Development Across the Lifespan

People grow and develop throughout the entire lifespan, in stages of development from birth through old age. While the most rapid changes occur in early childhood, individuals continue to change and evolve as they age. This chapter will give an overview of factors that influence development, review physical, cognitive (mental), social, cultural, and emotional aspects of development, address commonly accepted developmental stages, and discuss how indigenous culture influences development.

Child development refers to the stages of children’s development, growth, and learning. Developmental growth, such as when babies learn how to grasp items, sit up, crawl, stand, and walk, occurs in predictable patterns across cultures and environments. However, these “normal” patterns of development can vary between individuals, families, communities, and cultures.

The developmental process is affected by both genetics and environment. Genetics refers to traits passed down from parents to their children through their genes. Environmental influence refers to traits that are learned based on positive and negative experiences, including:

• The prenatal environment (before birth).
  • Positive factors include the mother eating a healthy diet, exercising regularly, and reducing stress.
  • Negative factors include the mother drinking alcohol or using tobacco and other drugs, eating a poor diet, being a victim or perpetrator of physical violence, and experiencing undue stress while pregnant.
    Note: There is no safe amount of alcohol, marijuana, or any recreational drug for a developing fetus. Pregnant mothers should only take medication that is prescribed by a doctor or approved for over-the-counter use with pregnant women. Encourage pregnant clients to consult with their medical provider with any questions about medications.
• The learning environment.
  • Positive factors include engaging the child by reading, singing, playing games, dancing, and storytelling.
  • Negative factors include a lack of social engagement and too much time watching television or being in front of computer screens or other electronic devices.
• The emotional environment.
  • Positive factors include love, encouragement, acceptance, attunement, and reflecting emotions. This also includes families having predictable and consistent expectations and rules, children having positive adult role models, and adults having healthy and respectful relationships.
  • Negative factors include emotional abuse, neglect, yelling, invalidation, and rejection. Negative factors also include substance abuse in the home and caregivers who allow children to engage in illicit behavior in the home or community.
• Physical surroundings.
  • Positive factors include access to clean clothes and bedding, healthy food, and physical safety. Physical safety includes having harmful items secured (e.g., firearms, poisons, and medications are locked or stored in a different home), family pets who are well trained and safe around children, and a designated safe place to go when there are problems.
  • Negative factors include overcrowding, physical aggression, exposed wires or insulation in the home, and a lack of adequate supervision for young children. For elders, this may include trip hazards inside the house or icy stairs and walkways outside the house.
• Social and cultural influences.
  • Positive factors include social time with family, friends, elders, and peers and participation in cultural events and activities like beading, sewing, hunting, fishing, collecting wood, or picking berries.
  • Negative factors include teasing, bullying, or name-calling. This also includes isolating or excluding others from social and cultural events and activities.

In addition to each of these environments or factors, development across the lifespan is also largely influenced by brain development. The brain is the most important organ in the body because it controls our physical actions and reactions, allows us to think and feel, and stores memories that help us relate to and navigate the world.

Most brain cells are formed before birth. During infancy and childhood, brain cell connections begin to form the foundation for how people think. Childhood is an intensive period for brain development; a three-year-old's brain is twice as active as an adult brain. Brain development is vulnerable to positive and negative influences in the womb and as a baby grows.

Brain cell connections get stronger with:

• Good food and nutrition.
• Responsive caregivers.
• Stimulating daily activities.
• Love or attachment between a child and other people.

Positive interactions between the child, caregivers, and the environment stimulate healthy brain development.

• Surrounding children with speech and language helps them develop healthy brains.
• Children do not need special or expensive learning toys for healthy brain development.
• Caregivers stimulate healthy brain development through expressive interactions with the baby or child. Encourage parents to smile at their children often, especially when their children smile.

Healthy activities for brain development include:

• Talking or making sounds to communicate.
• Touching and feeling different objects and textures.
• Singing.
• Playing.
• Reading.
• Learning multiple languages, such as Native languages. Native languages support emotional connections like laughter, rhythm, and identity.

Alcohol and drug use have a negative impact on brain development, especially for children and adolescents.

• Babies who have been exposed to drugs and alcohol before birth may have smaller or damaged brains (see Chapter E-5: Fetal Alcohol Spectrum Disorders for more information).
• Youth who drink alcohol may damage the part of the brain that handles memory and learning.
• The younger the person is, the greater the impact of drugs and alcohol on brain development.

Traumatic Brain Injury (TBI) is damage to the brain resulting from an injury. TBIs can cause mild to serious damage to brain development. For more information on TBIs, see Chapter E-3: Behavioral Health and Medical Conditions .

Trauma, child abuse, and neglect during infancy and early childhood have been shown to negatively affect early brain development. For more information on child abuse and neglect, see Chapter D-3: Abuse and Neglect.

A non-stimulating environment without healthy speech and language can also hinder a child’s developing brain.

There are several general areas of human development, and one area of development often affects another. For example, a delay in speech development may affect the child’s ability to communicate with others, build relationships, or develop healthy self-esteem.

Physical Development:

• Involves growth of the body, including bones, muscles, and organs.
• Contributes to control and coordination of gross motor skills (large body movements such as throwing a ball or running).
• Contributes to control and coordination of fine motor skills (small body movements such as grasping a pencil).
• Includes hands-on activities such as camping, taking walks, and connecting with nature, which promote physical development.

Cognitive (Mental) Development:

• Includes mental or intellectual growth, as well as brain development.
• Impacts thinking, memory, problem solving, and language skills.
• Involves working with the senses and providing stimulating experiences.
• Is influenced by many factors, including home environment, diet, and social connections.
• Can be severely impacted by prenatal exposure to alcohol or other drugs.
• Can be disrupted in minors by consuming any amount of alcohol or drugs.

Social and Cultural Development:

• Starts in early childhood.
• Includes how an individual interacts with others in social groups.
• Impacts relationships between the individual and the family, relatives, and other community members.
• Is promoted by learning traditional activities such as fishing, hunting, and dancing.
• Builds identity. People can learn family and community values and expected norms through traditional activities that reinforce knowledge.

Emotional Development:

• Includes the recognition of emotions and the development of feelings, both expressing and containing them.
• Involves a personal identity, self-esteem, and the ability to engage in two-sided emotional relationships.

Human development is often defined by loose developmental stages: prenatal/early childhood (0-6), childhood (6-12), adolescence (12-18), early adulthood (18-40), adulthood (40-65), and late adulthood/maturity (65+).

The first year of life is the foundation for learning that comes in later phases. For example, a child will learn a skill, practice it, and then move on to a new skill; the mastered skill then provides the basis for further development.

Several factors contribute to a child's early growth and development, including prenatal stress, prenatal exposure to alcohol or other substances, mother's age, and the child's natural temperament. The Typical Development table below provides greater detail regarding infants, early toddlers, toddlers, and preschoolers. Remember that these are general timeframes when development occurs; some children develop faster as children, while others may develop slowly or steadily over time. If there is concern about how a child is developing, encourage the parents to consult with the child's medical provider.

• Physical: Significant advances in physical development throughout early childhood include sitting up, rolling over, crawling, walking, running, and climbing. There are also advances in fine motor development, such as grasping, holding, coloring, and writing.
• Cognitive: Significant gains are made in cognitive development through early childhood, particularly regarding attention, memory, and perception. However, the most obvious development is language because it is the most accessible expression of the child's internal experience. In the first five years, children develop language rapidly, progressing from crying to cooing, smiling, fussing, babbling, first words, and full language.
• Social/Cultural: Children adapt socially when they have nurturing, attentive, and consistent caregivers. They learn that the world is safe and they are able to develop secure attachments and bonds with others. Caregiver attachment can be negatively affected by substance abuse, stress, mental illness, and infant temperament. This developmental stage is also when cultural practices are introduced and normalized. This may include the introduction of culturally relevant food items, clothing materials, games, or spiritual practices.
• Emotional: Children tend to see themselves as the center of the universe. Toward the end of this stage, they are able to develop a sense of self-concept and recognize ideas and thoughts they have about themselves. They are also able to start noticing that other people have thoughts and plans. Being able to identify different emotions at this age can be challenging, and young children tend to focus on being happy, sad, or angry.

TYPICAL DEVELOPMENT
Infants (Age 0 - 1 Year)
Physical	Natural reflexes become intentional movements Strengthens muscles by lifting head and rolling over Begins walking between 9 and 16 months Develops and maintains control over parts of the body
Cognitive	Alert and interested in environment Ability to move leads to broadened world and stimulates brain growth Develops object permanence at approximately 9-12 months; can search for an object hidden underneath a blanket or cloth
Social	Forms trusting attachments to caregivers and family members Imitates sounds Communicates through cries and facial expressions
Emotional	Learns to trust that caregivers will meet needs, forming the foundation for emotional security Develops a sense of attachment to caregivers
Early Toddlers (Age 1 - 2 Years)
Physical	Improves gross motor movements, like throwing a ball and running Develops fine motor movements, like grasping a crayon Improves balance and coordination
Cognitive	Begins to understand and produce language Symbolic thought emerges as part of play, e.g., using a box as a pretend car
Social	Learns simple games; play is the focus during this year Builds relationships with caregivers or other significant people
Emotional	Continues to build trust and attachment with caregivers Near age 2, gains the ability to separate and explore beyond the arms of the caregiver
Toddlers (Age 2-3)
Physical	Learns to use the potty; may continue to need help with skills like wiping and washing past this stage Is able to jump up from a standing position and learns how to jump onto and off of low structures
Cognitive	Practices using more speech and language skills; uses short sentences Communicates verbally with caregivers
Social	Learns to imitate social roles, e.g., making mud pies or pretending to hunt and fish Learns to play alongside other children, but not always interact with them (this is called parallel play)
Emotional	Begins to separate from the caregiver and explore the world Starts to show more independence, test boundaries, and use refusal skills such as saying “No!” Emotional and assertive development, often referred to as the “terrible twos,” is normal
Preschoolers (Age 3-5 Years)
Physical	Very busy, with lots of active movement Grows about 4-5 pounds and 3-4 inches per year Brain almost fully developed (about 80%)
Cognitive	Sees self as the center of the universe; unable to see the world from another’s eyes Thinks in literal and concrete ways, e.g., if somebody says it is “raining cats and dogs” the child might think there are real dogs and cats coming from the sky May have an imaginary friend or playmate
Social	Learns to play interactively with other children Experiments with playing social roles like mother, father, or hunter Begins to learn social rules such as sharing and taking turns Begins to learn boundaries for acceptable behavior
Emotional	Begins taking active steps to explore the world Needs to have trust with caregivers in order to make these steps towards independence

Youth in this developmental stage are better able to take care of themselves, and parents often feel that the period is less strenuous than early childhood. Social interests broaden through school and other activities; however, youth in middle childhood are still strongly influenced by their immediate family and caregivers.

• Physical: In comparison to early childhood, growth is relatively slow. Girls tend to have a growth spurt around age nine, whereas boys tend to have a growth spurt around age 11. Nutrition can have a significant impact on growth, weight, and height. There have been significant increases in childhood obesity rates among school-aged children in the United States. It is important for families to develop healthy eating habits and norms during this period. Physical activity is important to maintain a healthy body. Furthermore, physical activity also is beneficial to cognitive and emotional growth, academic performance, self-esteem, positive emotions, and overall mood.
• Cognitive: There is dramatic cognitive development through the middle childhood stage. Children develop complex reasoning and problem-solving strategies. For example, a six- or seven-year-old child may approach a problem or puzzle through trial and error, while an eleven- or twelve-year-old child will be more likely to think through possible outcomes and solutions. Middle childhood also involves an increase in language and expression. Children are better able to express their thoughts and participate in conversations with others.
• Social/Cultural: Secure parental attachment continues to be a key factor in the child's healthy development. However, friendships in this stage evolve beyond those in early childhood. Youth in middle childhood are more likely to seek social companions with shared interests. Furthermore, friendships may increase in closeness, trust, and loyalty. Middle childhood is also when youth become increasingly aware of their participation in cultural activities and integrate family and community values. Becoming aware of family and community roles is an important component of social and cultural development during the middle childhood stage.
• Emotional: A child's self-concept is heavily influenced by family members and peers. Because of rapid cognitive development, children in this stage become increasingly aware of their internal emotional experience. This period is also when youth can begin to experience fluctuations in their self-esteem, particularly if they believe or feel like they are inadequate compared to others in their social group or family. Youth in middle childhood become more aware of their individual limitations, and this can cause distress if they are not similarly able to identify their strengths and abilities.

TYPICAL DEVELOPMENT School-Age Children (Age 6-12)
Physical	Steady growth of 3-4 inches per year Takes fewer or no naps and has longer-lasting energy and activity Plays structured games like jump rope, basketball, or team sports May begin to experience early hormonal changes (puberty) by age 10-12
Cognitive	Develops increased logic and abstract thinking between 5 and 7 years of age (e.g., a child who hears that it is “raining cats and dogs” no longer thinks that real cats and dogs are coming from the sky and can understand that this is just a figure of speech) Grows language and memory skills; can now remember to follow simple instructions
Social	Learns to be guided by rules in play, games, and sports Understands more complex social roles such as teacher, mother, father, and family provider; gains a better understanding of family order
Emotional	Learns to be productive and hardworking, especially at school, which leads to increased confidence Becomes self-directed and goal-focused Can follow through on tasks, adding to sense of self within the community

This stage sees a significant increase in growth and conflict. Adolescents tend to seek increased freedom and independence from their families. This can include changes in the youth's interests, mood, and communication style. Parents of adolescents can find it challenging to facilitate their growth and development and still protect them from risky early-adult behavior.

• Physical: Adolescence is when individuals become physically capable of sexual reproduction. This developmental process is called puberty and involves a physical growth spurt as well as the development of sex characteristics. Weight and nutrition play a role in the timing of puberty; children who are underweight or malnourished may expect a delayed onset of puberty, whereas overweight or obese youth are more likely to experience an earlier onset of puberty than average. Sleep is also a major issue that influences physical development during adolescence. Adolescents typically need at least nine hours of sleep per night; however, they also experience a shift in their sleeping cycle and have a natural desire to stay up later at night. Insufficient sleep has been associated with cigarette use, alcohol use, sexual activity, suicidal ideation, sad or hopeless thoughts, and limited physical activity.
• Cognitive: The adolescent brain continues to evolve and change. Teens start to be able to think abstractly and consider alternative possibilities and perspectives when thinking about a topic. This leads to changes in thought patterns and behaviors. The structure of the brain continues to develop as well. During adolescence, the part of the brain that controls emotions, the limbic system, is close to reaching full maturity. However, the prefrontal cortex, which is responsible for complex planning and impulse control, develops at a much slower rate. This is one reason why adolescents can appear to so reactive and impulsive and may take more risks than those in other developmental stages.
• Social/Cultural: Teenagers spend increasing amounts of time away from their families during this period. They are often seeking to feel independent and in control of decisions made about their life. However, it is important for parents to be observant of and attentive to their teens. Peer groups are especially influential during the adolescent years. An important process in adolescence is developing a sense of personal identity. It is common for teens to experiment with and explore different interests, hobbies, and styles. Teens also become naturally aware and curious of their sexuality and sexual interests. Social and cultural development includes learning about healthy relationship patterns and sexual health and wellness education.
• Emotional: Physical changes during puberty and adolescence influence how youth see themselves. There are also a number of significant life transitions that teens can struggle to adjust to. Some include changes in school expectations, being required to be more responsible for chores or childcare at home, needing to work part time, entering their first romantic relationship, and/or being increasingly responsible to provide for the family. For some teens, this can take an emotional toll and contribute to higher levels of stress, as well as feelings of anxiety or depressed thoughts. Some teens try to manage internal distress through substance use or abuse. It is very important to help teens learn healthy coping patterns to deal with stress and negative emotions through exercise, writing, or speaking with Elders in the community.

TYPICAL DEVELOPMENT Adolescents (Ages 12-18)
Physical	Develops physical changes of puberty, including sex organs and secondary sex characteristics, such as the widening of hips for women, development of breasts, and addition of pubic hair Lower and deeper voice sounds due to growing voice box; this is especially prominent in boys Self–consciousness about body due to rapid physical development
Cognitive	Increases hypothetical thinking (considering "what if") and logical thinking (e.g., if/then) Expands abstract thinking; can think about concepts and ideas; develops insight
Social	Identifies with peers (e.g., regarding clothing and music) more than with family Greater importance on fitting into a peer group and the feeling of “belonging” Values loyalty and trust within relationships May be increasingly helpful to others, especially elders, and a contributing member of the community (e.g., may chop wood for others, learn how to hunt and share first catch with others, clean houses for Elders, or tutor children)
Emotional	Tries to figure out “Who am I?” and “How do I fit into this world?”; this sets the stage for continued growth in relationships, school, and work Develops an interest in romantic relationships and may start having casual or serious dating relationships

Early Adulthood (18-40): Early adulthood represents a significant change in the developmental lifespan. Often, this is when people leave their home of origin and have their own living space, enter the workforce full time, spend time outside of their home community, enter a long-term romantic relationship, and start their own families. There are many different ways to enter adulthood, as well as opportunities for work and education. Many youth in previous generations entered their 20s with a career path or life plan, but now, young adults have more of a tendency to delay long-term careers and explore different options.

• Physical: A number of physical changes occur during early adulthood. Individuals continue to grow and develop physically during the early stages of adulthood. For example, people tend to gain weight throughout the period of early adulthood before beginning to lose weight in middle adulthood. Skin may start to wrinkle and sag due to a loss of elasticity. Hair starts to gray, and both men and women can experience thinning hair or hair loss, although it is most common in men. Physical changes can be heavily influenced by environmental factors and lifestyle choices. In particular, smoking, drinking alcohol, drug use, and a poor diet will cause the aging process to occur more rapidly, and can contribute to physical health problems throughout adulthood.
• Cognitive: Significant growth in cognitive abilities continues throughout this stage. The prefrontal cortex (responsible for planning and judgment) is often not fully matured until the mid-20s and individuals develop more fluid thinking abilities (e.g., applying previously learned knowledge to new or novel situations) into their 30s. Adults also continue to learn and develop static knowledge or facts, particularly those related to their work or their role in the family.
• Social/Cultural: By adulthood, most individuals have developed a sense of purpose and of their role in their social and cultural community. Some factors contribute to challenges during this stage, particularly in rural Alaska. Climate change is affecting traditional hunting and gathering seasons. Also, economic strain within Alaska and the United States contributes to an extremely high cost of living in rural Alaska, which often results in people moving from rural communities to urban settings to pursue employment and stable, affordable housing. This can make it challenging to engage in meaningful cultural practices.
• Emotional: The transition from adolescence to adulthood brings with it significant stressors, particularly if the individual and/or community does not have the resources or opportunity to fulfill their expected role. People in adult stages can also experience high rates of unemployment, unaffordable housing, a lack of career opportunities, disrupted subsistence patterns, and the inability to contribute to their communities, which can lead to significant emotional distress.
  Note: Alaska Native men in this developmental stage are at a significantly elevated risk to die by suicide. Consult with your supervisor if you are concerned about any clients that might be particularly affected by these factors. For more information, see Chapter D-6: Suicidal Thoughts and Plans.

Middle Adulthood (40-65): People can take many different paths during their middle adulthood years. However, this is typically when individuals are settled into a career or occupation, which they will typically maintain until a later age than those in previous generations. They may have a long-term partnership or marriage and a family of their own. Adulthood is also influenced by cultural and economic factors and may include individuals becoming community mentors and culture bearers. This may involve formal roles, like teaching and coaching, and informal roles such as mentoring and modeling community and cultural values.

• Physical: Similar to early adulthood, physical changes continue as the body ages. In particular, skin may start to wrinkle and there may be discoloration. Exercise during adulthood is increasingly important to prevent the onset of illness or likelihood of injury. Abstaining from smoking and alcohol use, as well as maintaining a healthy diet, helps promote the healthy functioning of critical organs like the heart and lungs. From the mid-30s through the 50s, women tend to experience a decline in the hormone estrogen, which causes menopause, the permanent ending of menstrual cycles.
• Cognitive: People tend to gain more knowledge as they age and have a range of life experiences. Into mid-life, middle adults improve their ability to integrate different sources of information, such as emotional, relational, and personal memories; this helps to develop a more complete picture of their lives and experiences. There is not a significant decline in memory functioning during this period, and any differences are likely related to short-term memory lapses.
• Social/Cultural: Middle adults have developed a fairly consistent identity and role within their family and community. They may become more engaged in giving back and/or sharing knowledge with their community. Parenting can be a significant part of this life stage and can impact how people manage their work/life balance. Fulfilling the roles of productive employee, parent, and community member can be difficult and adults will need to prioritize where they direct their energy and resources. Finally, this stage may include the transition to caring for their own parents who are in late adulthood. The role reversal varies across cultural groups, with some aging parents moving in with their adult children or receiving care in supported living arrangements. Regardless, the experience can be challenging for the adult children and the aging parent.
• Emotional: As people age, they tend to become more emotionally stable and experience less emotional volatility, even for those whose mood swings were more intense than normal.

Late Adulthood/Maturity (65+): Late adulthood brings with it new possibilities and challenges. As individuals age and exit the workforce, they will often seek to find meaning in their lives through reflection and engagement in new or different activities. Spending time with family members and friends, as well as joining clubs and being part of community activities, are examples of some of the ways to enter maturity and find meaning.

• Physical: As people enter late adulthood, the senses of vision and hearing decline, which can cause difficulty. Skin continues to wrinkle, and muscle strength and bone density reduce over time. Older adults can reduce the likelihood of developing a disease by continuing to exercise and have a healthy diet. Many declines in physical capabilities are related to normal aging. However, these changes do put individuals at increased risk for injury and illness.
• Cognitive: Late adulthood also brings some declines, ranging from slight to significant, in cognitive abilities. Most commonly, older adults can experience difficulty with their working memory, making it difficult to manage multiple ideas or thoughts at the same time. Older adults are generally able to retain abilities to do learned tasks, such as beading, dance, or driving. However, their ability to quickly recall memories or hold a thought or idea for long periods of time may decline.
• Social/Cultural: Significant social stressors in later adulthood can include the death of a spouse or close friends. Retirement or exiting the workforce will lead to a new role transition, and depending on community and cultural resources, this can be both positive and rewarding as well as stressful and upsetting. In many indigenous communities and cultures, individuals in late adulthood are often held in high esteem and have vital roles within the community; continued engagement in the community is an important factor in the health of older adults.
• Emotional: Primary emotional challenges in late adulthood are often related to managing grief and processing significant life changes and transitions. Healthy transitions throughout the lifespan are indications that the individual will transition to maturity more adaptively than those who had challenges during transitions in earlier developmental stages. There is no significant increased risk of developing a psychological disorder during late adulthood in general; however, being a member of cultural group that values and engages older adults (such as Alaska Native cultures) can be a protective factor in late adulthood.

There are many changes and transitions that happen later in life which often result in an increased need for healthcare and support in daily activities. For more information, see: Caring for Elders.

Alaska Native traditions are important in raising children, and children have always been a top priority in traditional life. There are many traditional teachings about the relationship between a mother and her baby even before the baby is born. Traditional values are important for children’s healthy development. These values help to shape and build mind, body, and spirit.

Spiritual development is often an important element of growing up in an Alaska Native culture.

• As people develop physically, emotionally, mentally, and socially, they also experience spiritual development in stages.
• Spiritual development often occurs through teaching and mentoring. Stories from family members, Elders, and/or religious leaders play an important role.
• Examples of spiritual expression include drumming, dancing, praying, meditation, attending church, or connecting with nature.
• The specifics of how a child develops spiritually are likely to be different depending on regional, cultural, and family traditions.

Traditional parenting approaches. Cultural approaches to parenting may differ between regions, so it is important to learn about local beliefs and customs. As a BHA/P, there are many ways you can promote traditional values and practices for families raising children. You can encourage:

• Caregivers to honor these traditions; they help parents as well as children.
• Children to make intergenerational connections with elders.
• Caregivers and elders to engage in storytelling with children. This creates curiosity within children, fosters a connection to their culture, provides good life lessons, and strengthens listening skills.
• Everyone to engage in hands-on traditional activities that build self-esteem.
• Caregivers to help children learn responsibility and discipline through activities such as chores, helping family members, and completing school work.
• Caregivers to give their children attention and praise.