Developmental Considerations for Supporting Children and Teens

Developmental Considerations for Talking and Listening with Children

Self Efficacy: a person’s belief in his or her ability to succeed in a particular situation. If a child/teen believes s/he can be successful in a particular situation (such as dealing with a bully or facing classmates for the first time after burn injury), this belief helps determine how the child thinks, behaves, and feels. (Albert Bandura)

In support groups, children can experience a carefully managed social setting which affords them the opportunity to succeed; transferring this experience into their school, home, etc. is an invaluable tool. If they can feel safe, happy, and successful in support group, this impacts their ability to go back to their home setting successfully. Facilitators can help shape these feelings of success and build skills for children to use at home/school.  

Developmental Stages and Implications for Support Group Settings

Notes: Chronological age might not match developmental stage. It is normal for children and teens to experience some (temporary) developmental regression during times of stress. Human beings go “backwards” in their reactions and ability to process their emotions and external information when stressed!

Knowing these facts can help in your use of language and in building on the strengths that accompany each stage. Note each child’s functional level, recognize their struggles and celebrate their successes based on their milestones as well as valued and unique individuals. 

From Erikson's Stages of Development:

Infancy: Birth to 18 months: Trust vs. Mistrust; Needs maximum comfort with minimal uncertainty to trust himself/herself, others, andthe environment.

Basic strength: Drive and Hope
Existential Question: Can I trust the world? 
Application in support group setting: Children will likely be past this developmental stage when attending a formal group setting. However, keeping this in mind for siblings in the home (who were also burned or otherwise impacted by the injury) can also help you to understand your participants’ home dynamics. At this stage, children are learning to separate from parents/trusted adults and to feel safe and comfortable in the presence of others. 

Early Childhood: 18 months to 3 Years: Autonomy vs. Shame; Works to master physical environment while maintaining self-esteem.

Basic Strengths: Self-control, Courage, and Will 
Existential Question: Is it okay to be “me?”
Application in support group setting: Look for participants’ focus on mastering tasks during activities; frequently children in this stage will imitate others’ performance as examples for their own.
What to do: Provide positive feedback regarding their capabilities. (“You are doing a great job following the steps on this project. I like how you are doing x. . .”) Also, reinforce their capability to handle situations such as staring or dealing with fears. (“You’ve got some great words to help yourself when someone looks at you. Remember how you told me what you’d say?. .”) 

Preschool Age: 3 to 5 Years: initiative vs. Guilt; Begins to initiate, not imitate, activities; develops conscience and sexual identity

Basic Strength: Purpose
Existential Question: Is it okay for me to do, more, and act?
Application in support group setting: Participants will begin to use their own ideas for performance and tasks; they will display more ideas that deviate from others’ opinions; they will be more aware of “right” and “wrong” (and learn whether adults will support their assessment of right and wrong, tattling on peers), facing guilt and blaming themselves for events (such as an accident that caused a burn injury), even when there is no causal link. Siblings can also experience guilt at this level and beyond (“I was mad at my brother and used angry words, then he got hurt. It’s my fault.”). Additionally, children begin to differentiate stereotypically male and female behaviors (girls play with dolls, boys play with trucks, etc.).
What to do: Be concrete in your directions and expectations, allowing participants to clarify understanding. Praise participants for their capabilities (be concrete). Be concrete in clarifying situations which seem to cause guilt or feelings of inability, and validate the children’s logic and thoughts. (example: “Accidents happen; The fire/your brother’s injury was not your fault, you were not even present when it happened”, etc.)

School Age: 6 to 12 Years: Industry vs. Inferiority;Tries to develop a sense of self-worth by refining skills.

Basic Strength: Method and Competence
Existential Question: Can I make it in the world of people and things?
Application in support group setting: Participants assign self-worth to ability successfully manage situations and complete tasks. Frustration with struggles and blaming oneself for perceived failure can be an issue. Also, having to rely on a parent to complete basic tasks after burn injury (such as assistance in eating or getting dressed) can cause great frustration linked to this developmental need.
What to do: Provide opportunities for success and competence. Be aware of the level of difficulty of activities and have modifications/adjustments ready (physical alterations or otherwise). Utilize activities which allow participants to have a defined role in activities to reinforce their strengths and abilities.

 Adolescence: 12 to 18 Years: Identity vs. Role Confusion; Tries integrating many roles (child, sibling, student, athlete, worker) into a self-image under role model and peer pressure

Basic Strengths: Devotion and Fidelity
Existential Question: Who am I? What can I be?
Application in support group setting: Participants will associate their identity, self-esteem, and value with activities and roles. Frustration can arise when these identities don’t match/when expectations for different roles don’t match.
What to do: Be aware that burn injury can remove some roles, such as athlete, or a level of confidence in one’s own value. Use group time to reinforce the roles participants play (example: “John is great at analyzing the overall situation. He always helps the group work out puzzles. Or John, you’re really great at providing understanding to other group members. You are a valuable member of our group and we appreciate that about you.”). Provide opportunities to discuss “who I am” and “where I’m going” for participants in this group.  

Suggested Resources

WebSites, Printable handouts, and More Extensive Resource Lists:

• The Phoenix Society is the only national organization helping burn survivors everywhere get back to living. You can visit the website for a wealth of information.

• Centering Corporation and Grief Digest Magazine offers grief support resources and workshops.

• Self Esteem Shop (resource collection for purchase) is an independent bookstore that caters to mental health professionals and those they serve.

• Compassion Books: compassionbooks.com books, DVDs, and audios to help children and adults through serious illness, death and dying, grief, bereavement, and losses of all kinds.

Books:

1. “101 Fun, Creative, and Interactive Games for Kids” by Steven Peck

2. “Brave Bart: A Story for Traumatized and Grieving Children” by Carolina Sheppard

3. “Changing Faces: the Challenge of Facial Disfigurement” by James Partridge

4. “How to Talk So Kids Will Listen and Listen So Kids Will Talk” by A. Faber and E. Mazlish

5. “I Know I Made It Happen: A Gentle Book About Feeling Guilty” By L.B. Blackburn/Centering Corp

6. “Just Kidding” by Trudy Ludwig

7. “My Many Colored Days” by Dr. Seuss

8. “Quick Crowdbreakers and Games for Youth Groups” by Group Publishing.

9. “The Revised & Expanded Book of Raccoon Circles” by James Hallie Cain and Thomas E. Smith

10. “Severe Burns: A Family Guide to Medical and Emotional Recovery” by Andrew Munster

11. “Sometimes I’m Bombaloo” by Rachel Vail

12. “Sticks and Stones: 7 Wasy Your Child Can Deal with Teasing, Bullying and Putdowns” by Margaret M. Holmes

13. “The Struggle to Be Strong: True Stories by Teens About Overcoming Tough Times” by Al DeSerta and Sybil Wolin

14. “Support Groups for Children” by Kathleen O’Rourke and John Worzbyt

15. “A Terrible Thing Happened” by Margaret M. Holmes, Sasha J. Mudlaff, and Cary Pillo

16. “Words Will Never Hurt Me; helping Kids Handle Teasing, Bullying and Putdowns” by Sally Northway Ogden 

Jessica Irven, M.S. is a Licensed and Certified Recreational Therapist and Certified Child Life Specialist. She has worked with children, teens, young adults, and families in various settings for over fifteen years, and has worked in health care (both medical and mental health) for over 10 years. Her experience in the hospital inpatient, outpatient, and community settings includes burn center work and pediatric aftercare as well as workshops for young adults, families, burn camps, and retreats, both in the U.S. and abroad. She is a firm believer in seeing “what can be” in people and in using a mix of purposeful activity, supportive interactions, and individual reflection and growth as part of the coping and healing process.