the social environment.
2-3aGrowth as a Continuous, Orderly Process
People progress through a continuous, orderly sequence of growth and change as they pass from one age level to another. This has various implications. For one thing, growth is continuous and progressive. People are continually changing as they get older. For another thing, the process is relatively predictable and follows a distinct order. For example, an infant must learn how to stand up before learning how to run. All people tend to follow the same order in terms of their development. For instance, all babies must learn how to formulate verbal sounds before learning how to speak in complete sentences.
Several subprinciples relate to the idea that development is an orderly process. One is that growth always follows a pattern from simpler and more basic to more involved and complex. Simple tasks must be mastered before more complicated ones can be undertaken.
Another subprinciple is that aspects of development progress from being more general to being more specific. Things become increasingly more differentiated. For example, infants initially begin to distinguish between human faces and other objects such as balloons. This is a general developmental response. Later they begin to recognize not only the human face, but also the specific faces of their parents. Eventually, as they grow older they can recognize the faces of Uncle Horace, Mr. Schmidt the grocer, and then-best friend Joey. Their recognition ability has progressed from being very basic to being very specific.
Two other subprinciples involve cephalocaudal development and proximodistal development. Cephalocaudal development refers to development from the head to the toes. Infants begin to learn how to use the parts of the upper body such as the head and arms before their legs. Proximodistal development refers to the tendency to develop aspects of the body trunk first and then later master manipulation of the body extremities (e.g., first the arms and then the hands).
2-3bSpecific Characteristics of Different Age Levels
A second basic developmental principle is that each age period tends to have specific characteristics. During each stage of life, from infancy throughout adulthood, “typical” people are generally capable of performing certain tasks. Capabilities tend to be similar for all people within any particular age category. Developmental guidelines provide a very general means for determining whether an individual is progressing and developing typically.
2-3cIndividual Differences
The third basic principle of development emphasizes that people have individual differences. Although people tend to develop certain capacities in a specified order, the ages at which particular individuals master certain skills may show a wide variation. Some people may progress through certain stages faster. Others will take more time to master the same physical and mental skills. Variation may occur in the same individual from one stage to the next. The specific developmental tasks and skills that characterize each particular age level may be considered an average of what is usually accomplished during that level. Any average may reflect a wide variation. People may still be “typical” if they fall at one of the extremes that make up the average.

2-3dThe Nature-Nurture Controversy
A fourth principle involved in understanding human development is that both heredity and the surrounding environment affect development. Individual differences, to some extent, may be influenced by environmental factors. People are endowed with some innate ability and potential. In addition, the impinging environment acts to shape, enhance, or limit that ability.
For example, take a baby who is born with the potential to grow and develop into a typical adult, both physically and intellectually. Nature provides the individual baby with some prospective potential. However, if the baby happens to be living in a developing country during a famine, the environment or nurture may have drastic effects on the baby’s development. Serious lack of nourishment limits the baby’s eventual physical and mental potential.
Given the complicated composition of human beings, the exact relationship between hereditary potential and environmental effects is unclear. It is impossible to quantify how much the environment affects development compared to how much development is affected by heredity. This is often referred to as the nature-nurture controversy. Theorists assume stands at both extremes. Some state that nature’s heredity is the most important. Others hypothesize that the environment imposes the crucial influence.
You might consider that each individual has a potential that is to some extent determined by inheritance. However, this potential is maximized or minimized by what happens to people in their particular environments.
Former president Ronald Reagan maintained only a C average in college. Yet he was able to attain the most powerful position in the United States. It is difficult to determine how much of his success was due to innate ability and how much to situations and opportunities he encountered in his environment.
Our approach is that a person develops as the result of a multitude of factors including those that are inherited and those that are environmental.
2-3eRelevance to Social Work
Knowledge of human development and developmental milestones can be directly applied to social work practice. Assessment is a basic fact of intervention throughout the lifespan. In order to assess human needs and human behavior accurately, the social worker must know what is considered normal or appropriate. He or she must decide when intervention is necessary and when it is not. Comparing observed behavior with what is considered normal behavior provides a guideline for these decisions.
This book will address issues in human development throughout the lifespan. A basic understanding of every age level is important for generalist practice. However, an understanding of the normal developmental milestones for young children is especially critical. Early assessment of potential developmental lags or problems allows for maximum alleviation or prevention of future difficulties. For example, early diagnosis of a speech problem will alert parents and teachers to provide special remedial help for a child. The child will then have a better chance to make progress and possibly even catch up with peers.
2-4Profiles of Typical Development for Children Ages 4 Months to 11 Years
Children progress through an organized sequence of behavior patterns as they mature. Research has established indicators of normality such as when children typically say their first word, run adeptly, or throw a ball overhand. These milestones reflect only an average indication of typical accomplishments. Children need not follow this profile to the letter. Typical human development provides for much individual variation. Parents do not need to be concerned if their child cannot yet stand alone at 13 months instead of the average 12 months. However, serious lags in development or those that continue to increase in severity should be attended to. This list can act as a screening guide to determine whether a child might need more extensive Assessment.
Each age profile is divided into five assessment categories. They include motor or physical behavior, play activities, adaptive behavior that involves taking care of self, social responses, and language development. All five topics are addressed together at each developmental age level in order to provide a more complete assessment profile.
Occasionally, case vignettes are presented that describe children of various ages. Evaluate to what extent each of these children fits the developmental profile.
2-4aAge 4 Months
Motor: Four-month-old infants typically can balance their heads at a 90-degree angle. They can also lift their heads and chests when placed on their stomachs in a prone position. They begin to discover themselves. They frequently watch their hands, keep their fingers busy, and place objects in their mouths.
Adaptive: Infants are able to recognize their bottles. The sight of a bottle often stimulates bodily activity. Sometimes teething begins tins early, although the average age is closer to 6 or 7 months.
Social: These infants are able to recognize their mothers and other familiar faces. They imitate smiles and often respond to familiar people by reaching, smiling, laughing, or squirming.
Language: The 4-month-old will turn his or her head when a sound is heard. Verbalizations include gurgling, babbling, and cooing.
2-4bAge 8 Months
Motor: Eight-month-old babies are able to sit alone without being supported. They usually are able to Help themselves into a standing position by pulling themselves up on a chair or crib. They can reach for an object and pick it up with all their fingers and a thumb. Crawling efforts have begun. These babies can usually begin creeping on all fours, displaying greater strength in one leg than the other.
Children achieve their developmental milestones step by step.

Hideaki Shinohara/Moment/Getty Images
Play: The baby is capable of banging two toys together. Many can also pass an object from one hand to the other. These babies can imitate arm movements such as splashing in a tub, shaking a rattle, or crumpling paper.
Adaptive: Babies of this age can feed themselves pieces of toast or crackers. They will be able to munch instead of being limited to sucking.
Social: Babies of this age can begin imitating facial expressions and gestures. They can play pat-a-cake and peekaboo, and wave bye-bye.
Language: Babbling becomes frequent and complex. Most babies will be able to attempt copying the verbal sounds they hear. Many can say a few words or sounds such as mama or dada. However, they don’t yet understand the meaning of words. 2-4cAge 1 Year
Motor: By age 1 year, most babies can crawl well, which makes them highly mobile. Although they usually require support to walk, they can stand alone without holding onto anything. They eagerly reach out into their environments and explore things. They can open drawers, undo latches, and pull on electrical cords.
Play: One-year-olds like to examine toys and objects both visually and by touching them. They typically like to handle objects by feeling them, poking them, and turning them around in their hands. Objects are frequently dropped and picked up again one time after another. Babies of this age like to put objects in and take them out of containers. Favorite toys include large balls, bottles, bright dangling toys, clothespins, and large blocks.
Adaptive: Because of their mobility, 1-year-olds need careful supervision. Because of their interest in exploration, falling down stairs, sticking forks in electric sockets, and eating dead insects are constant possibilities. Parents need to scrutinize their homes and make them as safe as possible.
Babies are able to drink from a cup. They can also run their spoon across their plate and place the spoon in their mouths. They can feed themselves with their fingers. They begin to cooperate while being dressed by holding still or by extending an arm or a leg to facilitate putting the clothes on. Regularity of both bowel and bladder control begins.
Social: One-year-olds are becoming more aware of the reactions of those around them. They often vary their behavior in response to these reactions. They enjoy having an audience. For example, they tend to repeat behaviors that are laughed at. They also seek attention by squealing or making noises.
Language: By 1 year, babies begin to pay careful attention to the sounds they hear. They can understand simple commands. For instance, on request they often can hand you the appropriate toy. They begin to express choices about the type of food they will accept or about whether it is time to go to bed. They imitate sounds more frequently and can meaningfully use a few other words in addition to mama and dada.
Case Vignette A: To what extent does this child fit the developmental profile?
Wyanet, age 1 year, is able to balance her head at a 90-degree angle. She can also lift her head when placed on her stomach in a prone position. She is not yet able to sit alone. She can recognize her bottle and her mother. Verbalizations include gurgling, babbling, and cooing.
2-4dAge 18 Months
Motor: By 18 months, a baby can walk. Although these children are beginning to run, their movements are still awkward and result in frequent falls. Walking up stairs can be accomplished by a caregiver holding the baby’s hand. These babies can often descend stairs by themselves but only by crawling down backward or by sliding down by sitting first on one step and then another. They are also able to push large objects and pull toys.
Play: Babies of this age like to scribble with crayons and build with blocks. However, it is difficult for them to place even three or four blocks on top of each other. These children like to move toys and other objects from one place to another. Dolls or stuffed animals frequently are carried about as regular companions. These toys are also often shown affection such as hugging. By 18 months, babies begin to imitate some of the simple things that adults do such as turning pages of a book.
Adaptive: Ability to feed themselves is much improved by age 18 months. These babies can hold their own glasses to drink from, usually using both hands. They are able to use a spoon sufficiently to feed themselves.
By this age, children can cooperate in dressing. They can unfasten zippers by themselves and remove their own socks or hats. Some regularity has also been established in toilet training. These babies often can indicate to their parents when they are wet and sometimes wake up at night in order to be changed.
Social: Children function at the solitary level of play. It is normal for them to be aware of other children and even enjoy having them around; however, they don’t play with other children.
Language: Children’s vocabularies consist of more than 3 but less than 50 words. These words usually refer to people, objects, or activities with which they are familiar. They frequently chatter using meaningless sounds as if they were really talking like adults. They can understand language to some extent. For instance, children will often be able to respond to directives or questions such as “Give Mommy a kiss,” or “Would you like a cookie?”
Case Vignette B: To what extent does this child fit the developmental profile?
Luis, age 18 months, can crawl well but is unable to stand by himself. He likes to scribble with crayons and build with blocks. However, it is difficult for him to place even three or four blocks on top of each other. He can say a few sounds, including mama and dada, but he cannot yet understand the meaning of words.
2-4eAge 2 Years
Motor: By age 2, children can walk and run quite well. They also can often master balancing briefly on one foot and throwing a ball in an overhead manner. They can use the stairs themselves by taking one step at a time and by placing both feet on each step. They are also capable of turning pages of a book and stringing large beads.
Play: Two-year-olds are very interested in exploring their world. They like to play with small objects such as toy animals and can stack up to six or seven blocks. They like to play with and push large objects such as wagons and walkers. They also enjoy exploring the texture and form of materials such as sand, water, and clay. Adults’ daily activities such as cooking, carpentry, or cleaning are frequently imitated. Two-year-olds also enjoy looking at books and can name common pictures.
Adaptive: Two-year-olds begin to be capable of listening to and following directions. They can Help in dressing rather than merely cooperating. For example, they may at least try to button their clothes, although they are unlikely to be successful. They attempt washing their hands. A small glass can be held and used with one hand.
They use spoons to feed themselves fairly well. Two-year-olds have usually attained daytime bowel and bladder control with only occasional accidents. Nighttime control is improving but still not complete.
Social: These children play alongside each other, but not with each other in a cooperative fashion. They are becoming more and more aware of the feelings and reactions of adults. They begin to seek adult approval for correct behavior. They also begin to show their emotions in the forms of affection, guilt, or pity. They tend to have mastered the concept of saying no, and use it frequently.
Language: Two-year-olds can usually put two or three words together to express an idea. For instance, they might say, “Daddy gone,” or “Want milk.” Their vocabulary usually includes more than 50 words. Over the next few months, new vocabulary will steadily increase into hundreds of words. They can identify common facial features such as eyes, ears, and nose. Simple directions and requests are usually understood. Although 2-year-olds cannot yet carry on conversations with other people, they frequently talk to themselves or to their toys. It’s common to hear them ask, “What’s this?” in their eagerness to learn the names of things. They also like to listen to simple stories, especially those with which they are very familiar.
Case Vignette C: To what extent does this child fit the developmental profile?
Kenji, age 2 years, can walk well but still runs with an awkward gait. He likes to play with and push large objects such as wagons and walkers. He also likes to play alongside other children but is not able to play with them in a cooperative fashion. His vocabulary includes about 25 words, but he is not yet very adept at putting two to three words together to express an idea.
2-4fAge 3 Years
Motor: At age 3, children can walk well and also run at a steady gait. They can stop quickly and turn corners without falling. They can go up and down stairs using alternating feet. They can begin to ride a tricycle. Three-year-olds participate in a lot of physically active activities such as swinging, climbing, and sliding.
Play: By age 3, children begin to develop their imagination. They use books creatively such as making them into fences or streets. They like to push toys such as trains or cars in make-believe activities. When given the opportunity and interesting toys and materials, they can initiate their own play activities. They also like to imitate the activities of others, especially those of adults. They can cut with scissors and can make some controlled markings with crayons.
Adaptive: Three-year-olds can actively help in dressing. They can put on simple items of clothing such as pants or a sweater, although their clothes may be on backward or inside out. They begin to try buttoning and unbuttoning their own clothes. They eat well by using a spoon and have little spilling. They also begin to use a fork. They can get their own glass of water from a faucet and pour liquid from a small pitcher. They can wash their hands and face by themselves with minor help. By age 3, children can use the toilet by themselves, although they frequently ask someone to go with them. They need only minor help with wiping. Accidents are rare, usually happening only occasionally at night.
Social: Three-year-olds tend to pay close attention to the adults around them and are eager to please. They attempt to follow directions and are responsive to approval or disapproval. They also can be reasoned with at this age. By age 3, children begin to develop their capacity to relate to and communicate with others. They show an interest in the family and in family activities. Their play is still focused on the parallel level where their interest is concentrated primarily on their own activities. However, they are beginning to notice what other children are doing. Some cooperation is initiated in the form of taking turns or verbally settling arguments.
Language: Three-year-olds can use sentences that are longer and more complex. Plurals, personal pronouns such as I, and prepositions such as above or on are used appropriately. Children are able to express their feelings and ideas fairly well. They are capable of relating a story. They listen fairly well and are very interested in longer, more complicated stories than they were at an earlier age. They also have mastered a substantial amount of information including their last name, their gender, and a few rhymes.
2-4gAge 4 Years
Motor: Four-year-olds tend to be very active physically. They enjoy running, skipping, jumping, and performing stunts. They are capable of racing up and down stairs. Their balance is very good, and they can carry a glass of liquid without spilling it.
Play: By age 4, children have become increasingly creative and imaginative. They like to construct things out of clay, sand, or blocks. They enjoy using costumes and other pretend materials. They can play cooperatively with other children. They can draw simple figures, although they are frequently inaccurate and without much detail. Four-year-olds can also cut or trace along a line fairly accurately.
Adaptive: Four-year-olds tend to be very assertive. They usually can dress themselves. They’ve mastered the use of buttons and zippers. They can put on and lace their own shoes, although they cannot yet tie them. They can wash their hands without supervision. By age 4, children demand less attention while eating with their family. They can serve themselves food and eat by themselves using both spoon and fork. They can even Help in setting the table. Four-year-olds can use the bathroom by themselves, although they still alert adults of this and sometimes need Helpance in wiping. They usually can sleep through the night without having any accidents.
Social: Four-year-olds are less docile than 3-year-olds. They are less likely to conform, in addition to being less responsive to the pleasure or displeasure of adults. Four-year-olds are in the process of separating from their parents and begin to prefer the company of other children over adults. They are often social and talkative. They are very interested in the world around them and frequently ask “what,” “why,” and “how” questions.
Language: The aggressiveness manifested by 4-year-olds also appears in their language. They frequently brag and boast about themselves. Name calling is common. Their vocabulary has experienced tremendous growth; however, they have a tendency to misuse words and some difficulty with proper grammar. Four-year-olds talk a lot and like to carry on long conversations with others. Their speech is usually very understandable with only a few remnants of earlier, more infantile speech remaining. Their growing imagination also affects their speech. They like to tell stories and frequently mix facts with make-believe.
Case Vignette D: To what extent does this child fit the developmental profile?
Chaniqwa, age 4 years, is very active physically. She enjoys running, skipping, jumping, and performing stunts. She can use the bathroom by herself. She has a substantial vocabulary, although she has a tendency to misuse words and use improper grammar.
2-4hAge 5 Years
Motor: Five-year-olds are quieter and less active than 4-year-olds. Their activities tend to be more complicated and more directed toward achieving some goal. For example, they are more adept at climbing and at riding a tricycle. They can also use roller skates, jump rope, skip, and succeed at other such complex activities. Their ability to concentrate is also increased. The pictures they draw, although simple, are finally recognizable. Dominance of the left or right hand becomes well established.
Play: Games and play activities have become both more elaborate and competitive. Games include hide-and-seek, tag, and hopscotch. Team playing begins. Five-year-olds enjoy pretend games of a more elaborate nature. They like to build houses and forts with blocks and to participate in more dramatic play such as playing house or being a space invader. Singing songs, dancing, and playing DVDs are usually very enjoyable.
Adaptive: Five-year-olds can dress and undress themselves quite well. Helpance is necessary only for adjusting more complicated fasteners and tying shoes. These children can feed themselves and attend to their own toilet needs. They can even visit the neighborhood by themselves, needing help only in crossing streets.
Social: By age 5, children have usually learned to cooperate with others in activities and enjoy group activities. They acknowledge the rights of others and are better able to respond to adult supervision. They have become aware of rules and are interested in conforming to them. Five-year-olds also tend to enjoy family activities such as outings and trips.
Language: Language continues to develop and becomes more complex. Vocabulary continues to increase. Sentence structure becomes more complicated and more accurate. Five-year-olds are very interested in what words mean. They like to look at books and have people read to them. They have begun learning how to count and can recognize colors. Attempts at drawing numbers and letters are begun, although fine motor coordination is not yet well enough developed for great accuracy.
Case Vignette E: To what extent does this child fit the developmental profile?
Sheridan, age 5 years, can draw simple although recognizable pictures. Dominance of her left hand has become well established. She can readily dress and undress herself. She enjoys playing in groups of other children and can cooperate with them quite well. She has a vocabulary of about 50 words. She can use pronouns such as I and prepositions such as on and above appropriately. She can put two or three words together and use them appropriately, although she has difficulty formulating longer phrases and sentences.
2-4iAges 6 to 8 Years
Motor: Children ages 6 to 8 years are physically independent. They can run, jump, and balance well. They continue to participate in a variety of activities to help refine their coordination and motor skills. They often enjoy unusual and challenging activities, such as walking on fences, which help to develop such skills.
Children ages 6 to 8 love action play. They can run, jump, and balance well.

iStock.com/monkeybusinessimages
Play: These children participate in much active play such as kickball. They like activities such as gymnastics and enjoy trying to perform physical stunts. They also begin to develop intense interest in simple games such as marbles or tiddlywinks and collecting items. Playing with dolls is at its height. Acting out dramatizations becomes very important; these children love to pretend they are animals, horseback riders, or jet pilots.
Adaptive: Much more self-sufficient and independent, these children can dress themselves, go to bed alone, and get up by themselves during the night to go to the bathroom. They can begin to be trusted with an allowance. They are able to go to school or to friends’ homes alone. In general, they become increasingly more interested in and understanding of various social situations.
Social: In view of their increasing social skills, they consider playing skills within their peer group increasingly important. They become more and more adept at social skills. Their lives begin to focus around the school and activities with friends. They are becoming more sensitive to reactions of those around them, especially those of their parents. There is some tendency to react negatively when subjected to pressure or criticism. For instance, they may sulk.
Language: The use of language continues to become more refined and sophisticated. Good pronunciation and grammar are developed according to what they’ve been taught. They are learning how to put their feelings and thoughts into words to express themselves more clearly. They begin to understand more abstract words and forms of language. For example, they may begin to understand some puns and jokes. They also begin to develop reading, writing, and numerical skills.
2-4jAges 9 to 11 Years
Motor: Children continue to refine and develop their coordination and motor skills. They experience a gradual, steady gain in body measurements and proportion. Manual dexterity, posture, strength, and balance improve. This period of late childhood is transitional to the major changes experienced during adolescence.
Play: This period frequently becomes the finale of the games and play of childhood. If it has not already occurred, boys and girls separate into their respective same-gender groups.
Adaptive: Children become more and more aware of themselves and the world around them. They experience a gradual change from identifying primarily with adults to formulating their own self-identity. They become more independent. This is a period of both physical and mental growth. These children push themselves into experiencing new things and new activities. They learn to focus on detail and accomplish increasingly difficult intellectual and academic tasks.
Social: The focus of attention shifts from a family orientation to a peer orientation. They continue developing social competence. Friends become very important.
Language: A tremendous increase in vocabulary occurs. These children become adept at the use of words. They can answer questions with more depth of insight. They understand more abstract concepts and use words more precisely. They are also better able to understand and examine verbal and mathematical relationships.
2-4kA Concluding Note
We emphasize that individuals vary greatly in their attainment of specific developmental milestones. The developmental milestones provide a general baseline for assessment and subsequent intervention decisions. If a child is assessed as being grossly behind in terms of achieving normal developmental milestones, then immediate intervention may be needed. On the other hand, if a child is only mildly behind his or her normal developmental profile, then no more than close observation may be appropriate. In the event that the child continues to fall further behind, help can be sought and provided.
2-5Significant Issues and Life Events
Two significant issues will be discussed that relate to the decision of whether to have children. They have been selected because they affect a great number of people and because they often pose a serious crisis for the people involved. The issues are abortion and infertility.
2-6Examine the Abortion Controversy: Impacts of Social and Economic Forces
LO 3
Many unique circumstances are involved in any unplanned pregnancy. Individuals must evaluate for themselves the potential consequences of each alternative and assess the positive and negative consequences of each.
A basic decision involved in unplanned pregnancy is whether to have the baby. If the decision is made to have the baby, and the mother is unmarried, a subset of alternatives must then be evaluated. One option is to marry the father (or to establish some other ongoing relationship with him). A second alternative is for the mother to keep the baby and live as a single parent. In the past decade, the media have given increasing attention to fathers who seek custody. Joint custody is a viable option. Or the mother’s parents (the child’s grandparents) or other relatives could either keep the baby or Help in its care. Still another option is adoption. Each choice involves both positive and negative consequences.
Abortion is the termination of a pregnancy by removing an embryo or fetus from the uterus before it can survive on its own outside the womb. Social workers may find themselves in the position of helping their clients explore abortion as one possibility open to them. Highlight 2.3 provides a case example of how one young woman struggled with her dilemma.
Highlight 2.3
Case Example: Single and Pregnant
Roseanne was 21 years old and two months pregnant. She was a junior at a large midwestern state university, majoring in social work. Hank, the father, was a 26-year-old divorce she met in one of her classes. He already had a 4-year-old son named Ronnie.
Roseanne was filled with ambivalent feelings. She had always pictured herself as being a mother someday—but not now. She felt she loved Hank but had many reservations about how he felt in return. She’d been seeing him once or twice a week for the past few months. Hank didn’t really take her out much, and she suspected that he was also dating other women. He had even asked her to babysit for Ronnie while he went out with someone else.
That was another thing—Ronnie. She felt Ronnie hated her. He would snarl whenever she came over and make nasty, cutting remarks. Maybe he was jealous that his father was giving Roseanne attention.
The pregnancy was an accident. She simply didn’t think anything would happen. She knew better now that it was too late. Hank had never made any commitment to her. In some ways she felt he was a creep, but at least he was honest. The fact was that he just didn’t love her.
The problem was, what should she do? A college education was important to her and to her parents. Money had always been a big issue. Her parents helped her as much as they could, but they also had other children in college. Roseanne worked odd, inconvenient hours at a fast-food restaurant for a while. She also worked as a cook several nights a week at a diner.
What if she kept the baby? She was fairly certain Hank didn’t want to marry her. Even if he did, she didn’t think she’d want to be stuck with him for the rest of her life. How could she possibly manage on her own with a baby? She shared a two-bedroom apartment with three other female students. How could she take care of a baby with no money and no place to go? She felt dropping out of college would ruin her life. The idea of going on welfare instead of working in welfare was terrifying.
What about adoption? That would mean seven more months of pregnancy while she was going to college. She wondered what her friends and family would say about choosing adoption as an option. She thought about how difficult that would be—she would always wonder where her child was and how he or she was doing. She couldn’t bear the thought of pursuing this option.
Yet, the idea of an abortion scared her. She had heard so many people say that it was murder.
Roseanne made her decision, but it certainly was not an easy one. She carefully addressed and considered the religious and moral issues involved in terminating a pregnancy. She decided that she would have to face the responsibility and the guilt. In determining that having a baby at this time would be disastrous both for herself and for a new life, she decided to have an abortion.
Fourteen years have passed. Roseanne is now 35. She is no longer in social work, although she finished her degree. She does have a good job as a court reporter. This job suits her well. She’s been married to Tom for three years. Although they have their ups and downs, she is happy in her marriage. They love each other very much and enjoy their time together.
Roseanne thinks about her abortion once in a while. Although she is using no method of contraception, she has not yet gotten pregnant. Possibly she never will. Tom is 43. He has been married once before and has an adult child from that marriage. He does not feel it is a necessity for them to have children.
Roseanne is ambivalent. She is addressing the possibility of not having children and is looking at the consequences of that alternative. She puts it well by saying that sometimes she mourns the loss of her unborn child. Yet, in view of her present level of satisfaction and Tom’s hesitation about having children, she feels that her life thus far has worked out for the best.
The concept of abortion inevitably elicits strong feelings and emotions. These feelings can be very positive or negative. People who take stands against abortion often do so on moral and ethical grounds. A common theme is that each unborn child has the right to life. On the opposite pole are those who feel strongly in favor of abortion. They feel that women have the right to choice over their own bodies and lives.
The issue concerning unplanned and, in this context, unwanted pregnancy provides an excellent example of how macro-system values affect the options available to clients. In June 1992, the U.S. Supreme Court ruled that states have extensive power to restrict abortions, although they cannot outlaw all abortions. Due to this ruling, restrictions have increased significantly. From 2011 to 2013, 205 new restrictions were enacted in the United States (Center for Reproductive Rights, 2014). If abortions are illegal or unavailable to specific groups in the population, then women’s choices about what to do are much more limited.
The abortion issue illustrates how clients function within the contexts of their mezzo and macro environments. For example, perhaps a woman’s parents are unwilling to help her with a newborn, or the child’s father shuns involvement. In both these instances, some of the woman’s potential mezzo system options have already been eliminated.
The abortion issue is one of most controversial in the country. Here, opposite sides confront each other at a demonstration.

Bill Clark/CQ-Roll Call Group/Getty Images
Options are also affected by macro environments. If abortion is illegal, then social agencies are unable to provide them. Another possibility is that states can legally allow abortion only under extremely limited circumstances. For instance, it may be allowed only if the conception is the product of incest or rape, or if the pregnancy and birth seriously endanger the pregnant woman’s life.
Even if states allow abortions, the community in which a pregnant woman lives can pose serious restrictions on her options. For instance, a community renowned for having a strong and well-organized antiabortion movement may be supportive of actions (including legal actions) to curtail abortion services. Abortion clinics can be picketed, patients harassed, and clinic staff personally threatened. Such strong community feelings can force clinics to close.

EP 1
Additionally, the abortion issue provides an excellent opportunity to distinguish between personal and professional values. Each of us probably has an opinion about abortion. Some of us most likely have strong opinions either one way or the other. In practice, our personal opinions really don’t matter. However, our professional approach does. As professionals, it is our responsibility to help clients come to their own decisions. Our job is to Help clients in assessing their own feelings and values, in identifying available alternatives, and in evaluating as objectively as possible the consequences of each alternative. It is critical that social workers provide options, not advice.
The National Association of Social Workers (NASW) has established issue and policy statements on family planning and reproductive choice that include its stance on abortion. A policy is a clearly stated or implicit procedure, plan, rule, or stance concerning some issue that serves to guide decision making and behavior. The statements read as follows:
“As social workers, we support the right of individuals to decide for themselves, without duress and according to their own personal beliefs and convictions, whether they want to become parents, how many children they are willing and able to nurture, the opportune time for them to have children, and with whom they may choose to parent … To support self-determination, … reproductive health services, including abortion services, must be legally, economically, and geographically accessible to all who need them … Denying people with low income access to the full range of contraceptive methods, abortion, and sterilization services, and the educational programs that explain them, perpetuate poverty and the dependence on welfare programs and support the status quo of class stratification … NASW supports …
• [A] woman’s right to obtain an abortion, performed according to accepted medical standards and in an environment free of harassment or threat for both patients and providers.
• [R]eproductive health services, including abortion services, that are confidential, available at a reasonable cost, and covered in public and private health insurance plans on a par with other kinds of health services (contraceptive equity).
• [I]mproved access to the full range of reproductive health services, including abortion services, for groups currently underserved in the United States, including people with low income and those who rely on Medicaid to pay for their health care …” (NASW, 2012, pp. 131, 133)
Seven aspects of abortion are discussed here. First, we describe the current impact of legal and political macro systems. Second, we note the incidence of abortion and provide a profile of women who have abortions. Third, we explore reasons why women seek abortions. Fourth, we explain the abortion process itself and the types of abortion available. Fifth, we briefly examine some of the psychological effects of abortion. Sixth, we compare and assess the arguments for and against abortion. Seventh, we describe a variety of social work roles with respect to the abortion issue.
2-6aThe Impacts of Macro-System Policies on Practice and Access to Services
People’s values affect laws that, in turn, regulate policy regarding how people can make decisions and choose to act. Government and agency policies specify and regulate what services organizations can provide to women within communities. Subsequently, whether services are available or not controls the choices available to most pregnant women.
The abortion debate focuses on two opposing perspectives, antiabortion and pro-choice. Carroll (2013b) describes the antiabortion stance as the belief “that human life begins at conception, and thus an embryo, at any stage of development, is a person. [Therefore,] … aborting a fetus is murder, and … the government should make all abortions illegal” (p. 366).
Pro-choice advocates, on the other hand, focus on a woman’s right to choose whether to have an abortion. They believe that a woman has the right to control what happens to her own body, to navigate her own life, and to pursue her own current and future happiness.
For more than four decades, the political controversy over abortion has been raging. In 1973, the U.S. Supreme Court decision known as Roe v. Wade overruled state laws that prohibited or restricted a woman’s right to obtain an abortion during the first three months of pregnancy. States were allowed to impose restrictions in the second trimester only when such restrictions related directly to the mother’s health. Finally, during the third trimester states could restrict abortions or even forbid them, excluding those necessary to preserve a woman’s life and health. Women, in essence, won the right to “privacy,” or in other words, “the right to be left alone” (Hartman, 1991, p. 467). This, of course, is a pro-choice stance.
The courts have gotten increasingly more conservative concerning abortion. In Planned Parenthood v. Casey (1992), the Supreme Court ruled that states had the right to restrict abortions as they saw fit, except that they could not outlaw all abortions. Additionally, the Court has put restrictions of increasing severity into place. In Harris v. McRae (1980), the Court confirmed that both Congress and individual states could legally refuse to pay for abortions. This significantly affected poor women.
In Webster v. Reproductive Health Services (1989), the Supreme Court upheld a restrictive Missouri law. This law “prohibits performing abortions in public hospitals unless the mother’s life is in danger; forbids the spending of state funds for counseling women about abortion; and requires doctors to add an expensive layer of testing before performing abortions after twenty weeks if they feel it will help them determine whether a fetus would be viable outside the womb” (Wermiel & McQueen, 1989, p. 1).
Since this decision, many states have passed bills imposing restrictions on abortions that will be discussed in more detail later (e.g., requiring waiting periods or parental consent for teens). Kirk and Okazawa-Rey (2013) reflect on the gradual chipping away of abortion rights:
For nearly forty years, well-funded anti-abortion groups have worked strategically to undermine and overturn the right to abortion. They have used public education, mainstream media, protests and direct action-including attacks on clinics and their staffs …They have financed and elected anti-choice political candidates at city, state, and congressional levels. Republican congresspersons have introduced bills session after session to whittle away at the legality of abortion and elevate the unborn child, even as a “nonviable fetus,” to the status of “personhood” with rights equal to or greater than those of the mother. If the Supreme Court overturns Roe v. Wade, legal jurisdiction will revert to the states, many of which are poised to ban abortion or to re-criminalize it … This issue is central to women’s autonomy and will continue to be highly contentious. (p. 217)
The abortion debate continues. New decisions are made daily at the state and federal levels. However, numerous issues remain in the forefront when assessing the impacts on clients’ rights and on their ability to function. Several have surfaced in recent years and will probably continue to characterize the abortion debate. We will discuss a number of them here: restricting access through legal barriers, limiting financial support, the mother’s condition, the fetus’s condition, violence against clinics, stem cell research, and intact dilation and extraction (often referred to by opponents as “partial-birth abortion”). Spotlight 2.1 presents some international perspectives on abortion policy.
Spotlight on Diversity 2.1
International Perspective on Abortion Policy
Abortion incidence and policy vary around the world as explained by the following statistics (Guttmacher, 2016c). During 2010–2014, an estimated 56 million abortions occurred each year worldwide. This number is up from the rates of abortions from 1990 to 1994, mainly due to population growth. However, rates vary significantly among countries, especially between developed and developing nations. Women in developing regions have a higher likelihood of having an abortion than in developed regions. In developing regions, the number of abortions annually in 2014 was 50 million, whereas in developed regions the number was 7 million. The highest rates of abortion in 2010–2014 were in the Caribbean and South American, with the lowest rates being in North America and Western and Northern Europe. Induced abortions can be medically safe when done in accordance with recommended guidelines, but globally many are performed in unsafe conditions. Almost all abortion related deaths occur in developing countries.
Women who are poor that live in developing countries have little access to family planning services and few economic resources to pay for safe abortions. As a result, they are more likely to encounter health problems related to unsafe abortion practices. In places where abortion is legal, it tends to be much safer. On the other hand, where abortion is forbidden, it is less safe. That makes sense as legality offers the opportunity for trained, knowledgeable, and skilled personnel to perform abortions.
Huge variations exist around the world in abortion policy (Cohen 2009):
Throughout Europe, except for Ireland and Poland, abortion is broadly legal, widely available and safe … China was the first large developing country to enact a liberal abortion law—in 1957. The Soviet Union and the central and western Asian republics enacted similar laws in the 1950s. Over the next 50 years, abortion become legal on broad grounds in a wide range of less developed countries, including Cuba (1965), Singapore (1970), India (1971), Zambia (1972), Tunisia (1973), Vietnam (1975), Turkey (1983). Taiwan (1985), Mongolia (1989), South Africa (1996) and Cambodia (1997). Indeed, the worldwide trend in abortion law has continued to be toward liberalization. And since 1997, another 21 countries or populous jurisdictions have liberalized their laws, including Colombia, Ethiopia, Iran, Mexico City, Nepal, Portugal, and Thailand. During this same period, only three countries—El Salvador, Nicaragua, and Poland—have increased restrictions.
Today, 60% of the world’s 1.55 billion women of reproductive age (15–44) live in countries where abortion is broadly legal.
The remaining 40% live where abortion is highly restricted, virtually all in the developing world. In Africa, 92% of women of reproductive age live under severely restrictive laws; in Latin America, 97% do.
Also consider the following global facts (Cohen, 2009):
• Unsafe abortions take the lives of 70,000 women annually (or 12.5 percent of all deaths related to pregnancy).
• Around the world, seven women die from an unsafe abortion every hour.
• Eight million women experience complications from abortion that can be very serious.
• Almost 3 million women who experience serious complications related to abortion receive no medical attention.
Cohen (2009) makes the following conclusions. The most effective way to address unwanted pregnancy is to provide readily available contraception to prevent pregnancy from occurring to begin with. However, in developing nations where resources are scarce, this is now a difficult, perhaps impossible, goal. Women who are desperate will resort to abortion whether it is legal or not. In places where abortion is not legal, it is likely unsafe and potentially deadly.
Restricting Access
There are several ways legislation can restrict access to abortion (Center for Reproductive Rights [CRR], 2014). First, states can enact mandatory delays before an abortion can be performed. For example, a state may require a 24-hour waiting period from the time a woman initiates the abortion process to the time the procedure is completed. The decision to abort can be very painful for many reasons, and a waiting period can result in significant stress. Critics indicate that such rules aim to impose obstacles in getting abortions, thus discouraging women from doing so. This rule makes access to abortion especially difficult for poor women from rural areas who have to travel significant distances for the abortion and have little or no money for lodging.
A second type of restriction requires women to receive designated material that may present a negative view of abortion or counseling prior to undergoing an abortion. Critics of this legislation maintain that it only encourages women to delay an abortion procedure; “intrudes on a woman’s autonomy and dignity; interferes with the physician’s professional practice; and corrupts the informed consent process” (CRR, 2009).
The following summarizes state waiting periods and mandatory counseling requirements (Guttmacher Institute, 2016a).
• Thirty-five states require that women receive counseling prior to receiving an abortion.
• Twenty-seven of these states also require that a specified period of time, usually 24 hours, elapse between counseling and the actual abortion.
• Thirteen states require two separate visits to the facility, one for counseling and another to begin the waiting period.
A third legal barrier concerns requiring teenagers to either notify one or both parents or receive consent from one or both parents before getting an abortion. Some states also allow minors to seek a court order to exempt them from parental involvement. Thirty-eight states have enacted parental involvement laws (Guttmacher Institute, 2016b). Fear of confronting parents may cause many young women to delay making the decision to have an abortion. Receiving court permission, where allowed, may also result in difficult delays.
Other legal barriers can also be established. In 2013 Texas passed a law that “requires doctors performing abortions to have admitting privileges at a … hospital” that must be located within 30 miles of the clinic (Liptak, 2013). Although a number of abortion rights groups and clinics subsequently sought the attention of the U.S. Supreme Court, the Court refused to address and rule on the law. As a result, the law effectively closed 36 abortion clinics, left 24 counties without such services, and prevented “some 20,000 women a year from access to safe abortions” (Liptak, 2013).
Bill and Karen Bell (National Abortion Federation, 2004) tell the story of their “beautiful, vibrant, 17-year-old daughter Becky [who] died suddenly, after a six-day illness.” The diagnosis was a form of pneumonia “brought about by an illegal abortion.” Bill and Karen couldn’t believe that this had happened to their daughter. Why didn’t she tell them she was pregnant? They could have helped and supported her. They learned the heartbreaking answer by talking to Becky’s friends. Becky’s parents reflected, “Becky had told her girlfriends that she believed we would be terribly hurt and disappointed in her if she told us about her pregnancy. Like a lot of young people, she was not comfortable sharing intimate details of her developing sexuality with her parents.” A parental consent law was in effect in Becky’s state. Although a request to the court was an option, the presiding judge had never granted a request for an abortion in over a decade. Desperate, Becky opted for an illegal, unsafe “back-alley abortion.”
The U.S. military also restricts access to abortion while at the same time women in the military report difficulty getting the type of birth control they wanted before deploying or having trouble refilling prescriptions while on duty (Miller, 2016). Medical treatment facilities on military bases are restricted from performing abortions for U.S. military personnel unless the life of the mother is endangered or the pregnancy is the result of rape or incest. This can cause difficulties for military women who want to seek an abortion as they may need to return to the United States to receive safe and legal abortions and it also forces them to have to pay out of pocket for the expense.
Limiting Financial Support
One clear trend since 1973 has been the antiabortion factions’ pressure to limit, minimize, and eventually prohibit any public financial support for abortion. This significantly affects poor women. Only 17 states provide Medicaid funding for all medically necessary abortions (Guttmacher Institute, 2016d). (Medicaid is a public Helpance program, established in 1965 and funded by federal and state governments, that pays for medical and hospital services for eligible people, determined to be in need, who are unable to pay for these services themselves.) The Hyde amendment, introduced to Congress in 1977, abolished federal funding for abortion unless a woman’s life was in danger. Congress has renewed this legislation annually, imposing various restrictions on abortion funding. Since 1993, Medicaid can fund an abortion only in the case of rape, incest, or a life-threatening situation; 32 states and the District of Columbia abide by this standard (Guttmacher Institute, 2016d). “Even when a woman’s health is jeopardized by her pregnancy to the extent that it will leave her incapacitated, unable to care for her children or hold down a job, she is still not eligible for Medicaid funding in many states” (CRR, 2003, July 8).
Nabha and Blasdell (2002) provide an example:
31-year-old “Alina” had bipolar disorder [a mental disorder involving extreme moods including manic frenzy, severe depression, or both] and obsessive-compulsive disorder [a mental disorder involving an obsession with organization, neatness, perfectionism, and control], and was taking psycho-tropic medications known to cause fetal anomalies. She also had fibromyalgia, a disease that causes weakness, exhaustion, numbness, and dizziness, in addition to other symptoms. As a result of these circumstances, Alina chose to have an abortion. Although Alina was enrolled in Medicaid during this period, the program in her state refused to cover abortions necessary to protect a woman’s health, so she was unable to receive any public funds.
Another approach for limiting financial support involves the concept of a gag rule—that is, banning federal funding to agencies that allow staff to talk to pregnant women about abortion as an alternative. Depending on the stance of various administrations, gag rules have been supported or rebuffed. For example, at one point Planned Parenthood said it would give up its federal funding rather than fail to discuss all options available to clients, including abortion. (Planned Parenthood is an international organization dedicated to promoting the use of family planning and contraception.) The gag rule also has the potential to prohibit giving federal money to international groups that perform abortions or provide abortion information.
Ten states forbid private insurance plans from covering abortion; 21 states restrict insurance coverage of abortions for public employees (Guttmacher Institute, 2016e).
Condition of the Mother
Some people support the idea that abortion is acceptable under specific conditions. One involves the mother’s health. Should an abortion be performed if carrying the fetus to full term will kill the mother? Whose life is more important—that of the mother or that of the fetus?
Another issue is this: Should a woman impregnated during rape or incest be forced to carry the fetus to term? Is it fair for a woman who has undergone the horror of a sexual assault to be forced to live with the assault’s result, an unwanted child, for the rest of her life?
Fetal Condition
The condition of the fetus illustrates another circumstance in which some people consider abortion acceptable. If the fetus is severely damaged or defective, should the mother have to carry it to term? If the woman is forced to bear the child, shouldn’t she be provided with resources to care for herself and the child before and after birth? To what extent would a mother forced to bear a severely disabled child also be forced to provide the huge resources necessary for maintaining such a child?
Ethical Question 2.2

1. What are your personal views about abortion? Under what, if any, circumstances do you think it might be performed?
Violence against Clinics
The abortion controversy has been fraught with violence. Statistics on violence against abortion clinics have been recorded since 1977 (NAF, 2015). In 2014, there were 99 incidents of violence against abortion providers in the United States and Canada; these included arson, attempted bombings, invasions, vandalism, trespassing, anthrax threats, assault and battery, death threats, burglary, and stalking (“the persistent following, threatening, and harassing of an abortion provider, staff member, or patient away from the clinic”) (NAF, 2014). Several recent attacks reflect extreme aggression by people who stand strongly against abortion (LeClaire, 2013).
Since the first attack on an abortion clinic in 1976, antiabortion extremists have continued to attack abortion clinics, physicians who perform abortions, and women seeking abortions or medical care. In 2015, “heavily-edited, misleading” antiabortion videos were released on the internet and were said to be the reason for an attack on abortion facility in Colorado Spring, CO (which was featured in one of the videos) in which three people were killed and nine were injured (NAF, 2015). In the same year, there were arsons at clinics in California, Washington, Louisiana, and Illinois.
Abortion clinics and pro-choice groups stress that they are functioning legally and need protection from harassment and violence. In 1994, a legal decision and legislation served to help
safeguard women’s right to access their legal rights. After the public outcry associated with the public harassment, wounding, and death of abortion services providers, and the vandalism and bombing of various clinics, the Supreme Court ruled in Madsen et al. v. Women’s Health Center, Inc. [1994] to allow a buffer zone around clinics to permit patients and employees access and to control noise around the premises. The same year the Freedom of Access to Clinic Entrances (FACE) Act made it a federal crime to block access, harass, or incite violence in the context of abortion services. (Shaw & Lee, 2012, p. 308)
The Freedom of Access to Clinic Entrances (FACE) Act prohibits such activities as trespassing, physical violence such as shoving, “vandalizing a reproductive health care facility by gluing locks or spraying butyric acid” (an acid used in disinfectants and other pharmaceuticals), threatening violence, stalking employees, and making bomb or arson threats (NAF, 2015; Blasdell & Goss, 2004).
To the extent that violence against clinics and harassment of clinic staff and patients continue, women’s access to legal abortions may be significantly curtailed. For whatever reason, the number of U.S. abortions performed has reached its record low since 1980 (Guttmacher, 2016c).
Stem Cell Research
An ongoing controversial issue related to abortion involves the use of fetal tissue (stern cells) for health research and treatment. As Kail and Cavanaugh explain,
stem cells are unspecialized human or animal cells that can produce mature specialized body cells and at the same time replicate themselves … Medical researchers are interested in using stem cells to repair or replace damaged body tissues because stem cells are less likely than other foreign cells to be rejected by the immune system when they are implanted in the body. (Tissue and organ rejection is a major problem following transplant surgery, for example.) Embryonic stem cells have the capacity to develop into every type of tissue found in an adult. Stem cells have been used experimentally to form the blood-making cells of the bone marrow and heart, blood vessel, muscle, and insulin-producing tissue. (Kail & Cavanaugh, 2014, p. 26)
Significant research has focused on the potential for using stem cells to combat spinal cord injuries, Parkinson’s disease, juvenile diabetes, heart disease, and Alzheimer’s disease; more than 100 million Americans suffer from some form of disease that could potentially benefit from stem cell research (Kalb & Rosenberg, 2004). Kalb and Rosenberg give the example of Maggie, age 4, who suffers from juvenile diabetes and is in need of help. “Ten to 15 times a day, Maggie’s blood sugar must be checked. And the little blond ballerina has to wear a portable insulin pump, which delivers insulin through a tube inserted into her abdomen or lower back. She carries the device to preschool in a fanny pack decorated with yellow and green ladybugs” (Kalb & Rosenberg, 2004, p. 44).
Although research has focused on a few different types of cells with some potential to function as stem cells (the discussion of which is beyond the scope of this book), much attention and research has centered on embryonic stem cells. Embryonic stem cells are cells taken from a 3-to-5-day-old embryo that has been developed during an in vitro fertilization process. In vitro is Latin for “in glass,” referring to something done in an artificial environment, such as in a laboratory dish or test tube; in vitro fertilization (discussed later in this chapter) refers to a procedure that unites the egg and sperm in a laboratory; stem cells “are not derived from eggs fertilized in a woman’s body” (NIH, 2015). When such cells were no longer needed for the in vitro fertilization process, “they were donated for research with the informed consent of the donor” (NIH, 2015). Sometimes, you might hear the term embryonic stem cell lines. This refers to embryonic stem cells that “have been cultured under in vitro conditions” for continuous cell division and specialization (as they develop into more specific types of tissue) and are studied “for months to years” (NIH, 2015).
Many people have strong opinions about stem cell research. An issue at the heart of the debate concerns whether the study and use of human embryonic tissue reflects the obliteration of human life. “Religious conservatives argue that using those stem cells means deriving benefit from the destruction of human embryos—fertilized eggs in early stages of development—in their eyes no less a crime than abortion” (Lacayo, 2001, p. 17).
People who support embryonic stem cell research contend that it has incredible positive potential. The National Institutes of Health (2013b) reports on “the promise of stem cells”:
Studying stem cells will help us understand how they transform into the dazzling array of specialized cells that make us what we are. Some of the most serious medical conditions, such as cancer and birth defects, are due to problems that occur somewhere in this process. A better understanding of normal cell development will allow us to understand and perhaps correct the errors that cause these medical conditions.
Another potential application of stem cells is making cells and tissues for medical therapies. Today, donated organs and tissues are often used to replace those that are diseased or destroyed. Unfortunately, the number of people needing a transplant far exceeds the number of organs available for transplantation … [S]tem cells offer the possibility of a renewable source of replacement cells and tissues to treat a myriad of diseases, conditions, and disabilities including Parkinson’s disease, amyotrophic lateral sclerosis, spinal cord injury, burns, heart disease, diabetes, and arthritis.
The debate rages in the national and state political arenas. Depending on the political orientation of those in power at the national and state levels, stem cell research may or may not receive various degrees of support. Research may be encouraged or prohibited. Funding may be provided or withdrawn.
Consider recent shifting national policy (Research America, 2013). Former president George W. Bush limited stem cell research by allowing federal funding for study only involving already established stem cell lines (stem cells already cultured in vitro and ready for use in research). Subsequently, President Barack Obama issued an executive order in 2009 negating the prior mandate, allowing federal funding for potential study of new stem cell lines, and thereby expanding stem cell research. However, since this mandate has not been signed into law, the future of stem cell research remains uncertain. It depends on national leadership and the political climate.
Note that “[i]ndividual states have the authority to pass laws to permit human embryonic stem cell research using state funds” instead of or in addition to federal funds (NIH, 2010). Numerous states have taken steps to support stem cell research through funding (e.g., grants), such mechanisms as technical Helpance, and encouragement of inter-agency and inter-state cooperation (NIH, 2010).
Stem cell research provides an example of how the ever-changing political context affects what can be and is done. As with many other issues influencing the human condition, social workers should keep abreast of such circumstances in their ongoing learning about human behavior. Participating in a career-long learning process is part of their professional responsibility.
Ethical Question 2.3

1. What is your opinion about using embryonic stem cells for research? Should the possibility of helping many seriously ill people through stem cell research be pursued? Or is an embryo several days old a human being that should be respected as such? How do you feel about embryonic tissue that is discarded after use at fertility clinics?
Highlight 2.4 addresses another very controversial issue—the late-term abortion procedure known as intact dilation and extraction (referred to by some as “partial-birth abortion”).
Highlight 2.4
Intact Dilation and Extraction (Late-Term Abortion)
Intact dilation and extraction (D&X) is “a late-term abortion involving partial delivery of a viable fetus before extraction” (Berube, 2002, p. 1014). It is performed after “20 weeks and before viability” (Crooks & Baur, 2014, p. 323). Although physicians refer to it as intact dilation and extraction, its opponents often refer to it as partial-birth abortion (DiNitto, 2005, p. 462). Opponents view the procedure as “the interference with the birth of a live baby, rather than the termination of a pregnancy” (Greenberg, Bruess, & Conklin, 2011, p. 264). In practice, it has been “reserved for situations when serious health risks to the woman, or severe fetal abnormalities, exist” (Crooks & Baur, 2014, p. 323).
In November 2003, President Bush “signed into law the first ban on a specific abortion procedure,” namely the D&X, making it “a criminal offense for doctors to perform the procedure, even to preserve the woman’s health” (DiNitto, 2005, p. 462). In April 2007, the Supreme Court upheld this law that “includes no health exception” and prohibits the procedure from being used (Guttmacher Institute, 2013a).
The following facts reflect the current state of partial-birth abortion (Guttmacher Institute, 2013a):
• At the time of this writing, 32 states have established bans on “partial-birth” abortion, 19 of which are in effect and 13 of which have been blocked by a court.
• The definition of “partial-birth” abortion varies widely from one state to another.
• All 32 state laws incorporate some kind of exception.
In reality, the majority (61.2%) of abortions are performed at less than 9 weeks’ gestation, and 88.6 percent at or before 12 weeks (U.S. Census Bureau, 2011).
Ethical Question 2.4

1. What is your opinion about intact dilation and extraction? Should it be legally allowed if the pregnant woman faces serious health risks with continued pregnancy? If the woman risks death? If the fetus suffers from serious mental or physical abnormalities?
Commentary
We have just scratched the surface of some of the debates currently raging. Social workers need to understand the issues and the context in which opposing views are raised in order to help clients make difficult decisions. The abortion issue with its potent pro-choice and antiabortion factions in the political arena illustrates the impact that macro systems can have on individual lives. The extent to which national policies limit the availability of abortion relates directly to service accessibility. Organizations in the macro environment must have the sanction of the national and state macro systems in order to provide women with free choice.
The next sections describe the incidence of abortion, reasons for abortion, common abortion procedures, and the pros and cons of abortion. Finally, various social work roles concerning the issue are discussed.
2-6bIncidence of Abortion2-6cReasons for Abortion
Unplanned or accidental pregnancy has three basic causes. First, the couple may not use contraception at all. Second, they may use it ineffectively, inconsistently, or incorrectly. Third, no method of contraception is perfect; each has a failure rate. (Chapter 6 discusses contraception in greater detail.)
Women give several reasons for having an abortion. “Three-fourths of women cite concern for or responsibility to other individuals; three-fourths say they cannot afford a child; three-fourths say that having a baby would interfere with work, school or the ability to care for dependents; and half say they do not want to be a single parent or are having problems with their husband or partner” (Guttmacher Institute, 2016). Many abortions are also performed annually in the United States following a rape.
No one desires to have an unwanted pregnancy that ends in abortion. It is a difficult choice to make among a range of alternatives, all of which have negative consequences. One implication is the importance of readily accessible contraception and family planning counseling so that the difficult alternative of abortion is no longer necessary.

In 2011, the abortion rate was on the decline, with 1.06 million abortions performed compared to the 1.21 million in 2008 (Guttmacher, 2016c).
“Nearly half of pregnancies among American women are unintended, and four in 10 of these [unintended pregnancies] are terminated by abortion. Twenty-two percent of all pregnancies (excluding miscarriages) end in abortion” (Guttmacher Institute, 2016c). As Table 2.1 indicates, about one-third of all abortions were performed for women ages 20 to 24. Almost three-quarters of all abortions were for women between the ages of 15 and 29, which makes sense in terms of maximum female fertility. The largest number of women having abortions (41%) had not had any children. This was followed by those having had one previous child (26%) and two or more previous children (19%).
Table 2.1
Facts about Women Having Abortions 2014
Age Total Abortions (%)
Under 15 .2
15 to 17 years 3.4
18 to 19 years 8.2
20 to 24 years 33.6
25 to 29 years 26.5
30 to 34 years 15.9
35 to 39 years 9.1
40 years and over 3.1
Number of previous childbirths
None 40.7
One 26.2
Two or more 19.1

“Fifty-one percent of women who have abortions had used a contraceptive method (usually the condom or hormonal method) during the month they became pregnant” (Guttmacher Institute, 2016).
Almost 86 percent of women having abortions are unmarried (Jerman, Jones, & Onda, 2016). Abortions are spread across races. Thirty-nine percent of abortions occur to non-Hispanic white women, 28 percent to non-Hispanic African American women, 25 percent to Hispanic women, and 3 percent to women of other races (Jerman, Jones, & Onda, 2016). Thirty percent of women having an abortion state they are protestant and 24 percent Catholic (Guttmacher Institute, 2016). Women having abortions tend to be poor. Forty-nine percent of women having abortions have incomes below the federal poverty line, and another 26 percent have incomes of 100 to 199 percent of the poverty line (Guttmacher Institute, 2016).
2-6dMethods of Abortion
Several different procedures are used to perform abortions, depending on how far the pregnancy has progressed. The cost for an abortion during the first trimester is about $1,500 depending on the length of gestation, where you get services, and what type of services they are (Planned Parenthood, 2016). Costs are higher when the abortion occurs later in the pregnancy. The two major kinds of abortion are a medication abortion (sometimes referred to as an “abortion pill”) and abortion procedures performed within a clinic. Methods used early in pregnancy include vacuum aspiration and medication abortion. Procedures used later on include dilation and evacuation, and intact dilation and evacuation (discussed in Highlight 2.4). Illegal abortion will also be mentioned.
Medication Abortion
A medication abortion is an abortion induced by taking certain drugs. The most commonly used drug in the United States, mifepristone (formerly referred to as RU-486), triggers a deterioration of the uterine lining (Planned Parenthood, 2016). It was approved by the U.S. Food and Drug Administration (FDA) for use as an abortion drug in 2000, and has been used in several European countries for over a decade earlier. The process involves taking mifepristone and then taking a dose of misoprostol (a prostaglandin that triggers uterine contractions) up to three days later. As mentioned, mifepristone causes the uterine lining to break down, which makes it unable to support a fetus. The subsequent dose of misoprostol then causes uterine contractions that expel the fetus. A medication abortion can be performed up to 70 days (10 weeks) after the first day of a woman’s last period and costs up to $800; note that some states restrict the period of use to 49 days (Planned Parenthood, 2016).
A majority of women abort within four or five hours of taking misoprostol; overall, the process is 97 percent effective (Planned Parenthood, 2008a). Potential side effects include dizziness, severe cramping, nausea, diarrhea, abdominal pain, and mild fever or chills (most of which can be reduced by taking Tylenol or ibuprofen [e.g., Advil], not aspirin) (Planned Parenthood, 2013). In 2011, about 23 percent of all abortions were medication abortions (Guttmacher Institute, 2016b).
Vacuum Aspiration
Vacuum aspiration (also referred to as vacuum curettage or suction curettage) is a procedure used up to 16 weeks after a missed period (Planned Parenthood, 2016). The cervical entrance is enlarged, and the contents of the uterus are evacuated through a suction tube. Usually done under local anesthesia, the procedure involves first dilating the cervix (i.e., widening the opening into the uterus) by inserting a series of rods with increasing diameters. Then a small tube is inserted into the vagina and subsequently through the cervix into the uterus. The tube is connected to a suction machine that vacuums out the fetal tissue from the uterus. Sometimes, curettage (scraping with a small, spoon-shaped instrument called a curette) is used afterward (Planned Parenthood, 2016). The entire procedure takes about 5 to 10 minutes in addition to preparation time (Planned Parenthood, 2016).
Most abortions are performed in clinics, where staff usually require that a patient remain for a couple hours following an abortion. Primary side effects include some bleeding and cramping, which are considered normal. Vacuum aspiration is considered a very safe procedure and rarely has complications.
Dilation and Evacuation
Second-trimester abortions are more complicated and involve greater risks. An abortion method that can be used during the fourth and fifth months of pregnancy is dilation and evacuation (D&E). This method resembles vacuum aspiration in that fetal material is initially suctioned out of the uterus and then usually scraped out with a curette. However, because a D&E is performed later in pregnancy, a greater amount of fetal material must be removed. General anesthesia instead of local is used. Potential complications include those associated with vacuum aspiration and those resulting from general anesthesia.
Illegal Abortion
Many women turn to unsafe illegal abortions when safe procedures are illegal or inaccessible. We have established that 40 percent of women of reproductive age live in nations where abortion is highly restricted or prohibited (Cohen, 2009). In desperation, many women turn to unregulated, unqualified abortionists who may use unclean or unsafe instruments. Other women try to abort themselves by using some sharp object or ingesting some harmful substance. We have also established that 70,000 women around the world die annually from dangerous illegal abortions (Cohen, 2009).
2-6eThe Importance of Context and Timing
Although abortion is considered a very safe medical practice in the United States, the further a woman is into her pregnancy, the greater the risk of death; only one death occurs for every million abortions performed before eight weeks of pregnancy, one death for every 29,000 abortions during weeks 16 to 20 of pregnancy, and one death per 11,000 abortions performed at 21 or more weeks of pregnancy (Guttmacher Institute, 2013e). Problems are also less likely to occur when the woman is healthy, conditions are clean and safe, and follow-up care is readily available. Women are about 11 times more likely to die in childbirth than from an abortion performed during the first 20 weeks of pregnancy (Planned Parenthood, 2016).
Risks from abortion complications are negligible; less than 0.5 percent of women having an abortion require subsequent hospitalization for complications (Guttmacher Institute, 2013e). Risks such as allergic reactions to medication or sedation, infection, blood clots, or heavy bleeding are very rare in first-trimester abortions, but increase in probability as the pregnancy continues (Planned Parenthood, 2016).
Spotlight 2.2 explores the psychological effects of abortion on both women and men.
Spotlight on Diversity 2.2
Effects of Abortion on Women and Men

Research indicates that most women demonstrate positive adjustment a year after an abortion and rarely suffer long-term psychological effects from an abortion (Hyde & DeLamater, 2014; Munk- Olsen et al., 2011). Many women “report feeling relieved, satisfied, and relatively happy, and say that if they had the decision to make over again they would do the same thing”; there is little support for the existence of a “postabortion syndrome” characterized by traits similar to those of posttraumatic stress disorder (Hyde & DeLamater, 2014, p. 181).
However, Kelly (2008) cautions:
Although serious emotional complications following abortion are quite rare, some women and their male partners experience some degree of depression, grieving, regret, or sense of loss. These reactions tend to be even more likely in second or third abortions. Support and counseling from friends, family members, or professionals following an abortion often help to lighten this distress, and it typically fades within several weeks after the procedure. Counseling often helps in cases where the distress does not become alleviated in a reasonable time. (p. 324)
A frequently ignored psychological aspect of abortion is the male’s reaction to the process. Many men experience feelings of “residual guilt, sadness, and remorse” (Yarber & Sayad, 2013, p. 355). A man may feel ambivalent about the pregnancy and the abortion similar to that felt by his pregnant partner. Many clinics now provide counseling for male partners of women seeking abortion (Yarber & Sayad, 2013). Both partners should receive the counseling they need to make difficult decisions and to cope with whatever feelings they are experiencing.
2-6fArguments for and against Abortion
Numerous arguments have been advanced for and against permitting abortions. Many of these views are related to how facts are interpreted and presented. Following is a sampling of arguments in favor of abortion rights:
• Permitting women to obtain an abortion corresponds with the principle of self-determination and allows women to have greater freedom of choice concerning their own bodies and lives.
• If abortions were prohibited, women would seek illegal abortions as they did in the past. No law has ever stopped abortion, and no law ever will. Performed in a medical clinic or hospital, an abortion is relatively safe; but performed under unsanitary conditions, perhaps by an inexperienced or unskilled abortionist, the operation is extremely dangerous and may even imperil the woman’s life.
• If abortions were prohibited, some women would attempt to self-induce abortions. Such attempts can be life-threatening. Women have tried such techniques as severe exercise, hot baths, and pelvic and intestinal irritants, and have even attempted to lacerate the uterus with such sharp objects as nail files and knives.
• No contraceptive method is perfectly reliable. All have failure rates and disadvantages. Contraceptive information and services are not readily available and accessible to all women, particularly teenagers, the poor, and rural women.
• Abortions are necessary in many countries with soaring birth rates. Contraceptives may be inadequate, unavailable, or beyond what people can afford. Abortion appears to be a necessary population control technique to preserve the quality of life. (In some countries, the number of abortions is approaching the number of live births.)
Opponents of abortion argue:
• The right of a fetus to life is basic and should in no way be infringed.
• Abortion is immoral and against certain religious beliefs. For example, former Pope John Paul II condemned abortion as a sign of the “encroaching ‘culture of death’ that threatens human dignity and freedom” (Woodward, 1995, p. 56).
• A woman who chooses to have an abortion is selfish. She prefers her own pleasure over the life of her unborn child.
• In a society where contraceptives are so readily available, there should be no unwanted pregnancies and therefore no need for abortion.
• People supporting abortion are antifamily. People should take responsibility for their behavior, cease nonmarital sexual intercourse, and bear children within a family context.
Professional social workers must be aware of arguments on both sides of the issue. Only then can they Help a client in making the decision that is right for her.
2-6gSocial Worker Roles and Abortion: Empowering Women
Social workers can assume a variety of roles when helping women with unwanted pregnancies. Among them are enabler, educator, broker, and advocate. First, as enablers, social workers can help women make decisions about what they will do. This involves helping clients identify alternatives and evaluate the pros and cons of each. Chilman (1987) reflects upon how social workers can counsel women concerning abortion:
The ultimate decision … should be made chiefly by the pregnant woman herself, preferably in consultation with the baby’s father and family members. To make the decision that is best for the couple and their child, the pregnant woman—ideally, with the expectant father—needs to view each option in the context of the couple’s present skills, resources, values, goals, emotions, important interpersonal relationships, and future plans. The counselor’s role is to support and shape a realistic selection of the most feasible pregnancy resolution alternative. (p. 6)
A second role social workers can assume is that of educator. This involves providing the pregnant woman with accurate information about the abortion process, adoption, fetal development, and options available to her. The educator role may also entail providing information about contraception to avoid subsequent unwanted pregnancies.
A third social work role involves being a broker. Regardless of her final decision, a pregnant woman will need to acquaint herself with the appropriate resources. These include abortion clinics, prenatal health counseling, and adoption services. A social worker can inform her of available resources, explain them, and help her obtain them.
Finally, a social worker can function as an advocate for a pregnant woman. A woman might want an abortion, yet live in a state that severely restricts them; if she is poor, her access to an abortion is even further restricted. A worker can advocate on this woman’s behalf to improve her access to abortion or to financial support for abortion services. Another form of advocacy would be to work to change the laws and policies that inhibit women from getting the services they need. If a woman decides against an abortion, a social worker can advocate for the resources and services the woman needs to support herself and her pregnancy.
2-6hAbortion-Related Ethical Dilemmas in Practice

Picture yourself as a professional social worker in practice. What happens when your own personal values seriously conflict with those expressed by your client? A basic professional value clearly specified in the NASW Code of Ethics is the right of clients to make their own decisions.
By definition, an ethical dilemma involves conflicting principles. When two or more ethical principles oppose each other, it is impossible to make a “correct” decision that satisfies both or all principles involved. There is no perfect solution. For example, if a 15-year-old client tells you that he plans to murder his mother, you are caught in an ethical dilemma. It is impossible to maintain confidentiality with your client (a basic social work professional value) and yet do all you can to protect his mother from harm.
A wide range of situations involving abortion can force workers to address ethical dilemmas. Social workers should first consider what principles in the NASW Code of Ethics might help to guide their practice and make decisions. We have emphasized that professional values should take clear precedence over personal values about issues.
Dolgoff, Harrington, and Loewenberg (2012) have formulated a hierarchy of ethical principles, the Ethical Principles Screen (EPS), to provide a guide for making difficult decisions. They suggest which principle should have priority over the other when two ethical principles conflict. The hierarchy can be helpful in working through difficult situations. If the Code of Ethics does not directly apply or a significant amount of ambiguity exists, the worker may turn to the EPS described next.
The EPS hierarchy involves the following seven principles (pp. 80–82):
• Principle 1: Protection of life is of utmost importance. This might include provision of adequate food, shelter, clothing, or health care. It might concern acting in response to a person’s suicide threat or threat of physically harming another. This principle applies not only to clients but also to others whose survival is imperiled.
• Principle 2: After protection of life, social workers should strive to nurture equality and address inequality. On the one hand, groups should be treated equally and have equal access to resources. On the other hand, groups who are oppressed or hold lesser status should be treated specially so that their rights are not violated. For example, consider a child abuse situation. Because the child does not hold an equal position with that of an abusive parent, “the principles of confidentiality and autonomy with respect to the abusing adult are of a lower rank order than the obligation to protect the child, … even when it is not a question of life and death” (p. 81).
• Principle 3: Social workers should make practice decisions that “foster a person’s self-determination, autonomy, independence, and freedom” (p. 81). People should be allowed to make their own choices about their lives. However, this should not be at the expense of their own or someone else’s life as Principle 1 prescribes. Maintaining autonomy should not be pursued if equality supported by Principle 2 would be sacrificed.
• Principle 4: Social workers should pursue an option that results in the least harm to those involved in the decision and its results.
• Principle 5: Social workers should make practice decisions that promote a better quality of life for all people. People’s overall well-being is important. This involves not only the well-being of an individual or family, but also that of entire communities.
• Principle 6: Social workers should respect people’s privacy and maintain confidentiality. However, this principle is superseded when people’s quality of life is endangered.
• Principle 7: Practice decisions should allow workers to be honest and disclose all available information. Workers should be able to provide any information that they deem necessary in any particular situation. However, the “truth” should not be told for its own sake when it violates a client’s confidentiality, which is championed by Principle 6.
The following scenario poses an ethical dilemma concerning abortion that a worker might face in practice. Next, we give an example of how Dolgoff and colleagues’ hierarchy of ethical principles might be applied in this case. Highlight 2.5 provides several more scenarios for you to work out on your own. Remember, there are no easy or perfect answers.
Highlight 2.5
More Abortion-Related Ethical Dilemmas in Practice
Apply the hierarchy of ethical principles to each of the following case examples.
Scenario A
A 45-year-old woman becomes pregnant. She already has seven children and numerous grandchildren. Her personal physician refused to prescribe birth control pills for her because of her age and other health reasons. Nor did he discuss other forms of contraception with her or offer her the alternative of sterilization. Physically, it would be hazardous for her to have more children. She comes to you, distraught and crying. She doesn’t know what to do.
Scenario B
A 32-year-old woman with a severe intellectual disability becomes pregnant. She is unable to take care of herself independently. She has a history of numerous sexual encounters. Her genetic background indicates that she would probably have a child with an intellectual disability. It is clear that she would be unable to care for a child herself.
Scenario C
A 19-year-old college student is six weeks pregnant. She has been going with her boyfriend for seven months. For the past three months, they have been seeing only each other, but they do not consider themselves serious as yet. She had been using a diaphragm and contraceptive cream, but they failed to protect her. She doesn’t want a baby right now. However, she feels terribly guilty about getting pregnant.
Scenario D
A married 24-year-old woman is pregnant. She already has one child with a genetic defect. She and her husband have been through genetic Assessment and counseling at a local university. The conclusion is that because both parents have, a history of significant genetic problems, the chances for a normal child are extremely small. The couple was deciding upon a sterilization procedure when she became pregnant.
Scenario E
A married 28-year-old medical technician has been unaware of being pregnant until now, the seventh week of gestation. Throughout her pregnancy, she has been exposed to dangerous X-rays. The possibility that her fetus has been damaged by the radiation is very high. She and her husband want children at some time, but they dread the thought of having a baby with a serious impairment.
Scenario F
Four months ago, a married man of 42 had a vasectomy. His 41-year-old wife just found out that she is five weeks pregnant. Some sperm had apparently still been present in his semen. The couple already have three children in their teens. They do not want more.
Scenario G
A 14-year-old girl is pregnant. It happened one night when she was out drinking. She had never really considered using contraception. She’s shocked that she’s pregnant and is having difficulty thinking about the future.
Scenario A
A 16-year-old girl was raped by a middle-aged man as she walked home from school one night and became pregnant. Both she and her parents are horrified and plagued with worry. They come to you for help. The girl desperately wants an abortion.
Application of Ethical Principles in Scenario A
Consider Principle 1, the need to protect life. If you personally adopt an antiabortion stance and feel that abortion is murder, what do you do? A professional social worker’s personal values must be acknowledged yet put aside in professional situations. The young woman and her parents want her to have the abortion.
We then look at Principle 2, which calls for the nurturance of equality and the combating of inequality. According to this principle, people should be treated equally. In this case, they should have equal access to services. A neighboring state, its border only 25 miles away, allows abortions for all women who want them within the first trimester. Is this fair? Is this ethical? Should you help the young woman and her parents seek an abortion in a state that has different rules? Or should you work actively in your own state to advocate for change so that abortion would be a legal alternative for clients such as this?
Now consider Principle 3, which stresses people’s right to autonomy, independence, and freedom. The young woman has the right to make her own decision. Your state might legally allow abortions for all women seeking them, or it might restrict them to only those women who have been raped or sexually abused. Or your state might ban all abortions unless the life of the mother is critically endangered.
If an abortion is legal in your state for a teenager like this, you as a worker can help her get one. She has made her decision. It is her legal right. However, if your state does not allow her to have a legal abortion, you are confronted with another dilemma.
Principle 4 refers to choosing options that result in the least harm to those involved. Principle 5 reflects the importance of maintaining an optimum quality of life. If this young woman is prevented from having an abortion, will her future be harmed? In what ways might she lose control over her life? How will her short-term and long-term quality of life be affected?
This discussion simply raises questions and issues. Each case is unique. Circumstances and attitudes vary widely. It is a professional social worker’s ethical responsibility to resolve dilemmas and help clients solve problems to the best of that worker’s ability. Each client should be helped to identify alternatives, evaluate the pros and cons of each, and come to a final decision. There are no absolute answers or perfect solutions.
2-7Explain Infertility
LO 4
Ralph and Carol, both age 28, had been married for five years. Ralph was a drill press operator at a large bathroom fixture plant. Carol was a waitress at a Mexican restaurant. They both liked their jobs well enough. They were earning enough to purchase a small three-bedroom house and to enjoy some pleasurable amenities such as going out to dinner occasionally, taking annual camping vacations, and having cable television.
However, they felt something was wrong. Although Carol had stopped taking birth control pills more than three years before, she had still not gotten pregnant. She had read in an article in Cosmopolitan that women over age 35 had a much greater chance of having a child with an intellectual disability or birth defects. Although she still had a few years, she was concerned. She and Ralph had always wanted to have as large a family as they could afford. This meant that they had better get going.
The couple really didn’t talk much about the issue. Neither one wanted to imply that something might be wrong with the other one. The idea that one or both might be infertile was not appealing. It was almost easier to ignore the issue and hope that it would resolve itself in a pregnancy. After all, they still had a few years.
Infertility is the inability to conceive despite trying for 1 year, or 6 months for women age 35 or older (CDC, 2016). Women who are unable to sustain their pregnancies and experience miscarriage are also considered to have an infertility problem. Although many people assume that they will automatically initiate a pregnancy if they don’t use contraception, this is not always the case.
It is estimated that infertility affects 6.7 million American women ages 15 to 44, or almost 12 percent of this group (CDC, 2016). However, this is an aggregate statistic that does not take into account the effects of age or a wide range of other conditions. Therefore, the 11 percent figure is probably not useful to individual couples seeking infertility counseling. Many other factors should be considered.
For example, consider the statement that older women tend to experience increased infertility. “With increasing age, the quality and quantity of a woman’s eggs begin to decline. In the mid-30s, the rate of follicle loss accelerates, resulting in fewer and poorer quality eggs, making conception more challenging and increasing the risk of miscarriage” (Mayo Clinic, 2013b).
Several other factors also tend to increase infertility (Mayo Clinic, 2013b). Smoking increases the risk of miscarriage and ectopic pregnancy (a condition where a fertilized egg implants itself somewhere other than in the uterus, usually in a fallopian tube). Smoking may also age and diminish eggs prematurely, making it more difficult to become pregnant. Being overweight or extremely underweight, and heavy consumption of alcohol or caffeine (e.g., six cups of coffee or more each day) increases infertility. Contraction of STIs can damage the fallopian tubes, also making it harder to conceive.
2-7aCauses of Infertility
Of all infertility cases, males are responsible for approximately one-third and females for about one-third; the remaining third involves a mixture of male and female factors, or unknown causes (Mayo Clinic, 2013b). The following sections explore some of the major causes of infertility in both men and women.
Female Infertility
A primary cause of infertility in women involves difficulties with ovulation (CDC, 2016; Mayo Clinic, 2013b). Highlight 2.6 summarizes how age affects a woman’s fertility.
Highlight 2.6
Aging Affects a Woman’s Fertility
As a woman ages, five conditions affect her fertility (American Society for Reproductive Medicine, 2012a; CDC, 2013c):
1. Her ovaries’ ability to release eggs ready for fertilization declines.
2. The number of eggs has decreased.
3. The health of the eggs themselves weakens.
4. A woman is more likely to experience other health problems that negatively affect fertility.
5. Her risk of miscarriage increases.
Whether ovulation has occurred can be detected by daily monitoring of a woman’s morning temperature. Basal body temperature charts can be used for this purpose. A woman may experience a slight dip in body temperature on the day before ovulation. Immediately after ovulation, the body temperature rises slightly. There should be “a temperature shift of at least. 4 degrees over a 48-hour period to indicate ovulation” (Fertilityplus, 2010).
Another cause of infertility in women involves blocked fallopian tubes (CDC, 2016). Pelvic inflammatory disease (PID) is an infection of the female reproductive tract (especially the fallopian tubes) that can cause inflammation and scar tissue that blocks tubes. It often results from STIs such as gonorrhea and chlamydia (both described in Chapter 6). Tumors or various congenital abnormalities can also cause blocked tubes.
Other conditions affecting a woman’s fertility include physical abnormalities in the uterine wall and benign fibroid tumors (ASRM, 2012). Endometriosis—the growth of tissue resembling that of the uterine lining outside the uterus, which often results in severe pain—can also cause infertility.
Male Infertility
Common causes of male infertility are low sperm count and decreased sperm motility (sperm’s ability to maneuver quickly and vigorously) (CDC, 2016). Another frequent cause of male infertility is a condition called varicocele (pronounced VAIR-ih-koh-seel) (Hyde & DeLamater, 2014; NWHIC, 2009). Here the veins on a man’s testicle(s) are enlarged, thereby producing too much heat and affecting sperm production. Numerous conditions can affect sperm count. Age, environmental toxins, declining health conditions, medical problems, smoking, use of drugs or alcohol, use of some medications, and radiation treatment and chemotherapy for cancer have all been blamed as contributors to infertility (NWHIC, 2009).
Couple-Related Causes of Infertility
Sometimes infertility results from a mixture of conditions and behaviors shared by a couple. It may involve timing and frequency of intercourse or specific coital techniques used. Occasionally, infertility is a consequence of antibodies produced by a woman that attack the man’s sperm (Hyde & DeLamater, 2017).
2-7bPsychological Reactions to Infertility
Some people experience serious reactions to infertility. They may show signs of depression, guilt, deprivation, frustration, or anger as they pursue infertility counseling. They may feel that their lives are out of their control. In many ways feelings resemble those of grieving, including denial, anger, bargaining, depression, and finally, acceptance (Greenberg et al., 2014; Kübler-Ross, 1969).
Especially for those who really desire to have children, infertility can be associated with failure. Van Den Akker (2001) studied 105 people who were infertile and found that three-quarters of them were “devastated” by their infertility “diagnosis” (p. 152). Sixty-four percent of the female respondents and 47 percent of the males indicated happiness was an impossibility without having children. One respondent elaborated, “I was angry … there isn’t anything else in my life that I’ve worked that hard at really, that I didn’t get … I deserved to have succeeded. I didn’t have the energy to do anything else, I just couldn’t do it anymore. But I was really angry. It was like, this isn’t the way it was supposed to end” (p. 131).
An infertility problem is compounded by the fact that even the most intimate partners often don’t feel comfortable talking about their sexuality, let alone that something may be wrong with it. Some men associate their potency with their ability to father children. Traditionally, women have placed great importance on their roles as wife and mother. Hopefully, with the greater flexibility of women’s roles today, the technological advances aimed at improving fertility, and the new options available to infertile couples, the negative psychological reactions to infertility will be minimized.
2-7cTreatment of Infertility
A wide range of scenarios may reflect individual variations of infertility. One involves listening to the infamous ticking of the biological clock, an example of which Meadows (2004) describes:
Heather Pansera and her husband, Anthony, started trying to have a baby as soon as they got married … [A year later] they settled into a new house in Canton, Ohio, with plenty of room to raise a family. One year passed, and Heather, 32, didn’t think much about it. Another year passed and she panicked.
“We were a couple for five years by the time we got married, so we decided to let nature take its course,” she says. “It never crossed our minds that getting pregnant would be so difficult.”
“It seemed like everyone else was having babies,” says Anthony, 39. “I have three brothers and three sisters, and they all had kids. You’re happy for other people, but you want to experience it, too.”
The Panseras decided to pursue fertility treatments. After five unsuccessful attempts, Heather finally became pregnant.
Treatment for infertility depends, of course, on the specific problem involved and its seriousness. It is not necessarily an easy or effective process. It can also be very expensive.
After a year of trying to conceive, both partners should pursue a medical Assessment to help determine whether anything is physically wrong. When a woman is age 35 or older and has been trying unsuccessfully to get pregnant for six months, or when there is already some indication of a fertility problem, a couple may want to pursue treatment more aggressively before a year is up (see Highlight 2.6).
The first thing to be done in the case of suspected infertility is to bring the matter out into the open. People need to talk about their ideas and feelings. Only then can the various alternatives be identified and a plan of action determined. The couple’s sexual practices concerning pregnancy should also be discussed to make certain they have accurate and specific information.
2-7dAssessment of Infertility
The assessment of infertility usually begins with a general physical examination to evaluate the couple’s overall health; potential physical problems that might be inhibiting fertility are also investigated (ASRM, 2012). Additionally, the couple is asked about their sexual behavior to determine whether it is conducive to conception (ASRM, 2012).
Subsequently, infertility assessment typically involves a regimen of tests (Greenberg et al., 2014; NWHIC, 2009). Assessment of the male entails tests that evaluate the number, normality, and mobility of sperm. Sometimes hormonal tests are also conducted.
The first step in assessing female infertility usually involves evaluating whether the woman is ovulating each month. This can be done by monitoring her own body temperature fluctuations each day, by using home ovulation test kits that can be purchased over the counter at drug or grocery stores, or by a physician administering blood tests to establish hormone levels or taking ultrasounds of the ovaries. If it is determined that the woman is ovulating regularly, additional tests may include X-rays of the fallopian tubes and uterus after injecting dye (hysterosalpingography). The X-ray indicates whether the tubes are open and profiles the shape of the uterus. A laparoscopy may also be performed, in which a thin, tubular instrument is inserted into the body cavity to examine the female reproductive organs directly for any abnormalities.
2-7eAlternative Options for Starting a Family
Alternatives available to individuals and couples, both infertile and fertile, who want children include adoption, conventional treatment using surgery or drugs, in vitro fertilization, and various forms of Helped reproductive technology, all of which are explained in the following sections.
Adoption
Adoption is the legal act of taking in a child born to other parents and formally making that child a full member of the family. To provide a home and family for a child who has none is a viable and beneficial option for infertile couples.
Currently, there is an emphasis on encouraging parents to adopt children with special needs—that is, children who require additional support in the form of medical or financial help for adoptive placement; factors involved in special needs may include race, age, being part of a sibling group, or having a physical or mental disability (Barth, 2008). People pursuing the adoption alternative also often seek the adoption of foreign-born children (Barth, 2008; Crosson-Tower, 2013).
Surgery and Fertility Drugs
Conventional treatments including surgery or drugs are generally used first to treat infertility in 85 to 90 percent of all cases (Greenberg et al., 2014). Microsurgery has been used to correct blocked fallopian tubes, and remove pelvic adhesions and patches of tissue supporting endometriosis; examples of microsurgery for infertile men are vasectomy reversal and repairing varicose veins in the scrotum and testes (Hyde & DeLamater, 2017).
For women who have problems ovulating, drugs such as Clomid or Seraphine (taken orally), Repronex, or Gonal-F (both given by injection) may be prescribed to stimulate ovulation (Mayo Clinic, 2013b). Note, however, that such “fertility drugs” can result in multiple births, which may cause greater problems for both mothers and infants (American Society for Reproductive Medicine, 2012b). Infants may be born prematurely and experience health problems such as breathing difficulties, bleeding blood vessels in their brains, low birth weight, and other birth defects. Mothers may have difficulties during pregnancy including high blood pressure, diabetes, and low blood count (anemia). They may also encounter problems during the delivery of multiple infants.
Unfortunately, drug treatment for male infertility is much less advanced.
Intrauterine Insemination
Intrauterine insemination (IUI) (also referred to as artificial insemination [Al]) is the process of “injecting the woman with sperm from her partner or a donor” (Yarber & Sayad, 2016, p. 378). It tends to be used when the male’s infertility problems are mild or the cause of a couple’s infertility is unknown (CDC, 2013c). During IUI, sperm are deposited directly into the uterus instead of the vagina. This tends to enable pregnancy in cases where sperm have difficulty penetrating cervical mucus, as it allows it to bypass that barrier. Additionally, it gives sperm a head start.
Human sperm can be frozen for up to 10 years, thawed, and then used to impregnate (Carroll, 2013b). For a fee, a sperm bank collects and maintains sperm either for the donors themselves or for nondonors, depending on the arrangement made by the donor.
The sperm used in Al may be the husband’s or partner’s. This procedure might also be used for family planning purposes—for example, a man might deposit his sperm in the bank, then undergo a vasectomy, and later withdraw the sperm to have children. High-risk jobs or onset of a serious illness might prompt a man to make a deposit in case of impending sterility. It is possible to pool several ejaculations from a man with a low sperm count and to inject them simultaneously into the uterus or vaginal canal.
A second type of artificial insemination is by a donor other than the husband or partner. This practice has been used for several decades to circumvent male infertility and also when the partner is a carrier of a genetic disease (e.g., a condition such as hemophilia).
In recent years, an increasing number of single women have requested the services of a sperm bank. A woman requests the general genetic characteristics she wants from the father, and the sperm bank then tries to match the request from the information known about its donors. Donors are paid for their sperm and remain anonymous.
A third type of artificial insemination has received considerable publicity. Some married couples, in which the wife is infertile, may contract with another woman to be artificially inseminated with the husband’s sperm. Under the terms of the contract, this surrogate mother is paid and expected to give the infant to the married couple shortly after birth.
A number of ethical and legal questions have been raised about artificial insemination. Many religious leaders claim that God did not mean for people to reproduce this way. In the case of using another donor’s sperm, certain psychological stresses may be placed on partners and on marriages, as the procedure emphasizes the husband’s infertility and involves having a baby that he has not fathered. On a broader dimension, artificial insemination raises such questions as, What are the purposes of marriage and of sex? What will happen to male–female relationships if a couple does not even have to see each other to reproduce?
There are other possible legal implications. What happens if the sperm at a bank is not paid for? Would it become the property of the bank? Could it be auctioned off? If a woman was artificially inseminated by a donor and the child was later found to have genetic defects, could the parents bring suit against the physician, the donor, or the bank? What about frozen sperm used to inseminate a woman after the donor’s death? Could such children be considered the donor’s heirs?
Ethical Question 2.5

1. Does a child resulting from artificial insemination by an unknown donor have the right to know who that donor was? What if this knowledge is necessary for some medical reason, such as diagnosing a hereditary disease? What if the donor does not want the child to know who he is?
Helped Reproductive Technology
Helped reproductive technology (ART) involves procedures to promote pregnancy that involve handling both the sperm and the egg (CDC, 2016b). Artificial insemination is not considered ART because the egg is not manipulated. The results of ART procedures are often referred to as test-tube babies. However, this phrase is inaccurate because ART has nothing to do with a test tube. Earlier, we established that in vitro is Latin for “in glass” (Hyde & DeLamater, 2014). In vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, and direct sperm injection are ART procedures discussed in this section.
In Vitro Fertilization
In vitro fertilization (IVF) is a process in which eggs are removed from a woman’s body, fertilized with sperm in a laboratory dish, and then implanted in the woman’s uterus. Before egg removal, the woman is given fertility drugs to encourage multiple egg production. The process can be helpful for women whose fallopian tubes are damaged, blocked, or even absent, so that the normal process of fertilization is difficult or impossible.
The first successful IVF procedure took place in Oldham, England, in 1978. Baby Louise, weighing 5 pounds, 12 ounces, was born to her parents Lesley and John Brown. The world was stunned by such a feat. The physicians who developed the technique, Patrick Steptoe and Robert Edwards, had attempted the process more than 30 times before they achieved this first success.
As with artificial insemination, the ethical issues, legal complications, and other potential problems with IVF are numerous. For example, a Dutch woman underwent IVF after trying unsuccessfully to conceive for five years. The process was successful; twins were born—one black and one white. The University Hospital at Utrecht deemed “the mix-up ‘a deeply regrettable mistake,’ and took responsibility for accidentally fertilizing the woman’s eggs with sperm from a man from Aruba, as well as that of her husband” (American Association of Sex Educators, Counselors, and Therapists [AASECT], 1995).
ART’s effectiveness varies tremendously from couple to couple. As mentioned, variables include the viability of the eggs and sperm, the mother’s age, and the mother’s structural capacity to maintain a pregnancy. Mulrine (2004) describes the situation for some of the most difficult cases who seek help from the Sher Institutes for Reproductive Medicine in Las Vegas:
They have … graduated to advanced treatments beyond their wildest calculations. Most of them have already undergone two or more in vitro fertilization attempts with other doctors and some 75 percent of them have traveled from out of state to try again. It is an arduous process, not without its embarrassments. One couple speaks of feeling ridiculous racing through rush-hour traffic to deliver sperm gathered at home to the clinic; another describes an earlier treatment when the doctor, in a lame effort at humor, dressed in a bunny suit on egg retrieval day, in preparation for his “Easter hunt.” (p. 61)
In 2016, model Chrissy Teigen and her husband, singer John Legend, faced criticism when they announced to the world that they had picked the sex of their baby with the use of Preimplantation Genetic Diagnosis (PGD) during in Vitro Fertilization. The PGD process happens outside of the body. Once the sperm begins to fertilize the eggs (typically on the third day after fertilization starts), an embryologist removes cells from the embryo to determine whether the embryo is a male or a female. Following this procedure, only the embryos of the desired gender is transferred into the women’s uterus (Center for Human Reproduction, 2015). This can be an expensive procedure (approximately $18,000) and one that raises ethical questions (Yarber & Sayad, 2016; Hyde & DeLamater, 2017). A similar procedure, Micro-Sort, has already been banned in the United States by the Food and Drug Administration. Concerns have been raised about potential sex imbalances in the world and incidences in which the “non-chosen” sex is born. There is also no long-term research about the impact of these procedures.
Gamete Intrafallopian Transfer (GIFT)
In gamete intrafallopian transfer (GIFT), collected eggs and sperm are placed directly into a fallopian tube. Resulting embryos can then drift into the uterus. GIFT differs from IVF only where fertilization takes place. In IVF, fertilization occurs in a petri dish; in GIFT, fertilization occurs in the fallopian tube. All other aspects of the two processes are alike. Both allow natural implantation to take place in the uterus. GIFT can be performed only in those cases in which the fallopian tubes are clear and healthy. It may be used successfully with women who have endometriosis or when no specific cause for infertility has been identified. GIFT is not useful for women with blocked fallopian tubes, a common cause of female infertility.
Zygote Intrafallopian Transfer (ZIFT)
Zygote intrafallopian transfer (ZIFT) is similar to GIFT. In the ZIFT procedure, eggs and sperm are first combined in a laboratory dish to form a zygote. The zygote is then immediately transferred to the fallopian tube. An advantage of this technique is that fertilization is known to have taken place, whereas GIFT couples can only hope that it will take place. Natural implantation in the uterus can then occur.
Direct Sperm infection (ICSD)
In intracytoplasmic sperm injection (ICSD), or direct sperm injection, a physician, using a microscopic pipette (a narrow tube into which fluid is drawn by suction), injects a single sperm into an egg. The resulting zygote is subsequently placed in the uterus. This technique can be used when the male has a low sperm count or the couple has failed to conceive using traditional in vitro insemination (Rathus et al., 2014). The first successful birth using ICSD occurred late in 1994 (Sparks & Syrop, 2005).
Embryo Transplants
Embryo transplants may be used for women who do not have healthy ova (eggs) themselves, often due to age or ovarian failure (Carroll, 2013b; Rathus et al., 2014). Rathus and his colleagues (2014) explain:
Embryonic transfer can be used with women who do not produce ova of their own. A woman volunteer is artificially inseminated by the male partner of the infertile woman, or by donor sperm. Five days later the embryo is removed from the volunteer and inserted within the uterus of the mother-to-be, where it is hoped that it will become implanted. (p. 299)
Success Rates of ART
Note that the effectiveness of ART procedures varies from clinic to clinic. The Fertility Clinic Success Rate and Certification Act of 1992 requires all clinics practicing artificial reproduction technology to report their success rates annually to the Centers for Disease Control (CDC). The CDC, in turn, publishes an annual report, which details the success rate for each clinic (CDC, 2013g). (Note that success rates usually refer to pregnancy rates per cycle. A cycle involves a two-week period during which ART is undertaken, usually beginning with administration of a fertility drug [CDC, 2005]).
According to the 2013 CDC national summary on ART, the average percentage of ART cycles that led to a successful implantation in the uterus were as follows:
• 39.9 percent in women aged 34 or younger
• 30.8 percent in women aged 35–37
• 20 percent in women aged 38–40
• 10.7 percent in women aged 41–42
• 5.0 percent in women aged 43–44
• 2.3 percent in women aged 45 or older (CDC, 2016a).
Surrogate Motherhood
Thousands of individuals and couples who want children but who are unable to reproduce either because the woman is infertile or due to lack of a partner have turned to surrogate motherhood.
A surrogate can give birth to a baby conceived by artificial insemination using the sperm of the husband. Or a woman can function as a surrogate without using her own genetic material. For example, any egg fertilized using the GIFT or ZIFT process may be transferred to the surrogate mother’s fallopian tube.
On birth, the surrogate mother terminates her parental rights, and the child is legally adopted by the donor(s) of the egg and/or sperm. Agencies sponsoring surrogacy stress the need for clearly established contractual agreements. However, various ethical issues are involved in surrogacy, many of which are currently being debated in the courts. Ethical Questions 2.6 addresses some of them.
Ethical Question 2.6

1. What if the surrogate mother changes her mind shortly before birth or right after birth and decides to keep the baby?
If the child is born with severe mental or physical disabilities, who will care for the child and pay for the expenses? Should it be the surrogate mother, the contracting adoptive couple, or society?
Should the best interests of the resulting children rather than their procreators be taken into account? At some point in the children’s lives, should they be told that they have a surrogate mother somewhere? How might this affect their own psychological well-being?
Acceptance of Childlessness
For some infertile couples, accepting childlessness may be the most viable option. Each alternative has both positive and negative consequences that need to be evaluated. The positive aspects of childlessness need to be identified and appreciated. Increasing numbers of people are choosing to remain childless for various reasons. Not having children allows the time and energy that children would otherwise demand to be devoted to other activities and accomplishments. These include work, career, and recreational activities. A couple might also have more time to spend with each other and invest in their relationship as a couple. Children are expensive and time-consuming.
On the one hand, children can provide great joy and fulfillment. On the other hand, they also can cause problems, stress, and strain. Infertile couples (as well as fertile couples) may benefit from evaluating both sides of the issue.
Highlight 2.7 discusses the effects of macro systems on infertility.
Highlight 2.7
The Effects of Macro Systems on Infertility
Unlike abortion issues, which are fairly well crystallized and articulated, the issues, ethics, and values concerning infertility and reproductive technologies are only now being discovered and defined. Abortion has been available for a long time. However, modern technology has allowed sophisticated means of artificial fertilization to be undertaken for only a few decades. Additionally, new developments are rapidly advancing.
A major issue is that most fertility enhancement techniques are expensive. They may be available, but not to poor people and the uninsured. Organizations within the community will provide services only if they are paid. Is this fair or appropriate? Should infertile wealthy people be allowed to enjoy such advances when infertile poor people are not? Should these expensive advances be pursued at all in view of the world’s exploding population? Vital philosophical and ethical issues are involved here. Once again, there are no easy answers.
2-7fSocial Work Roles, Infertility, and Empowerment
Social workers may assume a number of roles to empower and help people address infertility: enabler, mediator, educator, broker, analyst/evaluator, and advocate. Social workers can enable people in making their decisions concerning the options available to infertile people. In cases in which the members of a couple disagree for some reason, a social worker can assume a mediator role to help them come to some compromise or mutually satisfactory decision. The social worker as educator can inform clients about options and procedures with specific and accurate data. The broker role is used to connect clients with the specific resources and infertility procedures they need.
The role of analyst/evaluator might be used to evaluate the relative effectiveness of different fertility clinics and the appropriateness of different Helped reproductive technologies to meet a couple’s or individual’s needs. As an advocate, a social worker might need to speak on behalf of clients if they are being denied services or if the process for receiving infertility treatment is overly cumbersome or expensive.
Spotlight 2.3 addresses client empowerment by using a feminist perspective on fertility counseling.
Spotlight on Diversity 2.3
A Feminist Perspective on Infertility Counseling and Empowerment
Feminist principles can be applied to counseling women who discover themselves to be infertile (Georgiades & Grieger, 2003; Solomon, 1988). The medical establishment tends to view infertility as a medical problem that needs to be solved, as dysfunctional equipment that needs to be fixed. Social attitudes tend to support this medical view in four basic ways (Georgiades & Grieger, 2003; Solomon, 1988). First, most people in society aren’t aware of the immense impact the crisis of infertility has on a woman. Second, people tend to look down on infertile women as if a woman can’t possibly live a well-rounded, worthwhile life without bearing children. Third, infertile women experience feelings such as denial, anger, and depression, as do people confronted with any serious loss (Carroll, 2013b). Fourth, infertility can pose a major life crisis for a woman (Yarber & Sayad, 2013). People in crisis are generally more vulnerable, more suggestible, and more easily manipulated than they are during more normal times.
A two-pronged approach to infertility treatment is proposed (Solomon, 1988). First, social workers and other helping professionals should address infertility as a very personal issue (Georgiades & Grieger, 2003). Women who are experiencing the crisis of infertility should be treated as people with other crises are treated. A woman needs to be encouraged to identify and express her feelings, even when they hurt, come to accept her situation, and eventually make decisions about how she wants to proceed. Too frequently, infertile women are told what to do by medical professionals and are led to follow extensive, expensive, complicated, time-consuming procedures that may have little chance of success. It should be acknowledged that the infertile woman is more vulnerable and more likely to respond to medical direction than when she is not experiencing a crisis. Instead, the infertile woman may need specific information about the options available to her, the risks, the amount of effort required to pursue treatment, and help in evaluating which alternative is to her individual best advantage. Each woman needs to evaluate whether she really wants to put forth the amount of effort needed. Infertile women need to be empowered to make their own choices.
The second level involved in a feminist approach concerns the more general social attitudes about women (Hyde, 2008), in this case infertile women and their treatment. Infertile women are stigmatized. They are viewed by society as having something wrong with them, as being incomplete. These attitudes need to be changed. The positive qualities of any life choice need to be emphasized. Women need to recognize their value as individual human beings, not as a failure or success because of their ability or lack of ability to bear children. People as citizens, advocates, and social workers can form pressure groups to encourage more extensive research into the causes and treatment of infertility and to alter the traditional manner in which fertility treatment is done. Women need to be and feel empowered, and to have their choices maximized.
Concept Summary
Technological Procedures to Help in Reproduction
Helped reproductive technology (ART): Procedures to promote pregnancy that involve handling both the sperm and the egg.
Direct sperm injection (intracytoplasmic sperm injection [ICSD]): A process in which a physician, using a microscopic pipette, injects a single sperm into an egg, hopefully resulting in a zygote, which is subsequently placed in the uterus.
Embryo transplant: “A method of conception in which a woman volunteer is artificially inseminated by the male partner of the intended mother, after which the embryo is removed from the volunteer and inserted within the uterus of the intended mother” (Rathus et al., 2014, p. 299).
Gamete intrafallopian transfer (GIFT): A procedure in which collected eggs and sperm are placed directly into a fallopian tube where fertilization, hopefully, will take place.
In vitro fertilization (IVF): A process in which eggs are removed from a woman’s body, fertilized with a sperm in a laboratory dish, and then implanted in the woman’s uterus.
Intrauterine Insemination (IUI) (Artificial insemination [Al]): The “process of injecting the woman with sperm from her partner or a donor” (Yarber & Sayad, 2013, p. 381).
Surrogate motherhood: The procedure in which an egg fertilized using the GIFT or ZIFT process is transferred to the fallopian tube of a surrogate mother (a woman who will bear a child for another woman).
Zygote intrafallopian transfer (ZIFT): A procedure in which eggs and sperm are first combined in a laboratory dish to form a zygote, which is then transferred immediately to the fallopian tube.
Chapter 3
Psychological Development in Infancy and Childhood
hapter Introduction

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Learning Objectives
This chapter will help prepare students to

EP 6a
EP 7b
EP 8b
• LO 1 Summarize psychological theories about personality development (including psychodynamic, neo-Freudian psychoanalytic, behavioral, phenomenological, and feminist theories)
• LO 2 Use critical thinking to evaluate theory
• LO 3 Relate human diversity to psychological theories
• LO 4 Examine Piaget’s theory of cognitive development
• LO 5 Review the information-processing conception of cognitive development
• LO 6 Apply Vygotsky’s theory of cognitive development
• LO 7 Explain emotional development (including the development of temperament and attachment)
• LO 8 Examine self-concept, self-esteem, and empowerment
• LO 9 Discuss intelligence and intelligence testing
• LO 10 Explain cultural biases and IQ tests
• LO 11 Analyze intellectual disabilities and the importance of empowerment
• LO 12 Examine learning disabilities
• LO 13 Discuss attention deficit disorder
“Hey, Barry, wha’d ya get on that spelling test?”
“I got an 87. How about you?”
“Aw, I got a 79. If I get a C in spelling, my ma will kill me.”
“Yeah, Marta got a 100 again. She always ruins it for the rest of us by getting straight A’s.
I’m so sick of Ms. Butcherblock comparing us to her.”
“I hear Billy flunked again. He’s never going to make it into fifth grade.”
“Yeah, Bill’s an okay guy, but he sure isn’t very smart.”
“Only ten more minutes to recess. I’m gettin’ out there first and get the best ball.”
“Wanna bet? I’ll race ya!”
Psychology is defined as the science of mind and behavior. Human psychological development involves personality, cognition, emotion, and self-concept. Each child develops into a unique entity with individual strengths and weaknesses. At the same time, however, some principles and processes apply to the psychological development of all people. Likewise, virtually everyone is subject to similar psychological feelings and reactions that affect their behavior.
This example portrays two schoolboys discussing their current academic careers. Numerous psychological concepts and variables are affecting even this simple interaction. The boys are addressing their own and their peers’ ability to learn and achieve. Learning is easier for some children and more difficult for others. Personality characteristics also come into play. Some children are more dominant and aggressive. Others are more passive. Some young people are more motivated to achieve and win. Others are less interested and enthusiastic. Finally, some children feel good about themselves, and others have poor self-concepts.
A Perspective
Psychological variables interact with biological and social factors to affect an individual’s situation and behavior. Their interaction influences the potential courses of action available to a person at any point in time. This chapter focuses on some of the psychological concepts that critically impact children as they grow up. There are four major thrusts. The first presents a perspective on how personalities develop. The second provides a basic understanding of how children think and learn. The third focuses on emotion, and the fourth on self-concept.
3-1Summarize Psychological Theories about Personality Development
LO 1
How many times have you heard someone make statements such as the following: “She has a great personality,” or “He has a personality like a wet dishrag.” Personality is the complex cluster of mental, emotional, and behavioral characteristics that distinguish a person as an individual. The term may encompass a wide array of characteristics that describe a person. For instance, a person may be described as aggressive, dominant, brilliant, or outgoing. Another individual may be characterized as slow, passive, mousy, or boring. Because personality can include such varying dimensions of personal characteristics, explaining its development can be difficult.
This section reviews a number of psychological theories that aim to provide conceptual frameworks for explaining why individual personalities develop as they do. Many more psychological theories exist. Theories addressed in this text were chosen because of their historical significance, widespread use, and relevance to social work assessment and practice. They include psychodynamic theory, neo-Freudian psychoanalytic theory, phenomenological theories, and feminist theories. Behavioral theory is mentioned only briefly here; Chapter 4 covers it extensively within the context of its application to effective parenting. Chapter 7 addresses other psychological theories in depth, including those of Erik Erikson and Lawrence Kohlberg, and applies them to adolescence and young adulthood.
3-1aThe Psychodynamic Conceptual Framework
Sigmund Freud is perhaps the best known of all personality theorists. This section discusses psychodynamic theory in some detail because of its historical significance. Arlow (1995) explains: “Originating as a method for treating psychoneurotic disorders, psychoanalysis has come to serve as the foundation for a general theory of psychology. Knowledge derived from the treatment of individual patients has led to insights into art, religion, social organization, child development, and education” (p. 15).
Adler (2006) describes Freud as the
theoretician who explored a vast new realm of the mind, the unconscious: a roiling dungeon of painful memories clamoring to be heard and now and then escaping into awareness by way of dreams, slips of the tongue and mental illness … [He was the] philosopher who identified childhood experience, not racial destiny or family fate, as the crucible of character … Not many still seek a cure on a psychoanalyst’s couch four days a week, but the vast proliferation of talk therapies—Jungian and Adlerian analyses, cognitive behavioral and psychodynamic therapy—testify to the enduring power of his idea. (p. 43)
Freud’s conception of the mind was two dimensional, as indicated in Figure 3.1. One dimension of the mind consisted of the conscious, the preconscious, and the unconscious. Freud thought that the mind was composed of thoughts (ideas), feelings, instincts, drives, conflicts, and motives. Most of these elements in the mind were thought to be located in the unconscious or preconscious. Elements in the preconscious area had a fair chance to become conscious, whereas elements in the unconscious were unlikely to arise to a person’s conscious mind. The small conscious cap at the top of Figure 3.1 indicates Freud’s theory that a person was aware of only a fraction of the total thoughts, drives, conflicts, motives, and feelings in the mind.
Figure 3.1Freud’s Conception of the Mind

The repressed area was a barrier under which disturbing material (primarily thoughts and feelings) had been placed by the defense mechanism of repression. Repression is a process in which unacceptable desires, memories, and thoughts are excluded from consciousness by sending the material into the unconscious under the repressed barrier. Freud thought that once a material has been repressed, it has energy and acts as an unconscious irritant, producing unwanted emotions and bizarre behavior, such as anger, nightmares, hallucinations, and enuresis.
The Id, Superego, and Ego
The second dimension of the mind was composed of the id, superego, and ego. These parts are interrelated and impact the functioning of each other.
The id is the primitive psychic force hidden in the unconscious. It represents the basic needs and drives on which other personality factors are built. The id involves all of the basic instincts that people need to survive. These include hunger, thirst, sex, and self-preservation. The id is governed by the pleasure principle; that is, the instincts within the id seek to be expressed regardless of the consequences. Freud believed that these basic drives, or instincts, involved in the id provide the main energy source for personality development. When the id is deprived of one of its needs, the resulting tension motivates a person to relieve the discomfort and satisfy the need. The id’s relationship with the ego allows a person to rationally determine a means to fulfill the need.
The ego is the rational component of the mind. It begins to develop, through experience, shortly after birth. The ego controls a person’s thinking and acts as the coordinator of personality. Operating according to the reality principle, the ego evaluates consequences and determines courses of action in a rational manner. The id indicates to a person what is needed or wanted. The ego then helps the person figure out how to get it.
The third component of this dimension of the mind is the superego, or conscience. Normally developing between the ages of 3 and 5, it consists of the traditional values and mores of society that are interpreted to a child by the parents. The superego’s main function is to determine whether something is right or wrong. When an instinctual demand strives for expression that the superego disapproves of, the superego sends a signal of anxiety as a warning to the ego to prevent the expression of the instinct. The emotion of guilt is said to originate from the superego. Without the superego to provide a sense of right and wrong, a person would be completely selfish. That is, a person would use the ego to rationally determine a means of getting what the id wanted, regardless of the consequences on other people.
An example of how the id, ego, and superego might function together is provided in the case of a 9-year-old girl looking at a hand-carved wooden horse in a store (she adores horses and hopes to own one someday). She has only $26.67 to her name and the wooden horse she craves costs $45.00. Her id, functioning by the pleasure principle, urges her to take the toy horse. Her ego reasons that she could slip the horse under her jacket and race out of the store. Her ego also encourages her to look to see if anyone, especially those “nosy” clerks, are anywhere around. She’s just about to do it when her superego propels itself into action. Clearly reminding her that stealing is wrong, it raises questions such as what her parents would think about her if she were to get caught. They would be terribly disappointed. Maybe she would even be kicked out of Girl Scouts. As a result, the girl gives the toy horse one last lingering look, sighs, and starts on her way home. Her ego has already begun to work on how much lawn mowing she will have to do to earn the money needed to purchase the wooden toy horse.
Psychosexual Development
Freud came to realize that many people had sexual conflicts, and he made sexuality a focus of his theories. The term he used for the energy of the id’s biological instincts was libido. This energy was primarily conceived as being sexual energy. Freud thought sexuality included physical love, affectionate impulses, self-love, love for parents and children, and friendship associations.
Freud further conceptualized that people in their development of personality progressed through five consecutive phases. During any one of the earlier phases, conflicts or disturbances could arise that, if not resolved, could fixate that person in some ways at that particular level of development. According to Freud, the term fixated meant that a person’s personality development was largely, though not completely, halted at a particular stage. In order to develop optimal mental health, an individual would either have to resolve these crises and/or use one of several defense mechanisms. A defense mechanism involves any unconscious attempt to adjust to conditions that are painful. These conditions may include anxiety, frustration, or guilt. Defense mechanisms are measures through which a person preserves his or her self-esteem and softens the blow of failure, deprivation, or guilt. Some of these mechanisms are positive and helpful. Others only help avoid positive resolution of conflict. Highlight 3.1 defines common defense mechanisms postulated by Freud.
Highlight 3.1
Definitions of Common Defense Mechanisms Postulated by Psychoanalytic Theory
• Compensation: struggling to make up for feelings of inferiority or areas of weakness. For example, a stock market analyst’s intense, aggressive competitiveness might be geared to compensating for internal feelings of inferiority. Or a man who was a weakling as a child might work to become a Mr. Atlas competition bodybuilder as an adult to compensate for his former weakness.
• Repression: mechanism through which unacceptable desires, feelings, memories, and thoughts are excluded from consciousness by being sent down deep into the unconscious. For example, you might repress an unpleasant incident, such as a fight with your best friend, by blocking it from your conscious memory.
• Sublimation: mechanism whereby consciously unacceptable instinctual demands are channeled into acceptable forms for gratification. For example, aggression can be converted into athletic activity.
• Denial: mechanism through which a person escapes psychic pain associated with reality by unconsciously rejecting reality. For example, a mother may persistently deny that her child has died.
• Identification: mechanism through which a person takes on the attitudes, behavior, or personal attributes of another person whom he or she had idealized (parent, relative, popular hero, etc.). Reaction formation: blocking out “threatening impulses or feelings” by acting out an “opposite behavior”; for example, a mother who resents her children might emphasize how much she loves them and could never live without them (Coon, 2002, p. 413).
• Regression: mechanism that involves a person falling back to an earlier phase of development in which he or she felt secure. Some adults when ill, for example, will act more childish and demanding, with the unconscious goal of having others around them give them more care and attention.
• Projection: mechanism through which a person unconsciously attributes his or her own unacceptable ideas or impulses to another. For example, a person who has an urge to hurt others may feel that others are trying to hurt him.
• Rationalization: mechanism by which an individual, faced with frustration or with criticism of his or her actions, finds justification for them by disguising from him- or herself (as he or she hopes to disguise from others) his or her true motivations. Often, this is accomplished by a series of excuses that are believed by the person. For example, a student who fails an exam may blame it on poor teaching or having long work hours, rather than consciously acknowledging the real reasons—for instance, that she had “partied hardy” the night before.
Freud’s phases of psychosexual and personality development include the oral, anal, phallic, latency, and genital stages.
Oral Stage
This phase extends from birth to approximately 18 months. It is called oral because the primary activities of a child are centered around feeding and the organs (mouth, lips, and tongue) associated with that function. Feeding is considered to be an important area of conflict, and a child’s attention is focused on receiving and taking. People fixated at this stage were thought to have severe personality disorders, such as schizophrenia or psychotic depression.
Anal Stage
Between the ages of 18 months and 3 years, a child’s activities are mainly focused on giving and withholding, primarily connected with retaining and passing feces. Bowel training is an important area of conflict. People fixated at this stage may have such character traits as messiness, stubbornness, rebelliousness; or they may have a reaction formation and have such opposite traits as being meticulously clean and excessively punctual.
Phallic Stage
From ages 3 through 5, the child’s attention shifts to the genitals. Prominent activities are pleasurable sensations from genital stimulation, showing off one’s body, and looking at the bodies of others. Also, a child’s personality becomes more complex during this stage. Although self-centered, the child wants to love and be loved and seeks to be admired. Character traits that are apt to develop from fixation at this stage are pride, promiscuity, and self-hatred.
Boys and girls experience separate complexes during this stage. Boys encounter an Oedipus complex. This is the dilemma faced by every son at this age when he falls sexually in love with his mother. At the same time, he is antagonistic toward his father, whom he views as a rival for her affections. As the intensity of both these relationships mount, the son increasingly suffers from castration anxiety; that is, he fears his father is going to discover his “affair” with his mother and remove his genitals. Successful resolution of the Oedipus complex occurs through defense mechanisms. A typical resolution is for the son to first repress his feelings of love for his mother and his hostile feelings toward his father. Next, the son has a reaction formation in which he stops viewing his father negatively, and turns this around and has positive feelings toward his father. The final step is for the son to identify with his father, and thereby seek to take on the attitudes, values, and behavior patterns of his father.
Girls, on the other hand, undergo an Electra complex during this phallic stage. Freud believed girls fall sexually in love with their fathers at this age. Meanwhile, they also view their mother with antagonism. Because of these relationships, girls also suffer from castration anxiety, but the nature of this anxiety is different from that of boys. Castration anxiety in a girl results from the awareness that she lacks a penis. She then concludes she was castrated in infancy and blames her mother for this. Freud went on to theorize that because girls believe they have been castrated they come to regard themselves as inferior to boys (i.e., they have penis envy). Therefore, they perceive that their role in life is to be submissive and supportive of males. Freud did not identify the precise processes for resolution of the Electra complex in girls.
Latency Stage
This stage usually begins at the time when the Oedipus/Electra complexes are resolved and ends with puberty. The sexual instinct is relatively unaroused during this stage. The child can now be socialized and become involved in the education process and in learning skills.
Genital Stage
This stage, which occurs from puberty to death, involves mature sexuality. The person reaching this stage is fully able to love and to work. Again, we see Freud’s emphasis on the work ethic, the idea that hard work is a very important part of life, in addition to being necessary to attaining one’s life goals. This ethic was highly valued in Freud’s time. Freud theorized that personality development was largely completed by the end of puberty, with few changes thereafter.
Psychopathological Development
Freud theorized that disturbances can arise from several sources. One source was traumatic experiences that a person’s ego is not able to cope with directly and therefore strives to resolve using such defense mechanisms as repression. Breuer and Freud (1895) provide an example of a woman named Anna O. who developed a psychosomatic paralysis of her right arm. Anna O. was sitting by her father’s bedside (her father was gravely ill) when she dozed off and had a nightmare that a big black snake was attacking her father. She awoke terrified and hastily repressed her thoughts and feelings about this nightmare for fear of alarming her father. During the time she was asleep, her right arm was resting over the back of a chair and became “numb.” Freud theorized that the energy connected with the repressed material then took over physiological control of her arm, and a psychological paralysis resulted.
In addition to unresolved traumatic events, Freud thought that internal unconscious processes could also cause disturbances. There was a range of possible sources. An unresolved Electra or Oedipus complex could lead to a malformed superego and thus lead a person to have a variety of sexual problems—such as frigidity, promiscuity, sexual dysfunctions, excessive sexual fantasies, and nightmares with sexual content. Unresolved internal conflicts (e.g., an unconscious liking and hatred of one’s parents) might cause such behavioral problems as hostile and aggressive behavior and such emotional problems as temper tantrums. Fixations at early stages of development were another source that largely prevented development at later stages and led the person to display such undesirable personality traits as messiness or stubbornness.
As indicated earlier, the main source of anxiety was thought to be sexual frustrations. Freud thought that anxiety would arise when a sexual instinct sought expression, but was blocked by the ego. If the instinct was not then diverted through defense mechanisms, the energy connected with sexual instincts was transformed into anxiety.
An obsession (a recurring thought such as a song repeatedly on your mind) and a compulsion (“an act a person feels driven to repeat, often against his or her will,” such as an urge to step on every crack of a sidewalk) were thought to be mechanisms through which a person was working off energy connected with disturbing unconscious material (Coon, 2002, pp. 448–449).
Unconscious processes were thought to be the causes for all types of mental disorders. These unconscious processes were almost always connected with traumatic experiences, particularly those in childhood.
3-1bCritical Thinking: Assessment of Psychodynamic Theory
We have established that critical thinking is “the careful examination and Assessment of beliefs and actions” to establish an independent decision about what is true and what is not (Gibbs & Gambrill, 1999, p. 3). It entails the ability to evaluate carefully the validity of an assumption and even of a so-called fact. Critical thinking can be used concerning almost any issue, condition, statement, or theory, including psychodynamic theory.
Freud was virtually the first to focus on the impact of the family on human development. He was also one of the earliest, most positive proponents of good mental health. However, he was a product of the nineteenth and early twentieth centuries, and many of his ideas are subject to serious contemporary criticisms.
First, research does not support either the existence of his theoretical constructs or the effectiveness of his therapeutic method. Part of this lack may be due to the abstract nature of his concepts. It is very difficult, if not impossible, to pinpoint the location and exact nature of the superego.
The second criticism involves the lack of clarity in many of his ideas. For instance, although Freud asserts that the resolution of a boy’s Oedipus complex results in the formation of the superego, he never clarifies how this occurs. Nor does he ever clearly explain the means by which girls might resolve the Electra complex.
The Electra complex leads us to a third criticism of Freud’s theories. Women never really attain either an equal or a positive status within the theory. Essentially, women are left in the disadvantaged position of feeling perpetual grief at not having a penis, suffering eternal inferiority with respect to men, and being doomed to the everlasting limbo of inability to resolve an Electra complex.
3-1cNeo-Freudian Psychoanalytic Developments
Since Freud’s time, many other theorists have modified and expanded on his ideas. These theorists, often referred to as neo-Freudians, or ego psychologists, include Carl Jung, Erich Fromm, Alfred Adler, and Harry Stack Sullivan, among others. In general, they are more concerned with the ego and the surrounding social environment than the role of instincts, libido, and psychosexual stages, which were central to Freud’s perspective.
Carl Jung, who lived from 1875 to 1961, was a Swiss psychologist originally associated with Freud. He later developed his own approach to psychology, called analytic psychology. Jung thought of the mind as more than merely a summation of an individual’s past experiences. He proposed the idea of an inherited “collective unconscious.” Each person’s individual experiences somehow melded into this collective unconscious, which was part of all people. He theorized that this gave people a sense of their goals and directions for the future. Jung stressed that people have a religious, mystical component in their unconscious. Jung was fascinated with people’s dreams and the interpretation of their meaning. He also minimized the role that sexuality plays in emotional disorders.
Erich Fromm came to the United States from Germany in 1934. Whereas Freud had a primarily biological orientation in his analysis of human behavior, Fromm had a social orientation. In other words, he hypothesized that people are best understood within a social context. He focused on how people interact with others. Individual character traits then evolve from these social interactions. Fromm used psychoanalysis as a tool for understanding various social and historical processes and the behavior of political leaders.
Alfred Adler was also associated with Freud in his earlier years. After breaking with Freud in 1911 because of his basic rejection of Freud’s libidinal theory, he went on to develop what he called “individual psychology,” which emphasized social interaction. Adler saw people as creative, responsible individuals who guide their own growth and development through interactions with others in their social environment (Mosak & Maniacci, 2011). Adler theorized that each person’s unique striving process or lifestyle “is sometimes self-defeating because of inferiority feelings. The individual with ‘psychopathology’ is discouraged rather than sick, and the therapeutic task is to encourage the person to activate his or her social interest and to develop a new lifestyle through relationship, analysis, and action methods” (Mosak & Maniacci, 2011, p. 67). This social interest, an inborn trait, guides each person’s behavior and stresses cooperation with others.
Of all the neo-Freudians, Harry Stack Sullivan, an American psychiatrist who lived from 1892 to 1949, made perhaps some of the most radical deviations from Freudian theory. He abandoned many of the basic Freudian concepts and terms. Like Adler, Sullivan emphasized that each individual personality developed on the basis of interpersonal relationships. He proposed that people generally have two basic needs, one for security and one for satisfaction. Whenever a conflict arose between these two needs, the result was some form of emotional disturbance. He emphasized that to improve interaction, communication problems must be overcome. Sullivan placed “greater emphasis upon developmental child psychology” than did Adler, and proposed six developmental stages ranging from infancy to late adolescence (Mosak, 1995; Mosak & Maniacci, 2011, p. 72).
Neo-Freudians have had a great impact on the way we think about ourselves and on the ways in which we view psychotherapy. However, they have not produced hypotheses that are specific enough to be tested scientifically. Most of these theorists were psychotherapists and writers focusing on philosophical interest rather than scientists who conducted rigorous research. Therefore, their major usefulness may involve providing ideas and ways to think about human behavior rather than contributing to the scientific foundation of psychology.
3-1dBehavioral Conceptual Frameworks
Behavioral or learning theories differ from many other personality theories in one basic way. Instead of focusing on internal motivations, needs, and perceptions, behavioral theories focus on specific observable behaviors.
Behavioral theories state that people learn or acquire their behaviors. This learning process follows certain basic principles. For example, behavior can be increased or strengthened by receiving positive reinforcement.
Behavioral theories encompass a vast array of different perspectives and applications. However, they all focus on behavior and how it is learned. More recently, greater attention has been given to the complex nature of social situations and how people react in them (Kazdin, 2008b, 2013; Wilson, 2011). This involves people’s perceptions about different situations and their ability to distinguish between one and another. More credit is given to people’s ability to think, discriminate, and make choices. This perspective in behavioral theory is frequently called social learning or social behavioral theory. Behavior is seen as occurring within a social context. Chapter 4 discusses social learning theory in depth and applies it to effective parenting. Therefore, it is addressed only briefly here.
3-1ePhenomenological Conceptual Frameworks: Carl Rogers
Phenomenological or self theories of personality focus on particular individuals’ perceptions of the world, and how these individuals feel about these experiences. A person is viewed as having various experiences and developing a personality as a result of these subjective experiences, rather than as being born with a specified personality framework. These theories assert that there are no predetermined patterns of personality development. Rather, phenomenological theories recognize a wider range of options or possibilities for personality development, depending on the individual’s life experiences. Uniqueness of the individual personality is emphasized. Each individual has a configuration of personal experiences that will produce a personality unlike any other. This is a relatively positive theoretical approach in that it focuses on growth and self-actualization.
One of the best-known self theorists, Carl Rogers, is the founder of person-centered (previously known as client-centered) therapy, which is based on his self theory. One of Rogers’s basic concept is the self, or self-concept. Rogers defines these terms as the “organized, consistent, conceptual gestalt composed of perceptions of the characteristics of the ‘I’ or ‘me’ and the perceptions of the relationships of the ‘I’ or ‘me’ to others and to various aspects of life, together with the values attached to these perceptions” (Raskin, Rogers, & Witty, 2011; Rogers, 1959, p. 200). In other words, self-concept is a person’s perception of and feelings about him- or herself, including his or her personality, strengths, weaknesses, and relationships with others. A person is the product of his or her own experience and how he or she perceives these experiences. Life, therefore, provides a host of opportunities to grow and thrive.
Rogers maintains that there is a natural tendency toward self-actualization—that is, the tendency for every person to develop capacities that serve to maintain or enhance the person (Raskin et al., 2011; Rogers, 1959). People are naturally motivated toward becoming fulfilled through new experiences.
In contrast to Freud, who viewed the basic nature of human beings as evil (having immoral, asocial instincts), Rogers views humans as being inherently good. Rogers believes that if a person remains relatively free of influence attempts from others, the self-actualization motive will lead to a sociable, cooperative, creative, and self-directed person.
The driving force in personality development is seen by client-centered theorists as the “self-actualization motive,” which seeks to optimally develop a person’s capacities. As an infant grows, the infant’s “self-concept” begins to be formed. The development of the self-concept is highly dependent on the individual’s perceptions of his or her experiences. The person’s perceptions of experiences are influenced by the “need for positive regard” (to be valued by others). The need for positive regard is seen as a universal need in every person (Raskin et al., 2011; Rogers, 1959). Out of the variety of experiences of frustration or satisfaction of the need for positive regard, the person develops a “sense of self-regard”—that is, the learned perception of self-worth that is based on the perceived attention and esteem received from others.
Although self-actualization is a natural process as people mature, they often encounter barriers. Ivey, D’ Andrea, Ivey, and Simek-Morgan (2002) introduce the dynamics involved:
A critical issue in Rogerian counseling is the discrepancy that often occurs between the real self [the person one actually is] and the ideal self [the person one would like to be]. Individuals need to see themselves as worthy. Often individuals lose sight of what they really are in an effort to attain an idealized image … This discrepancy between thought and reality, between self-perception and others’ perceptions, or between self and experience leads to incongruities. These incongruities in turn result in areas in which individuals are not truly themselves … The objective of therapy … is to resolve the discrepancies between ideal and real self, thus eliminating the tension and substituting forward-moving self-actualization. (pp. 248–249) (emphasis added)
One type of barrier to self-actualization involves a child’s introjection (taking on) of others’ values that are inconsistent with his or her self-actualizing motive. The introjection of values inconsistent with one’s self-actualizing motive results in conditions of worth—a person’s perceptions that he or she is only valuable when behaving as others expect and prefer him or her to act. A person, then, is only worthy (of value) under the condition that he or she behaves as expected. Good and Beitman (2006, p. 30) explain:
[Emotional and intellectual] growth is interfered with by conditions of worth outside of their awareness. Specifically, as children grow up and seek positive regard from others, they experience conflicts between their inner wishes and those of their caregivers. Children gradually internalize their caregivers’ appraisals of them, thereby developing conditions of worth (beliefs like “I am worthy when I do what others expect of me”). However, these conditions of worth occasionally are incongruous with people’s true inner selves. Hence, conflicts and discrepancies develop between people’s conscious, introjected values (taken in from others as one’s own) and their unconscious genuine values. As an example, a child growing up in a racist-homophobic community may experience criticism if he or she does not reflect the views of those around [him or her] … The child may introject … the discriminatory views of others as his/her own, even though such views conflict with his/her unconscious appreciation of diverse people.
Another example of incongruence involves a child who introjects values from her parents that sex is dirty or that dancing is bad. When that child reaches adolescence, she may feel morally righteous and view herself as being a value setter for refusing to dance or date. This reflects her ideal self, the person she would like to be. However, she may then experience that peers relate to her as being a prude with archaic values. Although her introjected values forbid her from dancing or dating, her real self may have a strong desire to participate. Incongruence occurs when a discrepancy exists between a person’s ideal self and real self, or self-concept and experience, resulting in tension, anxiety, and internal confusion.
An individual responds to incongruence between aspects of self and experiences in a variety of ways. One way is to use various defense mechanisms. A person may deny that experiences are in conflict with his or her self-concept. Or the person may distort or rationalize the experiences so that they are perceived as being consistent with his or her self-concept. If a person is unable to reduce the inconsistency through such defense mechanisms, the person is forced to face the fact that incongruences exist between self and experiences. This leads the person to feel unwanted emotions (such as anxiety, tension, depression, guilt, or shame) and potentially experience psychological maladjustment.
An individual then might enter therapy to resolve these problems and incongruences.
The therapist’s role is best characterized as nondirective. Therapists create a permissive, nonthreatening atmosphere in which clients feel accepted and feel free to explore their defenses and the incongruences between self and experiences. If growth is to occur, each person must assume responsibility for their actions, decisions, and behavior. Significant and enduring change must be self-initiated. Therefore, complete responsibility for the direction of treatment rests with the client. Client-centered therapists do not bring up subjects to discuss, give advice, make interpretations, or provide suggestions. Client-centered therapists believe that a person’s self-actualization motive best knows what courses of action they should take, and therefore client-centered therapy focuses on helping the client gain insight into inconsistent values and then allowing the self-actualizing processes to determine future directions.
Eysenck (1965) reviewed outcome studies conducted on the effectiveness of contemporary psychotherapy approaches, including that of client-centered therapy. The results are not encouraging for client-centered therapy because the studies of this approach fail to demonstrate that clients receiving this therapy improve at a higher rate than control groups of people with similar problems.
Why these rather discouraging results? It would seem that even though developing a helping relationship and helping clients gain insight into their problems are essential parts of counseling, these elements do not constitute the total healing process. Clients need to understand the nature and causes of their problems, but they also need to know what courses of action they can take to resolve the problem. Client-centered therapists do not inform clients of available resolution strategies, because they believe it is the clients’ responsibility to figure this out for themselves. Many therapists, such as Glasser (1965), point out the importance of having the counselor suggest various alternatives, of helping clients explore the merits and consequences of these alternatives, and then having clients make commitments (contracts) to try one of these alternatives.
3-1fFeminist Conceptual Frameworks

EP 2a
EP 2c
Feminist theories are based on the concept of feminism and the basic themes involved in that definition. Feminism is the “doctrine advocating social, political, and economic rights for women equal to those of men” and the “movement for the attainment of such rights” (Nichols, 1999, p. 483). They are included here with other theories of personality development because they provide a context for women’s development and experience throughout the life span.
Concept Summary
Client-Centered Therapy
• Ideal self: the person one would like to be.
• Conditions of worth: a person’s perception that he or she is only valuable when behaving as others expect and prefer him or her to act (only worthy under certain conditions).
• Incongruence: a discrepancy between a person’s ideal self and real self, or self-concept and experience, resulting in tension, anxiety, and internal confusion.
• Need for positive regard: the need to be valued by others.
• Psychological maladjustment: the condition in which a person experiences significant incongruence between self and experiences, resulting in emotional and psychological problems.
• Real self: the person one actually is.
• Self-actualization: the tendency for every person to develop capacities that serve to maintain or enhance the person.
• Self-concept: a person’s perception of and feelings about him- or herself, including his or her personality, strengths weaknesses, and relationships with others.
• Sense of self-regard: the learned perception of self-worth that is based on the perceived attention and esteem received from others.
Hyde and Else-Quest (2013) remark on the development of feminist theories:
Feminist theories were created by no single person. Instead, numerous writers have contributed their ideas, consistent with the desire of feminists to avoid power hierarchies and not to have a single person become the sole authority. But it also means that the feminist perspective … has been drawn from many sources. (p. 50)
Because of the multiple origins and ongoing nature inherent in their development, we refer to feminist theories instead of feminist theory. At least nine principles underlie these approaches.
First, feminist theories emphasize the “elimination of false dichotomies” (Van Den Bergh & Cooper, 1986, p. 4). That is, people should critically evaluate the way thought and behavioral expectations are structured within the culture. Western culture emphasizes separating people, things, and events into mutually exclusive categories. For example, people are classified as either male or female on the basis of biology. These categories are “viewed as mutually exclusive entities that should be manifest for one gender but not the other. Distinctions between the sexes, rather than commonalities, are emphasized” (Van Den Bergh & Cooper, 1986, p. 4). A traditional Western view stresses that men and women should have different traits such as women being emotional, social caregivers and men being strong, working, decision makers. In contrast, a feminist perspective emphasizes acknowledging and appreciating a balance of these traits for each male or female as an individual.
A second principle underlying feminist theories is “rethinking knowledge” (Hunter College Women’s Studies Collective, 1995, p. 63). In some ways, this is related to the first principle because they both involve how people think and view the world. Rethinking knowledge involves critically evaluating not only how you think about something, but also what you think about. It involves which ideas and thoughts are considered to reflect “facts” and which are thought to have value. Consider the following point:
Not only have topics of interest to women, but of less interest to men, such as rape, the sexual abuse of children, employment patterns among women, or the histories of women’s lives, been simply left out of traditional disciplines, but the very concepts and assumptions with which inquiry has proceeded have reflected a male rather than a universal point of view. (The Hunter College Women’s Studies Collective, 1995, p. 63)
A third dimension characterizing feminist theories is the recognition that differences exist in male and female experiences throughout the life span (Hyde, 2008; Land, 1995). One aspect of this dimension is the feminist focus on the impact of gender-role socialization. A gender role is the cluster of “culturally defined expectations that define how people of one gender ought to behave” (Hyde & DeLamater, 2014, p. 592). Socialization is the developmental process of teaching members of a culture the appropriate and expected pattern of values and behavior. Hyde and Else-Quest (2013) elaborate:
From their earliest years, children are socialized to conform to these roles … Essentially, gender roles tell children that there are certain things they may not do, whether telling a girl that she cannot be a physicist or a boy that he cannot be a nurse. Because gender roles shut off individual potential and aspirations, feminists believe that we would be better off without such roles or at least they need to be radically revised. (p. 52)
Gilligan’s (1982) work on the moral development of women, described in Chapter 7, provides a good example of work focusing on gender-related differences in life experience. Her proposed sequence of levels and transitions differ significantly from the traditional stages of moral development proposed by Kohlberg (1963, 1968, 1969, 1981a, 1981b), arguing that the latter relate primarily to the experience of men.
A fourth principle inherent in feminist theories is egalitarianism, a philosophy that people should be treated equally as individuals without focusing on gender (Hyde, 2008). This approach diverges from the traditional emphasis on hierarchies of power, where some (historically, men) have greater power and control over others. An egalitarian perspective is democratic, emphasizing the use of consensus building, collaboration, and the sharing of tasks (Hyde, 2008).
The fifth feminist principle, closely related to that of ending patriarchy, is that of empowerment (Hyde, 2008; Land, 1995; Netting & O’Connor, 2003), defined as the “process of increasing personal, interpersonal, or political power so that individuals can take action to improve their life situations” (Gutierrez, 2001, p. 210). A feminist perspective emphasizes the need to empower women, enhance their potential for self-determination, and expand opportunities. Means of empowerment include assertiveness training, enhancing self-esteem, improving communication and problem-solving skills, and learning conflict resolution and negotiating skills (Van Den Bergh & Cooper, 1986).
A sixth concept underlying feminist theories is that of “valuing process equally with product” (Hyde, 2008; Van Den Bergh & Cooper, 1986, p. 6). It is not only important what you get done, but how you get it done. A traditional patriarchal approach stresses the importance of the end result. For example, the fact that a male chief executive officer of a large oil company has amassed amazing wealth is considered significant. The traditional view would not consider how he had hoarded his wealth as significant (by ruthlessly stepping on competitors, breaking environmental regulations, and consistently making decisions on his own, not the employees’ nor the public’s, best interests). Feminist theories focus on decision making based on equality and participation by all. The concept of “having power over” others is irrelevant. Thus, feminist theories focus on aspects of process such as making certain all participants have the chance to speak and be heard, adhering to principles of ethical behavior, working toward agreement or consensus, and considering personal issues as important.
A seventh underlying principle in feminist theories is the idea that “the personal is political” (Bricker-Jenkins & Lockett, 1995, p. 2531; GlenMaye, 1998; Hyde, 2008). Personal experience is integrally intertwined with the social and political environment. Sexism is “prejudice or discrimination based on sex, especially discrimination against women” that involves “behavior, conditions, or attitudes that foster stereotypes of social roles based on sex” (Mish, 2008, p. 1141). Feminist theories maintain that sexism is the result of the social and political structure. It does not simply involve problems experienced by isolated individuals.
Another implication of this principle is that the political environment can be changed and improved by personal actions. Thus, personal experience can be used to alter the political environment, which in turn can improve the personal experience. For example, individual women can collectively campaign for a candidate who supports women’s issues, thus applying their personal actions to the political arena. As a result, the candidate gets elected and seeks to improve her supporters’ work environments and access to resources, a political result that affects women’s personal lives.
An eighth feminist principle involves unity and diversity (Bricker-Jenkins & Hooyman, 1986; Bricker-Jenkins & Lockett, 1995; Hyde, 2008). Women working together can achieve a better quality of life for all. In order to remain unified, women must appreciate each other’s differences. Diversity is viewed as a source of strength.
A ninth dimension inherent in feminist theories is the importance of advocating for positive change on women’s behalf (Hyde, 2008). Feminist theories go beyond the simple recognition of inequities in cultural expectations, individual rights, and options. Feminist frameworks stress the importance of making structural and attitudinal changes to attain equality and enhance opportunity for everyone.
Spotlight 3.1 discusses the diversity of feminist theories that vary in their relative emphasis on these nine concepts.
Spotlight on Diversity 3.1
Diversity in Feminism
Hyde and Else-Quest (2013) categorize five major approaches among feminist theorists. These include liberal feminism, cultural feminism, Marxist or socialist feminism, radical feminism, and postmodern feminism. Note, however, that these categories are presented only to stimulate your thinking about these issues. In reality, each individual has his or her own views that may involve some blend of these and many other perspectives.
Liberal Feminism
“Liberal feminism holds that women should have opportunities and rights equal to those of men” (Hyde & Else-Quest, 2013, p. 53). This is a relatively optimistic view that American society is founded on a sound basis of positive values including “justice and freedom for all” (Hyde & Else-Quest, 2013, p. 53). However, liberal feminism also acknowledges that injustice on the basis of gender does indeed exist for women. Therefore, there should be an ongoing pursuit of legal, social, and educational change that pursues real equality for women. The National Organization for Women (NOW) generally reflects a liberal feminist perspective.
Some of the issues that have been addressed by liberal feminism include pay inequities in the workplace (e.g., women earn significantly less than men), gender segregation (e.g., women tend to be clustered in lower-paying occupations and men in higher ones), and hitting the glass ceiling (i.e., a barrier involving psychological perception and decision making by those in power that prevents women from progressing higher in a power structure just because they are women). Another issue liberal feminism speaks to is the role of men and women in family caregiving (Lorber, 2010). If men and women are equal, to what extent do they and should they assume equal responsibilities in that arena?
Cultural Feminism
“Cultural feminism argues that women have special, unique qualities that differentiate them from men” (Hyde & Else-Quest, 2013, p. 53). This contrasts with liberal feminism, which views women and men as being essentially the same because they’re both human beings. Cultural feminism emphasizes placing greater importance on the positive qualities typically manifested by women, including “nurturing, connectedness, and intuition” (Hyde & Else-Quest, 2013, p. 53). The ongoing goal is to achieve equal but different respect, power, and appreciation.
Marxist or Socialist Feminism
“Marxist or socialist feminism … views the oppression of women as just one instance of oppression,” women being downgraded as one of various classes of people devalued by a capitalistic society (Hyde & Else-Quest, 2013, pp. 53–54). Such dAssessment serves those in power well. For example, consider the significant difference in wages typically earned by women and men (discussed more thoroughly in Chapter 9). “What would happen to the average American corporation if it had to start paying all of its secretaries as much as plumbers earn? (Both jobs require a high school education and a certain amount of manual dexterity and specific skills)” (Hyde & Else-Quest, 2013, p. 54). Marxist feminism seeks a total transformation of the current capitalist system such that wealth would be spread much more equally across classes, including women and other oppressed populations.
Marxist feminism contends that there are “two solutions to women’s exploitation in capitalism: wages for housework and government subsidization of wives and children” (Lorber, 2010, p. 48). This calls for women working in the home to be paid for that work because it is work, just as others are paid for working outside the home (Lorber, 2010).
Radical Feminism
Radical feminism perceives “liberal feminism and cultural feminism as entirely too optimistic about the sources of women’s oppression and the changes needed to end it” (Hyde & Else-Quest, 2013, p. 54). From this perspective, “men’s control” over women “manifests itself in gender roles, family relationships, heterosexuality, and male violence against women, as well as the wider male-dominated world of work, government, religion, and law … For radical feminists, women’s liberation requires the eradication of patriarchy and the creation of women-centered ways of living” (Kirk & Okazawa-Rey, 2010, p. 12). “Collective political and social action [is] … essential. Given the difficulty of changing social institutions, radical feminists sometimes advocate separatist communities in which women can come together to pursue their work free of men’s oppression” (Hyde & Else-Quest, 2013, p. 54).
Postmodern Feminism
“Postmodern feminism is not focused on social action, but rather is an academic movement that seeks to reform thought and research within colleges and universities” (Hyde & Else-Quest, 2013, p. 54). “It is particularly concerned with the issue of epistemology, which is the question of how people—whether lay-people or scientists—know. How do we know about truth and reality?” (Hyde & Else-Quest, 2013, p. 54). “Postmodern feminism claims that gender and sexuality are performances, and that individuals modify their displays of masculinity and femininity to suit their own purposes. Males can masquerade as women, and females can pass for men. Postmodern feminism argues that, like clothing, sexuality and gender can be put on, taken off, and transformed” (Lorber, 2010, p. 195).
Lorber (2010) explains:
Postmodern feminism examines the ways societies create beliefs about gender at any time (now and in the past) with discourses embedded in cultural representations or texts. Not just art, literature, and the mass media, but anything produced by a social group, including newspapers, political pronouncements, and religious liturgy, is a text. A text’s discourse is what it says, does not say, and hints at (sometimes called a subtext). The historical and social context and the material conditions under which a text is produced become part of the text’s discourse. If a movie or newspaper is produced in a time of conservative values or under a repressive political regime, its discourse is going to be different from what is produced during times of openness or social change. Who provides the money, who does the creative work, and who oversees the managerial side all influence what a text conveys to its audience. The projected audience also shapes any text, although the actual audience may read quite different meanings from those intended by the producers. Deconstruction is the process of teasing out all these aspects of a text. (pp. 268–269)
Deconstruction can be applied to any set of beliefs. In a way, it is a form of critical thinking. Deconstruction involves analysis of underlying meanings and assumptions when presented with an occurrence, trend, or so-called fact. It focuses on not how the phenomenon is objectively represented or portrayed, but rather on subjective interpretation within the phenomenon’s social, political, and economic context.
Lorber (2010) continues:
Soap operas and romance novels are “read” by women … action films and war novels are the stuff of men’s spectator-ship. Postmodern feminism deconstructs cultural representations of gender, as seen in movies, video, TV, popular music, advertising— whether aimed at adults, teenagers, or children—as well as paintings, operas, theater productions, ballet, and the Olympics. These are all discourses that overtly and subliminally tell us something about female and male bodies, sexual desire, and gender roles. A romantic song about the man who got away glorifies heterosexuality … These discourses influence the way we think about our world, without questioning the underlying assumptions about gender and sexuality. They encourage approved-of choices about work, marriage, and having children by showing them as normal and rewarding and by showing what is disapproved of as leading to a “bad end.”
By unpacking the covert as well as more obvious meanings of texts, postmodern deconstruction reveals their messages. We can then accept or reject them, or use them for our own purposes. The memoirs and the life histories of transgendered people, and the activities of gay men and lesbian women, as depicted in the media, create a different discourse. (p. 269)
Diversity and Intersectionality
Still another perspective on feminism questions the usefulness of clustering all women together. To what extent are the issues faced by lesbians, white women, and women of color the same or different? Some have criticized various feminist perspectives for giving lesser priorities to the issues confronting female groups other than white women (Hyde & Else-Quest, 2013; Lorber, 2010). Newer trends in feminist research and thinking involve a broader perspective on the human condition (Hyde & Else-Quest, 2013; Lorber, 2010). Examining “women and men across different racial ethnic groups, social classes, religions, nationalities, residencies, [and] occupations” reflects a trend of the future (Lorber, 2010, p. 306).
The concept of intersectionality applies here. Intersectionality is “the idea that people are complex and can belong to multiple, overlapping diverse groups” (Kirst-Ashman, 2013, p. 67). “The intersectional perspective acknowledges the breadth of human experiences, instead of conceptualizing social relations and identities separately in terms of either race or class or gender or age or sexual orientation”; rather, an intersectional approach focuses on the “interactive effects” of belonging to multiple groups (Murphy, Hunt, Zajicek, Norris, & Hamilton, 2009, p. 2). “Race, class, and gender are inseparable determinants of inequalities” that interconnect to generate numerous aspects of oppression; the resulting great burden of oppression can affect interpersonal relationships, people’s rights, how people are treated, and how they go about their daily lives (Murphy et al., 2009, p. 7). For example, “the meaning of womanhood for a middle-class, middle-age, African American woman is different than that held by a working-class, older, White woman” (Murphy et al., 2009, p. 10). (Intersectionality is addressed further in Chapter 5.)
The Feminist Future
The special needs of women and the issues they face must continue to be addressed. The issues, gender roles, and cultural expectations for women of color merit ongoing attention (Hyde & Else-Quest, 2013). Additionally, more awareness, research, and concentrated effort should focus “on adjustment problems in women, particularly on depression, anxiety, alcoholism, and eating disorders, because they can be so devastating. We need to know what causes depression and what can be done to prevent it (e.g., changing child-rearing practices, school policy, violence against women, or family roles)” (Hyde & Else-Quest, 2013, p. 358).
The development of feminist theories is anything but stagnant. There is a dynamic, rapidly growing body of research and ideas that focus on the importance of understanding women’s gender roles, issues, qualities, and oppression. (Chapter 9 addresses women’s needs and issues in much greater depth.)
Ethical Question 3.1

EP 1
1. What are your views about the various approaches to feminism? What is the fair way to treat women and men? What kinds of efforts, if any, do you think should be undertaken to improve current conditions?
Feminist Identity Development
How do people become feminists? One study focused on students enrolled in women’s studies courses, which are, of course, feminist based. Attending such classes tends to modify the attitudes and perceptions of both women and men, although perhaps more significantly for women. Five steps in the development of a feminist identity emerged for women (Bargad & Hyde, 1991; Hyde, 2002; Hyde & Else-Quest, 2013, pp. 358–359):
1. Passive acceptance. During this stage, women simply don’t think critically about gender issues or oppression. They passively accept that the way things are is the way they should be.
2. Revelation. This stage is characterized by the “Aha!” experience that yes, indeed, inequities do exist between women and men. A woman begins to confront issues and think more deeply about oppression. Common reactions during this stage include heated anger and resentment toward men.
3. Embeddedness. At this stage a woman becomes emotionally linked with other women, and receives support and sustenance from them. She begins to feel stronger in her identity as a woman.
4. Synthesis. Now a woman begins to assume a “positive feminist identity” that goes beyond focusing on gender-role differences. She gains greater understanding of herself as a woman and no longer resents men. Rather, she assesses her relationships with men as individuals.
5. Active commitment. During this stage, a woman’s feminist identity is firmly established. She uses her confidence to advocate on behalf of women to address inequities, oppression, and women’s issues.
3-1gCritical Thinking about the Relevance of Theory to Social Work
We have reviewed a number of psychological theories about human behavior that can help us better understand how people function. This section examines how theories are relevant to social work practice, and Highlight 3.2 proposes an approach for evaluating theory.
Highlight 3.2
Use Critical Thinking to Evaluate Theory
LO 2
The Assessment of Theory
There are many ways to evaluate theory. This is partly because theories can concern virtually anything from the best method of planting a garden to whether intelligent extraterrestrials. Four major approaches for evaluating theory are provided here. The approaches are applied to various theories throughout the text and are not necessarily presented in the order of importance. Different theories may require different orders and emphases in terms of how they can best be evaluated.
1. Evaluate the theory’s application to client situations. In what ways is the theory relevant to social work? In what ways does the theory provide a means to help us think about our clients and how to help them? For example, a theory about the mating patterns of gorillas would probably be very difficult to apply to any practice situation. However, a theory that hypothesizes how interpersonal attraction occurs between people might help you to work with an extremely shy, lonely young adult with serious interpersonal problems.
2. Evaluate the research supporting the theory. Research often involves singular, obscure, or puzzling findings. Such findings may be vague and may or may not be true. For example, the sample of people studied in a particular research project may have been extremely small. Thus, results may have been due primarily to chance. Or the sample may not have resembled the entire population very well. Therefore, the results should be applied only to the sample studied and not to anything or anybody else. (Consider this a commercial for why you need to take a research course!) On the one hand, it’s important to be cautious about assuming that any research study establishes a fact. On the other hand, when more and more studies continue to support each other, a fact (or as close as we can come to a fact) may begin to develop.
A student once complained to me about her textbook. She said that the author confused her by presenting “facts”—in reality, research findings—that were contradictory. She said she hated such contradictions and wanted the author to tell her what was or was not a fact. My response was that I didn’t think the world was like that. It cannot be so clearly divided, even though it sometimes seems that it would be more convenient that way. Facts are the closest estimation of the truth we can come to based on the limited information we have. For example, people believed that the world was flat until somebody discovered that it was round. They believed that the northern lights were reflections of sunlight off the polar ice cap until someone discovered that they are really the effect of solar radiation on the earth’s ionosphere.
Research can help establish whether theories portray facts or not. In other words, research can help determine how accurate and useful any particular theory is. We need theories to guide our thinking and our work so that we may undertake research-informed practice.
However, there are at least two problems with evaluating research in support of a theory. First, you might not have access to all, most, or any of the relevant research. Research findings (which often are interpreted as facts) can be found in thousands of journals. Second, there may be no research specifically directed at finding the specific facts you need to help you verify a theory in your own mind.
3. Evaluate the extent to which the theory coincides with social work values and ethics. Does the theory involve an underlying assumption that coincides with the mission of social work. According to the National Association of Social Workers’ (NASW) Code of Ethics, “the primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (NASW, 2008).
One example of how a theory can support or contradict professional ethics involves the ethical standard that social workers must be “sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice” (NASW, 2008). Consider a theory that one group of people is by nature more intelligent than another group. This theory obviously conflicts with professional values. Therefore, it should not be used or supported by social workers.
Another example is the theory that women are too emotional, flighty, and lacking in intellectual capability to vote or hold a political office. This theory was espoused by the powerful majority of men who held public office until 1920, when women finally won the right to vote after a long, drawn-out battle for this right. This theory, too, stands in direct opposition to professional values and ethics.
Another section discusses the importance of being sensitive to human diversity when examining psychological theories. It also introduces several concepts that are useful in that process.
4. Evaluate the existence and validity of other comparable theories. Are there other theories that adhere better to the first three Assessment criteria? If so, which theory or theories should be chosen to guide our assessments and practice?
The medical model and systems theory were compared earlier. The social work profession now subscribes to systems theory, which provides a better perspective for respecting people’s dignity and rights and for targeting the macro environment in order to effect change, reduce oppression, and improve social conditions.
Sometimes, two or more theories will have basic similarities. Recall the discussion concerning the differences between systems theory and the ecological model in Chapter 1. Both approaches provide frameworks for how to analyze the world and what to emphasize. Many of the concepts they employ are similar or identical. It was concluded that the ecological model is an offshoot of systems theory. This text assumes a systems theory perspective, yet adopts some ecological concepts.
For instance, the term system is used in both. Both social environment and coping are ecological terms. Thus, many times it may be determined that a combination of theories provides the best framework for viewing the world within a social work context. Each social worker needs to determine the theoretical framework or combination of frameworks best suited for his or her practice context.
At other times, no theory will be perfectly applicable. Perhaps you will decide that only one or two concepts make any sense to you in terms of working with clients. The quest for the perfect theory resembles the pursuit of the perfect fact. It’s very difficult to achieve perfection. Thus, when evaluating theories, be flexible. Decide which concepts in any particular theory have the most relevance to you and your work with clients.
In Chapter 1, we defined the term theory (or conceptual framework) as a coherent group of principles, concepts, and ideas organized to explain some observable occurrence or trend. In effect, theory provides a way for people to view the world. It helps them sort out and make sense of what they see. Likewise, it aids them in understanding how and why things are the way they are and work the way they do. Different theories provide us with different explanations.
For instance, consider the differences between systems theory and the medical model in trying to explain the reasons for human behavior. From the 1920s to the 1960s, social work programs used a medical model approach to human behavior. The medical model, developed by Sigmund Freud, views clients as “patients.” The task of the social worker providing services is to first diagnose the causes of a patient’s problems and then provide treatment. The patient’s problems are viewed as being inside the patient.
The medical model conceptualizes emotional and behavioral problems as “mental illnesses.” People with such problems are given medical labels such as schizophrenic, psychotic, bipolar, or insane. Adherents of the medical approach believe the disturbed person’s mind is affected by some generally unknown, internal condition, thought to be due to a variety of possible causative factors inside the person. These include genetic endowment, metabolic disorders, infectious diseases, internal conflicts, unconscious uses of defense mechanisms, and traumatic early experiences that cause emotional fixations and prevent future psychological growth.
In the 1960s, social work began questioning the usefulness of the medical model. Environmental factors were shown to be at least as important as internal factors in causing a client’s problems. Also, research demonstrated that psychoanalysis was probably ineffective in treating clients’ problems (Stuart, 1970). Social work shifted at least some of its emphasis to a reform approach. A reform approach seeks to change systems to benefit clients. Antipoverty programs such as Head Start and Job Corps are examples of efforts to change systems to benefit clients.
In the past several decades, social work has increasingly focused on using a systems approach to viewing clients and the world surrounding them. This approach integrates both treatment and reform by emphasizing the dysfunctional transactions between people and their physical and social environments. Human beings are viewed as being in constant interaction with other micro, mezzo, and macro systems within their social environment.
Social workers started to explore both causes and solutions in the environment encompassing any individual client instead of blaming the client. For instance, consider a person who is unemployed and poverty stricken. A social worker assuming a systems perspective would assess the client in situation. This worker would assess not only the problems and abilities of the client but also the client’s interactions with the multiple systems affecting him or her. What services are available to help the person develop needed job skills? What housing is available in the meantime? What aspects of the macro systems in the environment are contributing to the high unemployment and poverty rates? What services need to be developed in order to respond to these needs?
In contrast, the medical model might orient a worker to try to cure or “fix” the individual by providing counseling to help him or her develop a better attitude toward finding a job. There would be an underlying assumption that it was the individual micro system that was somehow at fault.
Thus, theory helps social workers decide how to go about helping people. The medical model versus systems theory is only one example. Throughout this text, a broad range of theories will be presented concerning various aspects of human development and behavior. Assessment of their relevance will often be provided. You, as a future social worker, will be expected to learn how to evaluate theories for yourself in order to apply them to your practice situations. Highlight 3.2 provides some suggestions for how to do this. Spotlight 3.2 stresses the importance of being sensitive to diversity when evaluating theories.
Spotlight on Diversity 3.2
Relate Human Diversity to Psychological Theories
LO 3

EP 2a
EP 2c
Psychological theories of development often focus on prescribed stages through which people progress throughout their lives. Such theories are also oriented to expectations about what is normal and what is abnormal during each stage. An issue facing us as we evaluate psychological theories is the rigidity with which some attempt to structure human development. In reality, people experience different worlds as they progress through their lives and time. We have established that their experiences are altered by many aspects of diversity and the intersectionality of factors. Such factors include “age, class, color, culture, disability and ability, ethnicity, gender, gender identity and expression, immigration status, marital status, political ideology, race, religion/spirituality, sex, sexual orientation, and tribal sovereign status” (CSWE, 2015).
A woman will experience life differently than a man because of variables related to being a woman. An American of Asian background will encounter different treatment and issues than will an American of Northern European origin moving through the same time. Thus, it is critically important to be sensitive to the vast differences people can experience because of their membership in certain groups or other characteristics.
For decades, social work has been moving to view clients and the world from a less rigid, more open-minded perspective that is sensitive to diversity and individual differences. The field has worked “to encompass new perspectives on women’s development and roles and the unique experiences, characteristics, strengths, and coping strategies of African Americans, Latinos, Asians, and other people of color and of other oppressed groups such as gay men and lesbians,” in addition to incorporating principles such as empowerment (Goldstein, 2008). It is up to us as social workers to be sensitive to people’s varying perspectives and needs. We must not make value judgments based on rigid assumptions about how people are supposed to behave. Rather, we must maintain flexibility thinking about human behavior and nurture our appreciation of differences.
People’s progress through life involves much more than distinct, predefined periods tied and limited to a person’s age and development. Rather, we should view life stages and circumstances as the result of integral interaction with many aspects of the environment. Various transitional points are experienced differently depending on an individual’s life context as characterized by the many variables described earlier (Devore & Schlesinger, 1999). The life course may be divided into seven transitional points—entry, childhood, adolescence, emerging adulthood, adulthood, later adulthood, and old age (Devore & Schlesinger, 1999, pp. 68–69). Persons with divergent characteristics and backgrounds can experience these transitional points in distinctly different ways.
For example, during the childhood transitional period, children’s psychological profiles are shaped by the ideas of their parents and of other people around them. This social context, in turn, is the product of culture. Berk (2012a) provides an example:
Culture influences emotional self-regulation. In a striking illustration, researchers studied children in two collectivist [that emphasizes the importance of group well-being above that of the individual] subcultures in rural Nepal. In response to stories about emotionally charged situations (such as peer aggression or unjust parental punishment), Hindu children more often said they would feel angry but would try to mask their feelings. Buddhist children, in contrast, interpreted the situation so that they felt OK, rather than angry. “Why be angry?” they explained. “The event already happened.” In line with this difference, Hindu mothers reported that they often teach their children how to control their emotional behavior, whereas Buddhist mothers pointed to the value their religion places on a calm, peaceful disposition (Cole & Tamang 1998; Cole, Tamang, & Shrestha, 2006). Compared to both Nepalese groups, U.S. children preferred conveying anger verbally in these situations; for example, to an unjust punishment, they answered, “If I say I’m angry, he’ll stop hurting me!” (Cole, Bruschi, & Tamang, 2002). Notice how this response fits with the Western individualistic emphasis on personal rights and self-expression. (p. 491)
Other examples of life-course differences involve the adolescent transitional period. Adolescents raised in different cultural environments with different experiences and treatment view their developing life, gender roles, and sexuality in very diverse ways. A female Puerto Rican adolescent learns her expected role by closely observing her mother and caring for the family’s children; however, there often is no mention of sex (Devore & Schlesinger, 1999). Kelly (2008) comments on Japanese adolescent sexuality:
In Japan, sexuality has been minimized and regulated as being tangential to the performance of responsible duty. Japanese youth consider chastity very important. There is less teenage sexual activity and far less single motherhood than in the United States, although abortion is quite accessible. Japanese youth often rush into sexual activity during late adolescence, as if making up for their more chaste earlier years. As the age of marriage becomes even later, the rate of premarital pregnancies and “shotgun” weddings has been increasing. (p. 159)
The transitional period of emerging adulthood provides more examples of diverse life course experiences. Young people experience this as a time of decision making about marrying or remaining single and pursuing a work or career path. Devore and Schlesinger (1999) remark:
For young Jewish women … [t]he plan to work continues a tradition established long ago by grandmothers and mothers whose diverse occupations were important to the survival of the family. Jewish tradition more easily accepts employment of women. In the present, however, the emerging Jewish woman has choice. The Jewish value of education is traditional but in the past was more reserved for men. Women now attend college in equal numbers with men but may experience conflict as they make the choice. “As a young Jewish woman I am achievement oriented, committed to individual achievement, accomplishment and career—but, I am equally committed to marriage. What then of my children? If I am to be a responsible mother then I must remain at home with my young children.” … Such is the ethnic dilemma shared by Italians and Slavic young women.
A young married Navajo woman expects to hold to the traditions of the past. Her husband is the formal head of the household, but she has as much, or perhaps even more, influence in the family management due to a reverence for matrilineal descent [heritage based on the female line]. This tradition provides her with support from the extended family, with her brothers assuming responsibility in the teaching and discipline of their nieces and nephews. Women and men, sisters and brothers participate in the retention of the ethnic reality. (pp. 77–78)
The important point here is the need for sensitivity to diversity when evaluating human behavior, regardless of which theory you apply.
Other concepts are also helpful when examining and evaluating psychological theories and their application to diverse populations. They include worldview (Choudhuri, Santiago-Rivera, & Garrett, 2012; Diller, 2015; Lum, 2007), spirituality (Canda, 2008; Canda & Furman, 2010; Cunningham, 2012), and the strengths perspective (Kim, 2008; Saleebey, 2013).
Worldview
A concept helpful for appreciating diversity when applying psychological theory to behavior is the worldview perspective. Worldview concerns people’s perceptions of the world around them and how they fit into that world. Perceptions include awareness of the surrounding environment, social status, social roles, legal rights, and economic status, among the many other variables characterizing people’s lives. Not only do worldviews consist of “our attitudes, values, opinions, and concepts, but they also affect how we think, define events, make decisions, and behave” (Sue & Sue, 2008, p. 294).

EP 2.1.1b, 2.1.1e, 2.1.5c
Understanding that people have different worldviews involves looking beyond the narrow boundaries of our daily existence. It means developing an openness and awareness of life in other neighborhoods, counties, states, and countries. It also requires developing an appreciation of differences instead of fear and aversion. It encourages us to allow new perceptions of the world to penetrate our consciousness instead of clinging doggedly to what we already know. There are many other ways to live than the way we are accustomed to.
The African American worldview is characterized by a strong achievement and work orientation.

Brian Summers/First Light/Getty Images
Sue and Sue (2008) reflect:
For marginalized groups in America, a strong determinant of worldviews is very much related to the subordinate position assigned to them in society. Helping professionals who hold a worldview different from that of their clients, and who are unaware of the basis for this difference, are most likely to impute negative traits to clients. In most cases, for example, clients of color are more likely to have worldviews that differ from those of therapists [and social workers]. Yet many therapists [and social workers] are so culturally unaware that they respond according to their own conditioned values, assumptions, and perspectives of reality without regard for other views. Without this awareness, counselors [and social workers] who work with culturally diverse groups may be engaging in cultural oppression. (p. 294)
Spirituality
A second concept important in understanding human diversity and psychological development is spirituality. Spirituality “includes one’s values, beliefs, mission, awareness, subjectivity, experience, sense of purpose and direction, and a kind of striving toward something greater than oneself” (Frame, 2003, p. 3). The spiritual domain is an important means by which many people organize their view of the world. The spiritual dimension is part of their reality. Therefore, it must be considered when you assess human behavior from a psychological perspective even though you may have very different beliefs concerning spirituality than your clients or your colleagues.
Spiritual beliefs can provide people with hope, support, and guidance as they progress through life. Spirituality, including Fowler’s (1981) seven stages of faith, will be discussed further in Chapter 7. Chapter 15 explores spirituality and some of the major religions.
The Strengths Perspective

EP 2.1.10e
The strengths perspective is a third concept that is useful in increasing sensitivity to human diversity, and understanding people from various ethnic and cultural backgrounds. Chapter 1 introduced the concepts of empowerment and strengths-based social work practice. Norman (2005) explains:
Strengths-based social work practice focuses on helping client systems tap into the strengths within them … Potential strengths include cultural values and traditions, resources, coping strategies, family, friends, and community support networks. Past successful experiences need to be linked to solving current problems … The client is the expert in identifying past success and in developing solutions based on past experiences. Focusing on concrete tasks and objectives … works better for people of color than more abstract methods…
Even when we are talking the same language, our perceptions of an interaction are culturally influenced … Different groups of people translate nonverbal communication, such as spatial observance, handshaking, and eye contact, in different ways … Mastering cross-cultural communication is the key to effective practice with individuals, families, groups, and communities of color. This requires sharpening observation and listening skills as well as learning about clients’ cultural beliefs and traditions. (pp. 403, 407)
3-2Examine Piaget’s Theory of Cognitive Development
LO 4
Specific theories and conceptual frameworks concerning how people develop their capacities to think and understand have also been developed. Cognition involves the ability to take in information, process it, store it, and finally retrieve and use it. In other words, cognition involves the ability to learn and to think. The most noted of the cognitive theorists is probably Jean Piaget. Piaget (1952) proposed that people go through various stages in learning how to think as they develop from infancy into adulthood. His theory, which concerns the stages through which people must progress in order to develop their cognitive or thinking ability, was derived from careful observations of his own children’s growth and development.
Piaget postulates that virtually all people learn how to think in the same way. That is, as people develop they all go through various stages of how they think. In infancy and early childhood, thinking is very basic and concrete. As children grow, thinking progresses and becomes more complex and abstract. Each stage of cognitive development is characterized by certain principles or ways in which an individual thinks.
The following example does an exceptionally good job of illustrating how these changes occur. In his studies, Piaget would show children of various ages two glass containers filled with a liquid. The containers were identical in size and shape, and held an equal amount of liquid (see Figure 3.2). Children inevitably would agree that each container held the same amount of liquid. Piaget then would take the liquid from one of the containers and pour it into another taller, narrower glass container. Interestingly enough, he found that children under age 6 would frequently say that the taller glass held more even though the amount of liquid in each was identical. Children approximately age 6 or older, however, would state that despite the different shapes, both containers held the same amount of liquid. Later studies established that the results of this experiment were the same for children of various backgrounds and nationalities.
Figure 3.2Conservation

Children under age 6 would say that the taller glass holds more, even though the amount of liquid in each is identical.
This example demonstrated how children in different cognitive stages thought about or conceptualized the problem. Younger children tended to rely directly on their visual perceptions to make a decision about which glass held more or less liquid. Older children, however, were able to do more logical thinking about the problem. They thought about how liquid could take various forms and how the same amount could look different depending on its container. The older children illustrated a higher, more abstract level of cognitive development. This particular concept involving the idea that a substance can be changed in one way (e.g., shape) while remaining the same in another (e.g., amount) is called conservation.
These ways of thinking about and organizing ideas and concepts depending on one’s level of cognitive development are called schema. A person perceives the world at an increasingly more abstract level during each stage. In other words, different aspects of the environment are emphasized depending on a person’s cognitive level of development.
Piaget hypothesizes that all people go through the cognitive stages in the same order. An individual progresses through them in a continuous manner. In other words, a child does not wake up one morning and suddenly state, “Aha, I’m now in the preoperational stage of development!” Rather, children gradually progress through each stage with smooth and continual transitions from one stage to the next. Each stage acts as a foundation or prerequisite for the next. Three other concepts that are also important are adaptation, assimilation, and accommodation.
Adaptation refers to the capacity to adjust to surrounding environmental conditions. It involves the process of changing in order to fit in and survive in the surrounding environment. Piaget would say that adaptation is composed of two processes, assimilation and accommodation.
Assimilation refers to the taking in of new information and the resulting integration into the schema or structure of thought. In other words, when a person is exposed to a new situation, event, or piece of information, not only is the information received and thought about at a conscious level, but it is also integrated into a way of thinking. The information is stored in such a way that it can be used later in problem-solving situations.
For example, go back to the situation in which young children observe and judge the quantities of liquid in glass containers. Younger children, those under age 6, assimilate information at a level using only their observations. Items and substances are only as they appear before their eyes. These children could not think of items as changing, as being somewhere else, or as being in a different context. They could not yet assimilate such information using higher, more logical levels of thought in which some qualities of a substance can change while others remain the same. Children of age 6 or older can think about substances or items that are not immediately before their eyes. They can think about other different circumstances and situations.
Accommodation refers to the process by which children change their perceptions and actions in order to think using higher, more abstract levels of cognition. Children assimilate (take in) new information and eventually accommodate it. That is, they build on the schema they already have and use new, more complex ways of thinking. Children age 6 or older have accommodated the information about the liquid-filled glass containers. Furthermore, they can think about changes in substance in a more abstract way. They can think of the liquid not only as being held in a container of a specific shape and size, but also as it may be held in other containers of other shapes and sizes.
Piaget describes four major stages of cognitive development: the sensorimotor period, the preoperational thought period, the period of concrete operations, and the period of formal operations. Each stage will be described next.
3-2aThe Sensorimotor Period
The sensorimotor period extends from birth to approximately 2 years of age. During this period, a child progresses from simple thoughtless reflex reactions to a basic understanding of the environment. Three major accomplishments are made during the sensorimotor period. First, children learn that they have various senses through which they can receive information. Additionally, they begin to understand that they can receive different kinds of sensory information about the same object in the environment.
For example, initially an infant may see and hear her parents squabbling over who will take the new Ford Mustang GT with air-conditioning on a 99-degree summer day and who will take the old Ford Escort in which the air-conditioning doesn’t work. Even though she will hear and see them squabbling, she will not be able to associate the two types of sensory information as referring to the same aspect of her environment—namely, her parents. By the end of the sensorimotor period, she will understand that she can both hear and see her parents at the same time. She will perceive their interaction through both modes of sensory input.
A second major accomplishment during the sensorimotor period is the exhibition of goal-directed behavior. Instead of displaying simple responses randomly, the child will purposefully put together several behaviors in order to accomplish a simple goal. For example, a child will reach for a piece of a wooden puzzle and try to place it into its appropriate slot. The child will plan to put the puzzle together. However, because a child’s thinking during the sensorimotor period is still very concrete, the ability to plan very far ahead is extremely limited.
The third major accomplishment during the sensorimotor period is the understanding that objects are permanent. This is the idea that objects continue to exist even when they are out of sight and out of hearing range. The concept of object permanence is the most important schema acquired during the sensorimotor period. Initially, children immediately forget about objects as soon as they no longer can perceive them. By age 2, children are generally able to think about the image of something that they can’t see or hear, and can solve a simple problem in relationship to that image. Children begin to use representation—the visual imagining of an image in their minds—which allows them to begin solving problems.
For example, take 2-year-old Ricky who is very attached to his “blanky,” an ancient, ragged, yellow blanket that he loves dearly. Ricky is in the midst of playing with his action garage toy set with his blanky placed snugly next to him. Ricky’s mother casually walks into the room, gently picks up the blanky, and walks down the hallway to the bedroom. Instead of forgetting about the blanky as soon as it’s out of sight, Ricky immediately gets up and starts actively seeking out his blanky, calling for it relentlessly. Even though he can’t presently see it and he doesn’t know exactly where his mother put it, Ricky is able to think of the blanky and begin a quest in search of it. Furthermore, he is able to run around the house and look for it in various nooks and crannies, thinking about where it might be.
3-2bThe Preoperational Thought Period
Piaget’s second stage of cognitive development, the preoperational thought period, extends from approximately ages 2 to 7. Some overlap from one stage to another should be expected. A child’s thinking continues to progress to a more abstract, logical level. Although children are still tied to their physical and perceptual experiences, their ability to remember things and to solve problems continues to grow.
During the preoperational stage, children begin to use symbolic representations for things in their environment. Children are no longer bound to actual concrete perception. They can think in terms of symbols or mental representations of objects or circumstances.
Words provide an excellent example of symbolic representation. Children may symbolize an object or situation with words and then reflect on the object or situation later by using the words. In other words, language can be used for thought even when objects and situations are not present.
Barriers to the Development of Logical Thinking
Despite children’s progress toward more abstract thinking, three major obstacles to logical thinking exist during the preoperational period: egocentrism, centration, and irreversibility.
Egocentrism
In egocentrism, a child is unable to see things from anybody else’s point of view. The child is aware only of himself or herself; the needs and perspectives of others don’t exist.
Piaget illustrated this concept by showing a child a doll in a three-dimensional scene. With the child remaining in the same position, the doll could be moved around the scene so that the child could observe it from different perspectives. The child would then be shown various pictures and asked what the scene would look like from the doll’s perspective or point of view. Piaget found that the child would often choose the wrong picture. The child would continue to view the scene from his or her own perspective. It was difficult if not impossible for the child to imagine that the doll’s perspective or point of view could be any different from the child’s own.
Centration
Centration refers to a child’s tendency to concentrate on only one detail of an object or situation and ignore all other aspects.
To illustrate centration, refer back to the example in which a child is asked to evaluate the amounts of liquid in two glasses. The child would observe the same amount of liquid being poured into two different shaped containers. One container was short and squat, and the other, tall and thin. When asked which container held more liquid, the child would frequently answer that the tall, thin container did. In this situation, the child was focusing on the concept of height instead of width. She was unable to focus on both height and width at the same time. Only one aspect of the situation was used to solve the problem. This is a good example of how centration inhibits more mature, logical thought.
Irreversibility
Irreversibility refers to a child’s ability to follow and think something through in one direction without being able to imagine the relationship in reverse. For example, 4-year-old Gary might be asked, “Who are your cousins?” Gary might then reply, “Sherrie, Donna, Lorrie, and Tanya.” If Gary is then asked who is Sherrie’s cousin, he will probably say he doesn’t know. Gary is able to think through a situation in one direction, but is unable to reverse his train of thought. He knows that Sherrie is his cousin. However, he is unable to see the reverse of that relationship—that he is also Sherrie’s cousin.
Developing Cognitive Ability
Despite barriers to the development of logical thought, several concepts illustrate ways in which children progress in their ability to think. Major changes concerning these concepts occur between the onset of the preoperational thought period and the culmination of adult logical thinking. Children gradually improve their perceptions and grasp of these concepts.
Classification
Classification refers to a child’s ability to sort items into various categories according to certain characteristics. The characteristics might include shape, color, texture, or size. Children gradually develop the ability to distinguish differences between objects and categorize them to reflect these differences.
For example, -year-old Kwan is given a bag of red, blue, and green “creepy crawlers.” In this case, the creepy crawlers consist of soft, plastic lizards, all of which are the same size and shape. When asked to put all the red lizards together in a heap, Kwan is unable to do so. She cannot yet discriminate between the colors in order to categorize or classify the lizards according to their color. However, when Kwan is given the same task at age 7, she is easily able to put the red, blue, and green lizards into their respective heaps. She has acquired the concept of classification.
Seriation
Seriation refers to a child’s ability to arrange objects in order according to certain characteristics. These characteristics might include size, weight, volume, or length.
For example, a child is given a number of soda straws cut to various lengths. The child’s ability to arrange such objects from shortest to longest improves as the child’s cognitive ability develops. By age 4 or 5, a child is usually able to select both the longest and the shortest straws. However, the child still has difficulty discriminating among the middle lengths. By age 5 or 6, the child will probably be able to order the straws one by one from shortest to longest. However, this would probably be done with much concentration and some degree of difficulty. By age 7, the task of ordering the straws would probably be much easier.
The ability to apply seriation to various characteristics develops at different ages depending on a specific characteristic. For example, children are usually unable to order a series of objects according to weight until age 9. Seriation according to volume is typically not possible until approximately age 12.
Conservation
Conservation, discussed earlier, refers to a child’s ability to grasp the idea that while one aspect of a substance (e.g., quantity or weight) remains the same, another aspect of that same substance (e.g., shape or position) can be changed.
For example, 4-year-old Bart is given two wads of Silly Putty of exactly equal volume. One wad is then rolled into a ball, and the other is patted into the shape of a pancake. When asked which wad has a greater among of material in it, Bart is likely to say that the pancake does. Even though Bart initially saw that the two wads were exactly equal, he focused on only the one aspect of area. In terms of area alone, the pancake appeared to Bart as if it had more substance. However, by the time Bart reached age 6 or 7, he would probably be able to state that both wads had equal substance. He would know that matter can take different forms and still have the same amount of material.
As with sedation, children achieve the ability to understand conservation at different ages depending on the characteristic to be conserved (Papalia & Martorell, 2015). For example, whereas conservation of substance is typically attained by age 7 or 8, conservation of weight is usually not achieved until age 9 or 10, and conservation of volume not until age 11 or 12.
3-2cThe Period of Concrete Operations
The period of concrete operations extends from approximately age 7 to 11 or 12 years. During this stage, a child develops the ability to think logically at a concrete level. In other words, a child has mastered the major impediments to logical thinking that were evident during earlier stages of cognitive development.
The child now develops the capacity to see things from other people’s points of view. Understanding and empathy are substantially increased during this period.
More complex thinking is developed. Situations and events can be viewed and examined in terms of many variables. The child gradually becomes less limited by centration. A child is no longer limited to solving a problem in terms of only one variable; rather, a number of variables can be taken into account. In the glass example, the child would begin to think in terms of height, volume, substance, and shape all at the same time.
A child also develops the ability to conceptualize in terms of reversibility during this period. Relationships begin to be understood from various perspectives. Returning to an example presented earlier, Gary would now understand that not only was Sherrie his cousin, but also that he was her cousin.
The concepts of classification, seriation, and conservation would also be mastered. During the period of concrete operations, a child gains much flexibility in thinking about situations and events. Events are appraised from many different points of view.
Additionally, children develop their use of symbols to represent events in the real world. Their ability to understand math and to express themselves through language greatly improves. Correspondingly, their memories become sharper.
Despite the great gains in cognitive development made during the stage of concrete operations, a child is still somewhat limited. Although events are viewed from many perspectives, these perspectives are still tied to concrete issues. Children think about things they can see, hear, smell, or touch. Their focus is on thinking about things instead of ideas. Children must enter the final stage of cognitive development, the period of formal operations, before they can fully develop their cognitive capability.
3-2dThe Period of Formal Operations
The final stage of cognitive development is the period of formal operations. This period, beginning at approximately age 11 or 12 and extending to approximately age 16, characterizes cognitive development during adolescence. Technically, this chapter addresses childhood and not adolescence. However, for the purposes of continuity, Piaget’s fourth period of cognitive development will be discussed here.
Abstract thought reaches its culmination during the period of formal operations. Children become capable of taking numerous variables into consideration and creatively formulating abstract hypotheses about how things work or about why things are the way they are. Instead of being limited to thought about how things are, children begin to think about how things could be. They begin to analyze why things aren’t always as they should be.
For example, Meredy, age 10, is still limited by the more concrete type of thinking that characterizes the period of concrete operations. She is aware that a nuclear bomb was dropped on Hiroshima near the close of World War II. When asked about why this happened, she might say that the United States had to defend its own territory and this was a means of bringing the war to an end. She can conceptualize the situation and analyze it in terms of some variables. In this case, the variables might include the fact that the United States was at war and had to take actions to win that war. Her ability to think through the situation might extend no further than that. When asked the same question at age 15, Meredy might have quite a different answer. She might talk about what a difficult decision such a step must have been in view of the tremendous cost in human life. She might describe the incident as one of the various tactical strategies that might have been taken. She also might elaborate on the political fallout of the event. In other words, Meredy’s ability to consider multiple dimensions when assessing an idea or event would improve drastically during the period of formal operations.
Three major developments, then, characterize adolescent thought. First, the adolescent is able to identify numerous variables that affect a situation—an issue can be viewed from many perspectives. Second, the adolescent can analyze the effects of one variable on another—that is, can hypothesize about relationships and think about changing conditions. Third, an adolescent is capable of hypothetical-deductive reasoning. In other words, an adolescent can systematically and logically evaluate many possible relationships in order to arrive at a conclusion. Various possibilities can be scrutinized in a conditional “if–then” fashion. For instance, the adolescent might begin thinking in terms of: if certain conditions exist, then certain consequences will follow.
3-2eCritical Thinking: Assessment of Piaget’s Theory
Criticisms of Piaget’s theory have addressed his general approach and also raised questions about specific concepts. One general criticism is that the vast majority of his suppositions are based on his observations of his own children rather than on scientific studies conducted under laboratory conditions. Questions have been raised about the manner in which he observed and interviewed his children, the language he used to obtain information from them, and personal biases that may have emerged. His findings were primarily based on only three subjects, his own children, instead of on a variety of subjects from different backgrounds.
A second general criticism involves the fact that Piaget focuses on the “average” child. Questions can be raised regarding who the average child really is. Cultural, socioeconomic, and ethnic differences were not taken into account.
Consideration of only limited dimensions of human development poses yet a third general criticism. Little is said of personality or emotional growth except in specific instances where they relate directly to cognitive development. The effects of social interaction are virtually ignored. Piaget concentrates on how children see and think of objects instead of the people closest to them.
Piaget (1972) has offered several responses to these criticisms. First, an individual’s social environment may influence cognitive development. Persons from deprived environments may not be offered the types of stimulation and support necessary to achieve high levels of cognition. Second, individual differences might have to be taken into account. Some persons might not have the necessary ability to attain the levels of thought that characterize the formal operations period. Finally, even if a person develops a capacity for formal operational thought, this capacity may not be versatile in its application to all problems. In other words, some individuals might be unable to use formal operations with some problems or in some situations.
Questions have also been raised regarding the meaning and appropriate age level attributed to some of Piaget’s specific concepts (Steinberg, Borstein, Vandell, & Rook, 2011a). He appears to have erred by underestimating children’s abilities concerning various conceptual achievements. Some research replicates Piaget’s in terms of principle. However, by simplifying the language used to communicate with children and by using words and concepts with which they are familiar, other researchers have found higher levels of performance at a given age. In other words, sometimes when children can relate better to the experiment, they better understand what is expected from them and thus can perform better.
For example, consider research that involves object permanence, the concept that objects continue to exist even when they’re out of sight. According to Piaget, children don’t attain this skill until nearing age 2, at the end of the sensorimotor period. However, Baillargeon (1987) cleverly adapted his experimental procedure to eliminate the need for infants to have a higher level of muscular coordination than is developmentally possible at their age in order to respond appropriately. He found that by months, and sometimes by age months, babies indicated that they were aware of object permanence.
Piaget’s examination of egocentricity has also received some criticism. Egocentrism involves the concept that a child is unable to see things from anyone else’s perspective but his own.
The idea that children in this age group are so self-centered may be overly harsh. Many parents can think of instances in which their young children appeared to show genuine empathic ability. For example, 4-year-old Johnnie approaches his father after finding a robin’s egg that fell from the nest. He states, “Daddy, poor birdie. She lost her baby.”
Additionally, there is some evidence that children are not quite as egocentric as Piaget initially claimed and that their thinking is much more complex (Dacey, Travers, & Fiore, 2009; Papalia & Martorell, 2015). A child’s ability to empathize with others depends somewhat on the circumstances and the issues involved. For example, children living in families that encourage discussion of feelings are more adept at recognizing other people’s emotions.
Piaget initially investigated egocentricity by having children observe three fabricated “mountains” of unequal heights placed on a table. Children were able to walk around the table and look at the mountains from various perspectives. They were then asked to sit on a chair at the table. A doll was placed in a chair on the opposite side of the table. The children were then shown a variety of photographs of the “mountains,” which illustrated how they looked from a number of perspectives. Piaget asked the children to select the picture that best showed how the mountains looked from where the doll sat. Children in the preoperational stage would choose the picture that best showed the mountains from where they themselves sat, not from where the doll sat. Piaget concluded, then, that the children had not yet worked through the barrier of egocentrism because they couldn’t comprehend the view of the mountains from the doll’s perspective.
When a variation of the mountain task was used, the results were quite different (Hughes, 1975; Papalia & Feldman, 2012). Instead of “mountains,” a child was seated in front of a square table with dividers on the top to divide it into four equal sectors. The researcher placed a doll in one of the sectors and a police officer figure in another sector. The child was then asked if she thought the police officer could see the doll from where he stood. The task was then complicated by placing another police officer figure somewhere on the table. The researcher then asked the child to place the doll somewhere on the table where she thought neither police officer could see her. Of 30 children aged to 5 years, 90 percent responded correctly. Most of these young children could clearly see the situation from another’s perspective. These results differ significantly from Piaget’s. Perhaps children had trouble understanding the concept of fake “mountains” on a table, with which they were unfamiliar. On the other hand, perhaps children could better relate to and understand the concepts of police officers and dolls, both of which were familiar to them.
These and other studies indicate that the cognitive development of children is a very complicated process, perhaps much more so than Piaget could guess. It’s interesting to note that a major thrust of these more recent studies is to emphasize what young children can do rather than what they cannot do.
Regardless of the various criticisms, Piaget must be given great credit. Decades ago, he provided us with a foundation for thinking about cognitive development and has tremendously influenced research in this area. Additionally, he set the stage for establishing appropriate expectations regarding what types of things children at various age levels can realistically accomplish.
3-3Review the Information-Processing Conception of Cognitive Development
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A newer perspective on cognitive development involves the information-processing approach. This conceptual framework focuses on the processes an individual uses to think and solve problems. It relates human thought to how computers function with both hardware and software. Kail and Cavanaugh (2014) explain:
Information-processing theorists draw heavily on how computers work to explain thinking and how it develops through childhood and adolescence. Just as computers consist of both hardware (disk drives, central processing unit, etc.) and software (the programs they run), information-processing theory proposes that human cognition consists of mental hardware and mental software. Mental hardware refers to [physical] cognitive structures … [that allow thought to take place and memories to be stored.] Mental software includes organized sets of cognitive processes [mental “programs”] that enable people to complete specific tasks, such as reading a sentence, playing a video game, or hitting a baseball. For example, an information-processing psychologist would say that, for a student to do well on an exam, she must encode the information as she studies, store it in memory, and then retrieve the necessary information during the test.
According to information-processing psychologists, developmental changes in thinking reflect better mental hardware and mental software in older children and adolescents than in younger children. For example, older children typically solve math word problems better than younger children because they have greater memory capacity to store the facts in the problem and because their methods for performing arithmetic operations are more efficient. (p. 12) (emphasis in original)
Three facets of information processing that are especially significant include attention, memory, and information-processing strategies (Kail & Cavanaugh, 2016; Rathus, 2014a).
3-3aAttention
Attention is “a process that determines which sensory information receives additional cognitive processing” (Kail & Cavanaugh, 2016, p. 131). As children mature, they develop the ability to focus on the more relevant aspects of a situation or problem and “screen out distractions” (Rathus, 2014a, p. 385). This involves selectively directing their attention. Eventually, children can attend to numerous facets of a problem at the same time, thus allowing them to solve more difficult problems and think at a more complex level. Rathus (2014a) provides an example of selective attention developing as children get older:
An experiment by Strutt and colleagues (1975) illustrates how selective attention and the ability to ignore distraction develop during middle childhood. The researchers asked children between 6 and 12 years of age to sort a deck of cards as quickly as possible on the basis of the figures depicted on each card (e.g., circle versus square). In one condition, only the relevant dimension (form) was shown on each card. In another condition, a dimension not relevant to the sorting also was present (e.g., a horizontal or vertical line in the figure). In a third condition, two irrelevant dimensions were present (e.g., a star above or below the figure, in addition to a horizontal or vertical line in the figure) … [T]he irrelevant information interfered with sorting ability for all age groups, but older children were much less affected than younger children. (p. 385)
Note that improvements in selective attention are related to brain development (Nelson, Thomas, & de Haan, 2006). However, a “child’s environment and experiences with parents are also important … Children from stimulating homes with warm, responsive parents gain control of their attention earlier than do children from less supportive homes. Why? One reason may be that frequent conversations with parents provide young children with guided opportunities to observe and practice concentration and self-regulation” (Steinberg, Bornstein, Vandell, & Rook, 2011a, p. 210).
3-3bMemory
Memory involves “the processes of storing and retrieving information” (Rathus, 2013, p. 285). Memory entails three basic types—sensory, short-term, and long-term (Rathus, 2013, 2014a).
Sensory Memory
Sensory memory is “a subconscious process of picking up sensory information from the environment (sights, sounds, smells, and touch). Sensory memory consists of fleeting impressions. This information is either forgotten or transferred to working memory: conscious representations of what a person is actively thinking about at a given time” (Steinberg et al., 2011a, p. 211). In order for a person to remember a sensory memory, the person needs to focus on it and probably relate it to other thoughts. Rathus (2013) explains:
When we look at an object and then blink our eyes, the visual impression of the object lasts for a fraction of a second in what is called sensory memory. Then the “trace” of the stimulus decays. The concept of sensory memory applies to all the senses. For example, when we are introduced to somebody, the trace of the sound of the name also decays, but we can remember the name by focusing on it. (p. 285)
Short-Term Memory (Working Memory)
Short-term (or working) memory is “[t]he structure of memory that can hold a sensory stimulus for up to 30 seconds after the trace decays” (Rathus, 2013, p. G-13). Steinberg and colleagues (2011a) explain that short-term memory involves
conscious, short-term representations of what a person is actively thinking about at a given time. It depends on the child (or adult) paying attention and encoding the impression in some way—for example, attaching it to a known word or image. Working memory improves during early childhood from recall of two numbers at age years to five numbers at age 7, and about seven numbers in adulthood.
Part of the reason for the improvements in working memory is biological; part, social … [The portions of the brain] that provide the “hardware” for short-term memory … are developing during early childhood and provide the capacity that supports an expanded working memory (Nelson et al, 2006). And, as is the case with attention, the development of working memory is accelerated by warm, stimulating interactions with parents at home and by attending preschools or child-care centers that are high quality. (p. 211)
Long-Term Memory
Long-term memory is “[t]he structure of memory capable of relatively permanent storage of information” (Rathus, 2013, p. G-8). Rathus (2013) explains:
Think of long-term memory as a vast storehouse of information containing names, dates, places, what Johnny did to you in second grade, what Alyssa said about you when you were 12. Long-term memories may last days, years, or, for practical purposes, a lifetime.
There is no known limit to the amount of information that can be stored in long-term memory. From time to time, it may seem that we have forgotten, or lost, a long-term memory, such as the names of elementary- or high-school classmates. But it is more likely that we cannot find the right cues to retrieve it. It is lost in the same way we misplace an object but know it is still in the house. (p. 287)
3-3cDevelopment of Information-Processing Strategies
As children grow older, they increase their abilities to process information and solve problems. They gradually get better at taking into account multiple variables, thinking about potential solutions, making decisions, and working out answers to problems. Children develop information-processing strategies to “store information in permanent [long-term] memory and retrieve it when needed later. To illustrate, how do you try to learn the information in a textbook? If you’re like many college students, you probably use some combination of highlighting key sentences, outlining chapters, taking notes, writing summaries, and testing yourself. These are all effective learning strategies that make it easier for you to store information permanently” (Kail & Cavanaugh, 2016, p. 198).
Other strategies include repetition, organization, elaboration, and the use of external supportive techniques (Kail & Cavanaugh, 2016). At age 7 or 8, children use simpler strategies like repetition. Repetition involves repeating some information over and over again to establish it more firmly in one’s memory. As they get older, children start to manage their information by using more complex strategies. Organization concerns “structuring information to be remembered so that related information is placed together” (Kail & Cavanaugh, 2016, p. 198). A child might group facts or concepts in categories according to some common variable. For example, a sixth grader studying for a history test might remember historical events geographically by relating them to the state or country in which they occurred. Similarly, that sixth grader might organize historical information chronologically according to the dates when events occurred.
Another more advanced information-processing approach involves elaboration. Elaboration is “[a] method for increasing retention of new information by relating it to well-known information” (Rathus, 2013, p. G-4). For example, a teacher might help a student remember new vocabulary words by placing them in the context of a sentence (Rathus, 2014a). Another example involves relating a new concept or word to other familiar words that sound similar. For instance, a child living in Juneau, Alaska, might be able to remember the word juniper (a type of evergreen shrub, pronounced joo-ne-per) by associating it with the word “Juneau.”
3-4Apply Vygotsky’s Theory of Cognitive Development
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Lev Vygotsky proposed an alternative sociocultural theory of cognitive development to that developed by Piaget. Kail and Cavanaugh (2016) explain:
Human development is often referred to as a journey that takes people along many different paths. For Piaget … children make this journey alone. Other people (and culture in general) certainly influence the direction that children take, but fundamentally the child is a solitary adventurer-explorer, boldly forging ahead. Lev Vygotsky (1896–1934), a Russian psychologist, proposed a very different account: Development is an apprenticeship, in which children advance when they collaborate with others who are more skilled. According to Vygotsky (1934/1986), children rarely make much headway on the developmental path when they walk alone; they progress when they walk hand in hand with an expert partner. (p. 138) (emphasis omitted)
Unfortunately, Vygotsky died at the age of 37 from tuberculosis so never had time to fully develop his ideas. However, he has had a major impact on the understanding of cognitive development. He stressed that “children’s thinking is influenced by the sociocultural context in which children grow up” (Kail & Cavanaugh, 2016, p. 16).
Several important principles underlie Vygotsky’s theory (Vander Zanden, Crandell, & Crandell, 2007). First, a child’s development will differ depending on what’s going on around that child. In other words, children will develop differently depending on the social and cultural circumstances and expectations evident in where they grow up. Second, children develop as they are exposed to various social situations and changes to which they must respond. Third, development occurs as part of children’s interaction in group activities. Fourth, children develop by observing others and learning from the activities and performance of those around them. Fifth, children must use a scheme of symbols such as language in order to process what they see and learn new skills. Sixth, children learn cultural values through their interaction with others around them.
According to Vygotsky, then, children interact with others and observe these interactions. They frame these interactions in their minds by thinking about them through the use of language. They then develop their ability to think and learn in the context of interpersonal interaction and understanding this interaction through language.
Vander Zanden and his colleagues (2007) provide an example of this process:
The child, according to Vygotsky, will observe something happening between others and then will be able to take that observation and mentally incorporate it. One of Vygotsky’s examples is the way children use language. First, a child will be told “Say please and thank you” by his or her parents. The child will also see people saying “Please” and “Thank you” to each other. Then the child will begin to say these words aloud. By saying “Please” and “Thank you” aloud, the child is internalizing the words and the concepts they stand for in a social setting. Only after assimilating the words’ meaning can the child individually start to act in a polite manner. It follows that development is always a social process for Vygotsky, and the child—adult interaction plays an important role (Berk & Winsler, 1995). So it should come as no surprise that for Vygotsky, the way to understand development is to observe the individual in a social activity. (p. 55)
Spotlight 3.3 illustrates how values can be shaped depending on the cultural environment in which a child is raised.
Spotlight on Diversity 3.3
Sociocultural Learning of Interdependence versus Independence

EP 2a
EP 2c
North American culture encourages independence on the part of children (Vander Zanden et al., 2007). From birth on, children usually sleep in a room apart from their parents. Children are often placed out of the home in day care while their parents work. “Parents also reinforce a preference for objects rather than people to be used as means of comforting in times of distress. Children are supplied and rely on ‘blankies,’ pacifiers, and stuffed animals rather than parents or other people to console them when they are upset or conflicted. Parents and children become adversaries over sleeping arrangements as children get older. The ‘terrible twos’ revolve around the young child’s eventual demand for independence” (Vander Zanden et al., 2007, p. 55). The culture generally encourages independence and competition. Children compete in school. Young adults compete for college admission. Workers compete for raises and advancement in their workplace environments.
In contrast, Vander Zanden and his colleagues (2007) describe how other cultures may encourage interdependence instead of independence:
Child-rearing practices in many other cultures stress interdependence, sometimes called collectivism, over independence or individualism, with the focus on ties to family. Children are socialized to think of themselves as being part of a group or community, rather than an individual at odds with those in the vicinity. For example, in the Pacific Island nation of Kiribati, an infant is in constant contact with some member of the extended family during the first year of life—sleeping with, eating with, and tagging along to work with a family member. These infants are socially involved in all of the day-to-day activities of the mother and father. Three generations of a family will gather around the baby to sing traditional songs while the infant is initiated into the social and cultural rhythms of the community. Rather than battling parents over issues of independence, the caregivers support the needs of the infant as they carry out the routine activities—there is no battle of the wills. (p. 55)
At least three concepts are important in understanding Vygotsky’s perspective: the zone of proximal development, scaffolding, and private speech (Vygotsky, 1934/1986).
3-4aThe Zone of Proximal Development
The zone of proximal (meaning “near”) development is “the difference between what a learner can accomplish independently and what he or she can accomplish with the guidance and encouragement of a more skilled partner” (Shaffer & Kipp, 2010, p. 283; Vygotsky, 1978). In other words, the zone “refers to a range of tasks that the child cannot yet handle alone but can do with the help of … [others who are better at performing the activity.] To understand this idea, think of a sensitive adult … who introduces a child to a new activity. The adult picks a task that the child can master but that is challenging enough that the child cannot do it by herself. Or the adult capitalizes on an activity that the child has chosen. The adult guides and supports, adjusting the level of support offered to fit the child’s current level of performance. As the child joins in the interaction and picks up mental strategies, her competence increases, and the adult steps back, permitting the child to take more responsibility for the task. This form of teaching—known as scaffolding [discussed in the Scaffolding]—promotes learning at all ages” (Berk, 2012a, p. 224).
The zone of proximal development, then, reflects the level of thinking a child can master when participating in an activity by him- or herself, compared to the higher level of learning that can occur by watching and interacting with others who know more about the activity. Consider the following example (Shaffer & Kipp, 2010):
Tanya, a 4-year-old, has just received her first jigsaw puzzle. She attempts to work the puzzle but gets nowhere until her father sits down beside her and gives her some tips. He suggests that it would be a good idea to put together the corners first, points to the pink area at the edge of one corner piece and says, “Let’s look for another pink piece.” When Tanya seems frustrated, he places two interlocking pieces near each other so that she will notice them, and when Tanya succeeds, he offers words of encouragement. As Tanya gradually gets the hang of it, he steps back and lets her work more and more independently. (p. 283)
3-4bScaffolding
One means by which children learn in the zone of proximal development is a process called scaffolding. In commonplace language, a scaffold implies a structure of support. Vygotsky defined scaffolding as the process whereby “adults help children learn how to think by ‘scaffolding,’ or supporting, their attempts to solve problems or discover principles” (Coon & Mitterer, 2009, p. 126; Daniels, 2005). Caregivers use scaffolding as they adjust their level of guidance and support to the level of help the child needs. In effect, the child and the caregiver are adjusting their behavior by responding reciprocally to each other.
Santrock (2016) elaborates:
For example, in the game peek-a-boo, parents initially cover their babies, then remove the covering and register “surprise” at the babies’ reappearance. As infants become more skilled at peek-a-boo, infants gradually do some of the covering and uncovering. In addition to peek-a-boo, pat-a-cake and “so-big” are other caregiver games that exemplify scaffolding and turn-taking sequences. (p. 211)
3-4cPrivate Speech
Consider Timmy, a 4-year-old who talks to himself intensively as he draws a picture of his house. Vygotsky emphasized the significance of private speech, “comments that are not intended for others but are designed to help children regulate their own behavior” (Kail & Cavanaugh, 2016, p. 139; Vygotsky, 1934/1986).
Kail and Cavanaugh (2016) describe the significance of private speech:
Vygotsky viewed private speech as an intermediate step toward self-regulation of cognitive skills (Fernyhough, 2010). At first, children’s behavior is regulated by speech from other people that is directed toward them. When youngsters first try to control their own behavior and thoughts, without others present, they instruct themselves by speaking aloud. Private speech seems to be children’s way of guiding themselves, of making sure that they do all the required steps in solving a problem. Finally, as children gain ever greater skill, private speech becomes inner speech, which was Vygotsky’s term for thought (pp. 139–140)
Dacey and his colleagues (2009) provide an illustration:
For example, think of a 5-year-old girl asked to get a book from a library shelf. The book is just out of her reach, and as she tries to reach it, she mutters to herself, “Need a chair.” After dragging a chair over, she climbs up and reaches for the book. “Is that the one?” “Just a little more.” “OK.” Note how speech accompanies her physical movements, guiding her behavior. In two or three years, the same girl, asked to do the same thing, will probably act the same way, with one major exception: She won’t be talking aloud. Vygotsky believed she would be talking to herself, using inner speech to guide her behavior, and for the difficult tasks she undoubtedly would use inner speech to plan her behavior. (p. 134)
3-4dCritical Thinking: Assessment of Vygotsky’s Theory
Vygotsky’s theory stresses the importance of social interaction and how a person functions within the environmental context, concepts basic to social work practice. This contrasts with Piaget’s theory, which proposes that all children progress through predefined phases in essentially the same way.
At least two positive implications of Vygotsky’s theory are important (Newman & Newman, 2015). First, it allows for appreciation of diverse cultures. How people think about and perceive things in one culture may differ radically from how they think about and perceive those same things in another culture. Whereas Piaget “viewed the emergence of logical thought as largely a universal process, Vygotsky considered the nature of reasoning and problem solving as culturally created” (Newman & Newman, 2015, p. 39). This focuses attention on the importance of family and social influence on the early development of ideas.
A second positive implication of Vygotsky’s theory is that “individuals can promote their own cognitive development by seeking interactions with others who can help draw them to higher levels of functioning within their zone of proximal development” (Newman & Newman, 2015, p. 39). Thus, children can learn by interacting with others around them who are more skilled.
There are also criticisms of Vygotsky’s sociocultural theory. For example, interactions that “rely heavily on the kinds of verbal instruction that Vygotsky emphasized may be less adaptive in some cultures or less useful for some forms of learning than for others. A young child learning to stalk prey in Australia’s outback or to plant, care for, and harvest rice in Southeast Asia may profit more from observation and practice than from verbal instruction and encouragement. Other investigators are finding that collaborative problem solving among peers does not always benefit the collaborators and may actually undermine task performance if the more competent collaborator is not very confident about what he knows or if he fails to adapt his instruction to a partner’s level of understanding” (Shaffer & Kipp, 2010, p. 291).
Berk (2012a) provides other criticisms:
Vygotsky’s emphasis on culture and social experience led him to neglect the biological side of development. Although he recognized the importance of heredity and brain growth, he said little about their role in cognitive change. Furthermore, Vygotsky’s focus on social transmission of knowledge meant that, compared with other theorists, he placed less emphasis on children’s capacity to shape their own development. Followers of Vygotsky stress that children actively participate in the conversations and social activities from which their development springs. From these joint experiences, they not only acquire culturally valued practices but also modify and transform those practices (Nelson, 2007; Rogoff, 2003). Contemporary sociocultural theorists grant the individual and society balanced, mutually influential roles. (p. 25)
Vygotsky appears to be the recipient of less criticism than Piaget. There are at least two reasons for this. First, his approach fits well with the social work person-in-environment focus. Second, Vygotsky died very young, before being able to develop his theory to the fullest. Perhaps greater specificity would have allowed more options for detailed criticism.
3-5Explain Emotional Development
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Both the concepts of personality and cognition and the relationship between them are complex and abstract. It is not clear exactly how thinking affects personality or how personality affects thinking. The tremendous amount of variation from one individual to another, and even one individual’s varying reactions from one situation to another, makes it even more difficult to comprehend these concepts.
Emotions are also involved in a person’s development. They complicate the profile of an individual’s personality even further. For our purposes, emotion is the complex combination of feelings and moods that involves subtle psychological reactions and is expressed by displaying characteristic patterns of behavior. For example, a 4-year-old boy’s goldfish might be found floating belly-up one morning. On hearing the unhappy news, the boy might become upset. His heart might start beating faster, and his breathing might accelerate. Finally, he might run to his room and start to cry. In this case, the boy has experienced an emotion. His body responded as he became upset. Finally, the behavior of crying clearly displayed his emotional state.
3-5aInfants’ Emotions
Bridges (1932), a very early researcher of infants’ emotions, claimed that infants initially showed only one basic emotion—excitement. J. B. Watson (1919), another early researcher, felt that infants were capable of three basic emotions: love, rage, and fear. Each of these emotions, according to Watson, was emitted as a reflex reaction to a specific stimulus. For example, an infant would experience love if stroked softly and spoken to gently by a parent, rage if physically restrained, and fear if startled by an unexpected loud noise.
Immediately upon birth, infants can express general interest, disgust, and distress. Other emotions, including surprise, anger, and sadness, occur approximately during the third to fourth month of life. Fear is displayed during months 5 through 7. Emotions that reflect self-awareness tend to develop later, sometimes not until the second year. Self-awareness is the realization that one is a unique entity distinctly separate from the surrounding environment and is involved in interaction with people and things in that environment. Such emotions include shyness, jealousy, pride, and shame.
Crying
One means by which babies can clearly display their emotions is through crying. Infants demonstrate at least three types of crying (Papalia & Martorell, 2015 Santrock, 2016). First, there is the basic cry (also referred to as the hunger cry). This is a “rhythmic pattern that usually consists of a cry, followed by a briefer silence, then a shorter … whistle that is somewhat higher in pitch than the main cry, then another brief rest before the next cry. Some infancy experts stress that hunger is one of the conditions that incite the basic cry” (Santrock, 2016, p. 193). The second type is the angry cry, an exceptionally loud cry in which the baby forces a large column of air through the vocal cords. The third type, the cry of pain, is characterized by an initial loud wail with no preceding sniffling or moaning. The cry may be followed by the baby holding its breath for a long period.
Kail and Cavanaugh (2016) explain the significance of crying:
Crying is the newborn’s first attempt to communicate with others. They need to decide what the infant is trying to tell them and whether that warrants a quick response or whether they should let the baby soothe herself. (p. 83)
According to Berk (2012a):
Although parents do not always interpret their baby’s cry correctly, their accuracy improves with experience … Fortunately, there are many ways to soothe a crying baby when feeding and diaper changing do not work … The technique that Western parents usually try first, lifting the baby to the shoulder and rocking or walking, is most effective. (p. 148)
Different societies use different techniques to comfort crying babies (Berk, 2012b). For example, in the harsh altitudes of the Andes Mountains, a Peruvian mother covers her infant’s body, including the head, with layers of blankets and clothing, and then places the infant’s pouch on her back. The warmth and the rhythmic motion of the mother’s walking serve to soothe the infant and encourage sleep. The desert !Kung people of Botswana carry their infants in hip slings made of animal skins. This positioning allows infants to view what’s going on around them and also to “nurse at will” (p. 149). Infants in cultures that promote extensive close contact with their mothers tend to cry less than North American babies (Barr, 2001).
Smiling and Laughing
Babies can also express themselves emotionally through smiling and laughing. Infants smiling at their parents and their parents smiling back provide a major means of fostering the primary relationship between children and parents.
Infants tend to progress through several basic phases of smiling (Martin & Fabes, 2009; Papalia & Martorell, 2015; Santrock, 2012b). Initially, involuntary reflex smiling occurs, often while sleeping, as an automatic function of central nervous system development. After a few weeks, infants begin smiling in response to “visual, tactile, and auditory stimulation”; by 6 to 8 weeks of age, social smiling occurs where “the infant smiles upon seeing Mother’s or Father’s face or hearing her or his voice” (Martin & Fabes, 2009, p. 208). “From 2 to 6 months, infants’ social smiling increases considerably, both in self-initiated smiles and in smiles in response to others’ smiles” (Santrock, 2012b, p. 306). The smiling process reflects infants’ gradual orientation toward other people and social relationships.
Laughing may begin at the fourth month (Martin & Fabes, 2009; Papalia & Martorell, 2015). “At first laughing occurs in response to physical stimulation, such as tickling or being swooped up high in Mom’s or Dad’s arms … After 6 months of age, infants increasingly laugh at visual and social stimuli, such as playing peek-a-boo or seeing a sister make a funny face” (Martin & Fabes, 2009, p. 208).
3-5bInfants and Temperament
It’s difficult to refer to personality with respect to infants. Personality implies a complex mixture of attitudes, expressions, and behaviors that develop over time and characterize a specific individual. Infants don’t yet have enough breadth or ability for expression to portray the complexity inherent in personality. Rather, psychologists tend to refer to an infant’s temperament instead of personality. Temperament is each individual’s distinguishing mental and emotional nature that results in a characteristic pattern of responses to people and situations.
Researchers have identified the following six concepts involved in temperament:
1. “Fearful distress, reflecting a child’s tendency to withdraw and become distressed in new situations or circumstances
2. Anger/frustration, reflecting the degree to which a child becomes angry or frustrated when his or her needs or desires are not met
3. Positive affect, reflecting the amount of positive emotion, pleasure, and excitement shown by a child
4. Activity level, reflecting a child’s level of gross motor activity and energy
5. Attention span/persistence, reflecting a child’s ability to maintain focus and interest
6. Regularity, reflecting the predictability of a child’s behavior” (Martin & Fabes, 2009, pp. 214–215; Putnam, Gartstein, & Rothbart, 2006; Rothbart & Mauro, 1990).
Psychologists often use three basic categories of temperament to characterize children (Rathus, 2011a; Santrock, 2016; Sigelman & Rider, 2012; Thomas & Chess, 1977, 1989, 1991). Easy children are those whose lives have a relatively predictable, rhythmic pattern. They are generally cheerful and easy to get along with. They accept change well and are interested in new situations. The second category of child temperament includes difficult children. These children are frequently irritable, show much irregularity in their daily pattern of activities, and have much difficulty adapting to new situations. They can have intense reactions when confronted with something unfamiliar. Finally, there are the slow-to-warm-up children. They tend to have a generally low level of activity, a mild temperament, and moderate reactions to new situations and experiences. They often withdraw from the unfamiliar, at least initially, and are slow to make changes in themselves.
Rathus (2014b) comments on the stability of temperament over time:
There is at least moderate consistency in the development of temperament from infancy onward (Elliot & Thrash, 2010; Zuckerman, 2011). The infant who is highly active and cries in novel situations often becomes a fearful toddler. An anxious, unhappy toddler tends to become an anxious, unhappy adolescent. The child who refuses to accept new foods during infancy may scream when getting the first haircut, refuse to leave a parent’s side during the first day of kindergarten, and have difficulty adjusting to college as a young adult. Difficult children in general are at greater risk for developing psychological disorders and adjustment problems later in life (Pauli-Pott et al., 2003; Rothbart et al., 2004). A longitudinal study tracked the progress of infants with a difficult temperament from through 12 years of age (Guerin et al., 1997). Temperament during infancy was assessed by the mother. Behavior patterns were assessed by both parents during the third year through the age of 12 and by teachers from the ages of 6 to 11. A difficult temperament correlated significantly with parental reports of behavioral problems from ages 3 to 12, including problems with attention span and aggression. Teachers concurred that children who had shown difficult temperaments during infancy were more likely to be aggressive later on and to have shorter attention spans. (pp. 246–247)
Note, however, that temperament and adjustment are very complex. Consider that the relationships between a child’s temperament and later adjustment are questionable in that they’re based on only a few studies (Santrock, 2016).
Additionally, more than a third of children do not fit neatly into any of these three categories (Berk, 2012b). An infant’s temperament involves emotionality, activity, and sociability. Many children show a combination of difficult and easy characteristics, yet still fall clearly within the realm of what is considered normal. For instance, a child may have an extremely irregular sleeping schedule, yet reach out and adapt quickly to new, unfamiliar people. Likewise, a child may be cheerful and easygoing most of the time, but horribly stubborn and difficult to live with on some occasions, such as when visiting relatives. The research points to some general tendencies; however, each infant, child, and adult is a unique person.
Theorists generally concur that an infant’s temperament results from both hereditary and environmental factors (Berk, 2012b; Santrock, 2016; Steinberg et al., 2011a). Some research found that identical twins were more likely to reflect a similar temperament than were fraternal twins (Buss & Goldsmith, 2007; Santrock, 2016; Steinberg, Vandell, & Bornstein, 2011b). Yet, the relationship is neither perfect nor clear.
Why does temperament change for many people as they age? People modify their behavior and attitudes as they encounter new experiences. A major variable related to overall adjustment may be the “goodness of fit” between the individual and the expectations in the social environment (Papalia & Martorell, 2015; Santrock, 2016; Sigelman & Rider, 2012). For instance, take parents who expect to have a dynamic, motivated child who is eager for new experiences. If they discover that their child is mild mannered, hesitant, and somewhat shy, they may be very disappointed. They may even place inordinate pressure on the child to be very different than he or she naturally is. On the other hand, take parents who sustain a family climate where moods are intense, daily routines are irregular, and changes are assimilated only slowly. A difficult child’s fit in such a family may be good. The family may not view the child as difficult at all, but rather as normal.
If parents recognize that their child has a temperament of his or her own that may be very different from their own temperaments, they can make adjustments in their own behavior and expectations to help that child along. For instance, a slow-to-warm-up child can be given more time to adjust to new situations. Likewise, parents of a difficult child who has trouble organizing her day in a predictable manner can help her by providing structure and helping her learn how to make plans and carry them out. Spotlight 3.4 discusses cross-cultural expectations and temperament.
An infant’s temperament involves emotionality, activity, and sociability.

John Henley/Jupiter images
Spotlight on Diversity 3.4
Cross-Cultural Diversity in Expectations and Temperament

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Parental and social expectations that vary dramatically from one culture to another can affect the development of temperament. Malaysian infants tend to be less flexible and responsive to new situations and more reactive to outside stimuli than American infants; this may be due to the fact that Malaysian parents shelter children from new conditions that necessitate adaptability, on the one hand, and promote sensitivity to new sensations such as the need for a diaper change, on the other (Banks, 1989; Papalia & Feldman, 2012).
Sigelman and Rider (2009) comment on an example posed by the Masai in East Africa:
In most settings, an easy temperament is likely to be more adaptive than a difficult one, but among the Masai during famine, babies with difficult temperaments outlived easy babies. Why? Perhaps because Masai parents believe that difficult babies are future warriors or perhaps because babies who cry loud and long get noticed and fed. As this example suggests, a particular temperament may be a good fit to the demands of one environment but maladaptive under other circumstances. (p. 315)
One cross-cultural study of Canadian and Chinese 2-year-olds found significant differences in temperament, with Chinese children generally being much shyer and more withdrawn than Canadian children (Chen et al., 1998). Canadian mothers were much more punitive and overprotective in orientation with shy children, whereas Chinese mothers supported and encouraged introverted behavior. Perhaps, this difference is due to the expectation in Western countries such as Canada that children should be more outgoing and assertive if they’re ever going to get anywhere in this world. Mothers might react to shy behavior either with cold rejection or with coddling. In contrast, introversion and self-control are valued in China. Therefore, mothers might encourage this sort of temperament and discourage more aggressive behavior.
Another example involves a group of Mayans in southern Mexico, the Zinacantecos (Greenfield & Childs, 1991). Their infants tend to be very quiet and relatively immobile as newborns. Bernstein, Penner, Clarke-Stewart, and Roy (2008) explain that Mayan mothers
reinforce this innate predisposition toward restrained motor activity by swaddling their infants and by nursing at the slightest sign of movement … This combination of genetic predisposition and cultural reinforcement is culturally adaptive: Quiet Mayan infants do not kick off their covers at night, which is important in the cold highlands where they live; inactive infants are able to spend long periods on their mother’s back as she works at the loom; infants who do not begin to walk until they can understand some language do not wander into the open fire at the center of the house. (p. 480)
3-5cAttachment
Attachment “is a strong affectional tie that binds a person to an intimate companion and is characterized by affection and a desire to maintain proximity” (Sigelman & Rider, 2012, p. G-2). Attachment theory, originally developed by John Bowlby (1969), provides a major perspective on initial human relationships. Kail and Cavanaugh (2016) remark:
According to Bowlby, children who form an attachment to an adult—that is, an enduring socio-emotional relationship—are more likely to survive. This person is usually the mother but need not be; the key is a strong emotional relationship with a responsive, caring person. Attachments can form with fathers, grandparents, or someone else. (p. 162)
Attachment theory emphasizes the importance of interaction between the parent (or other caregiver) and the child that results in emotional bonding. The infant is viewed as an active participant in the relationship-building process. This perspective differs from Freud’s oral stage, which stresses the infant’s passivity and dependence on the caregiver.
Stages of Attachment
Based on Bowlby’s conceptual framework, attachment develops in four stages, progressing from a fondness for people in general to an attachment to specific individuals who care for them (Berk, 2012b; Kail & Cavanaugh, 2016; Steinberg et al., 2011a). They include the following stages:
• Stage 1: “Preattachment.” During the first two months of life, infants learn to distinguish between people and things. Subsequently, they respond increasingly more to people in general by smiling and vocalizing.
• Stage 2: “Attachment in the making.” From age 2 to 8 months, infants learn to distinguish between primary caregivers and strangers. They respond more positively to caregivers and display enthusiasm and excitement during their interactions. They also demonstrate upset when the caregiver leaves. The complex process of emotional attachment develops as the infant and caregiver learn how to respond to each other.
• Stage 3: “True attachment.” From age 8 to 18 months, infants search out their caregivers and try to stay close to them. As crawling and mobility increase, infants maintain periodic eye contact with their caregiver as they explore their environment. They begin paying closer attention to the caregivers’ reactions to their behavior and often respond accordingly. For example, an infant might smile if the caregiver is near and giving the child close attention. Or the infant might quickly return to the caregiver if he or she perceives that the caregiver is too far away. Infants continue to develop a more detailed internal picture of the caregiver, his or her behavior, and his or her expectations. Infants become more adept at interpreting the caregiver’s reactions and anticipating how the caregiver will respond to their distress.
• Stage 4: “Reciprocal relationships.” Beginning at age 18 months, children develop increased sensitivity to their dynamic interaction with the caregiver. Children begin showing affection while seeking the love, attention, and physical contact they need. Children might ask their caregiver to read them a bedtime story or give them a hug. They develop increasing sensitivity to their caregivers’ feelings and goals (Kail & Cavanaugh, 2013, p. 170).
Qualities of Attachment
Four factors contribute to the attachment between the child and the caregiver (Cassidy, 1999; Colin, 1996; Newman & Newman, 2015):
1. Significant amount of time spent together.
2. Alert reactions to the child’s needs and the provision of attentive care.
3. The caregiver’s emotional responsiveness and depth of commitment to the child.
4. Being readily available in a child’s life over a long period of time.
Attachment theory emphasizes the importance of interaction between parent (or other caregiver) and child that results in emotional bonding.

Camille Tokerud/Photographer’s Choice RF/Getty Images
These variables make sense. The more responsive the care, attentiveness, and emotional commitment demonstrated by a caregiver are, the more intense the relationship with the child will be. Such qualities also provide the child with more opportunities to respond positively to the caregiver’s overtures. Positive responses can reinforce the dynamic interpersonal interaction between the caregiver and the child, resulting in an ever-increasing level of attachment.
Patterns of Attachment
Infants and caregivers have various degrees of attachment that are distinguished by the closeness and quality of the relationship. Four patterns have been established: secure attachment, anxious-avoidant attachment, anxious-resistant attachment, and disorganized attachment. Most infants form a secure attachment with their mother (or other primary caregiver or caregivers) (Thompson, 1998). Newman and Newman (2015) explain:
Infants who have a secure attachment actively explore their environment and interact with strangers while their mothers are present. After separation, the babies actively greet their mothers or seek interaction. If the babies were distressed during separation, the mothers’ return reduces their distress and the babies return to exploration of the environment …
Infants who show an anxious-avoidant attachment avoid contact with their mothers during the reunion segment following separation or ignore their efforts to interact. They appear to expect that their mothers will not be there when needed. They show less distress at being alone than other babies. Mothers of babies who were characterized as anxious-avoidant seem to reject their babies. It is almost as if they were angry at their babies. They spend less time holding and cuddling their babies than other mothers, and more of their interactions are unpleasant or even hurtful …
Infants who show an anxious-resistant attachment are very cautious in the presence of the stranger. Their exploratory behavior is noticeably disrupted by the caregiver’s departure. When the caregiver returns, the infants appear to want to be close to the caregiver, but they are also angry, so that they are very hard to soothe or comfort. Infants who are characterized as anxious-resistant have mothers who are inconsistent in their responsiveness …
In the disorganized attachment, babies’ responses are particularly notable in the reunion sequence. These babies have no consistent strategy for managing their distress. They behave in contradictory, unpredictable ways that seem to convey feelings of extreme fear or utter confusion …Some mothers are negative, intrusive, and they frighten their babies in bursts of intense hostility. Other mothers are passive and helpless, rarely showing positive or comforting behaviors. (pp. 164–165)
The characteristics of both the infant and the caregiver contribute to the development of attachment. Caregivers who are sensitive to a child’s needs and demonstrate the factors related to attachment discussed previously may facilitate the attachment process (Newman & Newman, 2015; Papalia & Martorell, 2015). Infant characteristics such as irritability may make the attachment process more difficult, although research indicates that caregivers’ responsive, positive approaches to meeting infants’ needs tend to override infant characteristics in the attachment process (Berk, 2012b). In the United States, about two-thirds of children are identified as security attached, while the others are more likely to be identified as anxious-avoidant (Newman & Newman, 2015).
Long-Term Effects of Attachment
One research review examined 63 studies exploring the relationship between parent–child attachment and children’s subsequent development of social relationships with peers (Schneider, Atkinson, & Tardif, 2001). Children who manifested secure attachment with caregivers early on tended to have more positive social interactions with peers as they got older and formed closer friendships. It follows that children who learn how to trust and interact positively as young children can apply these skills when they develop other social relationships later on.
The Adult Attachment Interview (AAI) asks adults about their attachment experiences. Studies have found that adults relate to their children in the same way their parent or caregiver responded to them (for example, an individual with a secure attachment with her mom is more likely to help her child form a secure attachment) (Newman & Newman, 2015). It has also been shown that parents can become more sensitive to their child’s attachment needs with support, changing the attachment pattern (Newman & Newman, 2015).
Attachment and Day Care
When considering the importance of attachment and interaction, some working parents worry about the effects that day care might have on their children. Coon and Mitterer (2011) address this issue:
Does commercial day care interfere with the quality of attachment? It depends on the quality of day care. Overall, high-quality day care does not adversely affect attachment to parents (National Institute of Child Health and Human Development, 1999). In fact, children in high-quality day care tend to have better relationships with their mothers and fewer behavior problems. They also have better cognitive skills and language abilities (Burchinal et al., 2000; Vandell, 2004). (pp. 100–101)
However, note that poor-quality day care has just the opposite effects (Coon & Mitterer, 2011). It can actually encourage behavior problems to develop (Pierrehumbert, Ramstein, Karmaniola, Miljkovitch, & Halfon, 2002).
What constitutes good day care? Parents should assess at least five aspects when considering a daycare center or provider (Howes, 1997). First, there should be a small staff-child ratio so that children receive adequate personal attention. Second, the size of the total group present should be no more than 12 to 15 children. Once again, the importance of personal attention is stressed. Third, caregivers should be trained in various relevant areas such as child development and child management to best meet children’s needs. Fourth, staffing should be stable with little turnover so that children can be secure in their relationships with caregivers and suffer minimal disruption. Fifth, the daily experience should be steady and predictable, with clearly established procedures and effectively planned activities. Coon and Mitterer (2011) note that parents should also probably “avoid any child-care center with the words zoo, menagerie, or stockade in its name” (p. 101).
Spotlight 3.5 addresses cross-cultural differences in attachment.
Spotlight on Diversity 3.5
Cross-Cultural Differences in Attachment

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As with temperament, social expectations adopted by parents (or other caregivers) for children’s levels of attachment, dependence, activity, or autonomy may affect how attachment develops. Berk (2012b) reflects:
German infants show considerably more avoidant attachment than American babies do. But German parents encourage their infants to be nonclingy and independent, so the baby’s behavior may be an intended outcome of cultural beliefs and practices (Grossmann et al., 1985). In contrast, a study of infants of the Dogon people of Mali, Africa, revealed that none showed avoidance attachment to their mothers (True, Pisani, & Oumar, 2001). Even when grandmothers are primary caregivers (as they are with firstborn sons). Dogon mothers remain available to their babies, holding them close and nursing them promptly in response to hunger and distress. (p. 268)
A high proportion of Japanese infants demonstrate anxious-resistant attachment. They are quite wary of strangers (Berk, 2012b), perhaps because Japanese mothers keep their infants very close to them. Japanese parents value infants’ dependence on them and expect infants to resist separation; thus, anxious-resistant attachment is a normal expectation for the development of the Japanese parent–child relationship (Rothbaum, Weisz, Pott, Miyake, & Morelli, 2000).
Finally, although cultural variations in attachment do exist, secure attachment still tends to be the norm in most infant-caregiver relationships (van IJzendoorn & Sagi, 1999).
3-6Examine Self-concept, Self-esteem, and Empowerment
LO 8
All individuals form impressions about who they think they are. It’s almost as if each person develops a unique theory regarding who exactly she feels she is. This personal impression of one’s own “unique attributes and traits,” both “positive and negative,” is referred to as the self-concept (Sigelman & Rider, 2012, p. 348). The idea of self-concept was introduced earlier in a discussion of Carl Rogers’s self theory. A related idea is that of self-esteem. Self-esteem refers to a person’s judgment of his or her own value. Although self-concept may include more aspects about the self than just value, the two terms are often used interchangeably.
Self-concept is an important theme throughout mental health literature. Improving one’s self-concept is often seen as a therapeutic goal for people with adjustment problems and as a means of empowerment. One’s self-concept is important throughout life. In order to continue working, living, striving, and positively interacting with others, one must have a positive self-concept. In other words, one must feel good enough about oneself to continue living and being productive. This is just as true for children as it is for adults. Highlight 3.3 demonstrates the effects of positive and negative self-concepts in children.
Highlight 3.3
The Effects of Positive and Negative Self-Concepts
Two 5-year-old girls, one with a good self-concept and the other with a relatively poor self-concept, illustrate the enormous effects of self-concept. Julie, who has a positive perception of self, is fairly confident in new situations. When she enters kindergarten, she assertively introduces herself to her peers and eagerly makes new friends. She frequently becomes a leader in their games. She often volunteers to answer her teacher’s questions. Her teacher considers her happy and well adjusted.
In contrast, Mary has a relatively poor self-concept. She does not think very highly of herself or her abilities. On her first day of kindergarten, she usually stays by herself or lingers on the fringes of activities. She speaks little to others out of fear that they might criticize her. She really wants to be liked but is worried that there is nothing to like about her. Thus, it is easier for her to remain quiet and unobtrusive. For example, one day the teacher brings out pieces of colored clay for the children to play with. Being so quiet and afraid, Mary does not rush up to her teacher to get hers even though playing with clay is one of her favorite pastimes. Rather, she waits until all the other children have their clay and are returning to their seats.
By the time Mary approaches the teacher, all the clay has been handed out. Instead of clay, her teacher gives her a coloring book and some crayons. Mary takes them passively and begins to color a big yellow duck. All the while she is crying silently to herself. She is very disappointed that she did not get any clay. She also is hoping no one will notice that she is different from everyone else. Mary has a poor self-concept. She is afraid of others and what they might think. She does not have much self-esteem.
The self-concept is an abstract idea. It is difficult to explain exactly what it involves. However, it is still an important factor in a person’s ability to function. People of virtually any age need to feel good about themselves in order to be confident and enjoy life’s experiences.
Theoreticians have emphasized the social significance of the self-concept and have labeled it “the meeting ground of the individual and society” (Markus & Nurius, 1984, p. 147). Middle childhood is the period when children are confronted with social expectations and demands. They become aware of the importance of the social setting and begin evaluating how they fit in.
One way of exploring the issue of self-esteem or self-worth stems from Harter’s work (1987, 1988, 1990, 1993, 1998, 1999, 2006). (For the purposes of our discussion, the terms self-esteem and self-worth will be used interchangeably.) Harter postulates that children develop a sense of global self-worth, an overall view of how positively they feel about themselves, in two ways. First, self-worth is based on how competent children perceive themselves to be. Second, self-esteem depends on the amount of social support they receive from those around them. Children tend to establish positive or negative perceptions of themselves by about age 5, but they are unable to describe this awareness in words until about age 8 (Papalia & Martorell, 2015)
In exploring self-worth, Harter asked elementary-school children how competent and confident they felt about five different areas of their lives. The first, scholastic competence, involved how well children felt they performed in doing schoolwork. The second area concerned athletic competence, the children’s perception of their sports prowess. Third, children were asked about their social competence—that is, how well accepted and popular they felt they were. The fourth area of competence concerned behavioral conduct, or how the children felt others viewed their behavior. The fifth area was physical appearance, how attractive they felt they appeared to others and how they felt about their specific physical characteristics (such as height, weight, hair, or facial attractiveness). In addition to these five areas, Harter asked questions directed at the children’s overall sense of global self-worth.
Harter’s research resulted in at least three major findings. First, the most significant variable contributing to self-esteem was how much positive regard children felt from people around them. The most important people were parents and classmates, followed by friends and teachers. It is interesting that these children rated classmates above friends in terms of importance. Perhaps they felt more social pressure and experienced more painful criticism from peers they were not close to. It is also interesting that children at all grade levels rated their parents high in importance. This contradicts the idea that as children grow up, their peers become more significant to them and their parents lose ground.
A second research finding was the ranking of the five areas. For both younger children (grades 3 through 5) and older children (grades 6 through 8), physical appearance was the most important, and behavioral conduct was the least important.
A third significant result involved the relationship between self-worth and affect (emotional mood). Children who felt a more positive global self-worth tended to be happier. They also were more likely to involve themselves in activities, trust in their own beliefs, express a high level of self-confidence, and handle criticism better. Those children who had a poorer sense of global self-worth were less happy, sad, and even depressed. They tended to hold themselves back from activities and be watchers rather than doers. They also were more likely to criticize themselves and experience frustration more easily. The implications of this research are that it is important to enhance children’s self-esteem, especially those children with exceptionally low levels.
3-7Significant Issues and Life Events
Several issues and life events that can affect children are discussed in this section. They were selected based on the importance of the effects they have on children and on the probability that social workers will encounter these issues in practice. The issues are intelligence testing, along with its potential problems and cultural biases; intellectual disabilities (mental retardation); learning disabilities; and attention deficit hyperactivity disorder. The content focuses on both characteristics and treatment.
3-8Discuss Intelligence and Intelligence Testing
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Intelligence may be defined as the ability to understand, to learn, and to deal with new, unknown situations. Beyond this general definition, little is known about the origins of intelligence. Attempts to refine and clarify the definition have ranged from primitive measurement of head size, referred to as phrenology, to the listing of specific mental abilities that are supposed to be involved in intelligence (e.g., the ability to perceive spatial relationships, perceptual speed, memory, word fluency, reasoning, numerical ability, and verbal ability) (Thurstone, 1938).
3-8aCattell’s Fluid and Crystallized Intelligence
Cattell (1971) identifies two different types of intelligence: fluid and crystallized. Fluid intelligence is an individual’s natural aptitude for solving highly conceptual problems as well as other problems, remembering facts, attending to the task at hand, and calculating numerical figures. This type of intelligence is innate and, therefore, theoretically not subject to change over the life span. Such native aspects of intelligence include the ability to perform abstract computations and memory capabilities. Crystallized intelligence, on the other hand, includes intellectual abilities that emphasize verbal communication and involve the ability to learn from others in the social environment through education and interaction. For instance, a person can learn a language or increase vocabulary. The person can also acquire new information and benefit from what has been learned through experience.
It would logically follow, then, that fluid intelligence would remain relatively constant throughout the life span, but that crystallized intelligence has the potential to increase.
3-8bSternberg’s Triarchic Theory of Intelligence
Sternberg (1984, 1985, 1986, 1987, 1990, 1996, 2000a, 2000b, 2004, 2008, 2009) has proposed a triarchic theory of human intelligence that emphasizes the context in which behavior occurs. He believes that three major components are involved in intelligence. These components are integrally related to a person’s adaptive behavior—that is, what is relevant in the individual person’s environment. For example, Bill Klumpe’s business was to install septic tanks around small towns and rural farmlands in southeastern Wisconsin. Septic tanks were necessary because public sewers were unavailable throughout the area. Bill’s reading skills were so poor that he had barely passed the written test to get his driver’s license. The advent of calculators was a blessing to him because he was not adept at adding and subtracting numbers when figuring out what his customers owed him.
However, Bill was the best septic tank installer people in the area had ever seen. He had learned the business as a teenager, and now, in his 50s, he knew just about everything about septic tanks. He could look at a piece of schedule 40 PVC piping and know immediately if it was the right size for the proper drainage capacity. His gaskets were perfect, and his pipe couplings never leaked. His buddies at the bowling alley tavern sometimes would tease him, “You don’t have a brain in your head, but you sure can dig!” Sternberg would say that what Bill had was intelligence. He had the capability to use his mind extremely well in those areas that were most significant to him.
Thus, Sternberg’s model emphasizes the relevance of what people think about. The three specific components of intelligence are the componential, experiential, and contextual elements. The componential element involves how people think about, process, and analyze information to solve problems and evaluate their results. People who have high levels of componential intelligence also score highly on intelligence tests and are good at debate and formulating arguments.
The second component of intelligence, according to Sternberg, is the experiential element. This involves a person’s actual doing of a task. It is the insightful, perceptive facet of intellect that enables an individual to put together information in new and creative ways. For example, Einstein conceptualized a theory of relativity. Part of this has to do with being able to master some tasks so that they become almost automatic. The mind can then devote greater attention to solving new parts of a problem or to working on new and better ways of accomplishing a task.
For example, Ruth, a medical transcriber at a large suburban hospital, types all the technical medical reports that physicians dictate on tape so that the information becomes part of each patient’s permanent medical record. Over her many years of experience, she has identified a large body of technical medical words that are used repeatedly. In order to save time and make herself more efficient, she has developed a coding system that uses symbols or abbreviations to represent technical words and has encoded these into her word-processing software. For instance, when she types the letters cd, the computer interprets the letters to mean cephalopelvic disproportion, which the processor automatically prints. This system allows Ruth to concentrate more closely on the new, unknown, or most difficult terminology.
Sternberg’s third component of intelligence is the contextual element. This involves the practical aspect of how people actually adapt to their environment. Within an individual’s personal situation, it involves what knowledge is learned and how that knowledge can best be put to use in a practical sense.
To illustrate these three components, consider three undergraduate social work students: Jackie, Danielle, and Sara. Jackie had gotten almost straight A’s in high school. In college, she was a whiz at taking both multiple-choice and true-or-false exams. However, she did not do nearly as well on essay exams, especially when they involved applications to problem situations in practice (e.g., how a social worker would intervene in a family where alcohol abuse was involved). She also had a terrible time when she entered her first social work practice course where she had to learn and apply interviewing skills in role plays. Eventually, she switched her major to sociology. She felt she could best apply her interest in working with people if she went on to graduate school in sociology and eventually did social research.
Danielle, on the other hand, did extremely well on essay exams but not as well on the objective multiple-choice and true-or-false tests. She got A’s in the social work practice courses, which involved articulating how she would help people solve problems in the field. Her instructors praised her for her creativity and ideas. When she got into her field internship, she performed relatively well. She was able to apply her knowledge and skills to practice situations. She had some difficulty, however, working with clients who came from socioeconomic and ethnic backgrounds radically different than hers. Her final grade in field was an .
Sara barely got her college application accepted. She was in the lowest 25 percent of her high school graduating class, which meant she had to begin college on probation. She barely squeaked by each semester with the minimal cumulative grade point necessary. She also managed to attain the required grade point necessary to get into her advanced social work courses and continue on in the major. However, when she finally got into her field placement, her social work supervisor raved about what an excellent student she was. Sara was able to take on difficult cases early in the semester and required relatively little supervision. Sara’s personal manner was such that she established relationships quickly with clients. She was able to make clear applications of the practice skills she had learned in her courses. It almost seemed like working with people as a social worker came naturally to her. She seemed to have a natural sense of what to do in situations that were completely foreign to her. She received an A in field-work, which contrasted with her C+ cumulative grade. The agency later enthusiastically hired her.
Each of these three individuals is strong in one component in Sternberg’s model of intelligence. Jackie was strong in the componential aspect of intelligence. She could conceptualize extremely well at abstract levels and clearly remember facts and details. Danielle’s strength lay in the experiential component of intelligence. She was creative and insightful. She could take recommendations for what to do in a specific situation and clearly apply them. Sara excelled in the contextual aspect of intelligence. She could adapt virtually to any situation and solve problems in a very practical sense.
In real life, people can be strong in any or all of these components. They have an intellectual mixture of strengths and weaknesses.
3-8cIntelligence Testing
We have established that no absolutely clear definition of intelligence exists. Therefore, it is important to recognize the relationship between the more global concept of intelligence and the intelligence quotient, commonly referred to as IQ. Many mistakenly assume that an IQ represents the absolute quantity of intelligence that a person possesses. This is not true. An IQ really stands for how well an individual might perform on a specific intelligence test in relation to how well others perform on the same test. The IQ, then, involves two basic facets. One is the score that a person attains on a certain type of test. The other is the person’s relative standing within the peer group.
An IQ score is the best thing available for attempting to measure whatever intelligence is there. Such a statement may not inspire confidence in the value of one’s IQ. However, perhaps it should elicit caution. IQ scores can be used to determine grade school placement, admission to special programs, and encouragement or lack thereof to attend college. A person who is aware of having a low IQ score may establish lower expectations. These lower expectations may act as a barrier to what the person could actually achieve. She might become the victim of a self-fulfilling prophecy—that is, what she expects is what she gets.
This could have been the case, for example, for a returning college student who was the mother of three children. She was also receiving social insurance benefits because of a permanent disability. Her vocational counselor told her that her IQ was not nearly high enough for success in college. He suggested that she stay home and enjoy her moderate financial benefits. Although his statements discouraged her, she had the courage and stamina to enroll with a full course load at a well-respected state university. Her final grade report after her first semester indicated that she had achieved a perfect 4.0 average. She immediately returned to her vocational counselor and requested financial Helpance for a computer to Help her in her course work. He mumbled in an embarrassed manner that that might be a good idea.
Intelligence testing is done in both group and individual formats. Many school systems use group testing because it is less time consuming and cheaper. Individual tests, however, tend to be more precise and useful in targeting specific areas of need. The most frequently used tests in the English language include the Stanford-Binet Test and the Wechsler Intelligence Scale, which are described in the next sections (Kalat, 2011).
The Stanford-Binet IQ Test
A common intelligence test is the Stanford-Binet IQ test. First used in 1905, it has continued to be refined. Schools frequently use the Stanford-Binet to determine program and grade placement and potential academic success.
The Stanford-Binet test can be administered to individuals age 2 through later adulthood (Coon & Mitterer, 2011; Roid, 2003). Scores can be obtained in five areas that measure both verbal ability (related to the use and understanding of language) and nonverbal ability (related to problem solving and thinking in ways that do not use language, such as completing pictures) (Roid, 2003). The five aspects of reasoning assessed include “fluid reasoning (e.g., completing verbal analogies, such as ‘hot is to cold asis to low’), knowledge (e.g., defining words, detecting errors in pictures), qualitative reasoning (e.g., solving math problems), visual-spatial processing (e.g., assembling a puzzle), and working memory (e.g., repeating a sentence). Each of the five abilities is measured by one verbal and one nonverbal subtest, so it is possible to calculate a core for each of the five abilities, a total score on all the verbal tests, a total score on all the nonverbal tests, and an overall score for all ten tests combined” (Bernstein, 2011, p. 277).
The Stanford-Binet measures “performance as an intelligence quotient or IQ, which is the mental age to chronological age (CA) multiplied by 100: . At any age, children who are perfectly average have an IQ of 100 because their mental age equals their chronological age. Furthermore, roughly two thirds of children taking a test will have IQ scores between 85 and 115. The IQ score can also be used to compare intelligence in children of different ages. A 4-year-old girl with an MA of 5 has an IQ of 125 (5/4 × 100), just like that of an 8-year-old boy with an MA of 10 (10/8 × 100)” (Kail & Cavanaugh, 2016, p. 206).
In the past, the Stanford-Binet was criticized because of its heavy emphasis on verbal ability. Children whose verbal ability was not strong for some reason may not have had their actual intellectual ability adequately reflected. However, the current edition diminishes that bias and focuses more on other avenues of reasoning. For example, a child might be asked to define several words, such as banana or pencil, as part of the verbal assessment, and then be asked to draw a course through a maze to test other aspects of thinking ability. The test is also designed to be more evenly responsive to a broad range of groups differing significantly in geographic location, ethnicity, and gender. Newly designed approaches stress nonverbal performance for people with “limited English, deafness, or communication disorders” (Roid, 2003).
The Wechsler Tests
Two commonly used variations of the Wechsler tests are the Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV) and the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV) (Kalat, 2011). Kalat explains that both tests
produce the same average, 100, and almost the same distribution of scores as the Stanford-Binet. The WISC is given to children up to age 16, and the WAIS is for everyone older …
A Wechsler test provides an overall score and four major subscores. One is the Verbal Comprehension Index, based on such items as “Define the word letter” and “How are a peach and a plum similar?” A second part is the Perceptual Reasoning Index, which calls for nonverbal answers. For example, the examiner might arrange four blocks in a particular pattern and then ask the child to arrange four other blocks to match the pattern….
A third part, the Working Memory Index, includes such items as “Listen to these numbers and then repeat them: 3 6 2 5” and “Listen to these numbers and repeat them in reverse order: 4 7 6.” The fourth part is Processing Speed. An example of an item is “Here is a page full of shapes. Put a slash (/) through all the circles and X through all the squares.” This task is simple, but the question is how quickly someone can proceed accurately. (p. 321)
Comparing verbal and performance scores as well as reviewing scores on specific subtests can be especially useful in detecting specific learning problems. For example, if a child performs significantly better on the performance segments than on the verbal ones, a learning disability (discussed later in the chapter) or some other perceptual deficit may be present.
Ethical Question 3.2

EP 1
1. Should children be informed of their IQ? Should parents be told of their child’s results? What are the reasons for your answers?
3-8eOther Potential Problems with IQ Scores
The use of IQ tests alone to categorize people is problematic for several reasons. One is cultural bias, discussed in Spotlight 3.6. Another is that the definition of IQ is arbitrary. At its most basic level, an IQ score reflects how well people perform on an IQ test. It does not provide a reliable indication of competence in the real world.
Spotlight on Diversity 3.6
Explain Cultural Biases and IQ Test
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It is critical to be vigilant about the potential for cultural biases in IQ tests. White middle- and upper-class children historically have had an unfair advantage over non-white children on these tests. Similarly, urban children have had advantages over rural children, and middle-class children over lower-class children in general. Biases can involve the use of words, concepts, and contexts that are more familiar to some children than to others.
For example, Kail and Cavanaugh (2013, p. 219) discuss the question, “A conductor is to an orchestra as a teacher is to what?” They pose the possible answers as “book,” “school,” “class,” or “eraser.” Children who have been exposed to the concept of “orchestra,” perhaps having attended a concert, are more likely to provide the correct answer than children who have little or no idea what orchestras or conductors are.
What is considered significant by members of a culture can influence what children consider important, and hence how they answer questions on IQ tests. Plotnik and Kouyoumdjian (2011) comment on how other cultures perceive the concept of intelligence differently by emphasizing other aspects of human behavior and existence:
For example, the Taiwanese conception of intelligence emphasizes how one understands and relates to others, including when and how to show intelligence (R. J. Sternberg & Yang, 2003). In Zambia (Africa), parents describe the intelligence of their children as including cognitive abilities as well as showing social responsibility, which is considered equally important (Serpell, 2003). In Micronesia, people demonstrate remarkable navigational skills as they sail long distances using only information from stars and sea currents (Ceci et al., 1997). These navigational abilities certainly indicate a high degree of intelligence that would not be assessed by traditional Western IQ tests. Thus, the definition of intelligence differs across cultures. (p. 291)
Even testing situations and children’s comfort level in them can affect IQ test results. Specific variables include the test-takers’ relationship with the test-giver, their ability to sit quietly and respond to instructions, and their understanding of the dynamics involved in taking tests successfully, such as going through the entire test first, answering the questions they know, pacing themselves, and then returning to the more difficult items so that they are able to complete most of the test (Ceci, 1991).
Much attention has been paid to cultural fairness in IQ tests. Culture-fair IQ tests try to include test items and terms that are familiar to children from as many cultural and socioeconomic backgrounds as possible. However, because a totally “culture-free” test (i.e., one with no culturally biased content at all) is impossible to achieve, it is important to remain sensitive to fairness and strive to make tests as “culture fair” as possible.
Another problem with IQ tests is that placing IQ labels on people may become self-fulfilling prophecies. An individual with a low IQ score may stop trying to reach his or her true potential. A person labeled with a high IQ may develop an inappropriately superior, even arrogant, attitude. We all probably know people like this.
Another potential problem with IQ scores is that they do not take motivation into account. A person with a lower IQ score who works hard and is motivated may attain much higher levels of achievement and success than a person with a higher IQ who is not motivated to use it. Simply having the ability does not necessarily mean that it will be put to use.
Many aspects of an individual’s personality, ability to interact socially, and adapt to society are not directly related to IQ. In effect, IQ is only one facet of an individual. People have numerous other strengths and weaknesses that make up their unique personalities. Each person is an individual whose worth and dignity merit appreciation.
3-9Analyze Intellectual Disabilities and the Importance of Empowerment
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Intellectual disability (formerly referred to as mental retardation) is a condition characterized by intellectual functioning that is significantly below average and accompanying deficits in adaptive functioning, both of which occurred before reaching adulthood (American Psychiatric Association [APA], 2013a, 2013b). Note two important points about the terms intellectual disability and mental retardation. First, the term intellectual disability has a less negative connotation than the term mental retardation. Second, it is important to refer to people with intellectual disabilities as people before referring to any disability they might have. For example, referring to them as intellectually, mentally, or cognitively challenged people tends to emphasize the disability because the disability is stated first. Our intent is simply to respect their right to equality and dignity. (Note that some states may use other terms for people with intellectual disabilities. Terms might include cognitive impairment, cognitive disability, mental impairment, mental disability, or mental handicap; more consistent and positive changes in terminology should occur over time to better understand and appreciate these people [Friend, 2011, p. 235].)
Individuals with intellectual disabilities, to some degree, are unable intellectually to grasp concepts and function as well and as quickly as their peers. The exact prevalence of intellectual disability is unknown; however, it is estimated that between 7 and 8 million Americans of all ages, or one in ten families, are affected by a person with an intellectual disability (Administration for Community Living, 2016). The following sections will elaborate on the definition of intellectual disability, the significance of support systems, and what people who have intellectual disabilities are like (see Spotlight 3.7).
Spotlight on Diversity 3.7
What Are People with Intellectual Disabilities Like?
There are huge differences in the capabilities of people who have intellectual disabilities, depending on their strengths and level of functioning. Therefore, it is important to maintain a strengths perspective and consider each person as an individual with his or her own special abilities and potential. Compared to people who have “normal” IQs, people with intellectual disabilities tend to experience deficits in six basic areas: attention, memory, language, self-regulation, motivation, and social development (Hallahan et al., 2012, p. 113). It is important to remember that not all people with intellectual disabilities have deficits in all areas.
This discussion on problems associated with intellectual disabilities is negatively oriented. It focuses on people’s deficits instead of their strengths. However, you need to understand where people with intellectual disabilities are likely to experience problems in order to emphasize and enhance their strengths in those and other areas.
People with intellectual disabilities may have trouble paying attention to ongoing activities and events as carefully as other people do. They may be easily distracted or pay attention to things other than what they are supposed to attend to.
Research has established that people with intellectual disabilities experience difficulty with memory, the second problem area. They may be weaker in their ability to remember things recently told to them or experienced by them. Complex ideas are more difficult for them to retain than simpler concepts.
Language development is the third area of difficulty that is evident in many people with intellectual disabilities. They usually take longer to master language skills. They will probably require more time to understand ideas and concepts. They may display speech and pronunciation problems.
Self-regulation, a fourth problematic area, is a person’s ability to organize thinking and plan ahead. People with intellectual disabilities may have less ability to organize their thoughts. For instance, when “normal” students take essay exams, they may use acronyms (words formed from the initial letter or letters of each of the successive parts of some complex term or succession of steps) to help them remember a series of steps or ideas. People with intellectual disabilities likely would not.
The fifth area of possible difficulty is motivation. People with intellectual disabilities generally do poorly in school compared with their peers and may develop a long history of defeat and failure. If they think that they will fail no matter how hard they try, they may not try to succeed at all.
Poor social development is a sixth area of potential difficulty. This may be due to low levels of self-esteem and poor self-concept. It may be due to having more difficulty learning how to respond appropriately in social situations. It also may result in more disruptive behavior than that of their peers. If children with intellectual disabilities have difficulties in learning, especially in academic settings, disruptive behavior may be a way for them to get attention or amuse themselves.
People with intellectual disabilities are often placed in categories called mild, moderate, severe, and profound according to the American Psychiatric Association’s Diagnostic and Statistical Manual (5th ed.) (DSM-5) (APA, 2013a). The following profiles of each category are based on descriptions in DSM-5. The intent is to provide you with some general ideas about the types of support people may need.
The majority of people with intellectual disabilities fall within the mild category. In the past, these people were referred to as “educable” in that they often achieved academic skills up to a sixth-grade level. As preschoolers, people with mild intellectual disabilities often develop social and communication skills, demonstrate minimal sensory or motor impairment, and generally fit in fairly well with their peers. In fact, the majority of people with intellectual disabilities are very similar to everybody else except that they are a bit slower in learning and don’t progress quite as far as others in the “normal” population. Their limitations usually become more evident as they advance in school. As adults, they usually gain employment “in jobs that don’t emphasize conceptual skills” (APA, 2013a, p. 34). They often require Helpance in making health and legal decisions, and frequently need support to fulfill the necessary functions involved in raising a family.
People with moderate intellectual disabilities progress more slowly in academic pursuits and require more Helpance. They tend to view issues and experiences more concretely than their peers. They likely have difficulty in reading and in managing finances by themselves. These people “show marked differences from peers in social and communicative behavior across development” (APA, 2013a, p. 35). They usually can form successful relationship ties with family members and with friends having abilities similar to their own. They tend to have difficulty accurately interpreting social cues. “Significant social and communicative support is needed in work settings for success” (APA, 2013a, p.35). They generally can assume responsibility for daily self-care tasks, but require substantial teaching and support in order to master household tasks. They can gain employment in jobs requiring “limited conceptual and communication skills,” but need significant support. Additionally, they require substantial help in “scheduling, transportation, health benefits, and money management” (APA, 2013a, p. 35). They can enjoy a range of recreational activities with adequate “supports and learning opportunities” (APA, 2013a, p. 35). They can potentially function well in their communities with enough support, usually living in a supervised environment.
Empowerment is essential for people with disabilities. Here, Gena Killinger, an athlete from Nebraska, raises her hand in victory after winning a 25-yard backstroke in a Special Olympics event held in Ames, Iowa.

AP Images/The Ames Tribune, Andrew Rullestad
People with severe intellectual disabilities develop little, if any, speech in early childhood. As childhood progresses, they can develop some speech capability and skills to take personal care of themselves. Conceptual and problem-solving skills are lacking. They generally can eventually develop very basic skills in uncomplicated social speech. They can enjoy family members and other people with whom they’re familiar. People with severe intellectual disabilities require substantial help in virtually all areas of life including decision making and self-care tasks. They need extensive, ongoing support in their daily life activities and living arrangements. They often live with their families or in some other closely supervised, structured setting.
People with profound intellectual disabilities most often have additional motor and sensory problems that prevent them from manipulating many objects effectively. They view the world as a very concrete place. They have major difficulties with conceptualization and formulation of ideas. Communication is primarily through nonverbal gestures instead of words, although they may learn to understand some simple words and directions. They can experience pleasure through interaction with family members and familiar others close to them. People with profound intellectual disabilities are “dependent on others for all aspects of daily physical care, health, and safety,” although many can learn to partake in some activities with Helpance (e.g., removing dishes from the dinner table) (APA, 2013a, p. 36). They can generally enjoy and participate in basic recreational ventures with extensive supervision. Such pursuits might include listening to music, taking walks, watching television, or being in a swimming pool.
People with intellectual disabilities have strengths and weaknesses just like the rest of us. Each is a unique individual. Most people with intellectual disabilities are pretty much like everybody else, but they have less intellectual potential. They have similar feelings, joys, and needs. And they have rights.
3-9aDefining Intellectual Disability
There are three major parts in the definition of intellectual disability (referred to as mental retardation) in the DSM-5 (APA, 2013a). First, a person must score significantly below average in general intellectual functioning. Although this determination was historically based on IQ tests, it now involves “both clinical assessment and individualized, standardized intelligence testing” (APA, 2013a, p. 33). In general, intellectual disability is thought to characterize people whose intelligence levels fall at least two standard deviations below the norm; this means having an IQ of 70 or below (APA, 2013b).
A second part of the definition of intellectual disability involves impairment in adaptive functioning, that is, how a person thinks about his or her situation, interacts with others, and masters daily life activities (APA, 2013a). Adaptive activities fall within three dimensions—conceptual, social, and practical (APA, 2013b). The conceptual dimension concerns the ability to think, remember, solve problems, and perform academically. The social dimension involves the ability to communicate with others, form relationships, and understand people’s emotional and other needs. The practical dimension entails conducting necessary daily tasks like attending to self-care and personal hygiene, holding a job, managing money, and fulfilling other educational and work responsibilities.
The third part of the definition of intellectual disability concerns the fact that the condition is identified or diagnosed “during the developmental period,” that is, the time before a person reaches adulthood (APA, 2013b). In the past, this meant turning age 18 but now other factors such as adaptive functioning may be taken into account (APA, 2013b). One intent of this part of the definition is to rule out people who become brain damaged (e.g., in a car accident) or experience some other mental impairment when they are adults. In those incidences, people would probably fall under other DSM-5 diagnostic categories.
Spotlight 3.7 recognizes the four traditional categories of intellectual disability, which historically emphasized IQ scores. The categories are noted here with their traditional IQ scores (APA, 2000, p. 42):
Mild: IQ of 50–55 to approximately 70
Moderate: IQ of 35–40 to 50–55
Severe: IQ of 20–25 to 35–40
Profound: IQ below 20 or 25
The ranges in each category reflected the varying results that can be attained on different IQ tests, the 5 percent measurement error in the tests themselves, and the importance of taking adaptive functioning into account (APA, 2000). For example, a person scoring 40 on an IQ test but suffering from serious deficits in adaptive ability might be placed in the “Severe” category. On the other hand, another person scoring 40 who has many adaptive strengths might be placed in the “Moderate” category.
Highlighting adaptive ability and achievement allows the individual to be evaluated as a unique functioning being. Older definitions of intellectual disability placed greater importance on IQ alone, which does not necessarily provide an accurate picture of someone’s ability to function and make decisions on a daily basis.
The new DSM-5 is the primary diagnostic tool used in the United States for mental and emotional disorders. New diagnostic procedures stress both clinical assessment of intellectual ability and extensive Assessment of adaptive functioning in addition to standardized IQ tests. The American Association on Intellectual and Developmental Disabilities (AAIDD, 2013) also emphasizes the use of adaptive skill areas when evaluating an individual’s ability to function independently. Additionally, the AAIDD (2013) stresses that the community social environment, “linguistic diversity,” and “cultural differences in the way people communicate” and behave be taken into account when assessing intellectual disability.
Ethical Question 3.3

EP 1
1. Do people with intellectual disabilities have the right to have children?
3-9bThe Significance of Empowerment by Support Systems
In addition to highlighting adaptive skill areas, it is important to evaluate the configuration and intensity of support an individual needs—“intermittent,” “limited,” “extensive,” or “pervasive”—besides considering IQ and adaptive skill acquisition (Hallahan, Kauffman, & Pullen, 2009, p. 148; Kirk, Gallagher, Coleman, & Anastasiow, 2012; Lightfoot, 2009a). Intermittent support is the occasional provision of support whenever it is needed. People needing only intermittent support function fairly well by themselves; they need help from family, friends, or service-providing agencies only sporadically. This usually occurs when they are experiencing periods of stress or major life transitions (such as a health crisis or job loss). Limited support is intensive help or training provided for a limited time to teach specific skills, such as job skills, or to Help in major life transitions such as moving from one’s parental home. Extensive support is long-term, continuous support that usually occurs daily and affects major areas of life both at home and at work. Finally, pervasive support is continuous, consistent, and concentrated. People need pervasive support for ongoing survival.
It’s important to remember that identification of the support level needed “must not limit the planning and opportunities developed” for a person with intellectual disabilities (Kirk et al., 2012, p. 180). These people are individuals who may demonstrate a wide range of strengths. The emphasis on, discovery of, and use of such strengths is an ongoing process.
The support systems perspective coincides well with social work values in at least four ways (DeWeaver, 1995). First, instead of labeling people as having mild, moderate, severe, or profound intellectual disabilities, it stresses people’s ability to function and achieve for themselves with various levels of support from others. It looks at what people can do with some help, rather than what they cannot do. Second, it refutes the sole focus on medical labeling and related issues as the primary concern. Medical labels are not necessarily useful when determining what you can do to help people. For example, labeling a person as having severe intellectual disability or mental retardation is not as useful as saying that this person requires extensive support. Third, the support systems perspective shifts the primary assessment focus from IQ to adaptive skills. Fourth, because of its focus on individual strengths, it encourages assessment and emphasis on ethnic, cultural, and linguistic differences and qualities. The professionals involved in assessment are not limited to examining one or two variables. Rather, they are encouraged to explore virtually any aspect of the individual’s environment.
3-9cMacro-System Responses to Intellectual Disabilities
The programs available for people with intellectual disabilities depend on policies that dictate where public funds should and will be spent. Once again, we see how policy (such as federal and state laws) affects social work practice. Policies provide the rules for how organizations can spend money and what services they can provide. Social workers must do their jobs within the context of the organizations they work for. Spotlight 3.8 discusses current legislation concerning people with disabilities.
Spotlight on Diversity 3.8
The Americans with Disabilities Act: The Pursuit of Social and Economic Justice

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The intent of the Americans with Disabilities Act (ADA) of 1990 was to provide the millions of Americans who have disabilities with access to public places, work settings, and “the mainstream of public life” (Jimenez, 2010; Smolowe, 1995a, p. 54; U.S. Department of Justice, 2005). “Unemployment and economic stress are major concerns” for people with disabilities (Segal, 2010, p. 112). The ADA “was intended as a sweeping civil rights law that works to eliminate discrimination against people with disabilities in the areas of employment, public accommodations, state and local government, transportation and communications” (Lightfoot, 2009b, p. 449; U.S. Department of Justice, 2005).
The ADA includes under its umbrella people who have intellectual disabilities, other developmental disabilities (various serious chronic conditions), and physical disabilities. “An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. The ADA does not specifically name all of the impairments that are covered” (U.S. Department of Justice, 2005).
The ADA is one attempt by a national macro system to improve the lives of people with disabilities and provide them with greater social and economic justice. The ADA consists of four major provisions (U.S. Department of Justice, 2005). Title I forbids job and employment discrimination against people with disabilities and requires employers to provide “the full range of employment-related opportunities available to others.” It “prohibits discrimination in recruitment, hiring, promotions, training, pay, social activities, and other privileges of employment.” It also restricts an employer’s questions about a person’s disability prior to making a job offer.
Title I requires employers with 15 or more employees to provide qualified individuals with disabilities an equal opportunity to benefit from the full range of employment-related opportunities available to others. For example, it prohibits discrimination in recruitment, hiring, promotions, training, pay, social activities, and other privileges of employment. It restricts questions that can be asked about an applicant’s disability before a job offer is made, and it requires that employers make reasonable accommodation to the known physical or mental limitations of otherwise qualified individuals with disabilities, unless it results in undue hardship.
Title II requires all state and local governments to provide equal opportunities to people with disabilities. Applicable services include those involved in “public education, employment, transportation, recreation, health care, social services, courts, voting, and town meetings.” These governing bodies are also required to make buildings accessible, modify policies to avoid discrimination, and provide communication channels for people with “hearing, vision, or speech disabilities.” Title II also prohibits “public transportation services, such as city buses and public rail transit (e.g., subways, commuter rails, Amtrak)” from discriminating against people with disabilities. This often entails making services accessible or providing individualized transportation when needed.
Title III requires that “businesses and nonprofit service providers” that offer goods and services to the public provide equal opportunities to people with disabilities. These include “restaurants, retail stores, hotels, movie theaters, private schools, convention centers, doctors’ offices, homeless shelters, transportation depots, zoos, funeral homes, day care centers, and recreation facilities including sports stadiums and fitness clubs.” Such accommodation often includes making locations accessible and making opportunities (e.g., for credentials requiring testing) or information available to people with disabilities.
Title IV requires that state and national telecommunication relay services accommodate people with hearing and speech impairments. These entities must allow people with such disabilities communications access 24 hours a day, 7 days a week. “Title IV also requires closed captioning of federally funded public service announcements.”
In summary, the ADA requires “universal access to public buildings, transit systems, and communications networks” (Smolowe, 1995a, p. 54). Significant gains have been made in terms of curb ramps, wide bathroom stalls, and public vehicles with lifts for wheelchairs for persons with physical disabilities.
However, employers and public agencies must make only “reasonable accommodation.” In reality, they are not compelled to provide such access or encouragement if the ensuing costs would result in “undue hardship,” often in the form of “undue financial and administrative burdens.” Because of the vagueness in terminology and lack of specification regarding how changes must be implemented, gains have been limited (Karger & Stoesz, 2013). What do the words reasonable accommodation, undue hardship, and undue administrative and financial burdens mean? What kind of accommodation is reasonable? How much money is unduly excessive? How can discrimination against capable people with intellectual or other specific disabilities be prohibited and equal opportunity enforced?
People with disabilities often experience “exclusion from typical activity and opportunity afforded to those who are not considered disabled” (DePoy & Gilson, 2004, p. 41; Mackelprang, 2008; Mackelprang & Salsgiver, 2009). Consider the following economic facts about people with disabilities (U.S. Census Bureau, 2016):
• Only 17.5 percent are employed.
• The median earnings for people with a disability are $21,232 compared to $31,324 for people without a disability.
• Twenty-eight percent of people with disabilities live in poverty compared to 12 percent without a disability.
Additionally, bear in mind the following about people with disabilities (National Organization on Disability, 2004, 2011; Patchner & DeWeaver, 2008):
• Twenty-two percent report that they have been victims of discrimination in some situation.
• Twenty-two percent of those who are employed report having been victimized by discrimination on the job.
• The extent of disability directly impacts quality of life in virtually every aspect of living. Jimenez (2010) describes more recent ADA amendments:
The ADA Amendments Act of 2008 was designed to enlarge coverage of the ADA by overturning a series of U.S. Supreme Court cases, which limited the number of persons who could demonstrate they were disabled. These new amendments call for “the definition of disability to be construed in favor of broad coverage of individuals,” shifting the burden of proof to those who would deny disabled persons the protection of the law. The amendments favor broad coverage of conditions that interfere with activities of daily living, as well as thinking and learning, working, lifting, and speaking. Unfortunately, the amendments did not clarify the important question in the ADA of what are “reasonable accommodations” that employers must make for… persons [with disabilities]. Under the amendments, Congress recognized that… persons [with disabilities] are often denied the right to participate fully in society because of social prejudice, as well as due to the existence of societal and institutional barriers. (p. 193)
The battle for equal access and opportunity for people with disabilities has not been won. Much of the public attention to the act has focused on people with physical disabilities, many of whom require wheelchairs for transportation. Where do people with intellectual and other developmental disabilities fit in? The ADA “will be successful only to the extent that these individuals [with disabilities] and those who advocate on their behalf learn about the ADA and use it as a means to ensure employment [and other] opportunities” (Kopels, 1995, p. 345).
For additional information, go to the ADA homepage at http://www.ada.gov.
Services for people who have intellectual disabilities or designated other disabilities are paid for primarily by federal and state programs, the majority of which are administered through programs under the U.S. Department of Health and Human Services. The rest are administered through the Department of Education.
Here, we address two issues involved in developing programs and providing services for people with intellectual disabilities: deinstitutionalization and community-based services. The important thing to remember throughout our discussion is that intelligence, although an important variable in terms of daily living and ability, is only one of many factors affecting people’s lives. Limited intelligence may reduce some of the alternatives available to an individual. However, other alternatives are available for that person to construct a rich, satisfying, and fulfilling life. A basic task of the social worker might be to help that person identify alternatives and weigh the various consequences of each.
Deinstitutionalization
Deinstitutionalization is the process of relocating people who need a significant level of care (e.g., people with intellectual disabilities, physical disabilities, or mental illness) from a structured institutional residence to a typical community setting. An assumption is that supportive community-based services and resources will take the institution’s place in meeting people’s needs.
Deinstitutionalization is supported by a number of rationales (Segal, 2008). First, the oppression caused by institutional living has been extensively documented. Second, costs of institutionalizing people are high. Third, social research continues to document that total institutionalization is frequently ineffective. Fourth, social values have increasingly emphasized the civil rights of all citizens, including people with intellectual disabilities; institutionalization severely inhibits civil rights. Fifth, other policies have been developed to provide aid to people in ways other than placing them in large residential facilities.
Historically, most federal money has been spent on maintaining people with intellectual disabilities in institutional settings. Worse, most of these institutions were actually intended for housing people who had mental illnesses (Segal, 2008). Current legislation, however, supports deinstitutionalization and the development of alternative services.
Concerns about deinstitutionalization have focused on lack of sufficient resources to provide adequate services and care outside of institutions (Hallahan et al., 2012; Segal, 2008). If deinstitutionalization is to work effectively, community, state, and national macro systems must invest enough resources to provide adequate levels of support for people with varying needs.
Community-Based Services
If a trend is to move people with intellectual disabilities out of institutional settings and into communities, the subsequent question is “Where?” Hallahan and his colleagues (2012) describe community residential facilities (CRFs) (also referred to as community-based residential facilities [CBRFs]) as
group homes [that] … accommodate small groups (three to ten people) in houses under the direction of “house parents.” Placement can be permanent, or it can serve as a temporary arrangement to prepare the individuals for independent living. In either case, the purpose of the CRF is to teach independent living skills in a more normal setting than a large institution offers.
Some professionals question whether CRFs go far enough in offering opportunities for integration into the community. They recommend supported living, in which persons with intellectual disabilities receive supports to live in more natural, noninstitutional settings, such as their own home or apartment. (pp. 125–127) (emphasis in original)
The key is to maximize self-determination while still providing adequate, necessary support. Much may depend on the individual’s potential level of functioning.
An important concept related to community-based services is normalization. This means arranging the environmental context for people with intellectual disabilities so that it is as “normal” as possible. The lives of people who have intellectual disabilities should be as similar to those of people in the “normal,” overall population as they can be.
Ethical Question 3.4

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1. Should people with intellectual disabilities be mainstreamed (i.e., be integrated into regular school classes) or be provided with separate special education to meet their special needs? What are the pros and cons of each approach?
3-9dSocial Work Roles
Social workers can perform many roles when working with people who have intellectual or other developmental disabilities. Social workers can function as enablers, helping people with intellectual disabilities and their families make decisions and solve problems. Social workers can be brokers, linking clients to the resources (e.g., transportation, job placements, or group homes) they need in order to go about their daily lives. Educator is another major role. People who have intellectual disabilities may need information about employment, interpersonal relationships, and even personal hygiene. Social workers can also function as coordinators who oversee a range of support services that clients need.
Social workers can also fulfill roles within the macro-system context. They can assume administrative functions as general managers within agencies providing services to clients and their families. In this capacity, they can evaluate the effectiveness of the services provided. Are clients getting what they really need? Is service provision as efficient as possible? Finally, social workers can serve as initiators, negotiators, and advocates. In communities and states where needed services are not readily available or are nonexistent, practitioners can work with organizational, community, and government macro systems to change policies so that clients can have access to what they need.
Spotlight 3.9 discusses the importance of empowering people with disabilities to advocate for themselves and get control of their own lives.
Spotlight on Diversity 3.9
Empowerment and a Consumer-Direct Approach

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Mackelprang and Salsgiver (2009) call for social workers and other human services professionals to emphasize the empowerment of people with disabilities. They stress the importance of identifying and focusing on the strengths and abilities of people with disabilities and the necessity of supporting their self-advocacy. They focus on the need to recognize and appreciate human difference rather than problems in functioning. Such an empowerment stance highlights the following six principles:
1. “People with disabilities are capable, have potential, and are important members of society.
2. DAssessment and a lack of resources, not individual pathology, are the primary obstacles facing persons with disabilities.
3. Disability, like race and gender, is a social construct, and intervention with people with disabilities must be political in nature.
4. There is a Disability culture and history that professionals should be aware of in order to facilitate the empowerment of persons with disabilities.
5. There is a joy and vitality to be found in disability.
6. Persons with disabilities have the right to self-determination and the right to guide professionals’ involvement in their lives” (Mackelprang & Salsgiver, 2009, pp. xv–xvii).
Lightfoot (2009b) elaborates on the importance of consumer-directed services (services that maximize the choice and self-determination of consumers, in this case, people with disabilities):
A growing trend in the area of disability policy is for people with disabilities to direct their own services. The move toward consumer-directed services, also known as consumer-controlled services, emanates from the concern that agency-controlled, services often do not meet the individual needs of people with disabilities and further increase the dependence on professionals and systems that people with disabilities experience. When agencies control services, people with disabilities have little choice over the personnel providing services, including services that are quite personal in nature. Consumer-directed services allow people with disabilities to hire, train, supervise, and fire their own staff with public money … [T]here are consumer-directed demonstration projects across the country that allow people of all ages who have disabilities to control the services they use (Benjamin, Matthias, & Franke, 2000; Mahoney, Simone, & Simon-Rusinowitz, 2000). Public social services policies for people with disabilities are likely to increasingly allow consumer-directed options, particularly as baby boomers age and desire more control over the supports they receive. (p. 457)
3-10Examine Learning Disabilities
LO 12

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Learning disabilities are commonly defined in one of two ways—the federal definition established in P. L. 94–142 and the definition adopted by the National Joint Committee on Learning Disabilities (NJCLD) (Friend, 2011; Hallahan et al., 2012). The federal definition is as follows:
Specific learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia … Disorders not included [:] … Specific learning disability does not include learning problems that are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage. (Individuals with Disabilities Education Act [IDEA], 20 U.S.C. §1401 [2004], 20 CFR §300.8[c][10]) (U.S. Department of Education, n.d.)
The NJCLD is an organization made up of representatives from a range of professional organizations that deal with students who have learning disabilities (Hallahan et al., 2012). The NJCLD found the abovementioned federal definition lacking in several ways (Hallahan et al., 2012). First, the definition makes no reference to causal factors, whereas the NJCLD considers “central nervous system dysfunction within the individual” as the cause (p. 187). Second, there is no mention of adults and the fact that a learning disability is a lifelong condition. Third, the definition fails to indicate that people with learning disabilities often experience difficulties regulating their own behavior (including problem solving) and face problematic issues in social interaction. Fourth, the definition includes terms that are hard to define and understand (e.g., “perceptual handicaps” or “minimal brain dysfunction”). Fifth, the definition includes spelling, which NJCLD feels falls under the umbrella of writing. Sixth, it fails to note that learning disabilities may occur concurrently with other disabilities (Friend, 2011).
Therefore, the NJCLD (2010) defines learning disabilities as follows:
Learning disabilities is a general term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self-regulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability. Although learning disabilities may occur concomitantly with other handicapping conditions (for example, sensory impairment, mental retardation, serious emotional disturbance), or with extrinsic influences (such as cultural differences, insufficient or inappropriate instruction), they are not the remit of those conditions or influences.
Both of these definitions are complex. Friend (2011) cites the following fundamental dimensions that characterize learning disabilities in general:
Learning disabilities comprise a heterogeneous group of disorders. Students with learning disabilities may have significant reading problems (dyslexia), difficulty in mathematics (dyscalculia), or a disorder related to written language (dysgraphia). They may have difficulty with social perceptions, motor skills, or memory. Learning disabilities can affect young children, students in school, and adults. No single profile of a person with a learning disability can be accurate because of the interindividual differences [relating to an individual’s unique interacting traits] in the disorder.
• Learning disabilities are intrinsic to the individual and have a neurobiological basis. Learning disabilities exist because of some type of dysfunction in the brain, not because of external factors such as limited experience or poor teaching.
• Learning disabilities are characterized by unexpected underachievement. That is, the disorder exists when a student’s academic achievement is significantly below her intellectual potential even after intensive, systematic interventions have been implemented to try to reduce the learning gap …
• Learning disabilities are not a result of other disorders or problems, but individuals with learning disabilities may have other special needs as well. For example, being deaf cannot be considered to be the basis for having a learning disability. However, some students who are deaf also have learning disabilities. (Emphasis omitted.) (p. 129)
A learning disability is different from either intellectual disability or emotional disturbance. Rather, learning disabilities entail a breakdown in processing information of some type. Difficulties involve either absorbing information in the first place or subsequently using this information to communicate and participate in activities. Spotlight 3.10 describes some other disabilities that can have an impact on children.
Spotlight on Diversity 3.10
Other Disabilities That Can Affect Children

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People with disabilities are at risk of being oppressed, discriminated against, ignored, ridiculed, and denied equal rights. Intellectual disabilities and learning disabilities are only two of the many disabilities that can affect children. Other disabilities arbitrarily mentioned here (considered developmental disabilities) include autistic spectrum disorders, cerebral palsy, hearing problems, vision problems, and epilepsy.
Autistic spectrum disorders (ASDs) “can cause significant social, communication and behavioral challenges” (CDC, 2016). People with ASDs have brains that process information in ways unlike the brains of other people. Such a disorder reflects a lifelong condition that begins before age 3. Because ASDs involve a spectrum, people can experience aspects characterizing ASDs in different ways, ranging from mild to severe.
Due to recent changes in the Diagnostic Statistical Manual (DSM V), several conditions that used to be diagnosed separately now are diagnosed under autism spectrum disorder, including autistic disorder, pervasive developmental disorder not otherwise specified, and Asperger’s syndrome (CDC, 2016c).
People with ASDs typically demonstrate intense inner-directedness and a number of other symptoms (CDC, 2010b). These include difficulties in social skills, such as problems communicating and lack of normal emotional reactions to others, including attachment. They often have trouble talking about their own feelings or being aware of other people’s feelings. People with ASDs may avoid eye contact and being physically touched. They frequently demonstrate sensory distortion such as underreacting to pain and overreacting to noise. They may engage in repetitive, self-stimulating movements and behavior such as hand flapping, spinning their bodies, or rocking back and forth.
Cerebral palsy (CP) is a disability involving problems in muscular control and coordination resulting from damage to the brain’s muscle-control centers before or during birth, or in the first years of life. Variations in muscle tone may result in movements that are very stiff and difficult, jerky, unbalanced, or floppy. Depending on the extent of damage, lack of balance, difficulty walking, tremors, involuntary movements, problems with precise motions, and difficulty talking or eating can result.
Hearing problems range from mild hearing losses to total deafness. They can result from any part of the ear not functioning normally and effectively. At least 50 percent of hearing problems in children are due to genetic causes, 25 percent due to “maternal infections during pregnancy, complications after birth, and head trauma,” and 25 percent due to unknown factors (CDC, 2015b). Symptoms in infants may involve failure to respond to sounds and in young children delayed speech.
Vision impairment “means that a person’s eyesight cannot be corrected to a ‘normal’ level. Vision impairment may be caused by a loss of visual acuity, where the eye does not see objects as clearly as usual. It may also be caused by a loss of visual field, where the eye cannot see as wide an area as usual without moving the eyes or turning the head” (CDC, 2015c). The severity of vision impairment may be classified in different ways. To be eligible for designated educational or federal programs in the United States, “blindness” is legally defined as visual acuity that is 20/200 or worse (i.e., when a person sees at 20 feet what a person with normal vision can see at 200 feet) (CDC, 2015c).
Epilepsy (commonly referred to as seizure disorder) consists of various disorders marked by disturbed electrical rhythms of the central nervous system and manifested in convulsive attacks. Symptoms range from periods of unconsciousness resembling daydreaming to violent convulsions.
Concurrent disabilities are also common. For example, a person with intellectual disabilities might also have a hearing impairment and/or epilepsy.
Currently, 5 percent of all students enrolled in public, schools are identified as having a learning disability, with 42 percent of these students receiving special education services (National Center for Learning Disabilities [NCLD], 2014). In addition, 66 percent of all students identified with learning disabilities are male, and more students with learning disabilities are found to be living in poverty than children from the general population (NCLD, 2014).
It is often difficult to identify learning disabilities because the children in question function normally in other areas. The first clue is commonly a problem in academic work. Other symptoms include a lack of attentiveness in classes; thoughtless, impulsive, overly active behavior; frequent mood shifts; difficulties in remembering symbols; lack of motor coordination in writing or play activities; apparent problems in speaking or listening; and other difficulties in completing academic work. These difficulties are often vague enough to raise questions about a child’s emotional health, family life, motivation to achieve, or intellectual level. Once a learning disability is suspected, assessment may involve standardized tests, such as achievement tests, as well as a range of other evaluative approaches, administered by teachers, that focus on individual work and progress.
3-10aCommon Problems Involved in Learning Disabilities
Although people “with learning disabilities typically have average or above-average intelligence,” they may experience weaknesses in one or more areas; a learning disability may involve cognitive, academic, or social/emotional characteristics (Friend, 2011, p. 133). Remember that each individual is unique, and so could experience only one of these difficulties or any number of them. The categories often overlap, as cognitive characteristics and processing problems are integrally related to performance in other areas. Many examples and references presented here concern students and educational settings, because this is often where learning disabilities are discovered and addressed.
Cognitive Characteristics
These include “attention, perception, memory” (Friend, 2011, p. 133), and the organization and generalization of information (Smith & Tyler, 2010). People with learning disabilities may have trouble paying attention to what they’re supposed to. They may be easily distracted by someone talking in the hallway or a noisy vehicle traveling down the street. They may have difficulty discriminating between what is important in their immediate environment and what is not, what they should focus on and what they should ignore.
A second potential cognitive characteristic of a person with a learning disability involves perceptual difficulties. “Perception does not pertain to whether a student sees or hears but rather to how her brain interprets what is seen or heard and acts on it. For example, a student with a visual perception problem may see perfectly well the words on a page. However, when asked to read the words, the student may skip some of them” (Friend, 2011, p. 133; emphasis in original). Another scenario is that a student might perceive items or symbols reversed from what they really are.
Perceptual difficulties may also involve understanding spatial relationships. Children might judge distances between one item and another inaccurately.
Perceptual problems may entail auditory processing difficulties. Some children have trouble paying attention to what is being said; the problem concerns being able to focus on the sounds most important in conveying meaning. Other children have trouble discriminating between one sound and another. For example, instead of hearing the word bed, a child may hear the word dead. The result is confusion for the child and difficulty in understanding and following instructions. Still, other children have trouble recalling what they have heard being said in the correct sequence. This also makes it difficult to follow instructions correctly. They cannot understand the proper order in which they are supposed to do things. These children have special difficulties in remembering content in a series format (e.g., months of the year).
A third cognitive characteristic for children with learning disabilities concerns memory and recall. Such children find it difficult to remember accurately what they have seen or heard. They commonly misspell words and forget where they placed objects.
A fourth cognitive trait often involved in learning disabilities entails lacking the ability to organize information received and generalize it to other scenarios. The organization of information concerns “classifying, associating, and sequencing” it so that it can be retrieved and generalized (Smith & Tyler, 2010, p. 164). Generalization involves the application of what you’ve already learned to new situations. For example, if you learn how to organize information and write a paper in your English course, you could generalize this skill to writing a paper in your social welfare policy course.
Academic Characteristics
Learning disabilities involve cognitive characteristics and processing issues as were just discussed. However, learning disabilities become more readily apparent in academic performance. Difficulties may surface in “reading, spoken language, written language, mathematics, or any combination of these” (Friend, 2011, p. 134; Hallahan et al., 2012). Academic achievement deficits reflect the most common problem found in learning disabilities.
Some students have difficulty reading. They may have difficulties in processing that interfere with their ability to use language and reasoning. They might be unable to grasp the meanings of words or how words relate to each other in terms of grammatical position. They may have trouble comprehending what they’ve read, such as being unable to answer questions about a story after reading it. They often are unable to read efficiently and smoothly.
Oral language is another potential problematic area for people with learning disabilities. They may have difficulty “using the correct sounds to form words” (Friend, 2011, p. 134). They may not grasp grammar, discriminate among similar words, comprehend the meaning of words, or participate readily in conversations (Friend, 2011). They may have trouble saying what they mean or would like to say. Sometimes this involves having difficulty remembering the words they want to say. Still others have trouble telling a story so that it makes sense or describing an event or situation so that the listener can understand it.
Written language may also pose problems. Spelling, punctuation, capitalization, or understanding word forms (such as possessives or tenses) may be very difficult for them (Friend, 2011). As discussed earlier, students may have trouble organizing information into stories or term papers.
Still, other people with learning disabilities experience extreme difficulty with math. They can have problems grasping basic math fundamentals, fractions, calculation, measurement, time, or geometry (Friend, 2011; Hallahan et al., 2012).
Having a learning disability may involve social emotional characteristics that increase the risk of social and emotional problems (Friend, 2011; Hallahan et al., 2012; Smith & Tyler, 2010). “For example, [children with learning disabilities] … are at a greater risk for depression, social rejection, suicidal thoughts, and loneliness (Al-Yagon, 2007; Bryan, Burstein, & Ergul, 2004; Daniel et al., 2006; Maag & Reid, 2006; Margalit, 2006)” (Hallahan et al., 2012, p. 149).
Hallahan and his colleagues (2012) explain a possible rationale for social/emotional characteristics:
One plausible reason for the social problems of some students with learning disabilities is that these students have deficits in social cognition. That is, they misread social cues and may misinterpret the feelings and emotions of others. Most children, for example, can tell when their behavior is bothering others. Students with learning disabilities sometimes act as if they are oblivious to the effect their behavior is having on their peers. They also have difficulty taking the perspective of others, of putting themselves in someone else’s shoes. (p. 150)
3-10bWhat Causes Learning Disabilities?
The specific causes of learning disabilities in most children are unknown. As discussed earlier, it is thought the disabilities involve neurological dysfunction (Hallahan et al., 2012).
Potential causes tend to fall into three categories (Hallahan et al., 2012). The first involves genetic factors (Friend, 2011; Smith & Tyler, 2010). There is a tendency for learning disabilities to be more common in some families. This may be due to heredity or the family being exposed to some causative agent in the environment. Second, teratogens (substances that can cause damage such as drugs causing malformation in the fetus) may cause learning disabilities. Malnutrition or poisoning by lead-based paint may also result in learning disabilities (Friend, 2011). Third, medical conditions such as premature birth or childhood AIDS may be directly related to the development of learning disabilities (Hallahan et al., 2012).
More extensive research concerning these possibilities is necessary to establish causes. The broad range of behaviors clustered under the title “learning disabilities” and their frequently vague descriptions make it difficult to pinpoint causal relationships.
3-10cEffects of Learning Disabilities on Children
Learning disabilities may psychologically affect children in several ways, including learned helplessness, low self-esteem, and lack of social competence. The learned helplessness reaction is one way of responding to a learning disability (Friend, 2011: Hallahan et al., 2012; Smith & Tyler, 2010). This is the situation where children have failed so often that they no longer want to try to learn; instead they depend on others to do things for them. In other words, they lose their motivation to try and just give up. Because the child refuses to take any new risks, potential progress is halted. Children may also use the fact that they cannot do some things to get out of doing other things they are capable of doing. The vague and complicated nature of learning disabilities does not help this situation. For example, a mother may ask her daughter to do her homework. The daughter responds, “Gee, Mom, I don’t know how.” The daughter’s learning disability involves reading. Her homework is an arithmetic assignment that she has no more difficulty completing than her peers. However, because of her learning disability, the daughter is perceived as being helpless in her mother’s eyes. As a result, the mother does not make the daughter do her homework.
Another possible reaction of a child with learning disabilities is low self-esteem (Friend, 2011; Smith & Tyler, 2010). These children are likely to see other children do things they cannot. Perhaps others make critical comments to them. Teachers and parents may show at least some impatience and frustration at the children’s inability to understand or perform in the areas affected by their learning disabilities. These children are likely to internalize their failures. The result may be that they feel inferior to others, and they may develop low self-esteem.
Research indicates that children with learning disabilities often suffer from a lack of social competence (Burden, 2008; Friend, 2011; Gumpel, 2007; Smith & Tyler, 2010). “Social competence is the ability to perceive and interpret social situations, generate appropriate social responses, and interact with others” (Smith & Tyler, 2010, p. 166). We’ve already established that some social/emotional learning disabilities may be related to the inability to interpret appropriately and accurately other people’s interaction and communication. It makes sense that this would affect one’s social competence and, in effect, popularity. For example, consider Melvin, a third grader, who’s waiting in line to leave the classroom and go out for recess. The other kids are excitedly talking about what games they’re going to play and who’s going to get to the best playground equipment first. Melvin, oblivious, simply states, “I’m going to visit Uncle Harry on Sunday. He works for a cell phone company.” Needless to say, this does not grab his peers’ interest. Instead, they roll their eyes and start to make fun of him. Melvin doesn’t have a clue regarding what might have been a more appropriate thing to say in order to “fit in” better with his peers.
Note that certainly not all or even most people with learning disabilities experience these negative emotional and social effects. We’ve established that learning disabilities vary widely and are highly individualized. Many children with learning disabilities are happy, well adjusted, and well liked (Meadan & Halle, 2004). Much depends on the classroom climate, the actions of teachers and other professionals, and the establishment of a positive, supportive classroom and family environment. At school, emphasis should be placed on mutual respect and productive learning instead of focusing only on problems.
What are the long-term effects of learning disabilities? Some people with learning disabilities may continue to experience problems in work and social adjustment as adults. However, how people with learning disabilities are treated and accepted is critical in terms of their satisfaction and achievement as adults. Their coping skills and motivation are also important. The best predictors for successful transition into adulthood include the following:
• “An extraordinary degree of perseverance
• The ability to set goals for oneself
• A realistic acceptance of weaknesses coupled with an attitude of building on strengths
• Access to a strong network of social support from friends and family
• Exposure to intensive and long-term educational intervention
• High-quality on-the-job or postsecondary vocational training
• A supportive work environment
• Being able to take control of their lives.” (Hallahan et al., 2012, p. 162)
3-10ePolicies to Achieve Social Justice for Children Who Have Learning and Other Disabilities
Major legislation has positively affected educational programming for children with learning and other disabilities in the past few decades (Lightfoot, 2009b; Mackelprang, 2008). Mackelprang and Salsgiver (2009) explain:
The All Handicapped Children Act of 1975 is one of the few pieces of legislation known to professionals in human services and education by its original number, Pub. L. No. 94-142. The All Handicapped Children Act of 1975 went through several levels of evolution and was renamed the Individuals with Disabilities Education Act (IDEA) in 1990, and most recently the Individuals with Disabilities Education Improvement Act, which Congress last modified in 2004 … Individuals from birth up through the age of twenty-one years are covered under this historic act. IDEA stipulates that “free appropriate public education” be provided at public expense to all children, including children with disabilities from age three through twenty-one years. The education of children with disabilities should be provided in the most open and “normal” environment possible (the least restrictive environment). When children need to be diagnosed, be evaluated, and receive prescriptions, the diagnosis, Assessment, and prescription should not produce stigmatization and discrimination. Parents and the child need to be primary players in any remedial or pedagogical plan established for the child’s education (Albrecht, 1992; Altschuler, 2007).
The original legislation provided for the establishment of an Individual Education Program (IEP). IDEA maintains the IEP as the central process in the education of a child with a disability. These plans should delineate the current level of education of the child, the goals and objectives of the child’s educational process, specific services needed and when they need to be provided, and the method by which the plan’s implementation will be evaluated …
Part C … of IDEA mandates that participating states provide early intervention services to children with developmental disabilities from birth to their third birthday. In addition, Part C covers children and youths to age twenty-one …
It is important … to understand some of the unique qualities of IDEA as a disability law. First, it covers … youths [with disabilities] through age twenty-one or until high school graduation, whichever comes first. Second, it mandates public support of substantial services placing financial and service responsibility on states and schools. Third, it mandates substantial involvement of both … individuals [with disabilities] and their families. Fourth, IDEA is entitling legislation: not only are people eligible for services, but schools and states are responsible for providing services. (pp. 144–145)
Children with learning, intellectual, and other developmental disabilities are thus guaranteed the right to an education. States and communities cannot ignore or reject children with learning and other disabilities. Excuses such as high costs or lack of existing facilities are no longer acceptable. This illustrates how legislation forces state, community, and organizational macro systems to respond to a social need and seek social justice.
3-11Discuss Attention Deficit Disorder
LO 13
One other condition merits attention because of its significance and prevalence for children of school age. It has been labeled, studied, and given much, public attention. Attention deficit hyperactivity disorder (ADHD), a psychiatric diagnosis, is a syndrome of learning and behavioral problems beginning before age 12 that is characterized by a persistent pattern of inattention, excessive physical movement, and impulsivity that appears in at least two settings (including home, school, work, or social contexts) (APA, 2013a). It is estimated that about 5 percent of all children and 2.5 percent of adults in most cultures have ADHD (APA, 2013a). Note that “ADHD often occurs simultaneously with other behavioral and/or learning problems such as learning disabilities or emotional or behavioral disorders” (Hallahan et al., 2012, p. 182). ADHD is more likely to affect boys more than girls by an estimated 3:1 ratio (Barkley, 2006; Kail & Cavanaugh, 2013).
The definition of ADHD has several dimensions. First, a child manifests a pattern of ADHD symptoms before the age of 7, although the pattern may not be identified until much later. A second dimension of ADHD is that it occurs in multiple settings, not just in one context or with one person. It involves uncontrollable behavior that is not necessarily related to a particular context. Finally, three primary clusters of behavior characterize ADHD. The first is inattention. Behavioral symptoms include messy work, carelessly handled tasks, frequent preoccupation, easy distractibility, aversion to tasks that require attention and greater mental exertion, serious problems in organizing tasks and activities, and difficulties attending to ongoing conversations. The second cluster of behaviors concerns hyperactivity, excessive physical activity that is difficult to control, resulting from an “impaired ability to sit or concentrate for long periods of time” (Smith & Tyler, 2010, p. 203). That is difficult to control (hyperactivity). This involves almost constant action, squirming or being unable to sit down at all, demonstrating great difficulty in attending to quiet activities, and talking nonstop. The third batch of behaviors falls under the umbrella of impulsivity. This is characterized by extreme impatience, having great difficulty in waiting for one’s turn, and making frequent interruptions and intrusions.
3-11aTreatment for ADHD
ADHD has been treated for decades by using drugs that “stimulate the parts of the brain that normally inhibit hyperactive and impulsive behavior. Thus, stimulants [e.g., Ritalin] actually have a calming influence for many youngsters with ADHD, allowing them to focus their attention” (Kail & Cavanaugh, 2013, p. 227). However, some questions have been raised about the effectiveness of long-term drug use (Hardman et al., 2014; Kail & Cavanaugh, 2013). Other treatment methods such as family intervention and provision of special treatment to children along with drug therapy are also frequently used.
Additional techniques suggested to help children who have ADHD involve providing a structured classroom environment with minimal distracting stimuli. For example, the student with ADHD might be given “a desk or work area in a quiet, relatively distraction-free area of the classroom. Other physical accommodations can include pointers or bookmarks to help a student track words visually during reading exercises, timers to remind students how much time is left before an assignment must be finished, [and] visual cues as prompts to change behavior (e.g., turning the classroom lights off to indicate that the noise level is too high)” (Smith & Tyler, 2010, p. 214). Other suggestions for the classroom include providing “directions that are clear, concise, and thorough (even better when they are presented both visually and orally)” and immediate, periodic praise for completing tasks successfully (Smith & Tyler, 2010, p. 214).
Behavior modification also offers techniques that are helpful for children with ADHD (Friend, 2011). Chapter 4 discusses behavior modification techniques with respect to effective parenting. For ADHD children, behavior modification focuses on specifying and reinforcing good behavior and decreasing poor behavior by monitoring and structuring each behavior’s consequences.
A major ongoing study initiated in the 1990s and sponsored by the National Institute of Mental Health is being conducted to evaluate the effectiveness of both drug and psychosocial treatment (i.e., psychologically and behaviorally oriented intervention with child and family) (Richters et al., 1995). Kail and Cavanaugh (2013) summarize findings. Initial results indicate that medication can often be effective in treating hyperactivity as such. However, related issues including specific academic problems, social skill development, and working in conjunction with parents are addressed slightly better when medication is administered along with the provision of psychosocial treatment. It should also be noted that medication is only effective when it is closely monitored with consistent visits to health-care providers and there is ongoing communication with school staff about the drug’s effects and the child’s behavior.
Friend (2011) expresses a number of factors to consider before using ADHD drug treatment, including the following:
• “The child’s age
• Prior attempts at other interventions and their impact on the behaviors of concern
• Parent and child attitudes toward using medication …
• Severity of symptoms
• Availability of adults in the household to supervise use of medications, ensuring that medications are taken regularly and as prescribed.” (p. 182)
3-11bSocial Work Roles
Social work roles with respect to clients with both ADHD and learning disabilities are similar to those used with clients who have intellectual disabilities. Social workers function as brokers to help link clients with resources. In the school setting, “besides participating in the multidisciplinary team conferences and consultation, social workers coordinate IEP [Individualized Education Program and IFSP [Individualized Family Service Plan] conferences, serve as trained mediators … lead parent education and informational groups, function as case managers, and facilitate the development of relationships that link the services of the school with those found in the community” (Atkins-Burnett, 2010, p. 187). Practitioners also function as advocates to effect positive change in macro systems that are not responsive to clients’ needs.
Chapter 4 Social Development in Infancy and Childhood

Chapter Introduction

Yellow Dog Productions/Photodisc/Getty Images
Learning Objectives
This chapter will help prepare students to

EP 6a
EP 7b
EP 8b
• LO 1 Explain the concept of socialization
• LO 2 Analyze the family environment (including variations in family structures, positive family functioning, macro systems and the pursuit of social and economic justice, and family system dynamics)
• LO 3 Apply systems theory concepts to families
• LO 4 Assess the family life cycle
• LO 5 Explain diverse perspectives on the family life cycle
• LO 6 Describe learning theory
• LO 7 Apply learning theory concepts to practice (including positive reinforcement, punishment, issues related to the application of learning theory, and time-out from reinforcement)
• LO 8 Examine common life events that affect children (including treatment of children in families, sibling subsystems, and gender-role socialization)
• LO 9 Recognize ethnic and cultural differences in families
• LO 10 Assess relevant aspects of the social environment (including the social aspects of play with peers, bullying, the influence of television and the media, and the school environment)
• LO 11 Examine child maltreatment (including incidence, physical child abuse, child neglect, psychological maltreatment, Child Protective Services, treatment approaches for child maltreatment and sexual abuse, and trauma-informed care)
“My dad could punch out your dad, I bet!” Jimmy yelled at Harry, the neighborhood bully. Harry had just bopped Jimmy in the nose. Jimmy, who was small for his age, felt hurt. So he resorted to name-calling as he edged away from his aggressor. Since his own house was a full two blocks away, Jimmy had to do some fast thinking about how to get there without everybody thinking he was chicken. The worst thing was that Harry was also a pretty fast runner.
To Jimmy’s surprise and delight, Harry was apparently losing interest in this particular quarry. Somebody called out from the next block and was trying to interest Harry, a good fullback, in a game of football.
Scowling, Harry shouted back to Jimmy, “Oh, get out of here, you nose wad. Your dad sucks eggs!” He then darted down the block and into the sunset.
That last remark did not make much sense, although Harry’s intent was to be as nasty as possible (intellect was not his strong suit). The important thing, however, was that Harry was running in the other direction. Any of the other guys who happened to witness this incident might just think that it was Harry who was running scared. Nonetheless, Jimmy thought it best not to reply, just in case Harry decided to change his mind.
“Whew!” thought Jimmy. “That was a close one.” He was usually pretty good at staying far out of Harry’s way. This meeting was purely an accident. He was on his way home from a friend’s house after working on a class project. That was another story. Their project involved growing bean plants under different lighting conditions. The bean plants that were supposed to be growing good beans weren’t. Jimmy secretly suspected that his partner was eating the beans.
Anyway, Jimmy had better things to do now. He had to finish his homework. His parents had promised to buy him an Xbox if he maintained at least a B+ average for the whole year. Harry would probably flunk this year anyhow. He was big, but he was also pretty stupid.
Jimmy hightailed it down the street. He imagined hearing the tones of Ear Discharge, his favorite hip-hop group. The horrible Harry affair was soon forgotten.
A Perspective
The attainment of primary social developmental milestones and the significant life events that usually accompany them have tremendous impacts on the developing individual and that individual’s transactions with the environment. Family and peer group mezzo systems are dynamically involved in children’s growth, development, and behavior. Social interaction in childhood provides the foundation for building an adult social personality. Children and their families do not function in a vacuum. Macro systems within the environment, including communities, government units, and agencies, can provide necessary resources to help families address issues and solve problems typically experienced by children. Impinging macro systems within the social environment can either help or hinder family members in fulfilling their potential.
4-1Explain the Concept of Socialization
LO 1
Socialization is the process whereby children acquire knowledge about the language, values, etiquette, rules, behaviors, social expectations, and all the subtle, complex bits of information necessary to get along and thrive in a particular society.
Although socialization continues throughout life, most of it occurs in childhood. Children need to learn how to interact with other people. They must learn which behaviors are considered acceptable and which are not. For example, children should learn that they must abide by the directives of their parents, at least most of the time. They must learn how to communicate to others what they require in terms of food and comfort. On the other hand, they must also learn what behaviors are not considered appropriate. They need to learn that breaking windows and spitting in the eyes of other people when they don’t get their way will not be tolerated.
Because children start with knowing nothing about their society, the most awesome socialization occurs during childhood. This is when the fundamental building blocks of their consequent attitudes, beliefs, and behaviors are established.
4-2Analyze the Family Environment
LO 2
Because children’s lives are centered initially within their families, the family environment becomes the primary agent of socialization. The family environment involves the circumstances and social climate within families. Because each family is made up of different individuals in a different setting, each family environment is unique. The environments can differ in many ways. For example, one obvious difference is socioeconomic level. Some families live in luxurious 24-room estates, own a Mercedes and an SUV in addition to the family minivan, and can afford to have shrimp cocktail for an appetizer whenever they choose. Other families subsist in two-room shacks, struggle with payments on their used 1998 Chevy, and have to eat macaroni made with processed cheese four times a week.
This section addresses several aspects of the family environment. They include variations in family structures, positive family functioning, impacts of social forces and policies on family systems, and the application of systems theory principles to families.
4-2aMembership in Family Groups: Variations in Family Structure
Families in the United States today are no longer characterized by two first-time married parents who live blissfully together with their 2.5 children. The traditional nuclear family included heterosexual parents married one time, with one or more children. Today’s families are more likely to reflect a varied medley of structures and configurations.
The term family is now identified as “two or more individuals living together who are related by birth, marriage, partnership agreement, or adoption.” The term family constellation is defined as “the many variables that describe a family group, including the presence or absence of mother and father, the number, spacing and sex of siblings; the presence or absence of extended family member in the household” (Newman & Newman, 2015, p. G-9).
A family is a primary group defined as people who have close personal relationships, interact often with each other, have shared expectations regarding how members in the group should behave, and are exposed to the same ongoing forces and experiences (Barker, 2014). Thus, family members as members of a primary group have significant influence on each other. They have mutual commitment and responsibility for other family members. Additionally, they interact frequently with each other, often living together.
Families, then, may consist of intact two-parent families with or without children, single-parent families, grandparent-led families, blended families, stepfamilies, LGBTQ families, friends or adult siblings choosing to live together to cut down costs and/or to help each other with child-rearing responsibilities, or any other configuration that fits our definition. Some of these terms are defined as follows.
A single-parent family is a family household in which one parent resides with the children but without the other parent. (Note that a household “comprises all persons who occupy a ‘housing unit’” [U.S. Census Bureau, 2015].)
In 2015, 27 percent of all household were headed by single parents: 23 percent of all households were headed by single mothers and 4 percent of all households were headed by single fathers (Child Trends, 2015). As is indicated, the majority of households (approximately 85%) headed by a single parent were headed by single mothers. Approximately 7 percent of all children lived with grandparents, with 4.4 percent having at least one parent living in their grandparents’ home as well (Child Trends, 2015).
Stepfamilies are families in which one or both parents reside with children from prior marriages or unions. Members may include stepmothers, stepfathers, and any children either may have from prior marriages. Stepfamilies may also include children born to the currently married couple. Stepfamilies have become extremely common because about half of all marriages end in divorce. Stepfamilies may also become very complex when one or both spouses have been married more than once and/or have children from a variety of relationships.
A blended family is any nontraditional configuration of people who live together, are committed to each other, and perform functions traditionally assumed by families. Such relationships may not involve biological or legal linkages. The important thing is that such groups function as families.
An extended family of Indian descent living in the USA

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Several other changes from traditional patterns characterize today’s family life (Mooney, Knox, & Schacht, 2013):
• Marrying later or not at all. Both men and women are waiting much longer to marry. In 1960, the median age for men to marry was 23 and women 20; now men marry at the median age of 28 and women at 26 (Mooney et al., 2013). At present, 13.8 percent of women and 20.4 percent of men in the 40 to 44 age group have never been married; this is the highest percentage ever in the United States (Mooney et al., 2013).
• Living together without being married. Heterosexual and same-gender cohabitation without marriage has escalated significantly in recent years (Mooney et al., 2013). Cohabitation is the situation where two adults share the same residence and have a sexual relationship, without the legality of marriage.
One recent study revealed the following results:
• —
In more recent years, women were increasingly likely to cohabit with a partner as a first union rather than to marry directly: 48 percent of women interviewed in 2006–2010 cohabited as a first union, compared with 43 percent in 2002 and 34 percent in 1995.
• —
The rise in cohabitation as a first union over this time period led to a lower percentage of women aged 15–44 whose first union was a marriage: 23 percent in 2006–2010 compared with 30 percent in 2002 and 39 percent in 1995.
• —
An increase in cohabitation as a first union for all Hispanic origin and race groups occurred between 1995 and 2006–2010, except among Asian women. The percentage of women who cohabited as a first union increased 57 percent for Hispanic women, 43 percent for white women and 39 percent for black women over this time period. (Copen, Daniels, & Mosher, 2013, p. 3)
• Being together but living separately. This new phenomenon involves couples who are married or “together” emotionally and sexually, but live in different cities or states. Many of these couples live apart because of being employed in different locations; however, some choose to live apart to maintain a sort of freedom and avoid daily conflicts resulting from too much intimacy (Mooney et al., 2013). This phenomenon has been observed not only in the United States, but also in various Western European nations (Levin, 2004).
• Increased births to single women. Of all births, the percentage to unmarried women is 40.2 (CDC, 2016); this reflects a rise from 18 percent in 1980, to 33 percent in 1994, to between 32 and 34 percent in 2002 (ChildStats.gov, 2013). In almost 75 percent of all births to women under age 25, the women were unmarried (ChildStats.gov, 2013).
• Higher divorce rates and more stepfamilies. Divorce will terminate between 40 and 50 percent of all marriages (Cherlin, 2010). A majority of divorced people will remarry and form stepfamilies (Mooney et al., 2013). Over 40 percent of adults living in the United States have a minimum of one person in their family that is a step-relative (Parker, 2011).
• More mothers being employed. About 72 percent of single women with children under age 18 and almost 70 percent of married women with such children are employed outside the home (U.S. Census Bureau, 2011). These figures have increased from 52 percent and more than 54 percent, respectively, since 1980 (U.S. Census Bureau, 2011). Note that women with small children are also likely to work. Almost 68 percent of single women and 61.6 percent of married women who have children under age 6 work outside the home (U.S. Census Bureau, 2011).
4-2bPositive Family Functioning
In view of the vast range of family configurations, it is extremely difficult to define a “healthy” family. However, at least two concepts are important when assessing the effectiveness of a family. These include how well family functions are undertaken and how well family members communicate with each other.
Family functions include a wide range of caregiving functions, including nurturing and socializing children, providing material and emotional support, and assuming general responsibility for the well-being of all members. Children must be nurtured and taught. All family members need adequate resources to thrive. Additionally, family members should be able to call on each other for help when necessary.
Good communication is the second characteristic of “healthy” families. Communication and autonomy are closely related concepts. Good communication involves clear expression of personal ideas and feelings even when they differ from those of other family members. On the other hand, good communication also involves being sensitive to the needs and feelings of other family members. Good communication promotes compromise so that the most important needs of all involved are met. In families that foster autonomy, boundaries for roles and relationships are clearly established. All family members are held responsible for their own behavior. Under these conditions, family members much less frequently feel the need to tell others what to do or “push each other around.” (Family communication is discussed more thoroughly in Chapters 8 and 12.)
Negotiation is also clearly related to good communication and good relationships. When faced with decisions or crises, healthy families involve all family members, so as to come to solutions for the mutual good. Conflicts are settled through rational discussion and compromise instead of open hostility and conflict. If one family member feels strongly about an issue, healthy families work to accommodate his or her views in a satisfactory way. Both unhealthy and healthy families suffer conflict and disagreements, but a healthy family deals with conflict much more rationally and effectively.
Families can be compared and evaluated on many other dimensions and variables. The specific variables are not as important as the concept that children are socialized according to the makeup of their individual family environments. The family teaches children what types of transactions are considered appropriate. They learn how to form relationships, handle power, maintain personal boundaries, communicate with others, and feel that they are an important subset of the whole family system.
4-2cMacro Systems, Families, and the Pursuit of Social and Economic Justice
We have established that families provide an immediate, intimate social environment for children as they develop. However, families do not exist in a vacuum. They are in constant interaction with numerous other systems permeating the macro social environment. Families can provide care and nurturance only to the extent that other macro systems in the environment, including communities and organizations, provide support and empower them.
For example, unemployment may soar because of an economic slump. Political decisions such as increasing business taxes may have sparked the slump. Ideologically, the general public may feel that in “a free country” of rugged individualists, it is each person’s responsibility to find and succeed in work. The public may not support political decisions to subsidize workers by providing long-term unemployment benefits or developing programs for job retraining. At the same time, legislators concerned about the increasing unemployment rate and their reelection may hesitate to impose increasing restrictions on business and industry such as more stringent (and costlier) pollution control regulations. Thus, the physical environment suffers.
This example, of course, is overly simplistic. Volumes have been written on each aspect of the political, economic, environmental, and ideological dimensions of the social environment. However, the point is that it is impossible to comprehend a family’s situation without assessing that family within the context of the macro social environment. For example, economic downturns and unemployment may leave a parent jobless and poverty-stricken. That parent will then be less able to provide the food, shelter, health care, and other necessities for a family environment in which children can flourish.
Likewise, the resources available to agencies and communities for dispersal to clients depend on legislative and organizational policies. For instance, U.S. society is structured such that all citizens have the right to receive a high school education. This idea is based in ideology that, in turn, is reflected by legislative and administrative policy that regulates how that education is provided.
Public day care or child care, on the other hand, is not provided to working parents on a universal basis. Day care involves an agency or a program that provides supervision and care for children while parents or guardians are at work or otherwise unavailable. There are many historical ideological reasons for this lack. For one, traditional thought is that a woman’s place is in the home and that she should be the primary caretaker of the children (Spakes, 1992). However, we have established that a strong majority of women, many with children under age 6, work outside the home (U.S. Census Bureau, 2011). Massive evidence suggests that although most women in heterosexual relationships work, they still continue to carry the overwhelming responsibility for child care and other household tasks (Kesselman, McNair, & Schniedewind, 2008; Kirk & Okazawa-Rey, 2013; Lorber, 2010; Shaw & Lee, 2012). We have noted that although most people marry, a significant number of marriages end in divorce. More than 85 percent of all single-parent families are headed by women (Child Trends, 2015). (Many of these issues will be discussed more thoroughly in Chapter 9.)
In summary, a number of facts point to the need for adequate day care to serve the nation’s children. First, most women work outside the home because of economic necessity. Second, the majority have the additional burden of being primary homemakers. Third, many women have no mate to help with child care.
Day care facilities are clearly inadequate to meet the nation’s needs (Kirk & Okazawa-Rey, 2013; Lein, 2008). Parents often struggle to find adequate, affordable, and accessible day care for their children. Many day care centers refuse to accept small infants because of the difficulty of caring for them. Furthermore, numerous children in the United States are provided day care in private homes, unregulated by public standards.
Why doesn’t the government require that facilities be developed to meet the day care need? There is no clear answer. Cost may be one possibility. Low priority may be another.
Ethical Questions 4.1

EP 1
1. As a student social worker, what do you think about the nation’s day care situation? How critical is it, especially for women? To what extent might you be willing to seek out answers for how to solve this problem and others like it?
4-2dThe Dynamics of Family Systems
In order to understand family functioning, it’s helpful to view the family within a systems perspective. Systems theory applies to a multitude of situations, ranging from the internal mechanisms of a computer to the bureaucratic functioning of a large public welfare department to the interpersonal relationships within a family. Regardless of the situation, understanding systems theory concepts helps you to understand dynamic relationships among people. Systems theory helps to conceptualize how a family works. Basic systems theory concepts were introduced in Chapter 1. The Apply Systems Theory Concepts to Families reviews those concepts and shows how they can be applied to family systems.
Systems theory helps us understand how a family system is intertwined with many other systems. Each member of a family is affected by what happens to any of the other members. Each member and the family as a whole are also affected by the many other systems in the family’s environment. For instance, if Johnny flunks algebra, the family works with the school system to help him make improvements. The entire family might have to cancel their summer vacation because Johnny has to attend summer school. The school system directly affects the family system.
A second example concerns Shirl, Johnny’s mother and the family’s primary breadwinner. She works as an engineering supervisor for Bob Bear, a corporation based in Racine, Wisconsin, that makes tractors. New World International, an immense conglomerate corporation, owns Bob Bear. What if New World International decides to close down the Bob Bear plant in Racine because of inadequate profits and to move the large plant to Bonetraill, North Dakota? Bonetraill is a far cry from small, but urban, Racine. One possibility for the family is to move two states away to a totally different environment because Shirl has been offered a comparable position in Bonetraill. Lennie, Johnny’s father, is a journalist for the local paper. In the event of a move, he would have to find a new job. The whole family would have to leave their neighborhood and friends. Another alternative is for Shirl to seek a new job in the Racine area. However, the economy there is depressed, and she would have difficulty finding a position with a salary anywhere near the one she is currently earning. Thus, the family system is seriously affected by the larger Bob Bear system, and the Bob Bear system by the even larger New World International system.
Another important reason can be given for understanding systems theory as it relates to families. Intervention in families with problems is a major concern of social work. Family therapy is intervention by a social worker or other family therapist with members of a family to improve communication and interaction among members and to pursue other changes and goals they wish to pursue. Family therapy is based on the idea that the family is a system. In finding solutions to problems within a family, the target of intervention is the family system.
Whether a particular problem is initially defined as an individual member’s or as the entire family’s, a family therapist views this problem as one involving the entire family system. The entire family should be the focus of treatment. In family therapy, the specific relationships between various family members in the family system need to be closely observed. Family interaction is discussed more thoroughly in Chapter 12.
4-3Apply Systems Theory Concepts to Families
LO 3
A number of the basic systems theory concepts introduced in Chapter 1 will be briefly redefined here and then applied to examples of family situations.
4-3aSystems
A system is a set of elements that form an orderly, interrelated, and functional whole. Several aspects of this definition are important. The idea that a system is a “set of elements” means that a system can be composed of any type of things as long as these things have some relationship to each other. Things may be people, or they may be mathematical symbols. Regardless, the set of elements must be orderly. In other words, the elements must be arranged in some order or pattern that is not simply random. The set of elements must also be interrelated. They must have some kind of mutual relationship or connection with each other. Additionally, the set of elements must be functional. Together they must be able to perform some regular task, activity, or function and fulfill some purpose. Finally, the set of elements must form a whole.
Families are systems. Any particular family is composed of a number of individuals, the elements making up the system. Each individual has a unique relationship with the other individuals in the family. Spouses normally have a special physical and emotional relationship with each other. In a family with seven children, the two oldest sisters may have a special relationship with each other that is unlike their relationship with any of the other siblings. Regardless of what the relationships are, together the family members function as a family system. These relationships, however, are not always positive and beneficial. Sometimes, a relationship is negative or even hostile. For example, a 3-year-old daughter may be fiercely jealous of and resentful toward her newborn brother.
4-3bHomeostasis
Homeostasis refers to the tendency of a system to maintain a relatively stable, constant state of equilibrium or balance. A homeostatic family system functions effectively. The family system is maintaining itself and may even be thriving. However, a homeostatic family system is not necessarily a perfect family. Mother may still become terribly annoyed at father for never wanting to go out dancing. Ten-year-old Bobby may still be maintaining a D average in English. Nonetheless, the family is able to continue its daily existence, and the family system itself is not threatened.
Homeostasis is exceptionally important in determining whether outside therapeutic intervention is necessary. Absolute perfection is usually unrealistic. However, if the family’s existence is threatened, the system may be in danger of breaking apart. In these instances, the family system no longer has homeostasis.
For instance, an 89-year-old maternal great-grandmother, Tula, no longer can care for herself. She has been living alone since the death of her husband 20 years earlier. Her eyesight is failing, and her rheumatoid arthritis puts her in constant pain. She remains fairly alert, however, with only some minor forgetfulness. Tula had raised her only grandchild, Jasmine, now age 35, since Jasmine was 3 when her own mother was killed in a car accident. Jasmine’s father left before Jasmine was born, never to be heard from again. Tula and Jasmine have always been very close.
Jasmine refuses to place Tula in a nursing home. She feels responsible for Tula because Jasmine is the only grandchild, and she would like to “pay back” all the care she received when she was young.
Jasmine’s husband, Hank, however, hates the idea of having Tula move in. Tula, he feels, has always tried to intervene in his marriage. He feels that she takes sides with his wife and constantly tells him what to do. He also feels she talks incessantly and is so hard of hearing that she listens to Jeopardy reruns loud enough to deafen him, even when he’s working down in the basement. Hank also feels that Tula’s presence in the home would seriously disrupt his own children’s lives. His son Bill is 11 and Bob is 8.
Hank relents, and Tula moves in. Jasmine and Hank start quarreling more and more over Tula. Soon they seem to be quarreling over everything. Jasmine has to quit her job because Tula requires more care and attention than Jasmine expected. The family had just purchased a new home with high mortgage payments. Without Jasmine’s salary, money becomes scarce for food, clothing, and other necessities. Jasmine and Hank fight over the financial situation; each blames the other for buying the expensive new home to begin with. Bill’s and Bob’s grades in school start dropping, and they begin to display some behavior problems. Hank simply threatens to leave if things don’t improve. The family system’s homeostasis is threatened.
At this point, intervention might take the form of family counseling to help the family clearly identify their problems, voice their opinions, and come to some mutually agreed-upon resolutions. Couple’s counseling might be involved to improve the communication between Jasmine and Hank. Social services might be needed to help Tula and the family decide what her best care alternative might be, including consideration of placement in a nursing home. In order for the family to survive, homeostasis must be restored and maintained.
4-3cSubsystems
A subsystem is a secondary or subordinate system—a system within a system. The most obvious examples are the parental and sibling subsystems. Other subtler subsystems may also exist depending on the boundaries established within the family system. A mother might have a daughter to whom she feels especially close. These two might form a subsystem within a family system, apart from other family members. Sometimes subsystems exist because of more negative circumstances within family systems. A subsystem might exist within a family with an alcoholic father. Here the mother and children might form a subsystem in coalition against the father.
4-3dBoundaries
Boundaries are repeatedly occurring patterns of behavior that characterize the relationships within a system and give that system a particular identity. In a family system, boundaries determine who are members of that particular family system and who are not. Parents and children are within the boundaries of the family system. Close friends of the family are not.
Boundaries may also delineate subsystems within a system. For instance, boundaries separate the spouse subsystem within a family from the sibling subsystem. Each subsystem has its own specified membership. Either a family member is within the boundaries of that subsystem or he is not.
4-3eInput
Input can be defined as the energy, information, or communication flow received from other systems. Families are not isolated, self-sufficient units. Each family system is constantly interacting with its environment and with other systems. For example, one type of input into a family system is the money received for the parents’ work outside the home. Another type of input involves the communication and supportive social interaction family members receive from friends, neighbors, and relatives. Schools also provide input in the form of education for children and progress reports concerning that education.
Family systems involve powerful interpersonal connections and dynamics. A subsystem may be subtle—a mother might feel especially close to one child.

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4-3fOutput
Output is the energy, information, or communication emitted from a system to the environment or to other systems. Work, whether it be in a job situation, a school setting, or in the home, can be considered output. Financial output is another form. This is necessary for the purchase of food, clothing, shelter, and the other necessities of life.
An important thing to consider about output is its relationship to input. If a family system’s output exceeds its input, family homeostasis may be threatened. In other words, if more energy is leaving a family system than is coming in, tensions may result and functioning may be impaired. For example, in a multiproblem family troubled by poverty, illness, lack of education, isolation, loneliness, and delinquency, tremendous amounts of effort and energy may be expended simply to stay alive. At the same time, little help and support may be coming in. The result would be severely restricted family functioning and lack of homeostasis.
4-3gFeedback
Feedback is a system’s receipt of information from an outside source about its own performance or behavior. Feedback can be given to an entire family system, a subsystem (such as a marital pair), or an individual within the family system.
Feedback can be information obtained from outside the system. For example, a family therapist can provide a family with information about how it is functioning. Feedback can also be given by one individual or subsystem within the family system to another. For example, the sibling subsystem might communicate to the alcoholic mother that they are suffering from the consequences of her alcoholic behavior. Finally, a system, subsystem, or individual within a system can give feedback to those outside the family system. For instance, a family might contact their landlord and notify him that their kitchen sink is backing up. They might also add that he won’t see another rent check until it’s fixed.
Feedback can be either positive or negative. Positive feedback involves information about what a system is doing right in order to maintain itself and thrive. Positive feedback can provide specific information so that members in a family system are aware of the positive aspects of their functioning. For example, a mother works outside her home as a computer programmer. During her job performance Assessment, her supervisor may tell her that she has maintained the highest accuracy record in the department. This indicates to her that her conscientiousness in this respect is valued and should be continued.
Negative feedback can also be valuable. Negative feedback involves providing information about problems within the system. As a result of negative feedback, the system can choose to correct any deviations or mistakes and return to a more homeostatic state. For example, the mother mentioned earlier who works as a computer programmer can receive negative feedback during the same job Assessment. Her supervisor indicates that she tends to fall behind on her weekly written reports. Although she feels the reports are extraordinarily dull and tedious to complete, her supervisor’s feedback gives her the information she needs to perform her job better.
Perhaps the most relevant example for social workers concerning feedback is its application in a family treatment setting. When a family comes in for help about a particular problem, feedback can raise their awareness about their functioning. It can help them correct areas where they are making mistakes. It can also encourage them to continue positive interactions. For example, if every time a husband and wife discuss housework responsibilities, they yell at each other about what the other does not do, a social worker can give them feedback that their yelling is accomplishing nothing. Constructive suggestions might then be given about how the couple could better resolve their differences over who takes out the garbage, who makes waffles for breakfast, and who separates the colors from the whites in the laundry.
Positive feedback might also be given. The husband and wife may not be aware that when asked a question about their feelings for each other or about how they like to raise their children, they are very supportive of each other. They immediately look to each other to check out the other’s feelings. They smile at each other and encourage the other’s opinions. Giving them specific positive feedback about these interactions by describing their behaviors to them may be helpful. Such feedback may encourage them to continue these positive interactions. It may also suggest to them that they could apply similar positive means to resolving other differences.
4-3hEntropy
Entropy is the natural tendency of a system to progress toward disorganization, depletion, and, in essence, death. The idea is that nothing lasts forever. People age and eventually die. Young families get older, and children leave to start their own families.
Homeostasis itself is dynamic in that it involves constant change and adjustment. Families are never frozen in time. Family members are constantly changing and responding to new situations and challenges.
4-3iNegative Entropy
Negative entropy is the process of a system moving toward growth and development. In effect, it is the opposite of entropy. Goals in family treatment often involve striving to make conditions and interactions better than they were before. A relationship between quarreling spouses can improve. Physical abuse of a child can be stopped. Negative entropy must be kept in mind when helping family systems grow and develop to their full potential.
4-3jEquifinality
Equifinality refers to the idea that there are many different means to the same end. It is important not to get locked into only one way of thinking, because in any particular situation, there are alternatives. Some may be better than others, but there are alternatives. It’s easy to get trapped into tunnel vision in which no other options are apparent. Frequently, family systems need help in defining and evaluating the options available to them.
Consider, for instance, a family in which the father abruptly loses his job. Instead of wallowing in remorse, they might pursue other alternatives. The family might consider relocating someplace where a similar position is available. The mother, who previously had not worked outside the home, might look into finding a job herself, to help the family’s financial situation. Moving to less expensive housing might be considered. Finally, the father might look into other types of work, at least temporarily. There are always alternatives. The important thing is to recognize and consider them.
4-3kDifferentiation
Differentiation is a system’s tendency to move from a more simplified to a more complex existence. In other words, relationships, situations, and interactions tend to get more complex over time instead of more simplified.
For example, two people fall in love, marry, and begin to establish their lives together. They have three children, and both parents work full-time in order to save enough for a modest home of their own. As time goes on, marital problems and disputes develop as their lives grow more complicated with children and responsibilities. Their initial simple life becomes clouded with children’s illnesses, car payments, job stresses, and so on. Systems theory provides a framework for viewing this couple’s relationship. It provides for the acknowledgment of increasing complexity. From a helping perspective, the basic fact of the couple’s affection for and commitment to each other may need to be identified and emphasized.
Concept Summary
Systems Theory Concepts
• System: A set of elements that form an orderly, interrelated, and functional whole.
• Homeostasis: The tendency for a system to maintain a relatively stable, constant state of equilibrium or balance.
• Subsystem: A secondary or subordinate system—a system within a system.
• Boundaries: Repeatedly occurring patterns of behavior that characterize the relationships within a system and give that system a particular identity.
• Input: Energy, information, or communication flow received from other systems.
• Output: Energy, information, or communication emitted from a system to the environment or to other systems.
• Feedback: A system’s receipt of information from an outside source about its own performance or behavior.
• Entropy: The natural tendency of a system to progress toward disorganization, depletion, and, in essence, death.
• Negative entropy: The process of a system moving toward growth and development.
• Equifinality: The idea that there are many different means to the same end.
• Differentiation: A system’s tendency to move from a more simplified to a more complex existence.
4-4Assess the Family Life Cycle
LO 4
Several decades ago, the traditional family life cycle was conceptualized as having six major phases (Carter & McGoldrick, 1980). Each phase focused on some emotional transition in terms of intimate relationships with other people and on changes of personal status. The six stages were as follows:
1. Separating an unattached young adult from his or her family of origin
2. Marrying and establishing an identity as part of a couple, rather than as an individual
3. Having and raising young children
4. Dealing with adolescent children striving for independence, and refocusing on the couple relationship as adolescents gain that independence
5. Sending children forth into their own new relationships, addressing midlife crises, and coping with the growing disabilities of aging parents
6. Adjusting to aging and addressing the inevitability of one’s own death
Today, our perspective on family life cycles is much more adaptable and varied. McGoldrick, Carter, and Garcia- Preto (2011) propose a contemporary framework for considering family life cycles that emphasizes flexibility and diversity. Spotlight 4.1 explores this new conceptualization of diverse family life cycles. Although the stages resemble those in the traditional approach, discussion focuses on the variability within each stage. Families are significantly affected by a wide range of conditions and issues. The stages described in Spotlight 4.1 may occur, but not necessarily in that order or at all. Rather, each family experiences a complex existence, as a system and as a collection of individuals, within an environmental context involving “race, ethnicity, class, gender, sexual orientation, religion, age, family status” and “disability” (p. 18). Additionally, “current or longstanding social, political, and economic issues” directly affect family life and the family life cycle; such matters include “random violence, affirmative action, de facto school and neighborhood segregation, gay and lesbian adoption or marriage, welfare reform, abortion rights, the education of all our children, prejudice against legal and illegal immigrants, health care and insurance, tax cuts, layoffs, social services to [older adults] … and other groups, cost and availability of infertility treatments, and physician-Helped suicide” (p. 18).
Spotlight on Diversity 4.1
Explain Diverse Perspectives on the Family Life Cycle
LO 5

EP 2a
EP 2c
McGoldrick and her colleagues (2011) articulate the following seven family life-cycle stages; these proposed stages may be considered as a “map” for examining and assessing how families respond to their widely diverse issues and circumstances (pp. 16–17).
Stage 1: Leaving Home: Emerging Young Adults
Early young adulthood arbitrarily extends from age 18 to 21, and older young adulthood from 22 to about 30 or older (Arnett, 2007; Fulmer, 2011). In the past, young adulthood marked the cessation of the dependence upon family of origin and the entrance into the world of independent living and work. Now, however, the concept of “breaking ties” with the family of origin is no longer so important. Whereas that old model “overemphasized separation,” the new perspective “blends separation and attachment by recognizing the need for individuation while retaining cross-generational relationships” (Fulmer, 2011, p. 176).
Stage 1 is often characterized by entrance into the self-supporting work world, formulation of intimate friendships and relationships, and possibly experimentation with mind-altering substances (Fulmer, 2011). However, these experiences are affected by a number of factors. For example, “poor urban groups have easier access to stronger drugs in their neighborhoods than do college students”; this may put such urban youth who are poor into high-risk groups for drug addiction and the negative repercussions resulting from addiction (Fulmer, 2011, p. 179). College students, on the other hand, may just use drugs “recreationally,” not necessarily suffering such dire consequences.
Another example of diverse circumstances concerns chronic illness and its effects on a family with an emerging young adult. Rolland (2011) explains:
If illness onset coincides with the launching … phases of the family life cycle [Stage 1], it can derail a family’s natural momentum. Illness or disability in a young adult may requires a heightened dependency and return to the family of origin for disease-related caretaking. The autonomy ad individuation of parents and child are in jeopardy, and separate interests and priorities may be relinquished or put on hold. Family dynamics as well as disease severity will influence whether the family’s reversion lo a child-rearing-like structure is a temporary detour or a permanent reversal. (p. 357)
Stage 2: Joining of Families through Marriage/Union
To varying degrees, marriage can require adjustment, compromise, and snuggle. Even small issues like how to arrange cereal boxes on the shelf, make spaghetti, or take out the garbage can require communication and cooperation. People going through Stage 2 may form a commitment with each other and readjust their relationships with friends and family as they establish themselves as a couple (McGoldrick, 2011).
However, numerous issues can make a couple’s adjustment to each other more difficult (McGoldrick, 2011). These include inadequate jobs or resources, differences in “religious, racial, ethnic, or class background,” disparities in “financial power, socioeconomic status, education, career option or skills,” and “issues with family of origin” (e.g., poor relationships with parents or siblings, financial dependence on parents, or living too far away or too close) (p. 210).
Gay and lesbian couples may face additional issues, such as loss of external family support, lack of legal acknowledgment, barriers to marriage, safety concerns, and job and/or financial discrimination based solely on their relationship status. Furthermore, “the stigmatizing of homosexual couples by our society means that their relationships are often not validated by their families or communities and they must cope with prejudice on a daily basis. The AIDS crisis produced a terrible trauma for the gay community and its impact on a whole generation of gay men at the point of forming couple relationships cannot be underestimated” (McGoldrick, 2011, p. 201).
Stage 3: Families with Young Children
Cultural values significantly affect how children are socialized, what values they acquire, and what behaviors they learn. “One cannot view the socialization of certain behaviors independently from the cultural context. Cultures define the basic values and ideals as well as the agents who teach the values and the settings in which they are taught” (Gardiner, Mutter, & Kosmitzki, 1998, p. 148). Greder and Allen (2007) reflect that “cultural traditions shape parenting by influencing child-rearing practices, expectations of roles of children at different ages and stages of development, where families live, family structure, and roles and responsibilities of adults in families” (p. 123). Spotlights 4.2 and 4.3 discuss further the influence of culture.
Greder and Allen (2007) continue that economic hardship also severely affects parenting ability:
Households headed by single mothers, individuals, and families from ethnic minority groups and families with pre-school children are overrepresented among those in the population who live in poverty … Geography and generations also play important roles in determining who becomes poor, as do factors such as adolescent parenting, insufficient education, lack of job training, and chronic unemployment. Limited access to health care (and resulting poor health outcomes), inadequate housing and homelessness and violent or unsupportive neighborhoods all contribute to the economic barriers confronting poor families. (p. 125)
Stage 4: Families with Adolescents
In the United States, adolescence can be a difficult period. Adolescents strive to establish their own identities, which often results in conflict with parents. Parents often struggle to maintain control, while adolescents vehemently resist it. Ethnic diversity and cultural values can add to the complexity of these scenarios.
As later chapters will explore, identity development is very important in adolescence. It, too, is subject to diverse factors. Preto (2011) addresses identity development for adolescents of color:
For African Americans, Latinos, Asians, and other adolescents of color, forming an identity goes beyond values and beliefs about gender, since they have to first cope with how society defines them, marginalizes, and oppresses them. For African Americans, forming a positive identity as a Black male or Black female in a racist society in which being Black has been demeaned for centuries poses a grave challenge for adolescents and their parents … Although there has been an increased visibility of African Americans in the popular culture, even more so since the election of Barack Obama as president the insidious effects of racism on the everyday lives of Blacks in this country hasn’t gone away. (p. 236)
Social class also impacts the conditions surrounding and the opportunities provided for adolescents. For example, families in the upper-level social classes, who have higher levels of education and greater income potential, view adolescents as needing attention, direction, and safekeeping; in contrast, working-class and poor families regard their adolescents as active participants needed to help with important family responsibilities such as washing, cooking, and babysitting (Kliman, 2011).
Stage 5: Launching Children and Moving on at Midlife
When children leave home to be on their own, family life often changes dramatically in many ways (McGoldrick et al., 2011). The original couple must reestablish itself as its own system. Relationships are developed with grown children, their partners, and grandchildren. The couple may establish new interests, activities, and relationships to replace the time no longer needed for child-care duties. The couple system’s own parents may require help and attention as they themselves age.
However, Stage 5 is also characterized by great diversity (Preto & Blacker, 2011). People may be married or in permanent couple systems, divorced, single, or remarried (possibly multiple times) by this stage of life. Some people are well adjusted. Others may face the clichés of a “midlife crisis” or “the empty nest syndrome.” People with greater assets and higher socioeconomic status often enter midlife in good health, eagerly seeking out new and exciting experiences. However, people in the lower socioeconomic classes frequently experience economic hardship, especially with diminishing availability of jobs, industrial downsizing and movement of production to other countries, and work environments characterized by escalating technology.
Stage 6: Families in Late Middle Age
Families in late middle age often face a range of conditions (Walsh, 2011). Stage 6 is often characterized by retirement and grandparenthood. Many people remain vibrant and healthy. As with other stages in life, socioeconomic status and available resources dramatically affect the quality of life in late middle age. People with many resources can experience travel, recreational pursuits, and good living conditions. People with inadequate resources may be forced to keep working, sometimes taking minimum-wage jobs to keep them afloat. Such people may not have adequate housing, food, or health care.
Other aspects of diversity, including race, also affect late middle age. For instance, increasing numbers of African American grandparents are assuming responsibility for their grandchildren (Brownell & Fenley, 2009; Cox, 2002, 2005; Diller, 2015; Misiewicz, 2012; Sue & Sue, 2008). Primary reasons include crack cocaine or alcohol addiction, incarceration for drug- or alcohol-related crimes, mental illness, and unwillingness to surrender custody of grandchildren to public foster care (Cox, 2002, 2005). “Surrogate parenting has been a pattern for African American grandparents in U.S. society” (Cox, 2002, p. 46).
These grandparents experience undue pressures when assuming such responsibility and are “prone to an increased incidence or exacerbation of depression and insomnia, hypertension, back and stomach problems … as well as increased use of alcohol and cigarettes … In addition, grandparents tend to ignore their problems and associated stresses to meet the needs of their grandchildren” (Cox, 2002, p. 46).
Cox (2002) calls for empowerment practice on their behalf and explains: “The immediate goals of empowerment practice are to help clients achieve a sense of personal power, become more aware of connections between individual and community problems, develop helping skills, and work collaboratively toward social change” (p. 46, citing Gutierrez, GlenMaye, & DeLois, 1995).
Cox calls for providing grandparents with information on a range of relevant topics and teaching them various skills to empower them. The recommended curriculum includes the following content: “(1) introduction to empowerment; (2) importance of self-esteem; (3) communicating with grandchildren; (4) dealing with loss and grief; (5) helping grandchildren deal with loss; (6) dealing with behavior problems; (7) talking to grandchildren about sex, HIV/AIDS, and drugs; (8) legal and entitlement issues; (9) developing advocacy skills; (10) negotiating systems; [and] (11) making presentations” so that they can share their knowledge with others (p. 47).
Stage 7: Families Nearing the End of Life
Facing the reality that life is coming to an end is important for families (McGoldrick et al., 2011). Often, this involves people dealing with losses, including the deaths of partners and friends. Preparing for one’s own death and legacy is also part of this stage. Decisions may be made about where to reside as health declines and increased supportive care is required.
Great diversity characterizes this stage. Depending on your cultural background, there are numerous ways of viewing and dealing with old age and death. For example, Dhooper and Moore (2001) maintain that
Native American [older adults] … those aged 65 and above, are more traditional in their philosophy and values and have a deeper understanding of racism and oppression against Native people as a result of having a longer history of experience with these forces. [Early in the last century] … the BIA [Bureau of Indian Affairs] sanctioned field agents to alter Native customs. “Forbidden were the wearing of long hair by males, face painting of both sexes, and wearing Indian dress” (Hirschfelder & Kreipe de Montano, 1993, p. 22) … The [older adults] … have been the vanguards of their culture and have passed down their traditions and cultural beliefs throughout the generations. Through the [older adults] … “traditional values are sustained … The ancient languages are spoken and taught, traditional ceremonies are observed and baskets are woven” (L. Hall, 1997, p. 755). As such they are held in high regard by their people and are treated respectfully. “Generally Native American traditional values consist of sharing, cooperation and a deep respect for elders” (Garrett, 1999, p. 87). (p. 191)
Similarly, various cultures view and deal with death very differently. Consider the approach assumed by the Lebanese:
Lebanese families are generally very expressive in their response to death, even after several generations of living in the United States. Extreme displays of emotion are common, and it is not unusual for older family members to ask the deceased to get up and perform a favored deed one last time (i.e., to dubkee, a Lebanese dance, or cook a favored meal). After the deceased is unable to respond to the request, the grief of the family is amplified and followed by wailing and crying. For immigrant Lebanese several decades ago, it was not uncommon to jump into the grave at the cemetery if a child had preceded a parent in death. In recent times Lebanese American reactions to death are less dramatic but still highly emotional and demonstrative. Calmness at wakes is perceived as a lack of love for the deceased, and emotional outbursts are perceived as respect for the deceased. Because of the strong bonds and emotional attachments of Lebanese families, wakes and funerals are highly charged experiences. (Simon, 1996, p. 374)
The Hindu perception and treatment of death involves the following:
Death is a particularly potent symbolic event among Hindus, given their beliefs about karma [destiny] … As with weddings, traditional rituals associated with death and mourning are likely to be modified when Indians live in the United States.
Mourning cycles vary, but … customs include a 10- to 12-day mourning ritual …in addition to requiring extensive absence from work. In keeping with Indian sex-role traditions, widows are expected to perform many rituals of sacrifice glorifying the family, whereas widowers and other family members are not required to observe such rites. (Almeida, 1996, p. 408)
Mindell (2007) explains Jewish families’ view and handling of death:
Judaism, regardless of denomination—Reform, Conservative, or Orthodox—has the overriding values of honoring the dead and comforting the mourners. Burial is usually within twenty-four hours after the death and the funeral service begins with the cutting of a garment or a black ribbon attached to the mourners, the immediate family of the deceased. This ritual is a visual representation of the individual being separated—cut away—from the loved one. The period of mourning at home after the burial lasts for one week. This ritual is called Shiva, the Hebrew word for seven. Friends, family, and neighbors visit the mourners in the home during Shiva, which provides the opportunity to share stories about the deceased, how his or her life touched others, and provide the bereaved a supportive environment to also share memories and to grieve. The first thirty days, referred to as Sheloshim, the Hebrew word for thirty, after the funeral is a time when the family might attend morning and evening services. Mourning ends after the first year, the anniversary of the death, when a tombstone is dedicated. At each anniversary of the death, the Yahzeit, the family lights a special twenty-four-hour memorial candle. Mourning is seen as a process that has stages and takes time. Rituals enable the living to remember the dead.
The religious customs that are practiced during the continuum of an individual’s life allow one to cope with difficult happenings, experiences, and emotions, in a supportive, emotional “home” as she or he struggles to make sense out of events that seem to have no meaning. The manner in which the struggle is done, the emotions expressed, and how the community supports its members reflect the religious and cultural history of the group and help to define the identity of the members of the group. (pp. 231–232)
Additional Issues Affecting Multiple Phases of the Family Life Cycle
Many other dimensions of diversity affect the life cycle of families and individuals. For example, Chapter 13 presents material on the life cycle of LGBTQ families and individuals. We will arbitrarily address two additional issues here that affect various life-cycle stages—adults who remain single and families dealing with immigration status.
Single Adults
Simply put, many adults for various reasons neither marry nor commit themselves to long-term intimate partnerships. The seven-stage family life cycle just described doesn’t really apply to them. The demographic picture has changed. More people remain single now than in past decades, people who do marry do so later than before, people often delay childbearing, and many people live much longer than they have in the past (Berliner, Jacob, & Schwartzberg, 2011).
Berliner and her colleagues (2011) describe four life-cycle stages often encountered by people who remain single. First, during their 20s, people establish their adult status. They make the transition from being dependent on their family of origin to starting their independent lives. They develop new contexts for living by establishing work status and friendship relationships.
During the second stage in their 30s, single adults may face “the single crises” (Berliner et al., 2011, p. 166). They contend with the condition that they are single and may remain so. They may develop new life objectives and possibilities that don’t include marriage. They may consider having children.
In their third phase of midlife, single adults may accept the fact that they may indeed neither marry nor have children. The dream of “the perfect family” may not materialize. They may take a new look at the status of work in their lives and attend to their financial future as single adults. They determine to view their status as single adults as valid and positive. Establishing social networks of friends for emotional support is also important.
The fourth phase entails “putting it all together” (Berliner et al., 2011, p. 166). This concerns single adults making decisions about work and their financial future. It means stressing the positive aspects of being free and independent. It also involves planning for future living conditions in the case of failing health. Finally, they cope with the decreasing health and death of people important to them.
Immigration Status
Immigration status is “a person’s position in terms of legal rights and residency when entering and residing in a country that is not that person’s legal country of origin” (Kirst-Ashman & Hull, 2012b, p. 26). Migrating from one country to another can powerfully affect a family’s life cycle.
People who migrate can assume any of the following statuses:
• Immigrants “are those individuals who depart their country of origin voluntarily in search of better economic and living arrangement” (Delgado, Jones, & Rohani, 2005, p. 5). They may be either permanent or temporary (e.g., students or seasonal workers); they may have either legal or illegal status, as described next (Potocky, 2008).
• Undocumented immigrants “are those individuals who enter this country without proper (legal) documentation, and have done so for reasons similar to those who are in this country as immigrants” (Delgado et al., 2005, p. 5). They sometimes are referred to as illegal aliens.
• Refugees “are those individuals who are forced to leave their country because of human rights violations and threats to safety” (Delgado et al., 2005, p. 5). They may also be victims of natural or man-made disasters (Potocky, 2008).
Migration to a new country and environment can dramatically affect a family’s life cycle (Falicov, 2011). Regardless of where a family is in its life cycle, migration forces family members to face major changes and disruptions. It also involves experiencing the losses of the known and familiar patterns of their old existence. “The age at the time of migration, the stage of personal development, and the length of stay in the adopted country alter how migration is constructed and lived over time” (Falicov, 2011, p. 337). Ability to adapt to new circumstances varies widely depending on the family member’s age. The experience will be very different for babies, “school-age children, adolescents, young adults,” and older adults (Falicov, 2011, p. 337). For example, young children generally have the ability to acquire a new language much more easily than older adults (Potocky, 2008).
There are many dimensions to the migration experience and many questions to ask about how the experience affects various family members. Garcia (2009) raises issues and questions to address in order to understand the family’s circumstances at whatever phase of the life cycle they’re in:
1. The process of immigration: Was the move voluntary or involuntary? Anticipated or not anticipated? What were the points of transit on the way to the United States? Who was left behind, what separations occurred with family members? What is the status of immigration documentation?
2. Social power changes and coping: Have there been socioeconomic, educational, occupational adjustments? Shifts in new employment or unemployment status? Shifts in family decision making due to structural family changes? What are the effects of language and literacy fluency in the new country? Is the immigrant facing workplace-related stressors? Is so, what types of stressors (e.g., supervisory, interpersonal, xenophobic [involving an intense dislike or fear of foreigners or foreign customs], immigration authorities)?
3. Economic and housing resources: What are the immigrant’s debt commitments and assets? What is the status of housing (e.g., quality), transportation, access to communication technology?
4. Physical and psychological health status: Are the immigrant’s basic needs for food and shelter being met? Can the immigrant utilize and/or access professional health providers and/or cultural healers? Are there any antecedent health conditions prior to immigration, during the immigration process (e.g., loss of health, limb)? What is the immigrant’s current health status?
5. Family system and social networks: What are the family constellations, structures, communication patterns, multi-generational experiences, and coping abilities? What social support systems, if any, is the family involved with (e.g., extended family, friends, religious, community, political, recreational)? To what degree is the individual or family isolated and/or active with social contacts?
6. Cultural: Profile and qualities of individuals’ social identity? In what ways and to what degree is the individual identified with his or her traditional culture, with the new American culture, and/or with other cultures (e.g., religious, people with disabilities, gender orientation)? (pp. 84–85)
Within the context of the family system’s life cycle, we will now turn our attention back to the social development of young children. We will focus on how children become integrated into their family system and how they learn to behave (or misbehave). Learning theory provides a relevant, conceptual base for understanding how socialization and learning occur. Thus, we will emphasize the theoretical basis for learning theory and its applications to practical parenting.
4-5Describe Learning Theory
LO 6
“Mom! I want a candy bar! You promised! I want one right now! Mom!” Four-year-old Huey screamed as loudly as he possibly could. He and his mother were standing in the checkout line at the local supermarket. An older adult woman was checking out in front of them. Two other women and a man were waiting in line behind them.
Huey’s mother saw everybody looking at her and her young son. Huey simply would not stop screaming. She tried to shush him. She scolded him in as much of a whisper as she could muster. She threatened that he would never see the inside of a McDonald’s again. Absolutely nothing would work. Huey just kept on screaming.
Finally, in total exasperation, his mother grabbed the nearest candy bar off the shelf, ripped off the wrapper, and literally stuck the thing into Huey’s mouth. A peaceful silence came over the grocery store. All witnessing the event breathed a sigh of relief. Huey stood there with a happy smile on his sticky face. One might almost say he was gloating.
The family environment has already been established as the primary agent of children’s socialization. It provides the critical social environment in which children learn. The next logical question to address concerns how children learn. The social and emotional development of children is frequently a focus of social work intervention. Children sometimes create behavior problems. They become difficult for parents and other supervising adults to manage. When they enter school, these management problems often continue. Teachers and administration find some children difficult to control. Frequently, as children get older, problems escalate.
Children can learn how to be affectionate, considerate, fun-loving, and responsible. But they can also learn how to be selfish, spoiled, and inconsiderate. This latter state is not good for parents and other supervising adults, nor for the children themselves. Children need to cooperate with others. They need to know how to get along in social settings in order to become emotionally mature, well-adjusted adults. Learning theory concepts are useful for recognizing why anyone, child or adult, behaves the way he does. However, the concepts are especially helpful when addressing the issue of behavior management.
4-5aCritical Thinking: Assessment of Theory
In order to change behavior, it first must be understood. Learning theory is a theoretical orientation that conceptualizes the social environment in terms of behavior, its preceding events, and its subsequent consequences. It posits that behavior can be learned, and therefore maladaptive behavior can be unlearned. Learning theory provides a framework for understanding how behavior develops. We will focus on learning theory for several reasons. First, it emphasizes the social functioning of people within their environments. The total person in dynamic interaction with all aspects of the environment is the focus of attention. This is in contrast to many other theoretical approaches that focus primarily on the individual’s personality or isolated history.
Second, learning theory emphasizes the importance of assessing observable behaviors. It also stresses the use of behaviorally specific terms in defining behaviors. This helps to make any particular behavior more clearly understandable.
Finally, learning theory provides a positive approach. The underlying idea is that behaviors develop through learning them, and therefore undesirable behaviors can be unlearned. This allows for positive behavioral changes. Instead of individuals being perceived as victims of their personal histories and personality defects, they are seen as dynamic living beings capable of change.
Behavior modification involves the therapeutic application of learning theory principles. Much evidence supports the effectiveness of behavioral techniques for a wide variety of human problems and learning situations (Degangi & Kendall, 2008; Kazdin, 2013; Miltenberger, 2012; Spiegler & Guevremont, 2010; Sundel & Sundel, 2005; Wilson, 2011).
4-5bRespondent Conditioning
One view of understanding behavior focuses on a stimulus and the response resulting from that stimulus. A stimulus is “an object or event that can be detected by one of the senses, and thus has the potential to influence the person” (Miltenberger, 2012, p. 66). A particular stimulus elicits a particular response. The stimulus can be a word, a sight, or a sound.
For example, Martha, who has been on a strict diet for a week, stops by to visit her friend Evelyn. Evelyn is in the process of preparing a lobster dinner. She is also baking a German chocolate cake for dessert. Martha begins salivating at the thought of such appetizing food. Martha’s response, salivation, occurs as a result of the stimulus, witnessing Evelyn’s preparation of the wonderful, albeit fattening, food. Figure 4.1 portrays this relationship.
Figure 4.1A Stimulus–Response Relationship

Much respondent behavior is unlearned; that is, a response is naturally emitted after exposure to a stimulus. This stimulus is called an unconditioned (naturally occurring) stimulus. Respondent conditioning (also called classical or Pavlovian conditioning) occurs when a person learns to respond to a new stimulus that does not naturally elicit a response. This new stimulus is called a conditioned (learned) stimulus. In order to accomplish this, the new stimulus is paired with the stimulus that elicited the response naturally. The person then learns to associate the new stimulus with a particular response even though it had nothing to do with that response originally.
For example, Mr. Bartholomew, a third-grade teacher, slaps students very hard on the hand when they talk out of turn. (This punitive physical behavior, of course, could get Mr. Bartholomew into a LOT of trouble.) As a result of this stimulus, the slapping, students fear Mr. Bartholomew. By associating Mr. Bartholomew with getting a slap on the hand, the students eventually learn to fear Mr. Bartholomew even when he isn’t slapping them. Mr. Bartholomew himself has been paired with the hand slapping until he elicits the same response that the slapping did. Figure 4.2 helps to illustrate this relationship.
Figure 4.2Respondent Conditioning

Some behavioral techniques used by social workers involve the principles of respondent conditioning. Systematic desensitization provides an example. Systematic desensitization is a procedure in which a person with a phobia practices relaxation while imagining scenes of the fear-producing stimulus. A phobia is “a fear in which the level of anxiety or escape and avoidance behavior is severe enough to disrupt the person’s life” (Miltenberger, 2012, p. 552). The extreme fear or anxiety may involve almost anything. Examples include snakes, enclosed places, or school.
Systematic desensitization usually has two major thrusts. First, the client is exposed very gradually to the thing he or she fears. Second, while the client is being exposed to the fearful item or event, he or she is also taught an incompatible response. The incompatible response must be something that cannot occur at the same time as the anxiety and fear. A good example of an incompatible response is progressive relaxation.
For example, the client first learns how to control his or her body and relax. Then the standard procedure is that he or she is exposed to the feared item or event in increasing amounts or degrees. A person who fears rats might first be shown a picture of a rat in the distance while, at the same time, using his or her newly acquired relaxation skills. Anxiety and fear cannot occur while the individual is in a relaxed state. They are incompatible responses.
The individual might then be shown an 8-by-10-inch photo of a rat. Once again, the individual would use relaxation techniques to prevent anxiety from occurring. The client would be exposed to rats in a more and more direct manner until the client could actually hold a laboratory rat in his or her hand. The client would gradually learn to use the incompatible relaxation technique to quell any anxiety that rats might once have elicited.
A variety of techniques based on respondent conditioning have also been used to treat enuresis, or bed-wetting, overeating, cigarette smoking, alcohol consumption, and sexual deviations (Kazdin, 2001, 2008a, 2013; Sundel & Sundel, 2005). However, they are not nearly as abundant nor are they as common as those behavioral techniques based on operant conditioning, discussed in a later section.
4-5cModeling
A second perspective on understanding behavior and learning involves modeling, the learning of behavior by observing another individual engaging in that behavior. In order to learn from a model, an individual does not necessarily have to participate in the behavior. An individual only needs to watch how a model performs the behavior. For obvious reasons, modeling is also called observational learning. A behavior can be learned simply by observing its occurrence.
Modeling is important within the context of practical parenting. Parents can model appropriate behavior for their children. For example, a father might act as a model for his son concerning how to play baseball. The father can teach his son how to throw and catch a ball by doing it himself. The child can learn by watching his father.
In social work intervention, modeling can be used to model appropriate treatment of children so that parents may observe. For example, 5-year-old Larry, who frequently has behavior problems, may pick up a pencil that the social worker 4-5dOperant Conditioning
Operant conditioning is one of the dominant types of learning focused on in the United States. It allows for the easiest and most practical understanding of behavior. Many treatment applications are based on the principles of operant conditioning.
Operant conditioning is “a type of learning in which behaviors are influenced primarily by the consequences that follow them” (Kazdin, 2008a, p. 458; 2013). New behaviors can be shaped, weak behaviors can be strengthened, strong behaviors can be maintained, and undesirable behaviors can be weakened and eliminated. The emphasis lies on the consequences of behavior. What follows a particular behavior affects how frequently that behavior will occur again, as illustrated in Highlight 4.1.
Highlight 4.1
Consequences and Recurring Behavior
The Johnsons hired their neighbor, 9-year-old Eric, to mow their lawn once a week during the summer. Eric, not being sophisticated in the ways of money management, failed to discuss how much he would be paid per hour. Eric slaved away for four hours one Saturday afternoon when he would rather have been playing baseball.
When Eric had finished, Mr. Johnson came out, complimented Eric on what a fine job he had done, and gave him $12 for his trouble. Unfortunately, $12 worked out to be $3 per hour. Mr. Johnson thought this was more than adequate. Mr. Johnson himself had been paid only a grand total of $1 for doing a similar job when he was a boy. Eric, however, felt this was more than chintzy on Mr. Johnson’s part. He knew that $12 would barely begin to cover the brand new Xbox of his dreams.
The consequences for Eric’s lawn-mowing behavior were not positive. He did not receive his expected $32. Thus, Eric never mowed Mr. Johnson’s lawn again. Instead he turned to other, more generous and benevolent neighbors to upgrade his financial future. He also learned to make salary one of the first items on his business agenda. If Mr. Johnson had given him his expected rate of $8 an hour, Eric would have been a dependable and industrious worker for him throughout the summer. In other words, more favorable consequences for Erie would have encouraged his lawn-mowing behavior. He would have been conditioned to mow Mr. Johnson’s lawn. As it turned out, Mr. Johnson was doomed to mowing his own lawn for the remainder of the summer.
accidentally dropped and return it to the social worker. The social worker may then model for the parent how the child can be positively reinforced for his good behavior. The social worker may say, “Thank you for picking up my pencil for me, Larry. That was very helpful of you.”
Another example of modeling within a social work practice context is role playing, practicing behavior through a trial run in preparation for a later situation in which some goal is to be achieved (such as gaining greater understanding of another’s position or learning more effective communication skills). For example, a social worker might ask a mother who has trouble controlling her son to role-play that son and mimic his behavior. She is instructed to act the way she thinks her son would act. The social worker may then model for the parent some appropriate, effective things to say to the son when the son behaves in that way. Such modeling provides the opportunity for the parent to learn new ways of responding to her son.
Modeling can also teach children inappropriate and ineffective behavior. For example, consider a mother who strikes other family members whenever she gets the least bit irritated with them. She is likely to act as a model for that type of behavior. Her children may learn that striking others is the way to express their anger.
Some classic research studied the effects of positive and negative consequences on modeling (Bandura, 1965). Children were shown a film of an adult hitting and kicking a large doll, obviously modeling aggressive behavior. Afterward, the children were divided into three groups. Each group then observed the model experiencing different respective consequences. One group of children viewed the model being punished for the aggressive behavior. Another group of children saw the model being rewarded for the same behavior. A third group of children saw the model being ignored. The children were then placed in situations where they could display aggression. Children who saw the model receive a reward for aggressive behavior and those who saw him experience no consequences clearly displayed more aggressive behavior than those children who saw the model punished. It was ascertained that all the children had learned the aggressive behavior; when they were told they would receive a reward for being aggressive, they all could indeed be aggressive. The conclusion is that modeling behavior can be affected both by consequences to the model and to the observer.
Other conditions can also affect the effectiveness of modeling or the degree to which modeling works. These conditions include “the similarity of the model to the observer; the prestige, status, and expertise of the model; and the number of models observed. As a general rule, imitation of a model by an observer is greater when the model is similar to the observer, more prestigious, and higher in status and expertise than the observer and when several models perform the same behavior” (Kazdin, 2008a, pp. 24–25; Miltenberger, 2012; Sundel & Sundel, 2005).
Modeling has been used in a variety of clinical settings, including the control of fear and the development of social skills. Usually, it’s used in conjunction with other behavioral techniques.
4-5eThe ABCs of Behavior
One way of conceptualizing operant behavior is to divide it into its primary parts, known as antecedents, behaviors, and consequences. Another way of referring to them is the ABCs of behavior.
Antecedents are the events occurring immediately before the behavior itself. These events set the stage for the behavior to occur. For instance, some individuals state that they are able to quit smoking cigarettes except when they are socializing at a party. The party conditions act as a stimulus for smoking behavior, whereas other environments do not. In other words, the party setting acts as an antecedent for smoking behavior.
Behavior is “any observable and measurable response or act … Behavior is occasionally broadly defined to include cognitions, psychophysiological reactions, and feelings, which may not be directly observable but are defined in terms that can be measured by means of various assessment strategies” (Kazdin, 2008a, p. 450; Miltenberger, 2012). The important phrase here is that behavior is “defined in terms that can be measured.” Therefore, even thoughts and feelings can be changed as long as words can be found to clearly describe what they are. For instance, specific messages that people send to themselves can be altered as long as these messages can be clearly defined and measured. A woman who frequently tells herself “I am so fat,” can have that message changed to “I am a worthwhile person.” Each time she tells herself this message, it can be noted, so that the overall frequency can be measured.
Most behavior involved in operant conditioning is observable. Even thoughts and feelings frequently occur with accompanying behaviors. For example, Ieasha is a 6-year-old who has been clinically diagnosed as depressed. Any thoughts she has about being depressed are not noticeable. However, she makes frequent statements about what a bad girl she is, how her parents don’t like her, and what it would be like to die. These statements can be observed and noted. Such statements might be used as indicators for childhood depression.
Ieasha’s statements can also be measured; that is, the types of statements she makes and how often she makes them can be counted and evaluated. She might make a statement concerning what a bad girl she is 12 times per day, about how her parents dislike her 5 times per day, and about her own death 16 times per day. When her depression begins to subside, these types of verbal statements may decrease in frequency and severity. For example, Ieasha may make derogatory remarks about herself only 4 times per day instead of 12. She may say only once each day that her parents dislike her. Statements about death may disappear altogether.
In addition to verbal behavior, physical behavior or actions may also be observed and measured. Besides making statements that indicate she’s depressed, Ieasha may spend much of her time sitting in a corner, sucking her thumb, and gazing off into space. The exact amount of time she spends displaying these specific behaviors may be observed and measured. For example, Ieasha initially may spend five hours each day sitting in a corner. When depression begins to wane, she may spend only half an hour in the corner.
The final component as a basis for operant conditioning involves the consequences of the behavior. A consequence may be either something that is given or something that is withdrawn or delayed. In other words, something happens as a direct result of a particular behavior. Consequences are best described in terms of reinforcement and punishment.
4-5fReinforcement
Reinforcement refers to a procedure or consequence that increases the frequency of the behavior immediately preceding it. If the behavior is already occurring at a high level of frequency, then reinforcement maintains the behavior’s frequency. A behavior occurs under certain antecedent conditions. If the consequences of the behavior serve to make that behavior occur more often or be maintained at its current high rate, then those consequences are considered reinforcing. Reinforcers strengthen behaviors and make them more likely to occur in the future.
Positive Reinforcement
Reinforcement can be either positive or negative. Positive reinforcement refers to positive events or consequences that follow a behavior and strengthen it. In other words, something is added to a situation and encourages a particular behavior. For example, 8-year-old Herbie receives a weekly allowance of $15 if he straightens up his room and throws all of his dirty laundry down the clothes chute. Receiving his allowance serves to strengthen, or positively reinforce, Herbie’s cleaning behavior.
Negative Reinforcement
Negative reinforcement is the removal of a negative event or consequence that serves to increase the frequency of a behavior. There are two important aspects of this definition. First, something must be removed from the situation. Second, the frequency of a particular behavior is increased. In this manner, positive and negative reinforcement resemble each other. Both function as reinforcement that, by definition, serves to increase or maintain the frequency of a behavior.
A good example of negative reinforcement is a seatbelt buzzer in a car. The car door is opened, and a loud and annoying buzzer is activated. It will not stop until the driver’s seatbelt is fastened. Conceptually, the buzzer functions as a negative reinforcer because it increases the frequency of buckling seat belts. The buzzer is also negative or aversive. It increases seatbelt buckling behavior because people are motivated to stop (remove) it.
To take another example of negative reinforcement, suppose Orlando, a college sophomore, is trying to study in his dorm room one Thursday night. His next-door neighbor, Gavin, has decided that Thursday nights are much better for partying than for studying. Gavin, therefore, decides to invite a bunch of his friends over to take some illegal substance. Gavin cranks up his speakers to the highest vibration level it can tolerate.
Orlando tries to ignore this nuisance and continues trying to study until he can’t stand it anymore. In a state of fury, he stomps up to the wall between the rooms, smashes his fist on it several times, and screams, “Shut the #$@*$%& up in there!”
On the other side of the wall, Gavin says to his buddies, “That guy is such a dweeb. If I don’t turn it down, he’ll probably narc on me to the hall director. Let’s go somewhere else.” He turns off his speakers and leaves with his friends.
Evaluating this scenario with learning theory leads to several conclusions. First, Orlando’s screaming behavior served as negative reinforcement for Gavin’s turning off his speakers and leaving the room. Orlando’s screaming was aversive to Gavin. In order to terminate it, Gavin turned off his music and left. Moreover, from then on, Gavin made it a point to turn off his speakers whenever Orlando was around and leave his room when he wanted to party. Thus, Orlando’s (aversive) screaming reinforced (increased the frequency of) Gavin’s turning off his speakers and leaving his room when he wanted to party.
Looking at his situation from another perspective, Gavin’s room-leaving behavior served as positive reinforcement for Orlando’s screaming behavior. Orlando was positively reinforced for screaming because he got what he wanted—namely, peace and quiet. Orlando became much more likely to scream at Gavin in the future (i.e., Orlando was reinforced), because he immediately received something positive as a result of his behavior.
Although at first glance this may appear obvious and simplistic, it is easy to become confused about the type of reinforcement that is occurring. In any particular situation, both positive and negative reinforcement may be taking place at the same time. Consider, for instance, the example given initially to illustrate learning theory, involving 4-year-old Huey and his mother at the supermarket. Huey yelled for a candy bar. His mother finally gave in and thrust one into his mouth. His crying immediately stopped. Both positive and negative reinforcement were occurring in this example. Mother’s giving Huey the candy bar served as a positive reinforcer. Huey received something positive that he valued. At the same time he learned that he could get exactly what he wanted from his mother by screaming in the supermarket. Giving him the candy bar positively reinforced his bad behavior. Therefore, that type of behavior would be more likely to occur in the future.
At the same time, negative reinforcement was occurring in this situation. Mother’s giving-in behavior was encouraged or strengthened. She learned that she could stop Huey’s obnoxious yelling by giving him what he wanted—in this case, a candy bar. Huey’s yelling, therefore, acted as negative reinforcement. It increased his mother’s giving-in behavior by motivating her to stop—or to escape from—his yelling.
4-5gPunishment
Punishment and negative reinforcement are frequently mistaken for each other. Perhaps this is because they both concern something negative or aversive. However, they represent two distinctly different concepts.
Punishment is the presentation of an aversive event or the removal of a positive reinforcer, which results in a decrease in the frequency of a behavior. Two aspects of this definition are important. First, the result of punishment is a decrease in a behavior’s frequency. This is in direct opposition to negative reinforcement, which increases a behavior’s frequency.
Second, punishment can be administered in two different ways. One way involves presenting a negative or aversive event immediately after a behavior occurs. Negative events may include spankings, scoldings, electric shocks, additional demands on time, or embarrassing criticisms. For example, 10-year-old Susie hadn’t studied for her social studies exam. Her parents had already complained about the last report card. She just hadn’t given the test much thought until Ms. McGuilicutte was handing out the test papers. Susie looked over her test paper and gasped. Nothing looked even vaguely familiar. She was sitting next to Juana, whom she considered the class genius. She figured that just a few brief glances at Juana’s paper wouldn’t hurt anybody. However, Susie was wrong. Ms. McGuilicutte immediately noticed Susie’s wandering attention. Ms. McGuilicutte swooped down on Susie and confiscated her test paper. In front of the entire class Susie was told that cheating resulted not only in an F grade, but also in two weeks of detention after school. Susie was mortified. She vowed to herself that she would never cheat again.
Susie received extremely aversive consequences as the result of her cheating behavior. The consequences included not only a failing test grade and two weeks of detention, but also humiliation in front of her peers. Her cheating behavior decreased in frequency to zero.
The second way in which punishment can be administered is by withdrawing a positive reinforcer. Once again, the result may be a decrease in the frequency of a particular behavior. For example, 7-year-old Robbie thought it was funny to belch at the table during dinner. Several times his parents asked him to stop belching. Each time Robbie was quiet for about a minute and then started belching again. Finally, his mother stated firmly that such belching was considered rude behavior and that, as punishment, Robbie would not receive the banana split she had planned for his dessert. Robbie whined and pleaded, but his mother refused to give it to him. Robbie loved desserts, and banana splits were his favorite. Robbie never belched at the table again, at least not purposefully. Removal of the positive reinforcer—the banana split—had served as punishment. The punishment resulted in an abrupt decrease in belching behavior.
It should be emphasized that the term punishment as it is used in learning theory does not necessarily mean physical punishment. For some of us, the word may bring to mind pictures of parents putting children over their knees and spanking them. Punishment does not have to be physical. Verbal reprimands such as a mother saying how disappointed she is that she caught her daughter “making out” with her boyfriend in the family room can also serve as punishment. The reprimand functions as a punishment if the behavior decreases. Likewise, withdrawal of a valued activity, such as not allowing a child to go to a popular movie, can be a punishment if it acts to decrease or stop some negative behavior.
4-5hExtinction
Extinction is the process whereby reinforcement for a behavior stops, resulting in the eventual decrease in frequency and possible eradication of that behavior. Reinforcement simply stops; nothing is actively taken away. Note that extinction and punishment are two separate concepts “In extinction, a consequence that was previously provided no longer follows the response. An event or stimulus (money, noise) is neither taken away nor presented. In punishment, some aversive event follows a response (a reprimand) or some positive event (money) is taken away” (Kazdin, 2008a, p. 58; 2013; emphasis in original). In everyday life, extinction often takes the form of ignoring a behavior that was previously reinforced with attention.
An example of extinction concerns the reduction of tantrum behaviors in a 21-month-old child. When put to bed, the child screams until his parents return to the room to comfort him. This provides positive reinforcement for the child’s behavior. The parents are instructed to put the child to bed, leave the room, and ignore his screaming. The first night, the child screams for 45 minutes. However, the next night when the parents leave the room, no screaming occurs. Eventually, withdrawing the positive reinforcer of attention results in the total elimination of the child’s tantrums. Ignoring, therefore, can be used as an effective means of extinction.
Here the differences between positive reinforcement, negative reinforcement, punishment, and extinction are summarized. Important differences involve what happens and what results with each behavioral approach.
Extinction occurs with many other reinforcers in various daily situations. For example, if putting a dollar in a coffee machine results in nothing but a gush of clear, hot water without the cup, use of that coffee machine will probably be extinguished. Likewise, say you’re having difficulty in your biology lab course. You don’t understand what the professor is saying during lectures, and you’re not sure what he wants from you on exams (you’ve already received a D+ on two of them). Three times you try to see your professor during his office hours, and each time he is not there. Eventually, you stop trying to see him, despite your frustration. Your behavior involved in seeing him to get help has been extinguished.
One other aspect of extinction is important to note. Frequently, when reinforcement is initially stopped, a brief increase in the frequency or intensity of the behavior may occur. This is referred to as an extinction burst. For example, consider again tantrums in a small child. When the reinforcement of attention is withdrawn, the child’s behavior may escalate temporarily. If in the past the child has always received positive reinforcement through attention for his behavior, it may be very confusing suddenly to receive no attention for that very same behavior. The child may try exceptionally hard to get the attention to which he was accustomed. The intensity of the undesirable behavior can seriously strain the patience and tolerance of parents. However, eventually the child will learn that the tantrums are not reinforced and are therefore simply not worth the effort. Thus, the tantrum behavior is extinguished.
The relationships between positive reinforcement, negative reinforcement, punishment, and extinction are summarized in Figure 4.3.
Figure 4.3Positive Reinforcement, Negative Reinforcement, Punishment, and Extinction

4-6Apply Learning Theory Concepts to Practice
LO 7
As children become socialized, they learn and assimilate various behaviors. Because learning is a complicated process, sometimes the behaviors they learn are not those that their parents would prefer. Behavior management is a major issue for many parents.
Parents have various alternative ways of responding to a child’s behavior. At any point, an individual can follow alternative plans of action. For each alternative, there are consequences. The critical task is to evaluate each alternative and select the one with the most advantageous results. Learning theory concepts provide parents with a means of understanding the alternatives open to them and predicting the potential consequences of each alternative. It can help them gain control over their children’s behavior.
An example of parental alternatives in response to behavior is provided by Tung, age 4. At the dinner table, Tung nonchalantly and without warning says an unmentionable four-letter word. Tung’s parents are shocked. At this point, they can respond in several different ways. They can ignore the fact that Tung said the word. Without being given undue attention, saying the word may be stopped. A second alternative is to tell Tung calmly that the word is not considered a very nice word. They might add that some people use it when they’re angry and that other people don’t really like to hear it. They might also ask him not to use the word anymore. A third alternative is for the parents to display their horror and disbelief, scream at Tung never to say that word again, and send him to bed without being allowed to finish his supper.
When this incident actually occurred, the parents opted to respond as described in the third alternative. Poor Tung really didn’t understand what the word meant. He had just heard it on the playground that afternoon. He was amazed at the response of his parents and at the attention he received. His mother reported that for the following two years, he continued to repeat that unmentionable four-letter word virtually everywhere. He said it to the dentist, to the grocer, to the police officer, and even to his grandmother. His mother reported that after a while she would have been willing to pay Tung to stop using that word, if such a strategy would have worked.
Concept Summary
Learning Theory Principles
• Learning theory: The theoretical orientation that conceptualizes the social environment in terms of behavior, its preceding events, and its subsequent consequences.
• Respondent conditioning: Responses that develop when a person learns to respond to a new stimulus that does not naturally elicit a response.
• Unconditioned (naturally occurring) stimulus: A stimulus that naturally results in specific response.
• Conditioned (learned) stimulus: A stimulus that does not result in a response naturally, but does result in a response after being paired with an unconditioned stimulus that elicits the response naturally (i.e., a person learns to respond to a conditioned stimulus).
• Systematic desensitization: The procedure whereby a person with a phobia practices relaxation while imagining scenes of the fear-producing stimulus, with the intent of decreasing that fear.
• Modeling: The learning of behavior by observing another individual engaging in that behavior.
• Operant conditioning: A type of learning in which behaviors are influenced primarily by the consequences that follow them.
• Reinforcement: A procedure or consequence that increases the frequency of the behavior immediately preceding it.
• Positive reinforcement: Positive events or consequences that follow a behavior and strengthen it.
• Negative reinforcement: The removal of a negative event or consequence that serves to increase the frequency of a behavior.
• Punishment: The presentation of an aversive event or the removal of a positive reinforcer, which results in a decrease in the frequency of a behavior.
• Extinction: The process whereby reinforcement for a behavior stops, resulting in the eventual decrease in frequency and possible eradication of that behavior.
In Tung’s situation, his parents’ attention became a strong positive reinforcer. Perhaps if they had stopped and thought in terms of learning theory principles, they could have gained immediate control of the situation and never thought another thing of it.
4-6aThe Use of Positive Reinforcement
Positive reinforcement is based on the very fundamental idea that behavior is governed by its consequences. If the consequences of a particular behavior are positive or appealing, then the individual will tend to behave that way. In other words, the frequency of that behavior will be increased.
Positive reinforcement provides a valuable means of behavioral control. It has been established as an appropriate technique for achieving positive behavioral changes in numerous situations (Degangi & Kendall, 2008; Kazdin, 2013; Miltenberger, 2012). The use of positive reinforcement helps to reduce the risk that clients will begin associating the negative effects of punishment, for example, with the therapist, resulting in an aversion to therapy. Positive reinforcement can also teach individuals exactly how to improve their behavior.
Various aspects of positive reinforcement will be discussed here. First, we’ll examine the types of reinforcers available. The differences between positive reinforcement and the use of rewards will be explained. Finally, we’ll offer suggestions for maximizing the effectiveness of positive reinforcement.
The manner in which parents use reinforcement and punishment directly affects children’s behavior.

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Types of Positive Reinforcers
Reinforcers can be separated into two major categories, primary and secondary. Primary or unconditioned reinforcers are rewarding in themselves, without any association with other reinforcers. They include objects and activities that people naturally find valuable. Food, water, candy, and sex are examples of primary reinforcers. Individuals respond positively to them naturally, without having to learn their value.
Secondary reinforcers, on the other hand, have values that are learned through association with other reinforcers. The key idea is that they must be learned. Alone they have no intrinsic value. Money perhaps is the most easily understood example. A $1,000 bill in itself is nothing but a small piece of high-quality paper with printed symbols on it. However, it is associated with things of value. It can be used to purchase actual items ranging from diamonds to pistachio nuts. Money is valuable only because it is associated with other, concrete primary reinforcers.
The concepts of primary and secondary reinforcers can be readily applied to treatment situations. For example, a child with a developmental disability may not initially value verbal praise. He may not yet have learned to associate verbal praise with his actual behavior. A social worker may be working with the child concerning his ability to dress himself. Initially, saying, “That’s good,” may mean nothing to the child. However, saying, “That’s good,” while at the same time giving the child a small chocolate star, may eventually give the verbal praise some meaning. The child learns to associate verbal praise with the positive value of the candy. Eventually, the praise itself becomes reinforcing to the child, even without the candy. This technique involves pairing a primary reinforcer, the chocolate star, with a secondary reinforcer, verbal praise. The secondary reinforcer becomes valuable to the child through its initial association with the candy.
Categories of Secondary Reinforcers
Four major types of secondary reinforcers will be addressed here:
• (1)
material reinforcers and nonfood consumables,
• (2)
activities,
• (3)
social reinforcers, and
• (4)
tokens (Fischer & Gochros, 1975; Kazdin, 2001, 2008a, 2013; Spiegler & Guevremont, 2010).
Material Reinforcers and Nonfood Consumables
Material reinforcers are specific objects or substances that can be used as rewards to increase specific behaviors. Eight-year-old Herbie received an allowance for cleaning his room. Herbie’s cleaning behavior was strengthened or reinforced by receiving an allowance.
Money might be considered an object (a specific, tangible thing) that reinforces a behavior. Other objects that might have been used as tangible reinforcers for Herbie include video games and toys. Each of these items would have acquired their value through learning. Therefore, they would be considered secondary reinforcers.
Food has already been established as a primary reinforcer along with a number of other things that are naturally reinforcing; learning is not involved. In addition, people can learn to value some nonfood consumables. Examples include cigarettes, gum, and chewing tobacco. Although these are not naturally desired, a taste for them can be acquired. Because they are material substances, they are included in this category of secondary reinforcers.
Activities
Activities make up the second category of secondary reinforcers. Activities are tangible events whose value has been learned. Positively reinforcing activities for children might include watching rented movies, playing with friends, staying up late at night, being read to, going shopping, or visiting the stock-car races.
For example, 12-year-old Gina hates doing her homework at night. However, she loves going to the movies on Saturdays. Her parents positively reinforce her for doing an hour’s worth of homework five nights per week by giving her money to go to the movies on Saturday. Going to the movies is an activity that serves as positive reinforcement for Gina’s doing her homework.
Premack (1965) recognized that people have hierarchies of preferred behavior. In other words, any individual when given a choice will choose one behavior over another behavior. For instance, if given a choice, an individual might prefer to plant flowers in the garden over doing the laundry. The Premack Principle states that “the opportunity to engage in a high-probability behavior (a preferred behavior) as a consequence for a low-probability behavior (a less-preferred behavior)” will “increase the low-probability behavior,” but never vice versa (Miltenberger, 2012, p. 68). Thus, more-preferred activities can be used to reinforce less-preferred activities. Consider the person who prefers garden work over laundry. Allowing him to plant the garden after he completes the laundry will serve to reinforce the laundry-related behavior. He will be more likely to do the laundry if he knows he can plant the garden afterward.
We’ve established that enjoyable, exciting activities can serve as secondary reinforcers if they are indeed valued and enjoyed by the person involved. The Premack Principle implies that activities needn’t be special or extremely valued but simply preferred in order to act as a secondary reinforcer. The garden work might not be something the same individual would choose if a weekend in Las Vegas were also given as an option. However, he still would choose the garden over the laundry. Therefore, the garden could be used as a secondary reinforcer for the laundry. Following the same line of thinking, a trip to Las Vegas could be used as a secondary reinforcer for working in the garden or doing the laundry.
One of the implicit assumptions here is that each individual will have a different hierarchy of preferred activities. For example, on camping trips, Nick prefers the following specific activities in this order, from most preferred to least preferred: reading Peterson’s 4-Wheel & Off-Road magazine; cooking the food; doing the dishes; reading science fiction, especially space horror stories. Karen, on the other hand, prefers the specified camping activities in this order: reading science fiction, especially space horror stories; doing the dishes; cooking the food; reading Peterson’s 4-Wheel & Off-Road magazine (“Winch Wisdom,” the title of the leading article, doesn’t excite her at all). For Karen, reading science fiction would function as a secondary reinforcer for any of the other three activities. She would be more likely to do any of them if she could read science fiction afterward. For Nick, however, the science fiction would not serve to reinforce any of the other activities, whereas reading Peterson’s 4-Wheel & Off-Road magazine would.
Social Reinforcers
Material reinforcers and activities are not the only things that people learn to value. Various aspects of social interaction can also be considered valuable. Social reinforcers include words and gestures used to indicate caring and concern toward another person. These can be communicated in one of two ways, by giving either verbal or physical praise. Verbal praise involves words or phrases that indicate approval or appreciation of someone’s specific behavior, such as “Good job,” “You did that very well,” or “That’s terrific!”
Effective verbal praise is directed at a specific behavior or activity. The person receiving the praise should be clearly aware of what the praise concerns. For instance, 8-year-old Linda did the dishes without being asked for the two days her mother was out of town attending a professional conference. Her mother, on her return home, stated, “Thank you very much for helping out and doing the dishes. I understand you did them without even being told. I really appreciate your help.” Linda’s mother made it very clear exactly what Linda did that was appreciated. When such praise acts to strengthen Linda’s dish-washing behavior in the future, it is positive reinforcement. If Linda’s mother instead had said, “You’re a very good girl,” it might not have been clear to Linda exactly why she was good. The positive regard communicated by such a statement, of course, is valuable in itself. However, Linda might have understood her mother to mean that she was good because she didn’t cry when her mother left or because she stayed up only one half hour past her bedtime. Linda might not have understood that her mother appreciated her washing dishes, and thus might never have done so again without being told.
The second type of social reinforcement is physical praise. Physical praise involves communicating appreciation or praise through physical gestures or body posture. This may simply involve a smile or a nod of the head. Hugging, clapping, or even winking can also indicate praise.
Consider, for example, how a smile might acquire significance. An infant may not initially value her mother’s smile. However, the infant may soon learn to associate the smile with comfort, warmth, and food. Eventually, the smile itself becomes reinforcing. It is a secondary reinforcer. The infant learns to value it. The smile is valued not because it is of value itself, but because the infant has learned to associate it with things of value.
The effects of social reinforcement are illustrated by Beverly, age 5, who had acquired a role in the kindergarten play. Her part involved playing a duck whose job was to waddle back and forth across the stage. Beverly was extremely nervous about her part because she was an exceptionally shy child. She even had to get a new yellow dress and wear red boots to help characterize her role. She had been practicing her waddling for days before the play. Finally, the critical night arrived. It was almost time to initiate her waddle and dare to venture out on the stage. At the last minute, she almost backed down and started crying. However, she looked out into the audience and saw her parents in the second row, looking directly at her. They were both smiling proudly and nodding their heads. With such encouragement, she waddled across that stage like no one had ever waddled before. Her parents’ obvious approval and encouragement had served to positively reinforce her acting and waddling behavior. After this experience, she was much more likely to volunteer to participate in activities that required performing before an audience.
Tokens
Tokens provide the fourth category of secondary reinforcers. Token reinforcers are designated symbolic objects reflecting specific units of value that an individual can exchange for some other commodity that he or she wants. Tokens can include poker chips, artificial coins, points, checkmarks, or gold stars. In and of themselves, they mean nothing. However, they can be associated with something of value and eventually be exchanged for that item or activity.
A practical application of tokens is the use of a token economy in child management. For example, a new bicycle might serve as a strong positive reinforcer for a particular child. However, it is absurd to give the child a new bicycle every time the child cleans his or her room. Rather, a system can be designed in which a child can earn tokens. The child can be told that if he or she earns a certain number of tokens, he or she can exchange them for a new bicycle. Tokens become a secondary reinforcer. A large sum of tokens can be used to acquire a new bicycle, the item of real value.
Reinforcers versus Rewards
A distinction must be made between reinforcers and rewards. A reward is not necessarily a positive reinforcer. A reward is something that is given in return for a service or a particular achievement. It may or may not increase the frequency of a particular behavior. A soldier might receive a medal of honor at the end of a war for shooting down 27 enemy aircraft. This is a reward. This reward does not, however, increase the frequency of this individual’s shooting down more aircraft during his civilian life.
Reinforcers, by definition, increase the frequency of a behavior. Receiving an A on an exam is a positive reinforcer for studying behavior if it serves to increase the frequency of a particular student’s studying in preparation for exams. However, the student may not value the grade very much. The A may not serve to motivate him to increase or maintain studying behavior. The student becomes bored with studying and receives C and D grades on the next two exams. In this case, the A grade might be considered a reward for performance on one exam. However, the grade is not a positive reinforcer because it neither maintained nor increased the frequency of his studying.
By definition, something serves as reinforcer only if it increases behavior. A positive reinforcer needs to be valued by an individual for it to be effective. Not all items, activities, and social interactions are reinforcing to all people. A roller-coaster ride at Disney World may be positively reinforcing for a third grader whose dream it is to visit Disney World. However, that same ride may not be at all reinforcing to the third grader’s father who tends to become ill on roller coasters.
Suggestions for Using Positive Reinforcement
Four suggestions to enhance the use of positive reinforcement involve the quality, the immediacy, the frequency of positive reinforcement, and the use of small steps for shaping behavior.
Quality of Positive Reinforcement
In order to be considered reinforcement, an item or event must actually increase the frequency of some behavior. We’ve already established that what is reinforcing for one person may not be reinforcing for another.
A more subtle issue, however, involves the varying degrees of reinforcement value of any particular reinforcer. A particular positive reinforcer might be more reinforcing in one form than in another.
A high school senior working as a part-time janitor at a small inner-tube factory provides an example. The young man, Jorge, is working to save for a down payment on a car. The idea of owning a car is very reinforcing to him. Because of the tremendous costs involved in purchasing a car, Jorge had decided to be satisfied with almost anything that he could reasonably afford. However, when he found a 2005 tomato-red Mustang with black racing trim for sale, his working behavior sharply increased. He asked if he could double his working hours. To Jorge, the Mustang served as a much stronger positive reinforcer than an older, beat-up van.
Immediacy of Positive Reinforcement
Positive reinforcement has a greater effect on behavior if it is administered immediately or shortly after the behavior occurs (Miltenberger, 2012; Spiegler & Guevremont, 2010). It’s important that the behavior and the positive reinforcement occur very close to each other in time. Positive reinforcement loses its effect if it is delayed too long. For example, one morning a 5-year-old boy brushes his teeth without being told. Praising him for this behavior immediately after he’s finished or even while he’s brushing will have a much greater effect on whether he brushes his teeth again on his own than if he’s praised when he gets into bed at night. By bedtime, it becomes more difficult for him to associate the praise with the specific teeth-brushing behavior.
Frequency of Positive Reinforcement
The most effective way to increase a particular behavior is to reinforce it every time it occurs. This is referred to as continuous reinforcement. For example, Kaitlyn, age 12, is supposed to do her math homework every night. If Kaitlyn’s teacher collects the assignments every morning and gives Kaitlyn credit for doing them, Kaitlyn is likely to complete her homework every night. However, if Kaitlyn’s teacher collects only the Thursday night homework, Kaitlyn is less likely to do her homework every night.
Continuous reinforcement is the most effective in establishing a particular behavior. However, if the positive reinforcement stops for some reason, the behavior is likely to extinguish rapidly. For example, Kaitlyn’s teacher collects her homework every morning for two months. Suddenly, the teacher decides that it’s no longer necessary to collect the homework. As a result, there is a fairly strong likelihood that Kaitlyn will stop doing her homework if she no longer gets credit for it.
An alternative to continuous reinforcement is intermittent reinforcement. In this case, a behavior is not reinforced every time it is performed, but is reinforced only occasionally. In the real world, continuous reinforcement is difficult to administer. It is difficult to be with a person every minute of the day in order to observe that person’s behavior. Sometimes intermittent reinforcement is a viable alternative.
Intermittent reinforcement is not as powerful in initially establishing a behavior. It may take longer to establish the behavior, and the behavior may not occur as regularly as it would under the conditions of continuous reinforcement. For example, Kaitlyn might not do her homework every night because of the chance it wouldn’t be collected the next day.
However, intermittent reinforcement is less subject to extinction. That is, suppose Kaitlyn’s teacher had only occasionally collected her homework. Suddenly, she no longer collects the homework. Kaitlyn would be more likely to continue doing the homework after an intermittent schedule of reinforcement than after a continuous schedule. When she was accustomed to intermittent reinforcement, Kaitlyn would be more likely to continue doing her homework on the chance that it might be collected again. If homework collection stops abruptly after continuously being collected, Kaitlyn would probably think that her teacher no longer liked to collect it. As a result, Kaitlyn would probably stop doing her homework.
Each type of intermittent reinforcement dictates a different procedure for how frequently or in what order reinforcement should be administered (e.g., every third time or randomly). These various procedures are referred to as schedules of reinforcement.
Shaping Behavior
Sometimes the behavior that’s supposed to be positively reinforced never occurs. It is impossible to reinforce a behavior that isn’t there. In such cases, a technique called shaping can be used. Shaping refers to the reinforcement of successive approximations—that is, small steps of progress made toward the final desired behavior.
For example, 7-year-old Ralph is terrified of the water. His mother thinks that it would be valuable for him to learn to swim. However, swimming behavior cannot be reinforced because Ralph simply refuses to enter a swimming pool. In this case, it might be useful to break down the specific behavior into smaller, more manageable pieces of behavior: going to the beach and playing far away from the water, playing several feet away from the water, playing while sitting in an inch of water, wading, entering the water waist deep, moving arms around in the water, briefly dunking head beneath the water, and finally starting to practice beginning swimming strokes. At each step, Ralph could be positively reinforced with praise, attention, or toys for participating in that step. Eventually, his behavior could be shaped so that he would participate in behavior resembling swimming. Specific swimming techniques could then be initiated and reinforced.
4-6bThe Use of Punishment
Punishment is frequently and often unwillingly chosen as the first alternative in controlling children’s behavior. Often punishment is used in the name of discipline. Punishment involves either the application of an aversive consequence or the removal of a positive reinforcer. In either case, the result is a decrease in the frequency of a behavior.
Potential Negative Consequences
Before using punishment as a means of behavioral management, it’s important to consider the potential negative consequences. Five of them will be mentioned here (Kazdin, 2001, 2008a, 2013; Miltenberger, 2012; Sundel & Sundel, 2005). First, punishment tends to elicit a negative emotional response. The child may come to dislike the learning situation. For example, if a child is punished for spelling some words wrong in a composition, the child may no longer want to write at all. The child may also have a negative reaction toward the person administering the punishment.
For example, a young woman in junior high school was walking through the crowded halls from study hall to her next class. The gruff varsity football coach grabbed her by the shoulder and shouted, “Act like a lady!” She had no idea what he was referring to. However, from that time on, she avoided both crowded hallways and that football coach whenever she could. She had developed an intense dislike for the man.
This example also illustrates the second possible negative side effect of punishment: avoidance of either the punishing person or the punitive situation. In homes where physical punishment is used freely and regularly, children may try to stay away from the home as much as possible. Lying may provide another effective means of avoiding punitive situations. (Children sometimes learn to lie because parents set the price for honesty too high.)
The third possible negative effect of punishment is that it can teach children to be aggressive. Another way of saying this is that a punishing agent models aggressive behavior. Children can learn that the way to deal with frustration or with not getting their own way is to hit or scream. This can carry over to their interactions with peers, siblings, or adults. An example is an adolescent who had been labeled as having severe emotional and behavioral problems. When he was a small child, physical punishment was used frequently in the home. By the time he reached age 16 and had grown to be 6 feet 3 inches tall, a different problem became apparent in the home. The boy began to physically assault his mother whenever they had disagreements. He had learned to be aggressive.
The fourth potential problem with using punishment, specifically physical punishment, is the possibility of physically harming the child. A parent may lose control or not be aware of his or her real strength. Without initial intent, physical damage may result.
Finally, there is a fifth reason for questioning the use of punishment. Punishment teaches people what they should not do but gives them no indication as to what they should do. Scolding a child for being impolite when visiting Aunt Edna does not help the child know how she could have treated Aunt Edna more appropriately.
In summary, all five of these considerations involve losing control of the consequences of punishment. The outcome of punishment is unpredictable, and therefore it should be used with extreme care.
The Nature of Punishment
Punishment has several characteristics (Kazdin, 2001, 2008a, 2008b, 2013; Miltenberger, 2012). First, a decrease in the frequency of a behavior usually occurs relatively soon after the punishment is presented. If the behavior doesn’t decrease almost immediately after the supposed punishment starts, there is a good possibility it never will. Thus, it is not wise to continue punishment if it doesn’t work almost immediately.
For example, 1-year-old Tyrone was crawling happily on his mother’s kitchen floor when he discovered the electric socket. His mother, who was watching him out of the corner of her eye, ran over to him, slapped his hand, and raised her voice in a loud, “No!” He looked at her and returned his attention immediately to the socket. After this occurred four times, his mother slapped him even harder. He then started crying, and she removed him to another room. In this incident, scolding and hitting were not effective. Instead, the mother’s attention appeared to positively reinforce Tyrone’s playing with the electric socket. Since scolding and hitting were not effective even after several attempts, it was not likely that they would ever work. Calmly diverting Tyrone’s attention might have been a more effective approach to controlling Tyrone’s behavior.
Another characteristic of punishment is that its effects, although often immediate, frequently do not last very long. Relatively soon after receiving punishment, a person often reverts to the old behavior. For example, a driver may receive a speeding ticket for driving 87 mph on a 55-mph expressway. For a while he takes care to drive within the speed limit. However, he soon finds it too restrictive and time consuming to drive so slowly. His speeds gradually creep up to the old levels of 85 to 90 mph.
A third characteristic of punishment is that its effects are frequently limited to the conditions under which the punishment occurred. In other words, punishment tends to work only in the specific situation in which it occurred or only with the particular person who administered the punishment. For example, Trudy, age 7, likes to spit at people as they pass by her on the sidewalk. Her mother spanks her when she sees this behavior. Therefore, Trudy never spits in front of her mother. However, when her mother is in the house or at the grocery store, or when Trudy is at the babysitter’s, she continues to spit at passersby. The babysitter has spanked her twice, but it hasn’t changed Trudy’s behavior. Spanking functioned as punishment for Trudy only when her mother was present and only when her mother administered it.
The Effectiveness of Punishment
Miltenberger (2012) comments that “authority figures such as governments, police, churches, or parents impose punishment to inhibit inappropriate behavior—that is, to keep people from breaking laws or rules. Punishment may involve prison time, the electric chair, fines, the threat of going to hell, spanking, or scolding. However, the everyday meaning of punishment is very different from the technical definition of punishment used in behavior modification” (p. 104).
Sundel and Sundel (2005) reflect:
Despite the disadvantages of punishment and the stringent requirements for ensuring its effectiveness, punishment is still commonly used as a behavioral control technique. One reason for this is that punishment usually works immediately to suppress undesired behavior. Therefore, the short-term consequences are reinforcing for the individual who administers the punishment. For example, Mel spanked his daughter Terri when she complained about eating her vegetables. Terri stopped complaining; thus, her father was reinforced for spanking her. (p. 133)
This everyday scenario focuses on the immediate, short-term effects of punishment, not on long-term effects or consequences other than the immediate cessation of the targeted behavior. Kazdin (2008a) discusses the use of punishment as a means of behavior modification:
There has been extensive debate within the profession regarding the use of aversive events … Many of the discussions have focused on self-injurious (e.g., head banging, face slapping) and aggressive behavior (e.g., fighting). Behaviors that are dangerous warrant immediate attention and require complete elimination if at all possible. Early in the development of behavior modification, electric shock was used (brief, mild, and delivered on few occasions) and was shown to be effective in eliminating self-injurious behavior. This was significant because in a number of instances, the behavior was long-standing and had not responded to other treatments. Over the past several years, significant advances have been made in devising alternative procedures to reduce and eliminate dangerous behaviors. (p. 415)
In summary, punishment may be effective when used to curb extremely self-destructive or aggressive behavior in cases in which other treatment approaches have failed. The problematic behavior’s dynamics should be carefully assessed to determine the appropriateness and potential effectiveness of punishment. Serious thought should go into the method of punishment to be used. It should be the least severe possible to be effective. The well-being of the person experiencing the behavioral program should always be of paramount importance. Finally, the potential side effects of punishment, mentioned earlier, should be cautiously considered.
Suggestions for Using Punishment
When the decision is made to use punishment, follow three suggestions for maximizing its effectiveness (Kazdin, 2001, 2008a; Miltenberger, 2012; Spiegler & Guevremont, 2010; Sundel & Sundel, 2005). First, intervention should occur early; that is, punishment should be administered as soon as possible after the behavior that is to be punished occurs.
For example, 10-year-old Santiago had been stealing DVDs for about six months. One afternoon, he decided to shoplift a DVD from Wal-Mart. Although he made it out to the parking lot, his friend, Maynard, was not so lucky. A huge male clerk grabbed Maynard by the wrist as he was hoisting a DVD under his T-shirt. Santiago, although feeling very bad that his friend got caught, also felt relieved that he himself did not.
Two weeks later Santiago’s father received a phone call from the police. Apparently under duress and with the promise of a lesser punishment, Maynard had relented and given the police Santiago’s name. Santiago’s punishment was being grounded for the next month. Being grounded involved reporting in by 8:00 p.m. every night including weekends. Although Santiago was not particularly happy about his situation, he was more unhappy about being caught than about stealing a DVD. He interpreted his punishment to mean “Don’t get caught.” The punishment had virtually no effect on his DVD-stealing behavior. He continued to steal DVDs, but did so with exceptional care. In this situation, because the punishment was not administered soon after the stealing behavior occurred, it had little effect.
A second suggestion for using punishment is to administer the punishing consequences every time the behavior occurs. In Santiago’s situation, he was punished only once. Many other times his stealing behavior was positively reinforced by his getting and enjoying the DVDs he wanted. Receiving a punishment every time a behavior occurs helps to strengthen the idea that the consequence of that particular behavior is unappealing.
The third suggestion concerning the use of punishment is the most important. At the same time that punishment is used, a complementary program should be used to reinforce other, more appropriate behaviors. Punishment has been found to be most effective when an individual is being reinforced for adopting more appropriate behaviors at the same time. For example, a therapeutic goal for a child with profound intellectual disabilities was to walk instead of crawl (O’Brien, Azrin, & Bugle, 1974). Punishment for crawling involved restraining him from movement for five seconds. However, this did not really serve as punishment because the child’s crawling behavior didn’t decrease. Nor did his walking behavior increase. Eventually, a new approach was tried. While the child was being restrained from crawling, he was also encouraged or positively reinforced for moving his body. This included being helped to walk. As a result, his walking behavior increased, and his crawling behavior decreased. In this case, punishment was effective when the child was reinforced for a more appropriate behavior at the same time. It has been found that the negative side effects of punishment, such as resentment toward the punitive person, aggressive behavior, and avoidance of the punitive situation, are not nearly as great when reinforcement for alternative appropriate behaviors is used (Carey & Bucher, 1986).
Additionally, Patterson (1975) makes a fourth suggestion for using punishment: Remain calm while administering it. Excessive attention directed at a particular behavior may serve as a positive reinforcer for that behavior rather than as a punishment. For example, 18-month-old Petey discovered a book of matches lying on the coffee table. He immediately sat down and started to play with them. His mother saw him, ran over to him, and spanked him. She also took away the matches. Because both of Petey’s parents smoked, it was fairly likely that Petey would find more matchbooks lying around the house. In fact, he found some the next day. His mother responded in a similar manner. Petey learned that he could get attention from his mother by playing with matches. As a result, he loved to find matches and play with them. Although his mother’s attention was negative, it was forceful enough to serve as positive reinforcement. Petey continued to play with matches every chance he got.
Ethical Questions 4.2

EP 1
1. What are your thoughts about punishing children? What was your experience with punishment as a child? If punishment was used, in what ways were you punished? Did punishment work or not? Why?
4-6cAdditional Issues
In addition to the focus on positive reinforcement and punishment, three additional issues merit attention here. They concern common elements encountered in practice. The additional issues include accidental training, the use of behaviorally specific terminology, measuring improvement, and the importance of parental attention.
Accidental Training
Thus far, the discussion has emphasized planned behavioral change. However, many times reinforcement and punishment affect behavior without conscious planning. Behavior can be increased or decreased without intention. When attempting to understand the dynamics of behavior, it’s important to understand that accidental training does occur.
Negative attention is frequently an effective means of providing accidental training. Attention, even in the form of yelling, can function as positive reinforcement. Even though it is supposed to be negative, the social reinforcement value can be so strong that the behavior will be strengthened instead of weakened. For example, if Ethan’s mother yells at him for picking her favorite peonies, then Ethan may learn that picking those peonies will make his mother yell. If Ethan continues to pick the peonies and his mother continues to yell at him for it, the yelling has served to reinforce his peony-picking behavior. Highlight 4.2 provides another example of accidental training.
Highlight 4.2
Accidental Training
Tommy was an only child. His parents, who were in their late 30s, had tried to have children for years without success. When Tommy came along, they were overjoyed. Both parents thought almost everything Tommy did was “simply darling.” One time, when Tommy was 3 years old, he approached some dinner guests and asked for money. He had learned that money bought ice cream and other good things. Two things occurred. First, his parents thought it was cute, so they laughed. Then they appropriately told him that asking for money was not a good thing to do. But they maintained happy, smiling faces all the while. Tommy thus received massive social reinforcement in the form of praise and attention for his begging behavior. Second, Tommy did receive $2, which he later spent for mocha fudge ice cream. The guests were not quite as entertained by Tommy’s behavior as his parents were. But they felt he was a cute kid and gave him money to avoid embarrassment in front of his parents.
The next time Tommy’s parents had guests, Tommy did the same thing. He came out for display, said hello, and then asked them if he could have some money. He received a similar reaction. As time went on, Tommy consistently continued his begging behavior in front of guests. His parents became less entertained as the years passed. They discovered that an 8-year-old Tommy coming out and asking guests for money was no longer as cute as a 3-year-old doing the same thing. However, by the time Tommy was 8, they were having a terrible time trying to decrease or extinguish his begging behavior. For an extended period of time, Tommy had accidentally been trained to beg. Such extensive accidental training had become very difficult to extinguish.
Behaviorally Specific Terminology
A major advantage of conceptualizing behavior in terms of learning theory is the emphasis on specificity. A behavior must be clearly and concisely defined. A clear description of behavior allows for all involved in the behavioral management of a child to understand exactly what behavior, including problem behavior, involves.
For example, Jessica, age 9, was described by her teachers as too passive. It is difficult to know what is meant by “too passive.” The word passive is relatively abstract. The image of a passive Jessica is quite vague. However, if Jessica’s passivism is defined in terms of her behavior, as it would be with a learning theory conceptualization, the image of Jessica becomes more distinct. Jessica’s passivism might be described behaviorally in the following way:
Jessica sits quietly by herself during classes and recesses at school. She avoids social contact with peers during recess by walking to the far side of the playground away from the other children. She does not volunteer information during class. When asked a question, she typically shrugs her shoulders as if she does not know the answer. She then avoids eye contact and looks down toward the ground. She is consistently standing last in lines for lunch, for recess, or for returning to school. When other children push her out of their way, she allows herself to be pushed without comment.
Learning theory mandates clear behavioral descriptions in order to conceptualize any particular behavior. The antecedents, the behavior itself, and the consequences of the behavior must be clearly defined in order to make changes in the behavior. The behavioral description of Jessica provides a much clearer picture than merely labeling Jessica as being “too passive.”
Measuring Improvement
Observation of behavior becomes much easier when it has been specifically described. Subsequently, improvements in behavior become more clearly discernable. For example, it might be difficult to establish if Jessica is becoming less passive. However, it is much easier to determine the number of times Jessica assertively raises her hand to answer a question in class.
Behavior must be observable in order to measure if it has improved. In other words, it must be clear when the behavior occurs and when it does not. In Jessica’s situation, the frequency of hand-raising in class has been targeted as a behavior that involves passivism. If Jessica never raises her hand to answer a question, she will be considered passive. If she raises her hand frequently, on the other hand, she will not be considered passive.
For the sake of this illustration, hand-raising is used as a means to measure passivism. Clearly stated behaviors can be counted. For example, in Jessica’s case, each time she raises her hand above shoulder level after her teacher has asked the class a question could count as one hand-raising behavior. In an actual situation, Jessica’s other behaviors could also be used. These might include behaviors such as the amount of time she spends talking to peers or the number of times she answers her teacher’s questions. Her improvement might be measured by using a summation of several measures.
The first step, then, is targeting a behavior to change. The next step is determining how severe the problem is in the first place. This must be known in order to tell when improvements have been made. In Jessica’s case, the hand-raising must be counted and a baseline established. A baseline is the frequency with which a behavior occurs before behavior modification begins. After a baseline is established, it is easy to determine when a change in the frequency of the behavior has occurred. The change is the difference between how frequently that behavior occurred at the baseline and how frequently the behavior occurs after the behavior modification program has begun.
For example, during the first month of school, Jessica raises her hand to answer a question zero times per school day. However, by the seventh month of school, she raises her hand to answer a question an average of six times per day. If one of the means of measuring passivism is the number of times Jessica raises her hand in class, then Jessica can easily be described as less passive during the seventh month of school than during the first.
The final point concerning behavioral specificity involves how the behaviors are counted in the first place—who keeps track of the frequency of the behavior and how this is done. Behavior checklists and charts can be developed for this purpose. A behavior checklist simply allows for a place to make note of when a behavior occurs. For example, a two-dimensional chart might have each day of the week listed on the horizontal axis. Each day might be broken down into individual hours on the vertical axis on the left-hand side. Table 4.1 illustrates how this might be applied to Jessica’s situation.
Table 4.1
Behavior Chart: Number of Times Jessica Raises Her Hand
Mon. Tues. Wed. Thurs. Fri.
8:00–8:59 am 0 0 0 0 0
9:00–9:59 am 0 0 0 0 0
10:00–10:59 am 0 0 0 0 0
11:00–11:59 am 0 0 0 0 0
12:00–12:59 am 0 0 0 0 1
1:00–1:59 pm 0 1 1 0 1
2:00–3:00 pm 0 0 1 3 3
Whenever Jessica raised her hand in class, her teacher would make a note of it on her behavior checklist. The total number of times could be counted. It could thus be clearly established if an improvement occurred.
We have not addressed the specific types of treatment that could be used to decrease Jessica’s passivism. A treatment program could be established in various ways. For example, positive reinforcement could be administered whenever she raises her hand. This could take the form of verbal praise, a piece of candy, or a token that could be used to buy something she really wanted.
The Importance of Parental Attention
One of the criticisms of the application of learning theory has been that it is a rigid and somewhat cold dissection of human behavior. Warmth, caring, and human concern are not readily evident. This certainly does not have to be the case. The importance of parents’ communicating with their children and genuinely showing spontaneous concern for them should not be overlooked. Learning theory provides a framework for analyzing and gaining control over behavior. Other important aspects of human relationships can occur concurrently with programs based on learning theory.
For example, active listening is often emphasized in suggestions for effective parenting (Ivey, Ivey, & Zalaquett, 2012, 2014). Active listening is the process in which the receiver of a communication pays close attention to what the sender of the communication is saying, and subsequently reflects back what was heard to make sure the “message has been accurately understood” (Sheafor & Horejsi, 2006, p. 148). A parent and a child often have different ways of saying things. Each has a different perspective. Active listening encourages a parent to stop for a moment and consciously examine what the child is saying. The idea is for the parent to look at the issue from the child’s perspective. This may not be clear from the particular words the child has spoken. The parent then is urged to reflect these feelings back to the child. The end result of a parent’s taking the time to understand a child should be an enhancement of the warmth and caring between them.
Charlene and her mother provide an example of active listening. Charlene, age 7, comes home after school, crying. She says to her mother, “Betty invited everybody but me to her birthday party.” Instead of passing it off as a simple childhood disappointment, Charlene’s mother stops for a moment and thinks about what this incident might mean to Charlene. She replies to Charlene, “You really feel left out and bad about this, don’t you?” Charlene comes into her mother’s arms and replies, “I sure do, Mom.” In this instance, her mother simply reflected to Charlene her empathy and concern. As a result, Charlene felt that her mother really understood. Warmth and feeling were apparent in their interchange.
Although this interaction is not structured within learning theory terms, it certainly illustrates the basic components of warmth and empathy necessary in the parent–child relationship. Feelings and communication are ongoing, dynamic parts of that relationship. They occur simultaneously along with the ongoing management of children’s behavior.
4-6dA Specific Treatment Situation: Time-Out from Reinforcement
Extensive volumes have been written about the various aspects of learning theory and its applications. Specific concepts have already been discussed. We have selected a specific treatment situation to illustrate the application of these concepts using specific techniques. It focuses on concepts frequently used by social work practitioners. The treatment situation presented here involves the use of a time-out from reinforcement procedure.
The term time-out refers to a time-out from reinforcement. In this procedure, previous reinforcement is withdrawn, with the intended result being a decrease in the frequency of a particular behavior. Kazdin (2008a) explains why time-outs are a form of punishment instead of extinction:
The defining feature of time-out is based on a period of time and the unavailability of reinforcement during that time period. Of course, time-out is also a punishment procedure. Something is withdrawn (availability of reinforcers) contingent on behavior. Extinction is not a punishment procedure. In extinction, a response that has been reinforced (e.g., praise for smiling) is no longer reinforced. The key feature of extinction is that a previously reinforced behavior is no longer reinforced. There is no time interval or period involved in extinction. When the response occurs, no consequence follows. In contrast, during time-out, when a response to be suppressed occurs, a period is invoked in which no reinforcers can be provided for any behavior. (pp. 210–211)
Instead of applying some aversive consequences such as a spanking after a behavior occurs, a child is simply removed from the reinforcing circumstances. If a child gets no attention or positive reinforcement for a behavior, that behavior will eventually diminish.
For example, 4-year-old Vernite loves to play with her Legos®. However, Vernite has difficulty sharing them with other children. When another child picks up one of the pieces, Vernite will typically run over to that child, pinch him, take the toy, and place it in a pile with the rest of her own Legos®. As a result, other children don’t like Vernite very much.
The goal here might be to decrease Vernite’s selfish behavior. Selfish behavior is defined as the series of behaviors involved in pinching and taking toys away from other children. A time-out from reinforcement procedure can be used to control Vernite’s selfish behavior. Whenever Vernite pinches another child or takes a Lego away from that child, her mother immediately picks her up and puts her in a corner behind a screen for three minutes. At the end of that time, her mother picks up Vernite again and puts her back in the play situation. What happens from Vernite’s perspective is that the positively reinforcing situation filled with fun, Legos, and other children is removed. (In actuality, of course, it is Vernite who is removed.) Without receiving the reinforcement of having the toys for herself, Vernite’s selfish behavior should eventually disappear. She should learn that such behavior is inappropriate and, in effect, not worth its consequences. Vernite’s selfish behavior should eventually be extinguished.
Improving the Effectiveness of Time-Outs
Several aspects of time-outs tend to improve their effectiveness. The following are suggestions for using time-outs:
1. A time-out should be applied immediately after the targeted behavior occurs in order for it to be effective.
2. Time-outs should be applied consistently. A time-out should occur as a consequence every time the targeted behavior occurs.
3. Time-outs should usually extend from 1 to 10 minutes (Miltenberger, 2012). Such short periods of time have been shown to be effective (Kazdin, 2001, 2008a, 2008b, 2013; Sundel & Sundel, 2005). “However, if the client is engaging in problem behaviors in the timeout area at the end of the time-out period, time-out is extended for a brief time (typically 10 seconds to 1 minute) until the client is no longer engaging in problem behaviors” (Miltenberger, 2012, p. 347). Extending time-outs for longer periods of time does not increase the effectiveness of the time-out (Kazdin, 2001, 2008a, 2008b, 2013). The relationship between the targeted behavior and the time-out becomes too distant. An extended time-out of an hour, for instance, may also take on some of the potential negative consequences of a more severe form of punishment such as resentment toward the person administering the time-out.
4. The time-out should take place in a very boring place. An ideal time-out should provide absolutely no positive reinforcement. It might take place in a chair facing a corner or in a room devoid of stimulating objects and pictures. If the time-out location is exciting or stimulating, it may positively reinforce a negative target behavior rather than extinguish it.
5. The person, frequently a parent, who is administering the time-out should be careful not to give the child positive reinforcement in the form of attention while the time-out is taking place. A parent might simply state to the child, “Timeout.” The child should then be removed to the time-out location with as little show of emotion as possible. No debate should take place.
6. A child should be told ahead of time exactly which behaviors will result in a time-out. The length of the time-out should also be specified. The intent is to help the child understand exactly what he or she is doing wrong and what the resulting consequences will be.
7. If the child refuses to go to the time-out location, he or she may have to be physically taken there. This should be done with as little show of emotion as possible. The child should be gently restrained from all activity until the time-out can begin.
8. The most important thing to remember about using the time-out procedure is that positive reinforcement should be used to reinforce more appropriate replacement behaviors for the same situation. Appropriate behavior should be praised as soon as it occurs after the time-out has taken place. For example, when Vernite is returned to the play scene, she should be praised for playing with her own toys and not taking them away from other children. Her mother might simply say, “Look how well you’re playing and sharing now, Vernite. Good girl.”
A simple anecdote taking place in a supermarket illustrates the ingenuity and creativity with which a time-out might be used. A mother was shopping, with her 2-year-old sitting in a shopping cart. Suddenly for no apparent reason the child began to scream. Much to the surprise of onlooking shoppers, the mother calmly removed her raincoat and placed it over the child’s head for 20 seconds. People who are unfamiliar with the time-out technique may have thought she was trying to suffocate the child. However, she performed the procedure calmly and gently. When she removed the raincoat, there sat a peaceful and quiet child. The mother had no further problems with screaming behavior in the supermarket that day. What this mother did was to remove the child from all positive reinforcement for a brief period of time. The child learned that screaming led to no positive consequences. Thus, the screaming stopped.
Ethical Questions 4.3

EP 1
1. What are your thoughts about using time-outs in child management? To what extent, if any, do you think they work? If they should be used, under what circumstances are they appropriate? Should any caregiver (e.g., day-care providers, teachers, and babysitters) be allowed to administer them, or should parents be the only ones to do so? What are the reasons for your answers?
Grounding
One other thing should be noted regarding the use of time-outs. Frequently, parents use grounding or sending children to their rooms to curb children’s behavior. Although superficially these techniques might resemble time-outs, they don’t seem to be very effective. Perhaps too many positive reinforcers are available in a child’s room. Often this form of time-out is administered long after the actual behavior occurs. The actual time of restriction is certainly longer than the recommended time period of a maximum of several minutes.
Ethical Questions 4.4

EP 1
1. To what extent, if any, do you think grounding works? What were your experiences with grounding if you had any? What were the results? Would you consider grounding as a means of disciplining your own children? Why?
4-7Examine Common Life Events That Affect Children
LO 8
Some basic aspects of family functioning have already been examined. These included a conceptualization of family systems and an examination of learning theory applied to parenting situations. Several other social aspects of childhood merit attention. Common events or situations involving the family that frequently affect the lives of children are discussed here. These include membership in sibling subsystems and gender-role socialization. Ethnic and cultural differences in families, the social aspects of play with peers, the influence of television, and the school environment are also examined. The incidence and dynamics of physical abuse, neglect, emotional maltreatment, and sexual abuse of children are explored. Finally, the treatment of child abuse and neglect is explained.
4-7aMembership in Family Systems
The family environment is of crucial importance to a child. Even though as children grow they become more and more involved with their peers, the family itself remains very important (McGoldrick et al., 2011). A good family environment provides nurturance, support, guidance, and a safe, secure place to which children can turn.
Baumrind conducted an interesting series of studies to evaluate how parents actually go about their business of parenting (Baumrind, 1971, 1978, 1991a, 1991b, 1993, 1996; Lamanna & Riedmann, 2009; Rathus, 2014b). Three basic styles of parenting emerged. First, permissive parents are very nondirective and avoid trying to control their children. Permissive parents may be either overly indulgent or rejecting-neglecting. “Permissive-indulgent parents … are easygoing and unconventional. Their brand of permissiveness is accompanied by high nurturance (warmth and responsiveness)”; permissive rejecting-neglecting parents shun or ignore their children, thereby leaving children to fend for themselves (Rathus, 2014b, p. 316). Such parents show little if any affection and responsiveness.
The second parenting style is authoritarian. Parents adopting this style have definite ideas about how children should behave. These parents do not hesitate to make rules and tell their children what to do. They emphasize control and conformity.
The third parenting style is authoritative. Parents using this style are neither permissive nor authoritarian, but somewhere in the middle. On the one hand, they provide control and consistent support. On the other hand, they involve their children in decision making and encourage the development of independence.
Which parenting style is the most effective? There is some support that an authoritative approach to parenting is preferable (Lamanna & Riedmann, 2009). Dacey and Travers (2006) describe this style: “Authoritative parents are high on control (they have definite standards for their children), high on clarity of communication (the children clearly understand what is expected of them), high in maturity demands (they want their children to behave in a way appropriate for their age), and high in nurturance (a warm, loving relationship exists between parents and children)” (pp. 206–207).
Rathus (2013) reflects that the research suggests that it’s best for parents to avoid either of the more extreme permissive or authoritarian styles in their parenting approach. He suggests using a number of effective techniques that coincide with the application of learning-theory principles. Effective parents should
• “Reward good behavior with praise, smiles, and hugs.
• Give clear, simple, realistic rules appropriate to the child’s age.
• Enforce rules with reasonable consequences.
• Ignore annoying behavior such as whining and tantrums…
• Be consistent.” (Rathus, 2013, p. 231)
Ethical Questions 4.5

EP 1
1. What type of parenting style do you think is best, and why? What style did your parents use? To what extent was it effective, and why?
One potential problem with the conclusion that an authoritative style is best is that it may not clearly reflect the values and effective child-rearing practices evident in other cultures. Spotlight 4.2 addresses the importance of cultural context in the assessment of the effectiveness of parenting style. Spotlight 4.3 explores ethnic and cultural differences in families.
Spotlight on Diversity 4.2
Cultural Context and Parenting Style

EP 2a
EP 2c
Various ethnic groups have markedly different parenting styles that don’t fit neatly into the permissive/authoritarian/authoritative classification system. Specific variations involve how parents perceive and demonstrate caring and control. For example, Chinese American parents are generally viewed as more demanding concerning control of their children’s behavior (Berk 2012a; Papalia & Martorell, 2015). For one thing, “most Chinese parents strictly control their children’s aggressive behavior” and demand “that their children display no aggressive behavior under any circumstances” (Ou & McAdoo, 1999, p. 255). The Baumrind system emphasizes control as characterizing an authoritarian parenting style. However, this approach suggests a somewhat different intent and purpose than that of the Western authoritarian parenting style. “High control [in Chinese culture] reflects the Confucian belief in strict discipline, respect for elders, and socially desirable behavior, taught by deeply involved parents” (Berk, 2013, p. 582). Chinese tradition emphasizes that a “child, no matter how old, should remain emotionally and financially attached to the parents,” and there are “strong indications of a lack of independence training in child rearing” (Lin & Liu, 1999, p. 238). The Chinese view control of children as a means to teach “obedience and cooperation,” the “values most emphasized.” … “Frequent receiving and giving of help between generations is seen by Chinese as an indication of family solidarity. Most children are expected to turn their earnings over to their parents to be used for general family needs” (p. 238).
So what Western eyes might view as an authoritarian trait is really a demonstration of warmth, support, and caring from the Chinese perspective. These latter values more closely characterize authoritative parents in Baumrind’s classification system, but without stressing the American values of rugged individualism and free choice (Papalia & Martorell, 2015) Berk (2013) reflects:
In Hispanic, Asian Pacific Island families, and Caribbean families of African and East Indian origin, firm insistence on respect for parental authority is paired with high parental warmth—a combination suited to promoting competence and strong feelings of family loyalty (Harrison, Wilson, Pine, Chan, & Buriel, 1994; Roopnarine & Evans, 2007). In one study, Mexican-American mothers living in poverty who adhered strongly to their cultural traditions tended to combine warmth with strict, even somewhat harsh, control—a style that served a protective function, in that it was associated with reduced child and adolescent conduct problems (Hill, Bush, & Roosa, 2003). Although at one time viewed as coercive, contemporary Hispanic fathers typically spend much time with their children and are warm and sensitive (Garcia Coll & Pachter, 2002; Jambunathan, Burts, & Pierce, 2000). In Caribbean families that have immigrated to the United States, fathers’ authoritativeness—but not mothers’—predicted preschoolers’ literacy and math skills, probably because Caribbean fathers take a larger role in guiding their children’s academic progress (Roopnarine, Krishnakumar, Metindogan, & Evans, 2006).” (p. 582)
African American mothers also tend to require immediate and rigorous compliance with their directions (Berk, 2012a). Their approach, however, combines caring and affection with strict discipline and rarely involves physical punishment. This no-nonsense tactic is viewed as a means of helping children regulate their behavior and keep themselves safe even when in a treacherous environment; children view such parental control as a means of caring for their welfare (Brody & Flor, 1998).
In summary, it is important to recognize the cultural context of child rearing, parental expectations, and social responsibilities before stating unilaterally that one parenting style is “best.” Learning from clients about their culture and cultural expectations concerning parenting style is a career-long process.
Spotlight on Diversity 4.3
Recognize Ethnic and Cultural Differences in Families: Empowerment through Appreciation of Strengths
LO 9

EP 2a
EP 2c
The father’s role in the family, the availability and nature of support systems, and perspectives on disciplining children vary greatly among cultures (Santrock, 2016). Despite these variations, research on 186 cultures throughout the world revealed a pattern of successful parenting (Santrock, 2008; Whiting & Edwards, 1988). The variables that emerged are consistency in the form of supportive control and genuine caring for children.
When assessing the dynamics of families from various cultures, three factors are important. First, cultural variations involving expectations and values reflect each culture. Second, people of different cultures living in the United States and Canada experience varying degrees of assimilation into the majority culture simply by living there. Third, people not of European origin frequently experience discrimination and oppression because of their differences.
Two other perspectives are helpful when thinking about multicultural diversity in families: cultural pluralism and internal variations or subgroups within a culture. In conceptualizing a multicultural nation, it is helpful to think in terms of cultural pluralism instead of a melting pot. A melting pot implies that all people blend together into one uniform whole. Cheese fondue comes to mind, where the cheese and other ingredients blend together in one bubbling mass. This is not really the case with a multicultural society. Rather, people from different cultures come together, and each cultural group retains its own rich spirit and customs. This is cultural pluralism. One of those huge lollipops made up of multicolored swirls comes to mind. It is one mammoth piece of candy, yet it is made up of distinct swirls of brilliant blue, red, yellow, orange, pink, and green blending together to various degrees.
Hispanic nuclear and extended family members celebrate a child’s birthday.

Mark Burnett/Alamy Stock Photo
Still another perspective useful in understanding cultural diversity involves respecting and appreciating the differences within large groups. For example, among Native Americans, there are far more than 500 specific groups (Weaver, 2008).
Social workers should strive to learn from clients about their diverse cultures. To be effective, this is a career-long process. Here we discuss some of the values, beliefs, and perspectives assumed by three cultural groups in American society: Hispanics, Native Americans, and Asian Americans.
Hispanic Families
Chapter 1 established that the terms Hispanic and Latino have generally been used to refer to people originating in countries where Spanish is spoken. However, we also noted that the terms in reality refer to people originating in a number of places. No one term is acceptable to all the groups of Spanish-speaking people.
The U.S. Census Bureau collects information by having people identify themselves as being Hispanic or not.
People who identify with the terms “Hispanic” or “Latino” are those who classify themselves in one of the specific Hispanic or Latino categories listed on the decennial census questionnaire and the various Census Bureau survey questionnaires-”Mexican, Mexican Am. Chicano” or “Puerto Rican” or “Cuban”-as well as those who indicate that they are “another Hispanic, Latino, or Spanish Origin”…Persons with other Hispanic origins (e.g., Salvadoran, Nicaraguan, Argentinean) were able to write in their specific origin group. The Census Bureau’s code list contains over 30 Hispanic or Latino Subgroups (2013).
According to the census, of those classifying themselves as Hispanic, 65.4 percent are of Mexican heritage, 8.9 percent Puerto Rican, 3.5 percent Cuban, and 16 percent Central or South American (U.S. Census Bureau, 2011). However, for any particular family, Goldenberg and Goldenberg (1998) caution: “Socioeconomic, regional, and demographic characteristics vary among Hispanic American groups, making cultural generalizations risky. Within groups, the counselor needs to be alert to the client’s generation level, acculturation level, languages spoken, educational background, socioeconomic status, rural or urban residence, adherence to cultural values, and religiosity/spirituality” (p. 307).
Keeping in mind that specific variations exist within the many subgroups, we will discuss some cultural themes important to Hispanic families in general. These include the significance of a common language, the importance of family relationships including extended family, and the traditional strictness of gender roles.
The first theme important in understanding the environment for children growing up in Hispanic families is the significance of a common language (Delgado-Romero, Nevels, & Capielo, 2013; Furman, Negi, & Loya, 2010). Everyday communication among Hispanic people is frequently in English. Almost 60 percent of Latinos speak only English, or at least speak it fluently, and almost 80 percent speak Spanish fluently; the uniting symbolic importance of the Spanish language should not be disregarded (Longres & Aisenberg, 2008). So many cultural activities and aspects of pride are associated with Spanish. Consider the cultural events and holidays (e.g., Cinco de Mayo for Mexican Americans, which celebrates the glorious day a small Mexican army defeated a French army battalion). Other cultural aspects may be celebrated and promoted, such as community murals reflecting important aspects of culture, art, or history, and traditional foods associated with a Hispanic heritage (Delgado, 2007).
A second theme involves the importance of both nuclear and extended family relationships (Diller, 2015; Longres & Aisenberg, 2008; Magana & Ybarra, 2010). Hispanic people generally place great value on maintaining the original two-parent family and its intensive involvement with the extended family. Commitment to the extended family group and upholding responsibilities to family members are emphasized. Note, however, that these family ideals are not always realized when families face the harsh realities of poverty, unemployment, and immigration difficulties (Longres & Aisenberg, 2008).
It is also important to be aware of the community support systems often available to Hispanic families. These include botanicas, bodegas, clubs sociales, canto familial, compadrazo, and faith healers. “Botanicas are shops that sell herbs as well as records and novels in Spanish. Bodegas are grocery stores, but they also serve as information centers for the Hispanic community, providing such information as where folk healers can be found. [Mexican, Puerto Rican, and Cuban Hispanic cultures espouse folk healers who help people deal with physical, emotional, and spiritual difficulties.] Club sociales provide recreation as well as links to community resources, including employment and housing.” There also are “special friends who furnish reciprocal support called como familial” and “the ritual kinship of compadrazo” people who “participate in baptisms, first communions, confirmations, and marriages, and often serve as parent substitutes” (Chilman, 1993, p. 160).
A third theme often characterizing Hispanic families is the traditional strict division of gender roles (Delgado-Romero et al., 2013; Dhooper & Moore, 2001; Sanchez & Jones, 2010; Weaver, 2005). Weaver (2005) reports that historically there have been “clear and distinct expectations for men and women. Men are expected to be strong, and women are expected to be submissive to male authority” (Weaver, 2005, pp. 145–146). However, Santiago-Rivera, Arredondo, and Gallardo-Cooper (2002) caution that “considerable debate” exists
over the extent to which Latinos adhere to traditional gender roles in contemporary U.S. society. Although evidence suggests that gender roles are undergoing transformation, the complexities surrounding this phenomenon are far from clear-cut … When examining gender role-based behaviors among Latinos, one must consider a variety of influencing factors such as socioeconomic indicators (e.g., level of education, income), place of residency, migration experience, language, and family composition. These determinants significantly influence gender roles. (p. 51)
Many “Latinas now work outside the home and may wield decision-making power about family finances” (Weaver, 2005, p. 146). Additionally, “more Latinas are heading households and as a result must take on roles that were traditionally dominated by men. As single heads of households, women are responsible for making major decisions about the welfare of their families and for providing for and nurturing their children” (Santiago-Rivera et al., 2002, p. 51). In summary, “it is important to understand evolving gender roles within Latino families” (Weaver, 2005, p. 146).
Native American Families
We have stressed that there are hundreds of Native American groups with hundreds of languages and dialects. Sensitivity to differences among tribes and appreciation of these differences are vital to effective social work practice. However, as with Hispanic people, several themes characterize many Native American groups. These include the importance of extended family, cooperation, mutual respect, harmony with nature, the concept of time, spirituality, and noninterference.
As with Hispanic people, family ties, including those with extended family, are very important (Diller, 2015; Paniagua, 2005; Sue & Sue, 2008). Extended family members include parents, children, cousins, aunts, uncles, grandparents, and even other community members who are integrally involved with the family. Diller (2015) explains:
Although the specifics of power distribution, roles, and kinship definitions vary from tribe to tribe, the vast majority of Native Peoples live in an extended family system that is conceptually different from the Western notion of family. Some tribes are matrilineal, which means that property and status are passed down through the women of the tribe. When a Hopi man marries, for example, he moves in with his wife’s family, and it is the wife’s brothers, not the father, who have primary responsibility for educating the sons. Family lies define existence, and the very definition of being a Navaho or a Sioux resides not within the individual’s personality, but rather in the intricacies of family and tribal responsibilities. When strangers meet, they identify themselves, not by occupation or residence but by who their relatives are. Individual family members feel a close and binding connection with a broad network of relatives (often including some who are not related by blood) that can extend as far as second cousins. (p. 270)
A second concept in Native American culture involves the emphasis on cooperation (Diller, 2015; Sue & Sue, 2008). The collective well-being of the family and tribe takes precedence over that of the individual (Paniagua, 2005). Weaver (2005) elaborates: “A sense of identity is rooted in group membership. Native people often refer to themselves as members of the Native community, regardless of their geographic location … Social cooperation is often valued over independent decision making. The wishes and plans of individuals must be balanced along with the needs of family and community members … This emphasis on the group leads to strong mutual support networks. The well-being of the group is paramount” (p. 90). Sue and Sue (2008) comment on how this emphasis on cooperation affects children: “Indian children tend to display sensitivity to the opinions and attitudes of their peers. They will actively avoid disagreements or contradictions. Most do not like to be singled out and made to perform in school unless the whole group would benefit” (p. 350).
A third theme that characterizes Native American culture is mutual respect, as Weaver (2005) explains: “Respect is emphasized in all social interactions. There are appropriate ways to communicate respectfully with others, including limiting eye contact and not interrupting someone who is speaking. People are accorded respect for the different roles they fulfill within a community. Elders are respected for their knowledge and wisdom, children are respected as the future of Native Nations, and leaders are respected for their willingness to sacrifice their own needs on behalf of First Nations [Native American] communities” (p. 91).
A fourth concept important in Native American culture is that of harmony with nature. Diller (2015) elaborates: “Native American cultures emphasize the interconnectedness and harmony of all living things and natural objects. This spiritual holism affirms the value and interdependence of all life forms. Nature is held in reverence, and Native people believe that it is their responsibility to live in harmony and safeguard the valuable resources we have been given” (p. 271).
A fifth theme of Native American life, related to harmony with nature, is the concept of time (Bearse, 2008; Diller, 2015). Time is considered an aspect of nature. Time flows along with life and, therefore, should not control or dictate how you live. Hence, other aspects of life, including interactions with other people, become more important than getting somewhere on time. Sue and Sue (2008) further describe this orientation: “Indians are very much involved in the present rather than the future. Ideas of punctuality or planning for the future may be unimportant. Life is to be lived in the here and now” (p. 350).
A sixth theme of Native American values concerns the importance of spirituality (Bearse, 2008; Sue & Sue, 2008). “The spirit, mind, and body are all interconnected. Illness is a disharmony between these elements” (Sue & Sue, 2008, p. 351). Spirituality, involving both tribal religion and Christianity, plays a critical role in the lives of many Native Americans. Although religious beliefs vary from one tribe to another, “religion is incorporated into their being from the time of conception, when many tribes perform rites and rituals to ensure the delivery of a healthy baby, to the death ceremonies, where great care is taken to promote the return or the person’s spirit to the life after this one” (Ho, 1987, p. 73).
A seventh important concept for Native Americans is noninterference (Sue & Sue, 2008, p. 350). “It is considered inappropriate in Native American culture to intrude or interfere in the affairs of others. Boundaries and the natural order of things are to be respected … With regard to communication, a premium is placed on listening” (Diller, 2015, p. 270). It is generally considered better “to observe rather than react impulsively” (Sue & Sue, 2008, p. 350). Silence is often used as a means of conveying respect (Diller, 2015).
Asian American Families
People who are typically considered Asian Americans are composed of three basic groups that, in turn, consist of numerous subgroups. These are “Asian Americans (Japanese, Chinese, Filipinos, Asian Indians, and Koreans), Asian Pacific Islanders (Hawaiians, Samoans, and Guamanians), and Southeast Asian refugees (Vietnamese, Cambodians, and Laotians)” (Paniagua, 2005, p. 73). Obviously, there is great variation among these groups, even though they are clustered under the umbrella term Asian Americans. Here we discuss four themes that tend to characterize many Asian American families: the significance of family, interdependence, investment made in children, and patriarchal hierarchy.
Like Hispanic people and Native Americans, Asian Americans tend to consider the family as the primary unit and individual family members as secondary in importance (Balgopal, 2008; Diller, 2015; Leong, Lee, & Chang, 2008). Phillips (1996) elaborates: “The welfare and the integrity of the family are of great importance. The individual is expected to submerge or to repress emotions, desires, behaviors, and individual goals to further the welfare of family and maintain its reputation. The individual is obligated to save face, so as to not bring shame onto the family. Therefore, there is incentive to keep problems within the family so that the family will not ‘lose face’” (p. 1).
A second theme, related to the significance of the family, is interdependence (Balgopal, 2008; Diller, 2015; Leong et al., 2008; Sue, 2006). “Studies have found that for most Asian Americans, their immediate and extended family are important loci of identity formation, social learning, support, and role development” (Leong et al., 2008, p. 117). “Children are expected to strive for family goals and not to engage in behaviors that would bring dishonor to the family. Asian American parents tend to show little interest in the child’s viewpoint regarding family matters. Instead, the emphasis is on family harmony, adapting to the needs of others, and adherence to ‘correct’ values (Rothbaum, Morelli, Pott, & Liu-Constant, 2000). Asian American adolescents appear to retain the expectation to Help, support, and respect their family even when exposed to a society that emphasizes adolescent autonomy and independence (Fuligni et al., 1999)” (Sue & Sue, 2008, pp. 362–363). An expectation that children will care for elderly parents is also important (Balgopal, 2008; Green, 1999).
A third theme characterizing many Asian American families involves hierarchical relationships (Balgopal, 2008; Sue, 2006; Sue & Sue, 2008). “Communication flows down from the parent to the child, who is expected to defer to the adults” (Sue & Sue, 2008, p. 363). Similarly, younger children are to defer to older children (Sue, 2006). Asian American families tend to have high expectations regarding children’s behavior and tend to impose stricter discipline when misbehavior occurs (Balgopal, 2008; Sue, 2006; Sue & Sue, 2008). “Problem behavior in children is thought to be due to a lack of discipline. However, differences in parenting style between Asian American groups have been found. Japanese and Filipino American families tend to have the most egalitarian relationships, while Korean, Chinese, and Southeast Asian Americans are more authoritarian (Blair & Qian, 1998)” (Sue & Sue, 2008, pp. 364–365).
A fourth theme involves patriarchal hierarchy (Balgopal, 2000, 2008; Sandtra & Madathil, 2013; Sue, 2006; Sue & Sue, 2008). Traditional values designate that men and older family members have greater status than other family members. Diller (2011) explains: “Family and gender roles and expectations are highly structured. Fathers are the breadwinners, protectors, and ultimate authorities. Mothers oversee the home, bear and care for children, and are under the authority of their fathers, husbands, inlaws, and at times even sons. Male children are highly prized … Older daughters are expected to play a caretaking function with younger siblings” (p. 274).
A Note on Difference
Our discussion concerning cultural themes of values and behaviors is general and brief. Actual practices may vary dramatically from one ethnic group to another and from one family to another. The point here is to enhance your sensitivity to and appreciation of potential cultural differences so that you may better understand and serve your clients.
A variety of other issues involving children and families will be discussed in Chapter 12. These include single-parent families, families of divorce, blended families, mothers working outside the home, family communication, family interaction, and common problems facing families.
4-7bMembership in Sibling Subsystems
Siblings compose a child’s most intimate and immediate peer group. Brothers and sisters will affect the development and behavior of a child. Siblings learn how to play with each other. They act as models for each other. They also learn how to fight with each other.
The Coming of a New Baby
Picture a -year-old girl waiting patiently for her mother to come home from the hospital with her new baby sister. When Mom arrives, imagine her surprise when she sees her beloved mother holding a blanket that looks like it has a tiny doll in it. Her mother is smiling and cooing down at the “doll.” The little girl thinks to herself, “That must be my baby sister.” She feels surprise, wonderment, happiness, and worry all at once, but is unable to articulate these feelings. Her general impression of the whole new situation is, “Now what?”
The coming of a new baby changes a child’s family environment. Children’s reactions to the change in circumstances vary dramatically. Some may withdraw into themselves and regress to more babylike behavior. Others may show open hostility toward the new baby and suggest giving it back. One 3-year-old boy was found holding a safety pin near his new infant brother, contemplating poking him in the eye. Still other children happily and proudly accept the family’s new addition and enjoy holding and playing with the baby.
Because of the complexity of the issue and the lack of clear-cut research, it is difficult to propose how to make the transition as easy as possible. Dr. Benjamin Spock (Spock, 1976; Spock & Rothenberg, 1985), the famous pediatrician who gave several generations of parents advice about how to raise their children, provided some logical suggestions.
First, children should be told in advance about all the changes they are to experience. Changes might include sharing a bedroom or having the new baby use their old high chair. Preparing them in this way is supposed to minimize surprises. Not knowing what’s going to happen is scary for children. Second, Spock suggested continuing to talk to older children and emphasizing how much they are loved and valued. Finally, children should be encouraged to express their feelings, including the negative ones, so that parents can allay their children’s fears and address problems as they occur.
Sibling Interaction
Approximately 80 percent of children in the United States have at least one brother or sister (Berk, 2012a; Santrock, 2016). Sibling interaction involves a multitude of behaviors and feelings. Siblings fight with each other but they also play with each other, work together, and show affection such as hugging each other.
Rathus (2011a) describes sibling interaction:
In early childhood, siblings’ interactions have positive aspects (cooperation, teaching, nurturance) and negative aspects (conflict, control, competition) (Parke & Buriel, 2006). Older siblings tend to be more caring but also more dominating than younger siblings. Younger siblings are more likely to imitate older siblings and accept their direction…
There is more conflict between siblings when the parents play favorites (Scharf et al., 2005). Conflict between siblings is also greater when the relationships between the parents or between the parents and children are troubled (Kim et al. 2006). (p. 167)
The Effects of Birth Order, Family Size, and Family Spacing
It is difficult to establish definite facts concerning birth order and development because so many factors are involved (e.g., parenting style, cultural expectations, socioeconomic status, number of persons residing in the family). However, some personality differences have been linked to birth order. Firstborn children tend to be more achievement oriented (Kail & Cave-naugh, 2010; Latham & Bud-worth, 2007; Rathus, 2011a). They also tend to do better academically (Healy & Ellis, 2007; Rathus, 2011a). “Compared with later-born children, firstborn children have also been described as more adult-oriented, helpful, conforming, and self-controlled,” although such differences are usually small (Santrock, 2016, p. 296). “On the negative side, firstborn children … show greater anxiety and are less self-reliant than later-born children” (Rathus, 2011a, p. 167).
Rathus (2014c) reflects:
Later-born children may learn to act aggressively to compete for the attention of their parents and older siblings … Their self-concepts tend to be lower than those of firstborn or only children, but the social skills later-born children acquire from dealing with their family position seem to translate into greater popularity with peers … They also tend to be more rebellious and liberal than firstborn children (Beck et al., 2006; Zweigenhaft & Von Ammon, 2000).
By and large, parents are more relaxed and flexible with later-born children. Many parents see that the firstborn child is turning out well and perhaps they assume that later-born children will also turn out well. (p. 161)
What about only children? Some research indicates that only children tend to be more achievement oriented and have more pleasant personalities than later-born children, especially those in large families (Jiao, Ji, & Jing, 1996; Kail & Cavanaugh, 2010; Santrock, 2012b). Please keep in mind, though, that no absolute predictors exist for how any child will turn out. Many other factors in the social environment can affect development.
4-8Assess Relevant Aspects of the Social Environment
LO 10
The family does not provide the only means of socialization for children. They are also exposed to other children as they play and to other adults, especially in the school setting. The transactions children have with their peers and with adults in school directly affect both the children’s behavior and their social development. Children learn how to relate to others socially. They learn what types of social behaviors others expect from them. They also are influenced by the amount of time they spend watching television. Issues to be addressed here include the social aspects of play, bullying, the influence of television and other media, and the role of the school. The impact of each will be related to the social development of children.
4-8aThe Social Aspects of Play with Peers
Luther, who is 8, screamed at the top of his lungs, “Red light, green light, hope to see the ghosts tonight!” He spun around and peered through the darkness. He was playing his favorite game, and he was “it.” That meant that he counted to 20 and then had to find the others and tag them. The first one tagged had to be “it” the next time.
“Where were those other kids anyway?” he said silently to himself. Randy usually hid in the garbage can. He thought that that made him smell so unappealing that no one would look for him there. Siggy, on the other hand, liked to hide in the bushes by the drainage ditch. However, a lot of mosquitoes were likely to consume anybody brave enough to venture over in that direction.
Horace was always an enigma. Luther never knew exactly where he was likely to hide. Once he had managed to squeeze into old Charlie’s doghouse. Charlie was a miniature mongrel.
On serious consideration of which route to take, Luther decided that the garbage can was his fastest and easiest bet. Just as Luther could’ve sworn that he heard Randy sneeze inside the garbage can, he heard his mother’s call. “Luther, you get in here this minute. I told you four times that you have to be home by 8:30 on weeknights. Come in right now, do you hear?”
“Aw, rats,” mumbled Luther. Just when he started to have some fun, he always had to quit and go home. Along came the other guys. See, he was right. Randy was in the garbage can, and sure enough, Siggy popped out from behind the bushes by the drainage ditch. As usual, he was scratching. Randy’s mother was really going to give it to him when he got home. He did smell awfully bad. Horace appeared suddenly out of nowhere. He wasn’t about to waste a good secret hiding place for nothing.
All four boys dragged themselves home. They walked as slowly as they could and procrastinated appropriately. Another hard summer’s day of play was done, but they were already thinking about tomorrow.
Children’s play serves several purposes. It encourages children to use their muscles and develop physically. It allows them to fantasize and think creatively. Finally, play enables children to learn how to relate to peers. Play provides a format for learning how to communicate, compete, and share. It functions as a major avenue of socialization.
Garvey (1977) defines play as activity that involves the following five qualities: First, play must be something that is done purely for enjoyment and not for a reward or because it is considered appropriate. Second, play has no purpose other than to be an end in itself. Third, people who play choose to do it. No one can force a person to play. Fourth, play involves active participation in an activity. Either mentally or physically, the individual must be involved. Pure observation does not qualify as play. Fifth, play enhances socialization and creativity. Play provides a context in which to learn interaction and physical and mental skills.
Play and Interaction
There are at least two basic ways of looking at how children play. These include social play and fantasy play. Social play involves the extent to which children interact with other children as they play. Fantasy play involves what children think about and how they imagine their pretend games as they play.
Social Play
Parten (1932) conceptualized a model for how children progress in their development of social play. Her research, which was done in the 1920s, focused on children ages 2 to 5. Observations of the children in action led to the proposition that there are actually six different levels of play. Theoretically, children progress through the following levels as they get older:
1. Unoccupied behavior: Unoccupied behavior involves little or no activity. A child might be sitting or standing quietly. Frequently, the child’s attention is focused on observing something going on around him.
2. Onlooker play: A child involved in onlooker play is simply observing the playing behavior of other children. The child is mentally involved in what the other children are doing. However, the child is not physically participating in the play. Onlooker play differs from solitary play in that the child’s attention is focused on the play of peers, instead of on simply anything that might be happening around him or her.
3. Solitary play: Solitary play involves the child playing independently. No attention is given to other children or what they might be doing.
4. Parallel play: A child involved in parallel play is playing independently but is playing in a similar manner or with similar toys as other children in the immediate vicinity. The child is playing essentially the same way as the other children, although no interaction occurs.
5. Associative play: Here children play together. There is some interaction, but the interaction is not organized. For example, children may share toys or activities and talk with each other. However, their play is very individualized. Each child plays independently from the others and focuses on individual activities.
6. Cooperative play: Cooperative play involves organized interaction. Children play with each other in order to attain a similar goal, make something together, or dramatize a situation together. Attention is focused on the group activity. Cooperation is necessary. Children clearly feel that they are a part of the group.
Parten proposed that different age levels are characterized by different types of play. Two-year-old children tend to play by themselves. By age 3, parallel play begins to be evident. Associative play is engaged in by more and more children as they reach the age of 4. By age 5, most children participate in cooperative play.
Parten’s levels of play have been criticized on several fronts. For one thing, the model doesn’t address the complexity of play; all children can be observed to participate in all levels of play (Papalia & Feldman, 2012; Rubin, Bukowski, & Parker, 1998). Another question involves how solitary play is viewed in Parten’s model. Is solitary play really less mature than play occurring in groups? Much of children’s solitary play is thoughtful, educational, and creative by nature, helping children to develop more advanced cognitive thinking. Where do such solitary activities such as drawing or building with blocks and Legos fit into Parten’s conception of normal play development?
Parents need to be aware of the normal developmental aspects of play at different age levels. Expectations of parents and other caregivers need to be realistic. Children should be encouraged to play with other children in ways appropriate to their age level. Yet children should not be pushed into activities that are beyond them. Children who are isolated in their play activities at an age when they need to be more outgoing may need encouragement in that direction. Parents and other caregivers can help children develop their play and interactional skills.
Gender Differences in Play
Two gender-related differences in behavior appear early in life. One is a difference in aggressive behavior with respect to play (Hyde & DeLamater, 2017). Boys behave more aggressively than girls. The other early behavioral difference is in toy preference (Rathus, 2014b). By age 3 or 4 girls begin choosing to play with dolls and participate in housekeeping play. Boys are more oriented toward toys such as trucks and guns. The reasons for these differences are not clear. Perhaps children play with the toys they are given and encouraged to play with. Girls’ rooms are filled with dolls and items devised for playing house. Boys’ rooms display various action-oriented toys such as cars, trucks, guns, and sports equipment.
For example, when Aunt Karen took 3-year-old Andrea, her niece and the apple of her eye, to Kmart one day to buy her a toy, Andrea headed straight for the “girls’ toys,” not the “boys’ toys.” When Aunt Karen suggested Andrea look at some “fun” trucks and cars (Aunt Karen knew that it was good for girls to become oriented to cars and trucks, both because they’ll have to use real ones someday and because such play aids in the development of spatial perception skills), Andrea screwed up her nose and said “No! Those are boys’ toys!” Her response was interesting because Andrea’s mother did most of the mechanical fixing and all of the outdoor work at their home. The impact of the media, especially television, and Andrea’s observation of other people must have been very great.
Another reason for the differences in toy preference may be that children, who become conscious of gender by age 3 (Crooks & Baur, 2014), learn early how they should be playing. They watch television and observe Mommy and Daddy; they learn that girls and boys should like to do different things.
There are at least three logical reasons why girls’ behavior is less aggressive than that of boys (Lott, 1987). These reasons all seem to relate to and reinforce each other. First, girls have fewer chances to “practice” aggressive behavior such as fighting, breaking, or hurting things. Second, girls’ aggressive behavior is less likely to be encouraged by adults than is the aggressive behavior of boys.
For instance, Aunt Karen had an opportunity to observe 3-year-old Andrea in the company of her male and female nursery-school peers. They were on a field trip to a local pumpkin farm with the idea of picking some small pumpkins. All of the boys in Andrea’s group were kicking, screaming, punching, bumping, running, and making brrrrrrrr and grrrrrrrr sounds. Several of the mothers calmly observed, smiled, and made proud comments like, “Isn’t he a real boy?” Meanwhile the girls stood silently on the sidelines watching the boys have “fun.” When one girl tried to get involved, her mother said, “Oh, no, Chrissy, you might get hurt. Those boys are so rough.”
A third reason why girls are less aggressive, according to Lott, is that girls are less likely to “experience success” at being aggressive than are boys. Boys are encouraged by adults to be more practiced at aggression than girls. Girls, on the other hand, are reinforced for being gentler and more ladylike.
The Peer Group and Popularity
The peer group is made up of a child’s equals. It can have an increasing impact on children as they get older, more independent, and more experienced. On a positive note, the peer group provides an arena for children to learn about themselves, build their self-concepts, and learn how to interact with others. On a negative note, the peer group can place pressure on children to do things they would never consider doing on their own.
Some children get along fabulously with peers; others are avoided, isolated, and withdrawn. What makes a child popular? Researchers have studied popular and unpopular children and concluded that popular children tend to display certain characteristics (Newcomb, Bukowski, & Pattee, 1993; Papalia & Martorell, 2015). They tend to be friendly with others and interact easily. They are neither too aggressive nor too passive. They tend to be trustworthy and able to supply emotional responsiveness and support to peers. They usually are bright and creative, yet don’t act superior or arrogant.
On the other hand, children who are unpopular tend to be characterized by opposite traits. They are socially immature. They tend either to be too pushy and demanding, or very shy and withdrawn. They might not be the brightest children around or the most attractive. They may not have the listening skills and the ability to empathize with others that popular children seem to have.
A common technique for examining children’s interaction is referred to as sociometry. This involves asking children questions about their relationships and feelings toward other people. The relationships can be illustrated on a diagram called a sociogram. Children in a group might be asked questions such as which three peers they like the best, which three they like the least, who they most admire, who would they like to sit next to, or who are they most afraid of. Each child can be represented by a circle. Arrows can then be drawn to the people they indicate in answer to each question.
Sociograms are shown in Figure 4.4. A sociogram can be created to illustrate the results of each question asked. Our example plots out two questions. The first reflects students’ feelings about who they thought was the strongest leader in the group. The second illustrates which peer they most liked in the group.
Figure 4.4Sociograms of a Special Education Class

Sociogram A clearly illustrates that Toby is thought to be the strongest leader in the group. He is bright, energetic, and very “street smart.” However, Sociogram B clearly illustrates that he is not the most popular or best liked in the group. Both Tom and Maria shine there. They both are more mature than the other group members. They are assertive and fairly self-confident, yet don’t impose their will on the others. They are among the brightest in the group. Toby, on the other hand, is more feared than respected. The others admire his apparent sophistication, yet don’t trust him. He doesn’t let anyone get close to him emotionally or physically. He keeps his distance.
Vince’s opinions differ radically from those of other group members. Vince stays by himself most of the time. He loves to wander off whenever he can. He sees Dean as being both a strong and likable leader. Dean is a very active, verbal person who is always in the center of activity. He has some trouble controlling his behavior and tends to provoke the other group members. Perhaps Vince admires Dean’s involvement.
These two sociograms are examples of how insights into a group’s interaction can be obtained and visually pictured. Although they only begin to portray some of the complexities of the group’s interaction, they do provide some interesting clues.
We’ve been speaking of children as being popular or unpopular. It is as if on a popularity scale from 1 to 10, each child is either a very unpopular 1 or a very popular 10. In real life, of course, most people lie somewhere in between. They may have some of the characteristics of the “popular person,” but not others.
It appears that social skills provide a primary basis for popularity. It follows, then, that because skills in general can be learned, social skills can be learned and popularity increased. Training may focus on teaching children how to draw attention to themselves in positive ways and to improve their ability to communicate with peers. Good communication skills involve showing interest in peers, asking appropriate questions, and sharing information that might be interesting to other children. Sometimes role playing is employed to teach children more effective responses to make in various situations (e.g., when playing a game or trying to get in line for recess).
4-8bBullying
“Nine-year-old Stephanie did not want to go to school … She had gotten into a disagreement with Susan, and Susan had told her she would beat her mercilessly if she showed up at school again. To highlight her warning, Susan had shoved Stephanie across the hall” (Ramus, 2014c, p. 217).
In this example, Susan was the bully and Stephanie the bully-victim. Steinberg and his colleagues (2011b) describe bullying:
Bullying refers to aggression by an individual that is repeatedly directed toward particular peers (victims) … It may be physical (hitting, kicking, shoving, tripping), verbal (teasing, harassing, name-calling), or social (public humiliation or exclusion). Bullying differs from other forms of aggression in that it is characterized by specificity (bullies direct their acts to certain peers) and by an imbalance of power between the bully and the victim … An older child bullies a younger one; a large child picks on a small, weaker one; a verbally assertive child torments a shy, quiet child. It is not bullying when equals have an occasional fight or disagreement. Bullies are more likely to use force unemotionally. (p. 318)
Although boys are more likely to bully, girls can also participate in such aggressive behavior (Perren & Alsaker, 2006). “In a national survey of more than 15,000 sixth- through tenth-grade students, nearly one of every three students said that they had experienced occasional or frequent involvement as a victim or perpetrator in bullying (Nansel & others, 2001)” (Santrock, 2016, p. 402; 2012b). Some research indicates that bullies and their victims are in regular contact with each other as 70 to 80 percent of them share the same classroom (Salmivalli & Peets, 2009). Therefore, it is a significant problem for many children.
The social environment and expectations about how peers should behave also can affect the occurrence of bullying (Salmivalli, Peets, & Hodges, 2011; Schwartz, Kelly, Duong, & Badaly, 2010). Peers are frequently aware of and observe bullying as it happens. Some bullies may even want observers so that they can feel important and powerful in front of witnesses.
Victims tend to fall into two categories (Rubin, Bukowski, & Parker, 2006). “The first are children who are shy, anxious, and socially withdrawn, which makes them easy prey. Often they do not have friends to protect them. But other victims are high in aggression themselves and engage in irritating behavior that elicits aggression. Other children see them as ‘asking for it’” (Steinberg et al., 2011b, p. 319).
Bullying involves aggressive, hurtful behavior by bullies toward targeted peer victims.

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What results from bullying? Some recent research indicates that when bullies and bully-victims become adolescents, they are more likely to become depressed, think about committing suicide, and actually commit suicide (Brunstein Klomek, Marrocco, Kleinman, Schonfeld, & Gould, 2007). Other research indicates that adolescents who had been either bullies or bully-victims “had more health problems (such as headaches, dizziness, sleep problems, and anxiety) than their counterparts who were not involved in bullying” (Santrock, 2009, p. 458; 2012b; Srabstein, McCarter, Shao, & Huang, 2006).
A newer type of bullying is called cyberbullying or online bullying. Cyberbullying is bullying that takes place using an electronic device, such as the computer or a cell phone, to access social media sites (Facebook, Snapchat, etc.), email, instant messaging, texting, or videos in order to bully, embarrass, or hurt another individual (stopbullying.gov, 2016). Due to easy access to electronic devices, cyberbullying can happen 24 hours a day, seven days a week. The School Crime supplement statistics show that 7 percent of students in grades 6 to 12 have experienced cyberbullying (stopbullying.gov, 2016). In another study, an average of 26 percent of students in an eight-year period said they had been a victim of cyberbullying at some point in their lifetime (Patchin & Hinduja, 2015). In addition, once these messages are sent or posted it can be difficult to track down the sender or erase the message, making the bullying almost impossible to get away from. In certain states, bullying and/or cyberbullying can be classified as a crime and most states have policy mandating schools address bullying (Cyberbullying Research Center, 2016).
So what can be done about bullying? Dupper (2013) suggests nine steps that school personnel can take to discourage and stop bullying among students:
An essential first step is conducting an accurate assessment of the extent and nature of bullying in the school … [This can be done by] administering an anonymous questionnaire to students about bullying… Findings from this survey can be used to motivate adults to take action against bullying and to help administrators and other educators tailor a bullying prevention strategy to the particular needs of the school…
A second step involves garnering the widespread support and significant commitment of all key stakeholders (e.g., administrators, teachers, students, parents, auxiliary school staff and community partners) in recognizing the importance of the problem and making a commitment to establish prevention and intervention programs and policies…
A third step is the formation of a school coordinating team. This team includes representatives from a number of groups, including a school administrator, a teacher from each grade, a member of the nonteaching staff, a school counselor or other school-based mental health professional (e.g., school social worker), a school nurse, and a parent. This team is involved in the development, implementation, maintenance, and Assessment of the program…
A fourth step involves the development and provision of ongoing in-service training for teachers and all adults in the school environment who interact with students…
A fifth strategy recognizes that antibullying efforts cannot be successful unless the language and needs of youth are taken into account … [One study] found that many youths engaged in practices that adults label “bullying” but that the youths do not name them as such because admitting that they’re being bullied (or worse, they are bullies) makes them feel weak and childish … When teenagers acknowledge that they’re being bullied, adults need to provide programs similar to those that help victims of abuse [that empower students and aid in] … emotional recovery…
A sixth strategy focuses on shifting group norms and dynamics in schools by targeting bystanders in antibullying interventions … [In some schools bullying behavior is taken for granted and becomes the norm. Students must be educated about bullying and empowered to come forward, label such behavior, and help stop it when it occurs.]
The seventh strategy is the establishment and enforcement of a discipline policy that includes simple, clear rules about bullying as well as the development of appropriate positive and negative consequences that are consistently enforced…
An eighth strategy involves an increase in adult supervision in the areas of the school where bullying occurs with the greatest frequency (i.e., “hot spots”) … Once school personnel have identified these “hot spots,” they should discuss and implement creative ways to increase adults’ presence in these locations in order to reduce opportunities for bullying…
A ninth and final strategy is to direct prevention and intervention efforts at the transition from elementary to middle school and throughout the critical middle school years due to a documented increase in bullying during early adolescence. (pp. 73–81)
4-8cThe Influence of Television and Other Media
Because television has become such a common aspect of a child’s environment, it merits a few comments here. Children spend 20 to 25 hours a week watching television; if continued at that rate, a high school graduate would have spent a full 2 years watching television for 24 hours a day (Kail & Cavanaugh, 2016; Rathus, 2014c). Of course, this is only an average. Some children watch more television than others, and others are playing video games on the television. For example, children from lower-income families watch more television than do their counterparts in families with higher economic status; “television is relatively cheap entertainment, and low-income families may not have the money to spend on other sources of entertainment” (Lemish, 2007; Martin & Fabes, 2009, p. 332). Also, the amount of time spent watching television varies with age. Martin and Fabes (2009) explain:
Children’s television viewing time increases during the preschool years to an average of 2.5 hours each day and continues to increase through the elementary school years (Lemish, 2007). Viewing time peaks at about 4 hours per day just before the start of adolescence, when competing activities reduce the number of hours spent in front of the television set (Pecora, Murray, & Wartella, 2007). When computers, DVDs, and video games are taken into account, children today spend an average of 5 hours a day in front of “video screens” (Woodward & Gridina, 2001). Similar patterns have been found in other countries (Lemish, 2007). (p. 332)
A major question raised about the impact of television is whether TV teaches children to be violent and aggressive. Research indicates that television does influence and increase children’s violent behavior (Berk, 2008a; Newman & Newman 2015; Rathus, 2011a; Wilson, 2008). Rathus (2011a) reflects:
Television is a fertile source of aggressive models (Villani, 2001). Children are routinely exposed to TV scenes of murder, beating, and sexual assault. Children who watch 2 to 4 hours a day of TV will see 8,000 murders and another 100,000 acts of violence by the time they have finished elementary school. (p. 172)
Even children’s cartoons demonstrate extremely violent behavior. How many times have the Teenage Mutant Ninja Turtles battled “bad guys” with seriously lethal, sharp, and dangerous weapons? How many times has the Coyote been blown up with a stick of dynamite given to him by the Roadrunner? How many times has Donald Duck been smashed by a baseball bat or pushed off a steep cliff? When you think about it, the implications of the amount of violence depicted are scary.
Note that television isn’t the only medium that can potentially teach and provoke aggressive behavior. Most video games provide a means not only to view, but also actually to practice, violent behavior. Many such games closely resemble reality. They provide a means to engage actively in violent pursuits, usually shooting down people or other figures. Even worse, they reinforce violent behavior by awarding points when targets are effectively annihilated.
At least three processes may operate to increase children’s aggression in response to TV or video game violence (Newman & Newman, 2015; Rathus, 2014c). First, children may model the violent behavior they see. If Rambo and other famous movie and TV characters can do it, why can’t they? Second, violence is arousing, so children are more likely to lose control and become more violent. TV violence can serve as a stimulus to trigger increased emotionality and aggression. Third, regular exposure to TV violence can influence a child’s value system and beliefs about how the world really is. Children who see a lot of violence may take it for granted that violence happens everywhere much of the time. How many times might a child watch a young man get “blown away” in vivid blood-red color before that image becomes commonplace in that child’s mind?
Other research establishes a relationship between the amount of violent television viewed in childhood and the amount of aggressiveness manifested by participants as adults (Huesmann & Miller, 1994; Johnson, Cohen, Smailes, Kasen, & Brook, 2002; Newman & Newman, 2012). In other words, children who watch more violent television may actually display more violent behavior themselves when they grow up. The link between TV violence and later aggression has been established even when other variables such as socioeconomic status and parents’ level of education are taken into account (Johnson et al., 2002). A survey by Time found that 66 percent of respondents believed there was too much violence on television (Poniewozik, 2005). Playing violent video games has also been linked to increased aggression and decreased concern for others in children and teens (Anderson & Bushman, 2001; Anderson et al., 2003). Violence is enhanced when children play routinely and identify with violent characters used and displayed in the game (Konijn, Bijvank, & Bushman, 2007). Research also found that placing age restrictions on games or labeling them as being violent only increased their attractiveness to children of all age groups, including children ages 7 to 8 and girls (Bijvank, Konijn, Bushman, & Roelofsma, 2009).
Some young people commit extraordinarily violent acts as they grow into adults, possibly demonstrating a link with TV violence. Consider the following examples:
• 20-year-old Adam Lanza, who, after killing his mother, took three guns to Sandy Hook Elementary School in Newtown, Connecticut. After shooting his way into the security-locked building, he shot and killed twenty 6- and 7-year-old students and six adults (CNN.com, 2013).
• 17-year-old senior Robert Butler, Jr., who, on January 5, 2011, fatally shot one Omaha, Nebraska, school administrator and then seriously wounded another after Butler had been suspended; he later shot and killed himself (World-Herald News Service, 2011).
• 23-year-old English major Cho Seung-Hui. Dressed in dark clothing resembling that portrayed in a popular video game, he suddenly opened fire on his fellow students at Virginia Tech, killing 31 of them, his instructor, and himself (ABC News, 2007; Romano, 2007).
• former student Stephen Kazmierczak, who, on February 15, 2008, abruptly opened fire on students at Northern Illinois University, killing 5 and wounding 16 before killing himself (NPR, 2008a, 2008b).
Following the April 1999 massacre of 12 high school students and a teacher by two teens at Columbine High School in Littleton, Colorado, President Clinton made three pleas to the media (Harris, 1999). First, “he urged movie studios to stop showing guns in ads and previews that children can see” (p. A3). Second, “he asked theaters and video stores to more rigorously enforce rules barring unchaperoned children under age 17 from viewing R-rated movies” (p. A3). Third, “he called for re-evaluating the ratings system, ‘especially the PG rating,’ to decide whether the ratings are ‘allowing too much gratuitous violence’ in movies approved for children” (p. A3).
There is another side to television, however. According to Newman and Newman (2012), “many programs, some developed for children and others intended for a broader viewing audience—convey positive ethical messages about the value of family life, the need to work hard and sacrifice in order to achieve important goals, the value of friendship, the importance of loyalty and commitment in relationships, and many other cultural values” (p. 261). For example, consider Sesame Street, which emphasizes the development of reading and arithmetic skills in addition to imparting such values as consideration for others’ feelings. Television “can have a positive influence on children’s development by presenting motivating educational programs, increasing their information about the world beyond their immediate environment, and providing models of prosocial behavior [interactions involving collaboration, support, and positive communication] (Wilson, 2008)” (Santrock, 2013, p. 317).
The American Academy of Pediatrics (AAP) (2007) suggests that parents scrutinize their children’s viewing behavior by observing how their children act after watching TV and by watching the programs themselves. Limits should be set regarding what is appropriate and what is not. When violence does occur, parents should talk to children about it. Parents can emphasize that violence is a bad way to solve problems and that better, nonviolent ways are available. Finally, parents should seek out television programs, games, and videos that provide high-quality, nonviolent content for children to watch.
Ethical Questions 4.6

EP 1
1. Is there too much violence on television? Should the amount of violence be monitored? Is so, who should be responsible for setting standards and scrutinizing content? Should children’s viewing of television be limited? If so, in what ways?
4-8dThe School Environment
School provides a major arena for socialization, where children are taught social customs, rules, and communication skills. Schools can influence children’s dreams and aspirations about future careers. Schools help to mold the ways in which children think. Specific issues related to the school environment will be discussed here. They include the teacher’s impact, the elements of an effective classroom, and the effects of social class and race.
The Teacher’s Impact
Students frequently perform at the level of their teachers’ expectations. This is sometimes referred to as a self-fulfilling prophecy—that is, students will perform to the level of expectation placed upon them. Higher expectations, therefore, can result in greater achievement.
There is some indication that low achievers are even more responsive to higher teacher expectations than are higher achievers (Madom, Jussim, & Eccles, 1997; Martin & Fabes, 2009; Smith, Jussim, & Eccles, 1999). Teachers should avoid categorizing students as poor performers, but rather should encourage them to work to the best of their ability.
Martin and Fabes (2009) reflect on how teachers can also influence children’s social development (Pianta, 2006): “This influence can be quite positive, encouraging feelings of competence and well-being. For example, teachers have been found to enhance positive outcomes for students if they
• (1)
reduce the tendency of students to compare themselves with one another,
• (2)
use cooperative interaction strategies in the classroom,
• (3)
promote beliefs about students’ competencies rather than their deficiencies,
• (4)
increase chances for students to be successful, and
• (5)
are warm, encouraging, and supportive (Pianta & Stuhlman, 2004; Stipek, 1997)” (p. 437).
Effective School Environments
The school environment can be a warm, welcoming place that encourages learning and productivity. Or, it can be a scary, intimidating setting that discourages students from even being there. A substantial body of research has established that the following variables are related to an effective school environment (Rathus, 2014b; Shaffer & Kipp, 2010, pp. 624–625):
• School Climate: Students’ positive perception of the school’s climate is an important variable in encouraging learning. This includes both their feelings of safety and teachers’ “support and encouragement” (Loukas & Robinson, 2004; Shaffer & Kipp, 2010, p. 624; Taylor & Lopez, 2005a). If students feel welcome and safe, it makes sense that they would experience greater freedom and have more energy to devote to making academic and social progress (Eccles & Roeser, 2005; Taylor & Lopez, 2005b).
• Academic Emphasis: Children perform best in schools that stress on academic work. Academic goals should be clearly specified. Homework that is explained, discussed, and evaluated should be required.
• Challenging, Developmentally Appropriate Curricula: Children can relate much better to content that focuses on their ethnicity, cultural background, customs, and history, and that involves the issues they’re currently facing in life. Incorporating such content into the curriculum can motivate students to learn because what they’re learning is interesting and relevant to them. Using such appropriate curricula enhances their achievement in areas such as “effort, attention, attendance, and appropriate classroom behavior” (Jackson & Davis, 2000; Lee & Smith, 2001; Shaffer & Kipp, 2010, p. 624). On the other hand, content that “turns off” student interest can lead to lower achievement levels and distancing from the educational environment (Eccles & Roeser, 2005; Jackson & Davis, 2000).
• Classroom Management: Having organized, efficient classrooms with structured expectations can encourage a healthy learning environment. Time management skills can be used to keep activities and lessons proceeding on time. This provides students with both direction and encouragement to get things done. Students should be consistently given positive reinforcement and praise to encourage productivity and high-quality effort. “The most effective teachers ask questions, give personalized feedback, and provide opportunities for drill and practice, as opposed to straight lecturing” (Rathus, 2011a, p. 431).
• Discipline: Rules should be clearly stated and consequences for rule violations imposed immediately. Physical punishment should be avoided, as it can lead to uncontrolled results and further aggressive behavior. “Students do not do well when teachers rely heavily on criticism, ridicule, threats, or punishment” (Rathus, 2011b, p. 431). At the same time, encouraging obedient, cooperative children to use their own discretion in making decisions where possible enhances their self-confidence and ability to achieve (Deci & Ryan, 2000; Grolnick, Gurland, Jacob, & Decourcey, 2002; Ryan & Deci, 2000a, 2000b).
• Teamwork: “Effective schools have faculties that work as a team, jointly planning curricular objectives and monitoring student progress, under the guidance of a principal who provides active, energetic leadership” (Shaffer & Kipp, 2010, p. 625).
An effective school environment can positively enhance students’ ability to learn and thrive.

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Spotlight 4.4 discusses how an educational program was developed to emphasize cultural strengths and meet the educational needs of Hawaiian students.
Spotlight on Diversity 4.4
Head Start and Cultural Responsiveness
Head Start is a program aimed at increasing the readiness to early childhood education and improves school readiness for low-income children. In 2014, Head Start programs served over 900,000 children, 29 percent who spoke a language other than English at home (Head Start, 2016). In 2007, the Improving Head Start for School Readiness Act was created to support children whose primary language was not English and who represent the diverse culture in the United States (National Center on Cultural and Linguistic Responsiveness, 2013).
Head Start has adopted 10 multicultural principles to ensure they were effectively meeting the needs of the different cultures among their community and workers. These 10 principles include the following: “1) Every individual is rooted in culture, 2) The cultural groups represented in the communities and families of each Head Start program are the primary sources for culturally relevant programming, 3) Culturally relevant and diverse programming requires learning accurate information about the cultures of different groups and disregarding stereotypes, 4) Addressing cultural relevance in making curriculum choices and adaptations is a necessary, developmentally appropriate practice, 5) Every individual has the right to maintain his or her own identify while acquiring the skills required to function in our diverse society, 6) Effective programs for children who speak languages other than English require continued development of the first language while the acquisition of English is facilitated, 7) Culturally relevant programming requires staff who both reflect and are responsive to the community and families served, 8) Multicultural programming for children enables children to develop an awareness of, respect for, and appreciation of individual and cultural differences, 9) Culturally relevant and diverse programming examines and challenges institutional and personal biases, and 10) Culturally relevant and diverse programming and practices are incorporated in all systems and services and are beneficial to all adults and children” (Head Start, 2016). These principles have a strong focus on working with the family and communities to ensure children’s needs are met.
According to data, Head Start does appear to be working (National Head Start Association, 2016). Aikens, Kopack Kleing, Tarullo, and West (2013) found that children in Head Start make progress towards norms in language, literacy, and math during the program year; and also show gains in social-emotional development as a result of participating in Head Start at both 3 and 4 years of age. In another study, it was found that parents were more likely to enroll their child for a second year of Head Start if the program was supportive of their culture and that Dual Language Learners and Black children benefited more than other groups from Head Start (U.S. Department of Health and Human Services, 2010). Early education programs using utilizing multicultural principles may help children of diverse backgrounds be ready for school.
Ongoing research is needed to establish what is really happening in school environments. Perhaps greater resources are necessary to update materials and enhance the multicultural learning atmosphere. Other targets of change may include teacher attitudes and skills. Teachers may require special training to meet the special needs of people from various cultural backgrounds.
Ethical Question 4.7

EP 1
1. What elements in the classroom environment do you believe are most effective, and why?
Race, Ethnicity, and Schools

EP 2a
EP 2c
Gaps exist between the educational attainment of whites and some other ethnic groups, including Hispanics and African Americans. Whereas 88.8 percent of Caucasians graduate from high school, 87 percent of African Americans and only 66.7 percent of Hispanics do so (U.S. Census Bureau, 2016). About 32.8 percent of Caucasians have a college education or more, whereas only 72.5 percent of African Americans and 15.5 percent of Hispanics achieve this educational level (U.S. Census Bureau, 2016).
A number of reasons may account for the discrepancies in educational attainment among whites, African Americans, and Hispanics. Some educators have attributed these differences to external factors such as lower socioeconomic status (Duncan & Brooks-Gunn, 2000; Steinberg et al., 2011b) and poorer quality schools (McAdoo, 2007). Both African Americans and Hispanics are more likely to have lower socioeconomic status than whites. Are schools in poorer neighborhoods receiving necessary resources to provide students with a good education? Other reasons for the discrepancy in educational attainment may involve internal variables, such as a social atmosphere, that discourage students and obstruct their performance. Also, textbooks and instructional materials may not adequately reflect relevant cultural values and ethnicity. For example, to what extent are African American and Hispanic history, literature, and values emphasized? Are teachers’ and educational administrators’ expectation levels for their students of different cultures too low? Do teachers have biases about the capabilities of students in particular ethnic groups?
4-9Examine Child Maltreatment
LO 11
Ralphie, age 8, came to school one day with his arm in a gigantic cast. His teacher asked him what had happened. He said he fell down the steps and broke his arm. He didn’t seem to want to talk about it much. When pressed about why the cast was so large, he replied, “Oh, that’s ’cause I busted it in a couple of places.” The teacher thought to herself how strange it was that he suffered such a severe injury from a simple fall. Eight-year-olds are usually so resilient.
Angel, age 4, didn’t want to sit down when one of her caregivers at the day care center asked her to. It was almost as if she was in pain. The caretaker called the center’s nurse to examine Angel. The nurse found a doughnut-shaped burn on her buttocks. When asked how it happened, Angel said she didn’t remember. The nurse thought to herself how strange this situation was.
As the plumber left the porch of the last house he visited, he wondered to himself how people could possibly live that way. There were three filthy, unkempt small children eating Froot Loops and glued to a blaring television set. The toilet was filthy; he was glad he had extra-thick rubber gloves on as he worked on the pipes. Then, as he was leaving the home, a small puppy leisurely urinated on the porch before his and the woman’s eyes. She looked at the salesman, making no effort to clean up the mess, and said, “Well, at least he didn’t do it inside the house.” She then turned around and walked back into the house.
Tony thought Alicia, one of his classmates at school, was just beautiful, albeit a little shy. They were both 14. He finally mustered up the courage to go over, talk to her, and ask her if she would like to go to the school dance next Friday night. She shrank back from him as if she was terrified and said, in a whisper, that she couldn’t possibly go. She added apologetically that her mother worked Friday nights and her “Daddy” always took her to the movies. That struck Tony as odd. However, he wasn’t up to fighting with parents. Alicia was cute, but she wasn’t the only girl around.
Each of these vignettes illustrates children who are being maltreated. Children can be abused or neglected in a number of ways. The umbrella term that includes all of them is child maltreatment. Maltreatment includes physical abuse; being given inadequate care and nourishment; deprivation of adequate medical care; insufficient encouragement to attend school consistently; exploitation by being forced to work too hard or too long; “exposure to unwholesome or demoralizing circumstances”; sexual abuse; and emotional abuse and neglect (Kadushin & Martin, 1988, p. 226). Definitions used by legal and social service agencies vary from locality to locality and state to state. However, most definitions include these eight aspects of maltreatment.
Many books have been written about each form of maltreatment. It is beyond the scope of this book to address them all in great depth. Usually, however, all can be clustered under two headings: child abuse (which includes both physical and sexual abuse) and child neglect. Child maltreatment is a critical issue for social workers to understand. They need to be aware of the clues that maltreatment is occurring. One screening tool, the ACES (Adverse Childhood Experiences), helps identify the number of traumas (including child maltreatment, parental incarceration and/or domestic violence) a child has experienced. It has been found that high ACE scores have been linked to adverse health outcomes, both physically and emotionally. Social workers also need to understand the dynamics of how child victims and their abusers behave in order to assess a situation and make treatment plans. Here, we will discuss the incidence and demographics of child maltreatment; the definitions of physical abuse, neglect, psychological maltreatment, and sexual abuse; the characteristics of victims and abusers; and some basic treatment approaches. Because of its distinctive characteristics and problematic features, sexual abuse will be discussed separately.
4-9aIncidence of Child Maltreatment
The actual number of child abuse and neglect cases is difficult to determine. Definitions for who can and can’t be included in specific categories vary. How cases are reported and how data are gathered also vary dramatically. One thing is certain: the chances are that any reported figures reflect a small percentage of actual cases. Indications are that vast numbers of cases remain unreported.
In 2014, there were an estimated 3.6 million referrals, involving 6.6 million children, made to child protective services (U.S. Department of Health and Human Services, 2016). Of these, 2.2 million referrals were screened in, indicating an investigation for abuse or neglect needed to occur (U.S. Department of Health and Human Services, 2016). It was determined that 702,000 cases of maltreatment (75% neglect and 17% physical abuse) had occurred, resulting in 1,580 fatalities (U.S. Department of Health and Human Services, 2016). With the use of the National Child Abuse and Neglect Data System (NCANDS), which is an electronic national data collection system enacted by the Children’s Bureau in Administration on Children, Youth and Families, it is now easier to track this data (U.S. Department of Health and Human Services, 2016).
4-9bPhysical Child Abuse
Physical abuse can be defined very generally as “non-accidental injury inflicted on a child,” usually “by a caregiver, other adults, or sometimes, an older child” (Crosson-Tower, 2013, p. 180). Some definitions focus on whether the alleged abuser’s purpose is to intentionally harm the child. Other definitions ignore the intent and instead emphasize the potential or actual harm done to the child. However, there often is a very fine line between physical abuse and parental discipline. Historically, parents have had the right to bring up their children as they see fit. This has included administering punishment to curb behavior when they thought it was necessary. Consider a father who beats his 13-year-old daughter on the buttocks with a belt because her math grade dropped over the course of a year from an A to a C. Is that his right, or is that child abuse?
Spotlight 4.5 raises some questions about what is considered discipline versus what constitutes abuse.
Angry outbursts and loss of emotional control on the part of parents can result in child abuse.

BananaStock/jupiter images
Spotlight on Diversity 4.5
Diverse Cultural Contexts: Discipline or Abuse?

EP 2a
EP 2c
Crosson-Tower (2013) reflects on some of the issues concerning the cultural context of abuse versus parental discipline:
Some cultures have customs or practices that child protection [agencies] would consider abusive. For example, some Vietnamese families, in a ritual called cao gio, rub their children with a coin heated to the point that it leaves burn marks. It is an intentional act, but designed, in that culture, to cure a variety of ills. Do the parents’ good intentions exempt this practice from being considered abusive? Similarly, the use of corporal punishment is sanctioned in many Hispanic cultures, but is seen as abusive in this culture when it becomes excessive. Some child protection advocates adopt the “When in Rome do as the Romans do” attitude that says that minorities must abide by the laws of the culture in which they now reside. One Puerto Rican social worker, working in a predominantly Hispanic section of New York City, vehemently disagreed: “Yes, there are laws, but those laws were made by Anglos. Is it fair to deprive new immigrants of everything including their customs? Maybe the laws should be changed?” The reality is that if a child is reported as being harmed for whatever reason, a child protection agency will usually investigate. If the reason is one of culture, this will be considered. (p. 180)
Social workers should orient themselves to learning from their clients about clients’ cultures. This is a career-long process, as the extent of variations in values and customs is infinite.
Characteristics of Physically Abused Victims
Both physical indicators and behavioral indicators provide clues that a child is being physically abused. Physical indicators can be broken down into six basic categories.
1. Bruises. Bruises on any infant should be suspect. Infants are not yet mobile. Therefore, it’s not likely that they can bruise themselves. Bruises in unusual places or forming unusual patterns may indicate physical abuse. Bruises that take a recognizable shape such as a hand mark or a belt mark should be noted. Finally, bruises that display a variety of colors may portray abuse. This may be an indication that a series of bruises have been received over time. On lighter-skinned people, bruises usually progress from an initial bright red to blue to blackish-purple within the first day; they become shaded with a dark green color after about 6 days and finally turn pale green or yellow after 5 to 10 days.
2. Lacerations. Cuts, scrapes, or scratches, especially if they occur frequently or their origin is poorly explained, may indicate physical abuse. Lacerations on the face and genitalia should be noted. Bite marks also may indicate abuse.
3. Fractures. Bone fractures and other skeletal injuries may indicate abuse. Strangely twisted fractures and multiple fractures are especially telltale signs. Infants’ fractures may be the result of abuse. Additional indicators are joint dislocations and injuries in which the periosteum, the thin membrane covering the bone, is detached.
4. Burns. Burns, especially ones that take odd forms or are in patterns, may indicate abuse. Children have been burned by cigarettes and ropes (from being tied up and confined). Burns that occur on inaccessible portions of the body such as the stomach, genitals, or soles of the feet are clues to abuse. Patterned burns may indicate that the child has been burned with some hot utensil. Sac-like burns result when a hand or foot has been submerged into a hot liquid. A doughnut-shaped burn will occur on the buttocks if a child has been immersed in very hot water. The central unburned area results from where the child’s skin touched the bottom of the receptacle holding the water.
5. Head injuries. Head injuries that can indicate abuse include skull fractures, loss of hair due to vigorous pulling, and subdural hematomas (blood collected beneath the outer covering of the brain after strenuous shaking or hitting). Black eyes should be suspect. Retinas may detach or hemorrhage if a child is shaken vigorously.
6. Internal injuries. Children have received injuries to their spleen, kidneys, and intestines due to hitting and kicking. The vena cava, the large vein by which blood is brought from the lower extremities to the heart, may be ruptured. Peritonitis, in which the lining of the abdominal cavity becomes inflamed, can be another indicator of abuse.
Some of the major questions to ask yourself if you think a child may have been physically abused include the following:
• Does this child get hurt too often for someone his or her age?
• Does the child have multiple injuries?
• Do the injuries occur in patterns, assume recognizable shapes, or look like some of the injuries described earlier?
• Are the injuries such that they don’t seem possible for a child at that stage of development?
• Do the explanations given for the injuries make sense?
If something doesn’t seem right to you, something may be wrong. If a little voice in the back of your mind is saying, “Oh-oh, that certainly is odd,” pay attention. It might be a clue to abuse.
In addition to physical indicators, behavioral indicators provide a second major dimension of clues to physical abuse. A physically abused child tends to exhibit behavioral extremes. Virtually all children may display these extreme behaviors at one time or another. However, the frequency and severity of these behaviors in abused children are clearly notable. At least three categories, plus a variety of specific behavioral indicators, have been established (Crosson-Tower, 2013, 2014; Kolko, 2002; Runyon & Urquiza, 2011):
1. Extremely passive, accommodating, submissive behaviors aimed at preserving a low profile and avoiding potential conflict with parents that might lead to abuse. Abused children can be exceptionally calm and docile. They have learned this behavior in order to avoid any possible conflict with the abusive parent. If they are invisible, the parent may not be provoked. Many times abused children will even avoid playing because it draws too much attention to themselves. This behavioral pattern is sometimes called hypervigilance.
2. Notably aggressive behaviors and marked overt hostility toward others, caused by rage and frustration at not getting needs met. Some physically abused children assume an opposite approach to the overly passive manner identified earlier. These children are so desperately in need of attention that they will try almost anything to get it. Even if they can provoke only negative attention from their parents, their aggressive behavior is reinforced.
3. Developmental lags. Because abused children are forced to direct their attention and energy to coping with their abusive situation, they frequently show developmental delays. These may appear in the form of language delays, poorly developed social skills for their age level, or lags in motor development.
Highlight 4.3
Shaken Baby Syndrome
Shaken baby syndrome or abusive head trauma is defined as an inflicted injury on infants and young children typically from violent shaking or impacting of the head of an infant or small child (National Center on Shaken Baby Syndrome, 2016). When shaken violently, blood vessels in an infant’s brain may tear causing brain bleeding. Other results can be brain bruising, skull fractures, tearing of the retina, and spinal cord damage (National Center on Shaken Baby Syndrome, 2016). Symptoms include irritability, difficulty staying awake, breathing problems, vomiting, seizures, paralysis, or coma (Mayo, 2014). Outcomes for victims of shaken baby syndrome can range greatly, from significant to milder (including learning disabilities, personality changes, blindness, seizure disorders, or death). Although legal courts have questioned the validity of shaken baby syndrome (Bazelon, 2011), many medical professional organizations (including the American Academy of Pediatrics, The World Health Organization, Center for Disease Control and Prevention, and the American Association of Neurological Surgeons) recognize the syndrome and believe prevention is the key to addressing the problem (National Center on Shaken Baby Syndrome, 2016). The main way to prevent this type of injury is through educating parents about the dangers of shaking their baby and providing support to parents when they are feeling frustrated or upset with their child. Programs such as PURPLE help parents understand normal infant crying and reduce shaken baby syndrome (National Center on Shaken Baby Syndrome, 2016). It is important that parents receive education on this topic to stop the syndrome from ever occurring.
Ethical Questions 4.8

EP 1
1. Do parents have the right to spank their children? When does discipline become abuse?
Characteristics of Abusers
The dynamics behind child physical abuse are complex and varied. However, the general characteristics of it tend to fall within six major domains (Crosson-Tower, 2013, 2014; Kolko, 2002; Miller-Perrin & Perrin, 2013; Runyon & Urquiza, 2011). Although no one person may have all the problems mentioned, a person will likely experience some.
Need for Personal Support and Nurturance
A basic quality characterizing abusers is low self-esteem. Their emotional needs often remain unfulfilled from their own childhoods. Because their own needs were not met, they are unable to meet the needs of their children. They often invite rejection and hostility because they have little confidence in their own abilities. They don’t know how to reach out for support. On the one hand, they often feel they are undeserving. On the other hand, they still have desperate needs for human support.
Social Isolation
Perpetrators’ own self-confidence may be low. They feel that no one will like them, so they isolate themselves. They reject attention, even though they need others for emotional support. They fear rejection, so they don’t try to reach out to others. As a result, when normal everyday stresses build up, they have no one to help them cope.
Communication and Relationship Difficulties
Relationships that abusers do have with family, a significant other, and others are often stormy. Communication may be difficult, hostile, and ineffective. Low self-esteem can also affect the relationship with a partner or a significant other. Abusers may not know how to get their needs met. They may allow their disappointments and anger to build up because they don’t know how to express these feelings more appropriately to others. They may feel isolated and alone even within a marriage or partnership. Children may become easy targets for parents who can’t communicate with each other. Children may provide a conduit for the expression of violence and anger that are really directed at a spouse or a significant other.
Poor Parenting Skills
Many abusive people don’t know how to raise their children in a nurturant family environment. Their own family of origin’s environment may have been hostile and abusive. They may never have observed nurturant behavior on the part of their own parents and caregivers. They couldn’t learn what they weren’t taught.
Additionally, their expectations for what constitutes inappropriate behavior at the various development levels may be lacking. For instance, their demands on the child for behavioral submission and even perfection may be very inappropriate. Parenting behavior may be inconsistent, hostile, or lacking in positive interaction.
Poor General Coping Skills
Perpetrators may be unable to cope with stress, lashing out at their children instead. They may lack anger management skills. In addition to not knowing how to meet their own emotional needs, they may not have learned to separate their feelings and emotions from their behavior. Therefore, if they get mad, they don’t talk about it; they hit.
Another unlearned skill involves the appropriate delineation of responsibility. Perpetrators tend to blame others for their mistakes. For example, it’s the child’s fault that he got hit and broke his arm, because he was naughty.
They may also lack decision-making or problem-solving skills. Abusers tend to have little confidence in their own ability, and so have little faith in their own judgment. They have difficulty articulating and evaluating the pros and cons of their alternatives, and are indecisive.
In addition, abusers often fail to learn how to delay their own gratification. The situation here and now becomes all-important. If a child misbehaves, a kick will take care of it immediately. If their stress level is too high, abusers need immediate relief. They focus on the moment and have trouble looking at what the consequences of their behavior will be in the future.
Extreme External Stress and Life Crises
Child abuse is related to lower socioeconomic status. Poverty causes stress. The abuser, who may lack coping strategies anyway, may feel isolated and incompetent. Additional life crises like job loss, illness, a marital or family dispute, or even a child’s behavior problem may push people over the brink so that they cannot cope. They may take out their stress on the easiest, most available targets—their children.
4-9cChild Neglect
Because neglect involves the absence of resources instead of the presence of something that is negative, it is difficult to define. Every social environment is different. When does a family environment cease being adequate and instead display neglect?
Consider the following case examples:
• Mark, who is 8 years old, is left to care for his 3-year-old sister, Maria, while their parents go out.
• Margaret fails to provide medication for her 10-year-old daughter, who has a seizure disorder.
• Jonathan refuses to allow his 16-year-old son into the family’s home and tells him not to return.
• Tyrone and Rachel live with their three children in a home that is thick with dirt and dust, smells of urine, and has nothing but rotting food in the refrigerator.
• Alicia leaves her 10-month-old infant unattended in a bathtub full of water. (Barnett, Miller- Perrin, & Perrin, 2011, p. 84)
Child neglect is a caregiver’s “failure to meet a child’s basic needs”; this may involve depriving a child of physical, emotional, medical, mental health, or educational necessities (Erickson & Egeland, 2011; Shireman, 2003, p. 32). Whereas child abuse involves harming a child through actions, child neglect causes a child harm by not doing what is necessary. Neglect occurs when children are not given what they need to survive and thrive.
Two of the most frequent aspects of neglect involve physical neglect and inadequate supervision. Physical neglect is the “failure to protect a child from harm or danger and provide for the child’s basic necessities including adequate food, shelter, and clothing” (Erickson & Egeland, 2011, p. 105). Inadequate supervision “refers to situations in which children are without a caretaker or the caretaker is inattentive or unsuitable, and therefore the children are in danger of harming themselves or possibly others” (Downs, Moore, & McFadden, 2009, p. 209). Children need someone to direct them, care for them, support their daily activities, and give them emotional support. Inadequate supervision includes psychological neglect, discussed later in the chapter.
Sometimes neglect is related to poverty. Many neglectful parents don’t have the resources to take care of themselves or their children. For instance, one woman who was charged with child neglect described her living conditions to a judge. She lived in a small, third-floor flat without hot water. She said, “It is an awful place to live. The wallpaper is in strips, the floor board is cracked. The baby is always getting splinters in his hands. The bathroom is on the floor above and two other families use it. The kitchen is on the first floor. I share it with another woman. I have no place to keep food. We buy for one meal at a time” (Hancock, 1963, p. 5).
A young social worker recounts a visit to a family suspected of child neglect:
It was my first visit to the Petersons’ home, or should I say second floor fiat. The house was in a very poor area in the inner city of Milwaukee. I was supposed to do an initial family assessment. Both parents and three small children were there. The house was filthy. Dirty laundry was heaped in piles on the living room floor. The walls were smeared with grease. Wads of dust rolled along the floor; if they had been at my apartment, I would’ve called them dinosaur dust bunnies.
The flat was small. The only furniture I could see included two double beds in the tiny living room, and a cheap, old dinette and appliances in the kitchen. The family asked me to sit at the old kitchen table. The chairs were black; I had to restrain myself from wiping one off with a Kleenex before I sat down. But I didn’t want to offend my clients. I was clearly aware of my middle-class bias already. None of the children were wearing shoes, which might not be too unusual for summer. However, black dirt streaked all of the children’s white arms, legs, feet, hands, and faces. Their hair was dirty and snarled.
As we talked, the parents asked me if I’d like a cup of coffee. The coffee maker in front of me was filthy as was the cup they gave me. It matched the dirty dishes heaped high in the sink. Again, not wanting to offend my clients, I gratefully accepted the coffee. As we talked, I accepted the second cup of coffee and then a third. That was my mistake. Suddenly it occurred to me I desperately needed to use the bathroom. I wondered where it was. I asked if I could, and Mr. Peterson said, “Sure, just a minute.” He stood up from the table, picked up a door that had been leaning against the wall around the corner, pointed to a literally open door out of my direct view around the refrigerator. Mortified as I was, I stepped into the bathroom. He laid the door in place (there were no hinges) and said he’d hold it until I was finished. Well, what else was there to do at that point? After I finished, I meekly said, “I’m through,” at which point he picked up the door and put it back in its place leaning against the wall. We continued with the interview. One thing is for sure; my coffee drinking behavior on home visits will never be the same!
Characteristics of Neglected Children
Each of us has infinite needs. To define and categorize all that we need to maintain physical and emotional health would be an awesome task. This is why neglect is often difficult to define for any specific family situation. Nonetheless, we will present 12 general indicators of child neglect here (Barnett et al., 2011; Crosson-Tower, 2014; Erickson & Egeland, 2011; Miller-Perrin & Perrin, 2013; Zuravin & Taylor, 1987). They provide at least a basis for assessment of situations in which neglect may be involved. As with the characteristics of physically abused children, it should be noted that not all of these characteristics apply to all neglected children. However, any one of them might be an indicator of neglect.
1. Physical health care. Illnesses are not attended to, and proper dental care is not maintained.
2. Mental health care. Children’s mental health problems are either ignored or left unattended. Sometimes caregivers refuse “to comply with recommended therapeutic interventions for a child with a serious emotional or behavioral disorder” (Erickson & Egeland, 2011, p. 105).
3. Educational neglect. “Parents fail to comply with laws that require children to attend school” (Erickson & Egeland, 2011, p. 104). Excessive truancy and tardiness without adequate or appropriate excuses may indicate neglect. This often concerns a “parent [who] has been informed of the problem and does not take steps to remedy it”; educational neglect also involves “situations in which parents refuse to permit their children with special needs to receive the services they need” (Downs et al., 2009, p. 209).
4. Supervision. Children are often or almost always left alone without adequate supervision. Very young children or even infants may be left unattended. Another common situation is that very young children are left in the supervision of other children who themselves are too young to assume such responsibility. A third common situation occurs when unsupervised children get involved in activities in which they may harm themselves. For example, we periodically read in the newspaper that a young, unsupervised child plays with matches, starts a fire, and burns down the house or apartment building and usually dies in the fire. A fourth example involves children who don’t receive adequate supervision to get them to school on time, or at all.
5. Abandonment and substitute child care. The most blatant form of neglect is abandonment, when parents leave children alone and unattended. A related scenario involves parents who fail to return when they’re supposed to, thereby leaving designated care providers in the lurch, not knowing what to do with the children.
6. Housing hazards. Housing may have inadequate heat, ventilation, or safety features. Dangerous substances such as drugs or weapons may be left in children’s easy reach. Electrical fixtures may not be up to code and therefore may be dangerous.
7. Household sanitation. Food may be spoiled. The home may be filled with garbage or excrement. Plumbing might not work or be backed up.
8. Personal hygiene. Children’s clothing may be ripped, filthy, and threadbare. Their hair may be unkempt and dirty. They themselves may be unbathed and odorous. They may be plagued with head lice.
9. Nutrition. Children who frequently complain that they’re hungry and search for food may be victims of neglect. Children receiving food that provides them with inadequate nutrition may be neglected. Significant delays in development resulting from malnutrition may also be a clue to neglect.
10. “Social and attachment difficulties” (Barnett et al., 2011, p. 96). Children may have problems interacting with parents, and they may fail to maintain secure attachment relationships (discussed in Chapter 3) in which they trust parents and respond positively and consistently to their parents’ presence and interaction (Erickson & Egeland, 2011). Children may act “passive and withdrawn” with parents or the “parent exhibits low sensitivity to and involvement with [the] child” (Bamett et al., 2011, p. 96). Children may also display problems in peer relationships, including “deficits in prosocial behavior, social withdrawal, isolation, [and] few reciprocal friendships” (Barnett et al., 2011, p. 96).
11. “Cognitive and academic deficits” (Barnett et al., 2011, p. 96). Children may exhibit language deficits, poor academic achievement, low grades, deficits in intelligence, decreased creativity, and difficulties in problem solving (Barnett et al., 2011). One study found that neglected children tend to experience greater cognitive and academic problems than do physically abused children (Hildyard & Wolfe, 2002).
12. “Emotional and behavioral problems” (Barnett et al., 2011, p. 97). Neglected children may exhibit indifference, withdrawal and isolation, low self-esteem, behavioral and verbal aggression, difficulties in paying attention, and psychiatric symptoms such as those characterizing anxiety or depression (Barnett et al., 2011).
Two pronounced physical conditions that can result from extreme neglect are nonorganic failure-to-thrive syndrome and psychosocial dwarfism (Crosson-Tower, 2014). Nonorganic failure-to-thrive syndrome (NFTT) occurs in infancy. It is characterized by infants who are “below the fifth percentile in weight and often in height” (Crosson-Tower, 2014, p. 70). This means that 95 percent of all other infants that age weigh more. Additionally, the infant must have had normal health at one time. Lags in psychomotor development are also apparent.
Psychosocial dwarfism (PSD) can affect children age 18 months to 16 years. In these children, “emotional deprivation promotes abnormally low growth. PSD children are also below the fifth percentile in weight and height, exhibit retarded skeletal maturation, and a variety of behavioral problems” (Crosson-Tower, 2014, p. 71). Additionally, they tend to have speech difficulties and problems in their social interactions.
Characteristics of Neglectful Parents
Crosson-Tower (2013) explains: “Parents who neglect were often neglected themselves as children. For them, it is a learned way of life. Their childhoods have produced in them nothing but anger and indifference. Their adult lives are dedicated to meeting the needs that were not met for them as they were growing up” (p. 186).
Mothers who neglect their children can be divided into five basic types (Crosson-Tower, 2013; Polansky, Chalmers, Buttenwieser, & Williams, 1991; Polansky, Holly, & Polansky, 1975):
1. The indifferent, lethargic mother is best described as numb. She has little or no emotional response and has little energy to do anything.
2. The impulsive, irresponsible mother treats her children inconsistently and often inattentively. She has poor impulse control and lacks coping strategies.
3. The depressed mother is reacting to life’s unhappy circumstances by giving up. Unlike the indifferent mother, she experiences extreme emotion by being depressed and miserable.
4. Mothers with intellectual disabilities neglect children because of their cognitive inabilities and a lack of the adequate support they need to help them assume their responsibilities. Note that not all women with intellectual disabilities neglect their children.
5. Mothers with serious mental illness, such as psychosis, are unable to function because of bizarre thought processes, delusions, or extreme anxiety.
Ethical Questions 4.9

EP 1
1. Should parents who neglect their children be punished or receive treatment? How should this be accomplished?
4-9dPsychological Maltreatment
Psychological maltreatment is illustrated in the following case scenarios:
• A mother locks her 3-year-old son in a dark closet as a method of punishment.
• A father shackles his 7-year-old son to his bed at night to prevent him from getting out of bed repeatedly.
• A mother says to her daughter, “You are the stupidest, laziest kid on earth. I can’t believe you’re my child. They must have switched babies on me at the hospital.”
• A father tells his daughter that he will kill her new puppy if she or the puppy misbehaves.
• A mother and father provide alcohol to their 16-year-old son and his friends at a party.
• A mother refuses to look at or touch her child.
• A father repeatedly states to one of his children, “I don’t love you.” (Barnett et al., 2011, p. 106)
Psychological (or emotional) maltreatment includes both psychological abuse and psychological neglect. Psychological abuse, like other abuse, is more aggressively active and negative. It is “belittling, humiliating, rejecting, undermining a child’s self-esteem, and generally not [conducive to] creating a positive atmosphere for a child” (Cohen, 1992, p. 175). Psychological neglect, like other forms of neglect, involves passively failing to meet children’s needs. It is the “passive or passive/aggressive inattention to the child’s emotional needs, nurturing, or emotional well-being” (Brassard, Germaine, & Hart, 1987, p. 267). Parents may deprive an infant of needed holding and attention or may simply ignore children who are in desperate need of emotional involvement. Both emotional neglect and abuse focus on interfering with a child’s psychological development and well-being.
At least five basic categories of behavior are involved in psychological maltreatment (Barnett et al., 2011; Crosson-Tower, 2014; Downs et al. 2009; Garbarino, Guttmann, & Seeley, 1986). They are summarized as follows:
1. Rejection includes “abandoning the child, failing to acknowledge the child, scapegoating the child [i.e., placing unjustified blame on a child for some behavior or problem or criticizing a child unfairly], and verbally humiliating the child.” A parent might emphasize how stupid a child is in front of her friends or neighbors.
2. Isolation includes “keeping the child away from a variety of appropriate relationships.” It might involve not allowing a child to play normally with peers or seeing other close family members. It might also involve locking a child in a closet for days, months, or years.
3. Terrorizing involves “threatening and scaring the child.” A parent might threaten to kill a child’s beloved pet if he doesn’t do the dishes. Or a caregiver might hold a child outside a second-story window and threaten to drop her if she doesn’t start “acting her age.”
4. Ignoring involves failing to respond to a child or simply pretending that the child isn’t there. Parents watching television might ignore children’s pleas for help with homework or requests for food, thereby forcing children to take care of themselves.
5. Corrupting includes “encouraging or supporting illegal or deviant behaviors.” A caregiver might force a child to shoplift or drink beer (Winton & Mara, 2001, pp. 90–91).
Characteristics of Psychologically Maltreated Children
Extensive research reveals that a multitude of problems in adulthood are related to psychological maltreatment during childhood. These potential effects include low self-esteem, anxiety, depression, a negative view of life, increased suicide potential, emotional instability, difficulties with impulse control, substance abuse, eating disorders, relationship difficulties, violence, criminal behavior, school problems, and poor performance on intelligence and achievement tests (Hart, Brassard, Binggeli, & Davidson, 2002; Hart et al., 2011).
Characteristics of Perpetrators
Like other parents and caregivers who abuse or neglect, those who psychologically maltreat then children usually suffer serious emotional problems or deficits themselves (Crosson-Tower, 2014; Shireman, 2003). They may find themselves in a marriage or a partnership that is disappointing or bland, and may seek easy targets (namely, children) for venting their anger and frustration. Like other people who maltreat children, perpetrators may lack coping skills to deal with their problems and emotional issues. Their own emotional needs may not have been met in childhood. Their own parents may have lacked nurturing skills and, thus, failed to teach perpetrators how to be good parents. They may also be dealing with personal problems such as mental illness or substance disorders (Barnett et al., 2011).
4-9eMacro-System Responses to Child Maltreatment
Macro-system responses concern how society addresses a problem like child maltreatment. Such responses addressed here include Child Protective Services, the social work role in treatment, and treatment by the courts.
A Macro-System Response: Child Protective Services
An abused or neglected child is usually referred to a Child Protective Services (CPS) unit. CPS agencies are governmental units that
• (1)
receive reports of suspected child maltreatment,
• (2)
investigate these reports,
• (3)
assess the extent that children are being harmed or are at risk of being harmed,
• (4)
determine how safe the home environment is or if placement outside the home is necessary, and
• (5)
provide or arrange for the provision of necessary and appropriate social, medical, legal, placement, and other services.
Although there is some variation from one local or state CPS program to another, the following themes reflect a common philosophy (Pecora et al., 2010):
• A safe and permanent home is the best place for children to grow up…
• Most parents want to be good parents and have the strength and capacity, when adequately supported, to care for their children and keep them safe…
• Families who need Helpance from CPS programs are diverse in terms of family structure, culture, race, religion, economic status, beliefs, values, and lifestyles…
• CPS efforts are most likely to succeed when clients are involved and actively participate as partners in the process…
• Services must be individualized and tailored…
• CPS approaches should be family centered. (p. 150)
CPS workers are usually employed by state or county public agencies whose designated task it is to protect children from harm. During the intervention process, CPS workers help families establish treatment plans to address and remedy problems. In the event that problems cannot be resolved, CPS workers try to develop alternative long-term or permanent placement of the children. CPS staff may work with the courts to declare that children require protection and to determine appropriate safe placement for them.
Treatment of Physical Abuse, Neglect, and Psychological Maltreatment: Social Work Role
Treatment of physical abuse, neglect, and psychological maltreatment follows the same sequential steps used in other areas of social work intervention. These include receipt of the initial referral, gathering of information about the case through a social study, assessment of the situation (including safety, risk, and family assessment), case planning including goal setting, provision of treatment, Assessment of the effects of treatment, and termination of the case (Pecora et al., 2010). Assessment focuses on many of the dynamics of the case that we’ve already discussed. Questions a practitioner should address include the following:
1. “Is the child at risk from abuse or neglect and to what degree?
2. What is causing the problem?
3. What are the strengths or protective factors that could be built on with services to alleviate the problem?
4. Is the home a safe environment or must the child be placed?” (Crosson-Tower, 2014, p. 216)
Certain factors affect risk (Crosson-Tower, 2014). These include the following:
• Child factors: Children who are younger or have intellectual or other disabilities are at greater risk.
• Caregiver factors: “Initially, the worker notes the level of cooperation and capabilities shown by the caregivers, remembering to frame this within a cultural context. Parents who recognize there is a problem present a better prognosis and less risk to the children than those who demonstrate hostility or refuse to cooperate. The physical, mental, and emotional capabilities of the parent—as evidenced by their expectations of the child, ability to protect the child, and the ability to control anger and other impulses—indicate the degree of risk to the victim. Parents who are unaware of children’s needs or demonstrate poor judgment or concept of reality present a high risk to the dependent child” (Crosson-Tower, 2014, p. 220).
• Abuser factors: Perpetrators who have a history of irrational, abusive behavior and who harm the child intentionally increase risk. Perpetrators who have greater access to victims also increase the risk factor.
• Environmental factors: “The incident itself is weighed in the light of future potential harm to the child. The worker determines the likelihood of permanent harm, the location of the injury, the previous history of abuse or neglect, and the physical conditions of the home. Environmental factors provide additional information. Parents who do not use support systems place the child at higher risk, for example, than those who can reach out for help. The degree of stress in the home also affects the likelihood of abuse. Death, divorce, incarceration of a parent, unemployment, career change, residence change, and birth of a child can all place a child at greater risk. Again, all these factors must be evaluated within a cultural context” (Crosson-Tower, 2014, pp. 220–221).
General treatment goals include stopping the maltreatment and strengthening the family enough to keep it together and, hopefully, have it thrive. Specific treatment modalities may include family therapy, involvement in support groups (e.g., Parents Anonymous), couple’s counseling, or individual counseling, depending on the family’s and the individual family members’ needs.
Parents may need to learn how to identify their feelings and express them appropriately. They may need to learn how to communicate their needs to others and, in two-parent homes, to each other. They might require building their self-concepts. They may also need to master effective child management techniques in order to gain control and avoid abusive situations. Being taught how to provide a nurturant family environment for their children and improve their parent–child relationships might also be necessary.
Many times outside resources are helpful. Day care for children can provide some respite for parents and time for themselves. Homemaker service provides training in household management and makes available to parents an individual to give support and nurturance. Parental aides can work in homes, form relationships with parents, and model how to nurture children as well as effective child management techniques.
Physically abused children also need treatment, including medical services for physical damage. Children suffering from developmental delays may need special therapy or remedial help. Exposure to appropriate adult role models through day care is often used. Organizations such as Big Brothers and Big Sisters provide another means of support.
Individual or group counseling may be needed for the maltreated child. At least three major categories of victims’ needs should be addressed (Crosson-Tower, 2014). These categories relate directly to the characteristics of maltreated children that we’ve discussed. The first need involves improving the victim’s relationships with other people, including both peers and adults. Their old behavior patterns most likely involved either defensive withdrawal or inappropriate aggression. New, more effective social interaction techniques need to be established. The second need involves helping victims learn how to express their feelings. Some maltreated children withhold and suppress their feelings to avoid confrontations; other abused children have never learned how to control their aggressive impulses. The third need concerns the maltreated child’s self-concept. For the many reasons we’ve discussed, maltreated children have a poor opinion of themselves and have little confidence in their own abilities.
A Macro-System Response: Involvement of the Courts
Courts become involved in maltreatment cases “when the child is in imminent danger or the parents are unable or unwilling to cooperate with the social service agency in improving the care of their children”; court involvement also can occur when parents are incapacitated for some reason, abandon children, fail to provide adequate medical treatment for serious health issues, severely physically hurt or even kill the child, or sexually abuse children and are subject to legal prosecution (Crosson-Tower, 2014, p. 248). Court involvement is a very difficult and scary process for both the family and victim. Juvenile court procedures vary from state to state. However, most involve three processes: the petition, adjudication, and disposition.
The petition is a written complaint submitted to the court that the alleged abuse or neglect has occurred. Adjudication is a hearing where the alleged abuse or neglect is proven or discounted. Both parents and victim are represented by separate legal counsel. The disposition involves a hearing in which the court determines what is to be done with the child. This is a separate hearing from the adjudication, where it is determined whether the abuse or neglect actually happened. The court process is complex and often lengthy. Many variations, including additional investigations and settlements, are possible. (See Crosson-Tower, 2014, for a detailed description of the process.) Protective service workers and other social workers are frequently called upon to provide input to aid in the court’s decision. Such input often is very influential and can have a direct impact on what happens to a child.
4-9fSexual Abuse
Sexual abuse is “any sexual activity with a child where consent is not or cannot be given … This includes sexual contact that is accomplished by force or threat of force, regardless of the age of the participants, and all sexual contact between an adult and a child, regardless of whether there is deception or the child understands the sexual nature of the activity. Sexual contact between an older and a younger child also can be abusive if there is a significant disparity in age, development, or size, rendering the younger child incapable of giving informed consent. The sexually abusive acts may include sexual penetration, sexual touching, or noncontact sexual acts such as exposure or voyeurism” (the act of gaining sexual gratification from watching people who are naked or engaging in sexual activities) (Berliner & Elliott, 2002, p. 55). Incest, a special form of sexual abuse, involves “sexual activities between a child and a relative—a parent, stepparent, parent’s live-in partner or lover, foster parent, sibling, cousin, uncle, aunt, or grandparent” (McAnulty & Burnette, 2003, p. 486). “Sexual activities” can include a wide variety of sexual behaviors, including “pornographic photography, sexual gestures, parental exposure of genitalia, fondling, petting, fellatio, cunnilingus, intercourse, and any and all varieties of sexual contact” (Crosson-Tower, 2014; Mayer, 1983, p. 4).
Specific statutes addressing definitions of and punishments for sexual abuse vary widely by state. Concerning the incidence of sexual abuse, it is very difficult to get accurate statistics for a number of reasons. For one thing, many experts believe that cases of sexual abuse are vastly underreported (Berliner, 2011; Berliner & Elliot, 2002; Crosson-Tower, 2014). It is also very difficult for children to report sexual abuse. Perpetrators emphasize secrecy and blame the victim. Often, if victims do try to tell someone, that person is uncomfortable talking about it and may avoid the subject altogether. Definitions of sexual abuse vary widely, so it’s difficult to collect and congregate data. Research estimates indicate that from about 19 to 22 percent of all women and 7 to 9 percent of all men state that they were sexually abused as children (Crooks & Baur, 2014; Rathus et al., 2014).
The Dynamics of Child Sexual Abuse
A major myth involved in child sexual abuse is that children should be warned about strangers. They’re told that they should not get into cars when strangers offer them lollipops and they should not talk to strange men who are hiding behind park bushes. The reality is that children are in much greater danger from people who are close to them, from people they trust.
Children are easy victims for sexual abuse. Because of the anxiety most people harbor about sexuality in general, children have little information about sex. They have limited life experience upon which to base judgments. Thus, they can easily be misled and tricked. They are small compared to adults and are easily intimidated. Adults, in some ways, are godlike to children. Adults tell them what to do, when to go to bed, when they can cross the street, and if they can go to McDonald’s. Children are oriented toward obeying adults, and most children want to please them, especially those adults who control their access to being loved, having food and shelter, and feeling safe.
Some data indicate that the “vast majority of offenders are male, although boys are more likely than girls to be abused by women (20 percent vs. 5 percent)” (Berliner, 2011, p. 219). An estimated 60 to 70 percent of sexual abuse occurs within the family (Crosson-Tower, 2013). This does not mean that the remaining 40 percent is perpetrated by strangers. Rather, much extra-familial abuse is done by others who are close to the family and trusted by the child. Only 5 to 15 percent of sexual abuse is committed by strangers (Berliner, 2011). When sexual abuse is perpetrated by someone outside the family, that person is usually called a pedophile (someone who prefers children for sexual gratification). Because of its prevalence, we focus on incest in the following discussion.
Progression of the incestuous relationship is usually gradual. It may appear innocent enough at first. For instance, the adult might appear nude or undress before a child. It then progresses to greater and greater intimacy. There are five basic phases to sexual abuse (Crosson-Tower, 2014, pp. 114–115). First comes the engagement phase. Here, the perpetrator will experiment with the child to see how close he can get and how the child will react. The second phase is the sexual interaction phase. Sexual activity in various degrees of intimacy occurs during this phase. Often the longer this phase lasts, the more intimate the abuser becomes with the victim. The third phase is one of secrecy. Sexual activity has already occurred, so the abuser will use some manipulations to hold the victim ensnared in the abuse. For instance, the perpetrator might say, “Don’t you tell your mommy; she won’t like you anymore,” or “This is our special secret because I love you so very much,” or “If you tell anybody, I’ll punish you.” Threats and guilt are used to maintain the secret. The fourth phase is the disclosure. For one reason or another, the victim reveals that abuse has occurred. It may be physically initiated if the child contracts a sexually transmitted disease or is damaged in some way. It may be the result of an accident if the sexual activity was observed or someone noted and reported the child’s indicative behavior. It may be that the victim feels she must tell someone because she can’t stand it anymore. Revealing abuse may or may not happen during childhood. The fifth and final phase is suppression. This is a time of high anxiety for both victim and family. Feelings may include denial on the part of the perpetrator, guilt and insecurity on the part of the victim, and anger on the part of other family members.
What factors increase the risk of child sexual abuse? Risk factors related to the child tend to differ depending on the source of the information (Berliner, 2011). Some research suggests that girls are more likely to be victimized than boys (Berliner, 2011). However, other data propose that “boys are almost equally as vulnerable” (Crosson-Tower, 2014, p. 122; Miller-Perrin & Perrin, 2013). Some research proposes that “the average age of those abused is between 4 and 6 years for boys and 11 and 14 years for girls (Berliner, 2011)” (Crosson-Tower, 2014, p. 122). In contrast, other sources suggest that “boys are older at onset of victimization” (Berliner, 2011, p. 219). Most studies reveal that children who have a disability are at greater risk of sexual abuse (Berliner, 2011; Crosson-Tower, 2014). These children are more vulnerable and less able to defend themselves. In essence, they offer easier targets for perpetrators.
There are also a number of risk factors characterizing families (Berliner, 2011; Crosson-Tower, 2014; Miller-Perrin & Perrin, 2013); these include the following:
• Absence of a biological parent from the home—stepfather or a mother’s boyfriend may be present.
• Family conflict and communication problems—when communication is poor, roles may become blurred. For example, when husband and wife or partners are in conflict, the male partner may turn to a female child to fulfill his needs.
• Family isolation—because secrecy is necessary for abuse to occur, a family may intensify its isolation even more.
• Having a mother who is not readily available to children (e.g., being ill or employed outside the home)—if communication is poor between mothers and daughters, it becomes even more difficult for daughters to turn to their mothers for help.
Consider the unknown proportion of mothers who do not know that the incest is occurring. There may be many reasons for this. The marriage is conflictual. Communication is lacking between the woman and her husband and the woman and her daughter. She may see things that are strange, but she works hard to deny them. She has a lot to lose if the incest is brought out into the open. She may feel resentment toward a daughter who has taken her husband and lover away from her. She may feel shame that this taboo is occurring within her own family. She may feel guilt for being such a failure to her husband that he had to turn to another. She may desperately fear having her family ripped apart. It is a very difficult situation for a mother in the incest triangle. She is not the abuser. Yet no alternatives are available that offer her a happy solution.
In some ways, the mother in the incestuous triangle is also a victim. She has been raised in a patriarchal society where she has been taught to be dependent, unassertive, and passive. She has also been taught that she is supposed to be the caretaker of the emotional well-being of her family. She has not been given the skills needed to aggressively fight for herself and her daughter in this desperate situation.
The Internet and Sexual Abuse Predators
The internet provides a readily accessible means for pedophiles to interact with each other, validate their thoughts and acts, and share pornographic materials (Crooks & Baur, 2014). It also provides fertile ground for pedophiles seeking victims to satisfy their pedophilic fantasies and needs. They can easily cruise bulletin boards and chat rooms intended for children and adolescents. Often, they adhere to the following process (Crooks & Baur, 2014). First, perpetrators converse with the intended victims online, trying to convince victims of genuine interest in victims’ troubles and issues. Second, they seek contact information such as email and home addresses. Third, perpetrators will send victims pornographic content, hoping to demonstrate that such behavior is proper and standard. Fourth, perpetrators will try to set up a meeting with intended victims.
Berliner (2011) reports on the incidence of internet sexual abuse:
Rates of unwanted Internet sexual solicitations declined from 19% to 13%, but harassment (6% to 9%) and unwanted exposure to pornography (25% to 34%) increased from 2000 to 2005 (Mitchell, Wolak, & Finkelhor, 2007). However, a 2005 survey found that youth were more likely to report aggressive solicitations, and the rates of different forms of online sexual victimization decreased or increased with variations by age, gender, race, and household. There is little data on voluntary participation in illegal sexual activities or involvement in child pornography. (p. 218)
Characteristics of Sexual Abuse Victims
Children who are sexually abused may display a variety of physical, psychological, and behavioral indicators. Physical indicators may include a variety of physical problems that are sexually related, such as sexually transmitted diseases, problems with the throat or mouth, difficulties with urination, penile or vaginal discharge, or bruises in the genital area. Pregnancy is also an indicator.
Psychological indicators include low self-esteem, emotional disturbance, anger, fear, anxiety, and depression, sometimes to the point of becoming suicidal (Berliner, 2011; Berliner & Elliott, 2002; Miller-Perrin & Perrin, 2013). Behavioral indicators include withdrawing from others and experiencing difficulties in peer interaction. Often, victims of either gender engage in excessive sexual activity and inappropriate sexual behavior (Berliner, 2011; Faller, 2003; Friedrich et al., 2001).
Behavior related to sex that strikes you as being odd may also be an indicator. This refers once again to your “gut reaction” that something’s wrong. For example, a child may know sexual terms or display sexual gestures that strike you as being inappropriate for her age level. A child may touch herself or others inappropriately in a sexual manner. A child may express desperate fears about being touched, undressing and taking showers in gym class, or being alone with a certain gender or with certain people.
Specific things that children say may strike you as odd and may be indicative of sexual abuse. For instance, a child may say, “Daddy and I have a secret”; “My babysitter wears red underwear”; or “I don’t like going to Aunt Shirley’s house. She diddles me.”
Long-Term Effects of Sexual Abuse
Although significant research indicates that sexual abuse victims can suffer long-term effects, this is a very complex issue. Abuse can vary in intensity, duration, and extent of trauma to the survivor. Long-term effects vary dramatically from one person to another (Rathus et al., 2014). Receiving treatment can also help survivors deal with issues and effects.
Research has established that survivors, as compared with people who have not been sexually abused, are more likely to experience emotional problems such as depression, fear of relationships, interpersonal problems, sexual dysfunctions, sexual acting out, and symptoms of posttraumatic stress (Berliner, 2011; Miller-Perrin & Perrin, 2013). Sexual acting out may involve overt sexual behavior directed “toward adults or other children, compulsive masturbation, excessive sexual curiosity, sexual promiscuity, and precocious sexual play and knowledge” (Miller- Perrin & Perrin, 2013, p. 123). Posttraumatic stress disorder is a condition in which a person continues to reexperience an excessively traumatic event such as a bloody battle experience or a sexual assault. Symptoms include extreme anxiety, nightmares, an inability to sleep or stay awake, an inability to concentrate, and explosive, angry emotional outbursts.
Note that because of the tremendous disparity in how sexual abuse affects individuals, no specific variables are consistently linked to long-term problems (Miller- Perrin & Perrin, 2013). Although they may contribute to the risk of having problems, sexual abuse experiences do not condemn a person to a miserable life. Effects depend on a number of factors. For example “the availability of social supports following the disclosure of abuse, such as maternal support or a supportive relationship with another adult, appears to mitigate negative effects and play a protective role” (Miller-Perrin & Perrin, 2013, p. 129; Pollio, Deblinger, & Runyon, 2011).
Research has established that the following five variables increase the risk of more serious problems in adulthood for survivors of sexual abuse (Berliner, 2011; Berliner & Elliott, 2002; Crosson-Tower, 2014; Miller-Perrin & Perrin, 2013):
1. Closer relationship to the perpetrator. Sexual abuse by a family member, or by another person the victim feels close to and trusts, is related to deeper trauma in adulthood.
2. Duration of the abuse. The longer the abuse continued, the greater the likelihood of long-term negative effects. However, even a single incident can cause severe trauma if extremely violent or sadistic behavior (the infliction of pain on the survivor for the offender’s sexual gratification) occurred (Beitchman et al., 1992).
3. Use of force and the intensity of abuse. Using force or causing pain tends to result in more devastating effects. The occurrence of penile penetration is also related to greater trauma.
4. Absence of parental and other support. When a victim first reveals the abuse, lack of support from those close to her potentially results in greater long-term problems. If others criticize or blame her, she may suffer significant psychological distress. The victim may even decide to hide into adulthood what she may perceive as her “dirty secret.” See Highlight 4.4 for suggestions about how to talk and positively relate to victims of sexual abuse.
5. Inability of the survivor to cope. Some individuals have a personality structure that naturally allows them to cope more effectively with crises and stress. Human personality is a complicated concept.
Highlight 4.4
Suggestions for Talking to Children Victimized by Sexual Assault
• Always believe the child. It takes courage to talk about such difficult things, and it’s easy to turn the child off.
• Be warm and empathic. Encourage the child to talk freely to you. Reflecting the child’s feelings back is useful.
• Don’t react with shock or disgust no matter what the child tells you, that only communicates to the child that he or she is the one to blame.
• Encourage the child to share all feelings with you, including the negative ones. Even getting the angry feelings out helps the child overcome the feelings of victimization. Give the child the chance to ventilate his or her feelings so he or she can deal with them.
• Listen to the child, Don’t disagree or argue. Interrupt only when you have to in order to understand what the child is saying.
• Talk to the child in a private place. The child may feel much more comfortable if others aren’t around to hear.
• Tell the child that he or she is not the only child who has had this experience. Other children have, too.
• Allow the child to express feelings of guilt Emphasize to the child that it was not his or her fault. The adult abuser is the one who has a problem and needs help.
• Talk in language that the child can understand. Give accurate information when it’s needed. Let the child repeat things back to you to make certain he or she understands.
• Tell the child that you are very glad he or she told you about the incidents. Emphasize that it was the right thing to do.
• Ask if the child would like to ask you any questions, and be sure to answer them honestly.
• Do not treat the child any differently after he or she has told you. This only communicates that you think he or she is to blame or did the wrong thing.
• If the child asks you to keep the abuse secret, answer honestly. Tell the child that you only want to help, that secrets that hurt people aren’t good to keep, and that the secrets need to be brought out into the open in order to help the person who abused him or her.
• Finally, depending on your situation, don’t let the issue drop. If you are the social worker involved, pursue the problem. Otherwise, tell the parents and/or the appropriate authorities so that the child can get help.
Treatment of Children Who Have Been Sexually Abused: Social Work Role
Because of its prevalence, we will focus on treatment of the incestuous family. Treatment usually progresses through three phases (Crosson-Tower, 2014, pp. 297–298). The first is the disclosure-panic phase. Strong feelings characterize this period of crisis. Family members display much anger and denial. The victim is often frightened about what will happen and eager to blame herself. The second phase is the assessment-awareness phase. During this phase, the family acknowledges that the abuse has occurred and struggles to deal with its consequences. Family members learn about themselves and the dynamics involved in their family interaction. The social worker works to redefine and realign the boundaries of subsystems within the family. This phase tends to be characterized by conflicting feelings. On the one hand, they are angry that the abuse has occurred and eager to blame each other. On the other hand, they are struggling to realign their relationships and express the feelings of love they have for each other. The third phase is the restructure phase. Here the family regains emotional health. Boundaries are clearly established and family members learn how to function within them. Communication is greatly enhanced and members can use it to work out their differences. Parents take responsibility for their behavior, and the victim feels much better about herself.
Initial treatment has several major objectives. The first is to provide a safe environment where the incest survivor feels comfortable enough to talk (Pollio et al., 2011). A survivor must learn how to identify, express, and share her feelings, even when they are negative and frightening. LeVine and Sallee (1999) explain:
Although the child may not have experienced fear during an incestuous relationship, discovery may create anxiety. Children need assurances that no matter what has happened in the past, they are now safe. The end of abuse through the efforts of the police or the child welfare worker will begin to build trust in the child. The child must feel that it is all right for him or her to feel any suppressed guilt, hurt, anger, and confusion. The opportunity to express these feelings honestly, in an atmosphere of trust, begins a sense of security. (p. 329)
A second treatment goal involves having the survivor acknowledge that the abuse was not her fault (Crosson-Tower, 2014; LeVine & Sallee, 1999). Guilt may result from feelings of love for the perpetrator, appreciation of the special attention she received from the abuse, or worry about what the disclosure will do to the family (Crosson-Tower, 2014). Dwelling on inappropriate and unfair self-blame only hampers the recovery process.
A third treatment objective involves teaching survivors to identify and express their emotions in addition to getting control of their problematic behaviors. Cognitive-behavioral therapy techniques, which reflect this objective, have been used effectively to help sexual abuse survivors (Miller- Perrin & Perrin, 2013; Pollio et al., 2011). These approaches embrace the conceptual framework espoused by behavioral (learning) theory (discussed earlier in the chapter). Additionally, they assume an educational perspective of providing information about sexual abuse and its effects, stress the use of homework, expect clients to become actively engaged in changing problematic behavior, and emphasize a strong role for the therapist (Corey, 2013). Cognitive-behavioral techniques “are time-limited, directive, transparent, evidence based, and active, and they focus on changing the factors thought to maintain psychological problems” (Wedding & Corsini, 2014, p. 195). Highlight 4.5 identifies a number of components that can be used in cognitive-behavioral therapy.
Highlight 4.5
Use of Cognitive-Behavioral Techniques with Children Who Have Been Sexually Abused
Miller-Perrin and Perrin (2013) identify and describe the following components of cognitive-behavioral therapy that can be used to help children who have been sexually abused:
• Psychoeducation: Providing accurate information about the problem of sexual abuse and common reactions to this abuse. This component also includes teaching safety skills to help children feel empowered and to help them protect themselves from future victimization.
• Anxiety Reduction Techniques: Training and practice in various relaxation skills to reduce fear and anxiety.
• Affective Expression: Building various skills to help children express and manage their feelings effectively.
• Exposure Therapy: Gradual exposure to elements of the abuse experience in order to decondition negative emotional responses to memories of the abuse. This component involves verbal, written, and play activities to encourage children to share and process abuse-related experiences.
• Cognitive Therapy Techniques: Identifying negative attributions and distorted cognitions (e.g., irrational thinking and inaccurate perceptions) associated with the abuse and replacing them with more accurate thoughts and beliefs.
• Parenting Skills: Training parents in various management techniques to help them become more effective parents. (Rational therapy, a cognitive therapy approach, is described in depth in Chapter 8.) (p. 138)
A fourth treatment goal involves enhancing family communication, support, functioning, and understanding of the abuse (Crosson-Tower, 2014). Individual concerns are dealt with in addition to family interaction issues. Miller-Perrin and Perrin (2013) explain:
Typical themes addressed in family-oriented therapies include parents’ failure to protect the victim from abuse, feelings of guilt and depression resulting from the abuse, the inappropriateness of secrecy, the victims anger toward parents, the perpetrator’s responsibility for the abuse, appropriate forms of touch, confusion about blurred role boundaries, poor communication patterns, and the effect the abuse has had on the child. (p. 142)
Trauma-Informed Care
Approximately 35 million children ages 0–17 have faced one or more types of trauma (National Survey of Children’s Health, 2011/2012). Children may face trauma in their own lives (e.g., maltreatment, domestic violence, poverty, separation from parents) or may face trauma through the witnessing of violence, war, or natural disasters. Children are more vulnerable than adults to psychological harm from these events (Papalia & Martorell, 2015). Children’s responses vary depending on their age and the nature and severity of exposure (Papalia & Martorell, 2015; Santrock, 2016).
Research has shown that trauma can have a negative impact on brain development, including decreased volume in the cerebellum, smaller pre-frontal cortexes, lower Cortisol levels, and decreased electrical activity in the brain (Child Welfare Information Gateway, 2015). These changes can result in children having a persistent fear response, being hyper-aroused, increased internalizing symptoms, diminished executive functioning, delayed developmental milestones, weakened response to positive feedback, and complicated social interactions (Child Welfare Information Gateway, 2015). It is important to note that early intervention can help the brain to recover from trauma (Child Welfare Information Gateway, 2015).
Social workers are encouraged to use trauma-informed approaches and trauma-specific interventions to help address trauma (SAMSHA, 2015). A trauma-informed approach
1. “Realizes the widespread impact of trauma and understands potential paths for recovery;
2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
4. Seeks to actively resist re-traumatization.” (SAMSHA, 2015)
Six key principles included in a trauma-informed approach include safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; cultural, historical, and gender issues (SAMSHA, 2015).
There are multiple trauma-specific interventions (SAMSHA, 2015). Some of these approaches include Adverse childhood experiences (ACE) response, neurosequential model of therapeutics (NMT), and the attachment and biobehavioral catch-up (ABC) for infants and young children (Child Welfare Information Gateway, 2015; SAMSHA, 2015). It is important to consider the clients specific needs in order to choose the right intervention. Trauma-specific interventions include respecting, informing and connecting the client; recognizing the interrelationship between trauma and trauma symptoms (e.g., acting out, substance use, mental health concerns), and the need to work collaboratively with the client, the client’s family and any agencies working with the client in order to empower the client and client system (SAMSHA, 2015). The field of neurobiology and the impact of trauma on the brain continues to expand. It is critical that social workers stay informed about the latest developments.
Prevention of Sexual Abuse: The Need for a Macro-System Response
The ideal way of dealing with sexual abuse is to prevent it from happening at all. Information and education are the keys to prevention. Parents need both education about how to raise children and knowledge that in the event they are in crisis resources are available to help. Parenting education could be made a required part of all high school curricula. Special programs could be made readily available in the community to help parents with these issues.
Educating Children about Sexual Abuse
Children need to be educated about sexual abuse. There are three basic preventative approaches. First, children should be taught that their bodies are their own and that they have private places where nobody can force them to be touched. What comes to mind are the parents who tell their 4-year-old son to go up to each relative at the culmination of an extended family event and “give them a kiss.” The child obviously finds this distasteful. He frowns, looks down at his shoes, and hides behind his mother. He knows that old Aunt Hilda gives really slobbery, wet ones. And she hugs him like the Crusher in a wrestling match, too. He hates the very thought of it, even though his aunt is a kind person who loves him.
Children should have the right to say no if they don’t want to have such intimacy. Parents and teachers can help children determine what are “good touches” and what are “bad touches.” They can also help children develop the confidence to say no to adults in uncomfortable situations involving touching them in ways they don’t like.
A second preventative measure for children is to learn correct sexual terminology right from the beginning. It’s easy for parents, especially if they’re uncomfortable with sexual terminology themselves, to sugarcoat words and refer to “ding-dongs” and “bumps.” One 3-year-old girl came out into the midst of a family gathering and told her mother, “My pooderpie hurts.” She had her hand placed over her clothes on her genital area. Her mother, with a look of terror, desperation, and embarrassment, jumped up and dashed off with her to the bathroom. Apparently, the little girl had to urinate and didn’t identify the feeling as such. A few months later, the same 3-year-old was chattering on about some topic that was desperately important to a 3-year-old, pointed to her buttocks, and interjected something about her pooderpie again. My reaction was, “Yikes, the pooderpie has moved. Where will it go next?”
The point is that if this little girl tells someone that a person touched her pooderpie, that someone might respond, “Oh, that’s nice.” Whomever she tells would have no idea what she was talking about. Inaccurate, childish terminology does not equip children with the communication skills they need if they encounter a sexually abusive situation. Children need to be able to specify what people are doing or have tried to do to them. Only then can their caregivers adequately protect them.
This leads to our third preventative suggestion. Lines of communication between caregivers and children should be encouraged and kept open. Children need to feel that they can share things with’ parents, including things that bother them. In the event that children are placed in a potentially abusive situation, they need to be encouraged and to be able to “tell someone.”

4-7cGender-Role Socialization
Infants are treated differently by virtue of their gender from the moment that they are born (Hyde & DeLamater, 2014; Yarber & Sayad, 2013). There is almost immediate segregation by pink or blue clothing. A basic question remains unresolved. To what extent are males and females inherently different, and in what ways?
This question is related to the nature-nurture argument regarding why people become the people they do. Supporters of the nature idea argue that people are innately programmed with inborn, genetic, or natural predispositions. According to the nurture perspective, people are the product of their environment. That is, people are affected by what happens to them from the day they’re born; they learn from their environment and are shaped by it. Each side of the debate has evidence and research to support its perspective. Probably the answer lies somewhere in the middle. People are probably born with certain potentials and predispositions that are then shaped, strengthened, or suppressed by their environments. Gender roles will be discussed again later in this chapter, in regard to differences in play, and more extensively in Chapter 9.

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