NORMAL DEVELOPMENT

Normal development in middle childhood

Gordon T Harold Dale F Hay

Middle childhood (511 years of age) is marked by gradual change in terms of physical growth, but significant change in terms of psychological development. This contribution reviews recent research highlighting dimensions of childrens normal psychological development and notes some factors operating in middle childhood that are linked to later mental health problems.

Physical growth and motor skill development

During middle childhood, muscle fibres increasingly replace the proportion of cellular fluid in tissue and bones continue to strengthen (Figure 1). Girls outpace boys in skeletal development: by 12 years of age, bone ossification in girls is 2 years ahead of that in boys. Childrens physical strength also develops. For example, the average 10-year-old can throw a ball twice as far as the average 6-year-old. The physical changes of middle childhood affect the childs emerging awareness of the self as a physical and social being. The self-concept becomes differentiated, as children come to understand that they are not equally competent in athletic, academic and social domains. A childs psychological well-being is influenced by his or her ability to understand and accept the fact that different children have different skills and deficits in these domains.

Weight gain and loss

One physical factor that may affect a childs emotional and physical well-being during middle childhood is weight gain and/or loss and its correlate, body image. Children who are overweight are sometimes subject to ridicule, resulting in lower levels of selfesteem. These problems do not augur well for future mental health. Indeed, overweight adults who were obese as children suffer more psychological problems than overweight adults who were of normal weight as children. By the end of middle childhood, many children are concerned about their weight; for example, in a 1999 study of 401 12-year-olds, 20% of girls and 8% of boys were currently dieting. Early-onset anorexia nervosa in the middle childhood years,

Gordon T Harold is a Senior Lecturer in the School of Psychology, Cardiff University, UK. His special interests include the role of the family environment in the onset and development of childhood emotional and behavioural problems. Dale F Hay is Professor of Psychology at Cardiff University, UK. She studies social development in infancy and childhood, with special emphasis on cooperation, conflict, interpersonal relationships and the development of psychopathology.

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2005 The Medicine Publishing Company Ltd

NORMAL DEVELOPMENT

Physical growth charts for children aged 612 years

Height by age percentiles: 612 years
160 150 140 130 120 110 100 6 7 8 9 10 11 12 50th 160 150 140 130 120 110 100 60 55 90th 50 45 90th

Weight by age percentiles: 612 years

60 55 50 45 40 35 50th 10th 30 25 20 15 10 6 7 8 9 10 11 12

Boys Girls

Height (cm)

Weight (kg)

40 35 30 25 20 15 10

10th

Age (years) 1

Age (years)

Adapted from Berger K S, Thompson R A. The developing person: through childhood and adolescence. 4th ed. New York: Worth, 1995.

which may be partly associated with reduced cerebral blood flow, is a serious mental (and physical) health problem.

Cognitive development in middle childhood

Cognitive development refers to how a person perceives, thinks and gains an understanding of his or her world through the action and co-action of genetic and learned factors. The study of cognitive development in childhood has long been influenced by Jean Piaget, who characterized middle childhood as a particularly important developmental stage. During this period, children begin to use concrete operations a set of rules or strategies for examining and interacting with the world. Piagets emphasis on cognitive operations drew attention to such abilities as reversibility and inductive logic. More recently, cognitive psychologists have been much influenced by the Russian theorist, Lev Vygotsky, who emphasized the social and cultural underpinnings of cognitive development and the importance of studying childrens thought in everyday social situations. Reasoning: current work on childrens reasoning suggests that the ability to appreciate logical argument emerges in the middle childhood years, although the ability to understand complex mental operations increases from early childhood to adolescence. Children apply their emerging reasoning abilities to many realworld issues, including the nature of friendship, environmental disasters and even the naturenurture debate (how genes and the social environment work together to affect development). Thinking about thinking: children in middle childhood show an ability to engage in metacognitive thought. In other words, they can think about their own cognitive processes as well as consider what is required to complete a specific task effectively. Six-yearolds who talk to themselves about what they are doing are more likely than other children to complete challenging tasks. Most children in primary school are able to reflect on their own ability to read, and their judgements are consistent with their teachers ratings of success at reading.
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Memory: while working memory begins to develop during infancy and early childhood, children in middle childhood (511 years of age) improve significantly in their ability to store and retrieve information (mnemonic ability). For example, they learn that rehearsing information is a useful aid to memory. They also show an increased ability to reflect on and recount stories about their past (autobiographical memory). This is partly due to an improvement in verbal skills, but is also influenced by parentchild interaction. However, childrens emotional reactions to traumatic events may influence the accuracy of their memories, which has implications if they testify in court: when asked for spontaneous memories, children generally report accurately, but may become confused in response to leading questions. Language and literacy: during middle childhood, childrens vocabularies increase, and they can better understand the complexities of other peoples speech, including the use of passive voice, comparatives and metaphorical speech. Development also occurs in the area of pragmatics, which includes the ability to express intentions, participate in conversation and talk at length on certain subjects. Middle childhood is also when children either master literacy skills or develop reading and writing problems. Reading ability develops more rapidly in some cultures than others, and fluent reading is more easily attained in phonetic languages such as Spanish and Welsh. Comparison of adoptive and non-adoptive sibling pairs revealed a moderate genetic contribution to stability in reading performance from 7 to 12 years of age; in contrast, change in reading performance over those years was related to unique environmental influences, such as particular schoolteachers and methods of instruction.

Socioemotional development in middle childhood

Understanding and regulating emotions: acquiring an understanding of the emotions expressed by other people, and regulating ones own emotions, are essential for healthy psychological development. Failures of emotional regulation are associated with anxiety, depression, high-aggressive attention deficit

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2005 The Medicine Publishing Company Ltd

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hyperactivity disorder (ADHD) and conduct disorder in middle childhood. Understanding and regulating emotions depends crucially on social engagement, and particularly on emotional socialization by parents. In later childhood, parents influence emotional attributes such as confidence, pride, shame, guilt and gender-appropriate emotional expression (e.g. big boys dont cry). Children who are exposed to hostile working models of family relationships show deficits in the understanding of emotion, and come to assume that other people have generally hostile intentions towards themselves. Maltreated children have problems regulating their emotions and are more likely both to bully their peers and to be victimized by other bullies. At the same time, maltreatment is itself linked to parents failure to understand childrens emotion. Parents and childrens relationships in middle childhood: although successful regulation and understanding of emotion may partly derive from secure attachment relationships in infancy, childrens emotional security does not necessarily remain stable over the childhood years. Some children become less secure in the face of divorce or other life events, whereas others become more secure. The nature of the relationship between the two parents, particularly the extent to which they engage in frequent, intense, poorly resolved and child-related conflict, affects the childs psychological development. Parenting style and discipline practices have implications for childrens autonomy, secure emotional development and psychological well-being. For example, children get angry or else withdraw emotionally when parents appear passive and unresponsive to their needs. Inconsistent discipline and harsh parenting predict conduct problems and delinquency. Parental psychopathology has a number of adverse effects on childrens emotional and cognitive development. Economic pressures put parents at risk for depression, and also undermine the quality of the interparental and parentchild relationships, which in turn put children at risk for mental health problems. Sibling relationships become increasingly important when there is family disruption. Siblings support each other in the face of serious family violence and divorce; indeed, a review of findings from existing studies revealed that sibling relationships are generally more positive in divorced families than in intact ones. On the other hand, in intact families, marital conflict can have adverse effects on sibling relationships. Sibling relationships are also affected by the gender composition of the sibling pair and parents own mental health and parenting practices. Sibling relationships are generally more fraught in complex step-family arrangements. Peer relationships increase in importance in middle childhood (Figure 2). There are clear links between peer relationships and family life. Parents social networks influence their childrens friendships, and secure attachments between children and their mothers foster positive peer relationships, especially in middle childhood. Sibling relationships also influence the quality of peer interaction. Within the classroom, or in other settings where peers meet, friendships and groups soon form, and some children are generally more popular than others. Preferences for same-sex peers begin in late infancy and are marked in the middle childhood years. In
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2 The importance of peers.

addition, children tend to reject other children who behave aggressively. The fact that aggressive children believe that other children are hostile, and act accordingly, further promotes rejection. Peer rejection contributes to a later tendency to associate with other aggressive children, which in turn predicts later conduct problems and delinquency. Peer rejection is also linked to childrens depressive symptoms, although this association is less stable over time.

Conclusion
Physical, cognitive and social factors (specifically the quality of family relationships and peer influences) collectively affect the adaptive or maladaptive pathways that children chart from childhood to adulthood. In middle childhood, children reach new levels of cognitive, emotional and social functioning that allow them to interpret and engage with their social worlds, as a preparatory step for the challenges that the next years will inevitably bring.

FURTHER READING Goswami U, ed. Handbook of childhood cognitive development. Oxford: Blackwell, 2002. Hart C, Smith P, eds. Handbook of childhood social development. Oxford: Blackwell, 2002. (These texts represent the most up-to-date accessible review of research covered in this article. A full reference list is available on request.)

PSYCHIATRY 4:6

2005 The Medicine Publishing Company Ltd