Studies have found several inconsistencies with developmental stage theories. In particular, key concepts from developmental psychology have been refuted in cross-cultural research and other recent studies. For example, the process of language acquisition can differ greatly between children, as can the age at which children recognize their image in a mirror (Broesch, Callaghan, Henrich, Murphy, & Rochat, 2011; Kidd, Donnelly, & Christiansen, 2018). Research has also shown that sympathy arises in children as young as ten months, which is in opposition to Piaget’s claims that young children are predominantly egocentric (Kanakogi, Okumura, Inoue, Kitazaki, & Itakura, 2013; Oakley, 2004). Piaget’s research on conservation with preschoolers has been challenged in that children’s errors were found to be linked to how the questions were asked (Rose & Blank, 1974; Samuel & Bryant, 1984; Winer, Hemphill, & Craig, 1988). We should, therefore, be careful when applying developmental theories to all children and all situations.
For hospitalized children, developmental theories are particularly problematic. Developmental theories offer no guidance in terms of explaining or predicting behaviors in these children, and they do not tell us how to interpret the sequencing and timing of stages. These theories infer that “sick” children are aberrations from the norm because many of them do not fit neatly in a stage that aligns with an age (Black, 2013; James, 2004; James & Curtis, 2012). The “standardization” of the hospitalized child is often difficult to achieve because children’s abilities can vary tremendously across age groups (James, 2004; Koller, 2017). Furthermore, developmental theories applied to children in hospitals do not represent how these children perceive themselves and what they are experiencing (Alderson, Sutcliffe, & Curtis, 2006; James & Curtis, 2012). Finally, dominant theories of child development depict children as immature and passive objects, creating distance between adults and children that can inhibit active youth participation (Berman & MacNevin, 2017; Brady, Lowe, & Lauritzen, 2015; Burman, 2017; James & James, 2012; James & Prout, 1997; Koller, 2017). Despite all these concerns, the predominance of child development theories informed by developmental psychology has had a powerful and significant influence on policy, pedagogy, and practice (Robinson & Jones Díaz, 2016).
In the field of child life, we continue to revere developmental theories without any apparent critical appraisal. Questions regarding developmental theories are included on certification exams, and many child life textbooks focus almost exclusively on developmental frameworks as foundational to child life practice. While we may not need to entirely discard these theories from our teaching and practice, we must acknowledge their impenetrable stance and invite students to “problematize” the premise of stage theories (Blaisdell, 2019; James, 2004; James & James, 2012). Student engagement in the evaluation of theories promotes critical thinking and reflective practice over time—two essential skills for healthcare professionals. At the same time, educators in child life have an ethical responsibility to identify the benefits, risks, and limitations of all theories that inform practice. For child life pedagogy, this means that we must teach students how to think rather than just what to think.
The over-reliance on developmental theories has led to the practice of developmental assessments and the use of screening tools. While assessment tools can offer helpful information about a child’s abilities, we must be explicit about their benefits, risks, and limitations. These assessments impose power dynamics between the adult and child, predominantly because the child is forced to “perform” a range of skills required by the screening tool. For example, the Denver Developmental Screening Test appraises a child’s pincer grasp—a fine motor skill that involves picking up a raisin with two fingers. While fine motor skills are important, child life should remain focused on psychosocial care that emphasizes strengths and risks associated with a child’s social and emotional well-being. Let’s leave pincer grasp assessments to the occupational therapists!
Professionals have the responsibility to challenge dominant discourses and to be open to alternative ways of knowing. This notion is consistent with the Code of Ethics (Association of Child Life Professionals, 2019), revised by the Association of Child Life Professionals’ Child Life Certification Commission to guide and enforce the ethical standards for Certified Child Life Specialists. These regulations are communicated through 13 fundamental principles that are directly related to professional development and the implementation of best practices within the field.
Specifically, Principles 5 and 6 state that Certified Child Life Specialists have a duty to maintain competencies in order to provide high-quality programs; this can be accomplished by “continually seek[ing] knowledge and skills that will update and enhance their understanding of all relevant issues affecting the children and families they serve” (Association of Child Life Professionals, 2019, p. 1).
Developmental theories are woven into the fabric of our society; these paradigms have shaped the ways in which children are understood (James & Prout, 1997). Because developmental frameworks are not always helpful in our work with children and families, professionals have looked elsewhere for theoretical relevance (Penn, 2014). For the past several years, the sociology of childhood and research involving child participants have shifted the focus from developmental stages to a strengthsbased model that views children as autonomous rights-holders (Alderson, 2007; Brady et al., 2015; James & James, 2012; Woodhead, 2005).
This alternative narrative emerged in the 1990s in response to dominant child development discourses (James & Prout, 1997). It posits that childhood is a social construction that is influenced by historical, political, and cultural contexts (Coyne, Hallström, & Söderbäck, 2016). Therefore, children are expected to develop differently based on a multitude of factors. Sociology of childhood “allows us to see the individual child as a social actor in the collectivity of children and allows us to recognise both the uniqueness of his/her childhood as well as its commonality as a life course phase” (James & James, 2004, p. 27).
We should make deliberate attempts to scrutinize our assumptions about how children develop and decide which aspects of developmental theories are worth keeping. We should also be prepared to embrace a strengths-based model that more adequately depicts the resilience and agency we see in children every day.