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Is Is A Little LearningA Little Learning
Such Such AA
Dangerous Thing?Dangerous Thing?
Sharing A Vision Conference
Springfield, IL
1 October 2003
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The University of Chicago
Bennett L. Leventhal, M.D.
Irving B. Harris Professor of Child and Adolescent Psychiatry
Professor of Psychiatry and Pediatrics
Director, Child and Adolescent Psychiatry
Director, The Sonia Shankman Orthogenic School
Laboratory of Developmental Neurosciences
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Is Is A Little LearningA Little Learning
Such Such AA
Dangerous Thing?Dangerous Thing?
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A little of what is being learned?
A little who is learning?
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What is the basic goal of early learning?
To enhance developmental outcomes
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Nature and Nurture
Interdependent concepts (examples) Nonhuman primate studies Effects of abuse on human infants
– effect of nurture on nature Effects of autistic disorder on maternal-
infant interaction– effect of nature on nurture
Additive or Synergistic when genetic parents raise child
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Basic Premise
All considerations of all events in childhood
(or in adulthood, for that matter), be they
physiologic, psychological or experientialmust take place
in a developmental context
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Why Consider Development?
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What is Development?
Longitudinal?
Cross-Sectional?
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Development is a Process
Individual and groups of characteristics and variables
acting individually and together.
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Phases/Stages– Characterized by most prominent signs of rapid
development within a given developmental line during a given time
– Length of phase determined more by completion of a related set of changes within a developmental line than by number of months or years
– Should not be generally assumed that developmental tasks which are not most prominent are not developing or being used
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Critical period
– Development of a function takes place during a restricted time period relative to gestation
– If appropriate stimulation is not present at that time, development will be affected
– Example - Hubel and Wiesel - monocular deprivation of kittens during critical period of visual system development (environmental input and NMDA receptor dependent)
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Sensitive period
Times during which loss of appropriate environmental stimulation may have adverse consequences, but which may be overridden by stimulation outside of a narrow window
Example - abused or neglected children, who develop relatively normally after rehabilitation of parents' substance abuse, or after placement in a nurturing, structured adoptive home
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Normality (necessary concept)
There is no normal race, gender, or sexual preference
Normality must be defined in the context of each person's personal and cultural context
For example, in Physical Diagnosis you won't be diagnosing your male patients as avaginal
Concept around which one should constantly refine one's clinical judgment as a physician
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Examples of normal as average not being healthy
Although most children in Israel or the Palestinian territories may have experienced violence, it does not make it a healthy experience
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Is Successful Development
NATURAL?
or
LEARNED?
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What is Successful Development?
The optimal use of individual and environmental factors to reach the highest possible level of adaptive
functioning
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Individual Characteristics
Genetics Appearance
Size Attractive/Dysmorphic
Intelligence Social Skills Personality Temperament
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Developmental Lines
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Development - Longitudinal
Developmental Lines Physical/Gross & Fine Motor Cognitive Language Psychosexual Interpersonal/psychosocial Affective Moral Spiritual
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Longitudinal Models
Social Freud Mahler – Separation-Individuation Erikson - Psychosocial Piaget - Cognitive Language Motor Kohut – Object Relations Kohlberg – Moral Others
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Social Stages of Development
0-12 months - Infancy 12 –36 months - Toddler 36 – 60 months - Preschool 7 – 12 years - School Age 12 – 18 years - Adolescence 18 – ?25 years Young Adulthood 25 – ?65 years - Adulthood 65 years + - Older Adulthood
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Language
6 months – Coos, smiles, reaches 12 months - First words 18 months - Increasing words 24 months – 2-3 word sentences 36 months - 3 word phrases 8 years - Knows person, place, time
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Gross Motor
Roll over at 4 mo. 4 months – roll over 6 months - Sit unassisted 12-15 months - Walk unassisted 30 months - run 36 months - Stairs one step/foot, Ride
tricycle 6-7 years - Ride bicycle
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Fine Motor
4 weeks – hands fisted 6 months - Grasps cube 18 months - Tower of 3 cubes 3 years - Draws circle 4 years - Draws square
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Development - Cross-sectional
Observation of human development at a given time
Domains are interdependent Quality of integration of domains is
important The "whole" child or adult is subject of
study Pro and con: See forest well, but trees not
as clear
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Cross-Sectional Development
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Prenatal Development
Almost all neurons “born” before 11 weeks gestation
Almost all cell migration complete by 16 weeks gestation
Drug exposures, most commonly alcohol and nicotine lead to later behavioral problems (dose-related)
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Prenatal Development
Nutrition important during prenatal development
Full-term or near-full term developmental failure is mostly due to hypoxia and related to CNS bleeding when birth excessively premature
However, outcomes progressively improving with advances in neonatal care
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Post-natal Development
When does it really begin? At delivery? In utero, near delivery?
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Post-natal Development
Physiological homeostasis is main goal
Key first step is feeding, which requires adequate muscle tone for sucking
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Post-natal Development First 2 months social life largely bilateral
Parental functioning is important Goodness of fit Support systems
Time after birth is a sensitive period for developing attachment between caregivers and the infant
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Post-natal Development Bonding vs Attachment
Bonding Lorenz like imprinting a critical period
Attachment Bilateral Complex behavioral interaction Begins at birth
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2-4 months 2 month social smile is very overdue for first-
time parents up all night with frequently crying infants
Parents begin to more reliably read subtle cues and patterns of child (e.g. communication of hunger vs. needing a diaper change
4 months - rolling over increases the risk for falls
Interest in objects in environment Color movement
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4-6 Months
Rolling over at 4 months to sitting up unassisted at 6 months
Child develops more three dimensional view of their world but mobility limited
By 6 months, children are relatively social without much fear of strangers
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6-9 Months Emergence of normative separation anxiety
and stranger wariness
Children become more mobile although not usually walking Creeping Crawling Pulling up and standing
For most children sleep and eating schedules are relatively organized
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9-12 Months
Exciting time with development of single words starting with ‘dada’ (then ‘mama’) and with many other single words by 12 months
Development of walking from assisted to unassisted typically by 12 months
Increasing need for child-proofing (although this should occur prenatally)
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12-18 Months Generally a time in which child is “in love with
the world” enjoying new mobility and its freedom
Object permanence by 12 months
Joint attention by 12 months (will follow a point by a parent to attend to something other than the parent and child, just because of interest to the parent)
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18-36 Month-olds 18-36 months - anal period
(psychosexual), autonomy vs. shame and doubt (psychosocial), separation-individuation
reorganization of nervous system (pruning in primary sensory cortex)
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18-36 Months
“Terrible two’s” Parental response important Child struggles to be soothed by parent
without feeling smothered Voracious appetite for learning and
trying new things Language
2-3 word phrases ->short sentences
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18-36 Months
Ambivalent struggle over autonomy, because child still needs parent Parent has to set limits where necessary
(esp. safety issues) Parent has to help child find a way out of
unsolvable conflicts (provide child with easy-to-understand choices)
Parent has to be secure enough not to have to try to win the power struggles
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36-48 Months
Emergence of focus on more complex relationships and enjoyment of developing skills without focusing on autonomy
Begin to directly play with other children but play is often parallel
Language plays a role in play Can speak in full thoughts – sentences
Many, but not all children enter nursery school Independence associated with bowel control –
end of traditional anal period
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Four year-olds
Has mastered toileting, although accidents not uncommon, especially through the night
Rapid increase in social interest and competence
Nursery school (common, but not compulsory) Conflicts over autonomy are not most
prominent conflict, but persist as a concern Fundamentals of spoken language mastered
– can tell a story and share feelings – but still concrete
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Four year-olds
Conflicts over autonomy are not most prominent conflict, but persist as a concern
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Four year-olds
Identify self by gender Gender roles become stereotypic
Internal forces– child feels how they behave is who they are – insecurity leads to conformity
External forces
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Four year-old
Learning basic rules of right and wrong Mastery of aggressive impulses often
more difficult for boys than girls ? due to less well developed social
competence in boys (can’t separate out nature from nurture here) vs. preference for aggressive behavior
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Four year-old
Triadic relationships are emergent domain (present before, but diadic relationships
often dominate scene earlier) Competition more prominent Often competition with same sex parent
and less conflictual relationships with opposite sex parent
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Five year-old
Kindergarten Pre-academic skills
early reading writing currently enhanced by “inventive
spelling” - idea is to encourage expression without constraint of spelling rules and details for which child not ready
early reading, mostly by sight identification
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Five-year old - Academic
early math skills - especially geometric and functional
Counting and alphabet usually solid Early adding, but subtraction not typical
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Five year-old
social skills further developing – most children can contain their violence in
classroom at this point disorders of activity and violence such as
ADHD and conduct disorder often first diagnosed
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Five year-old
Continence typical, even at bedtime Failure to establish continence first diagnosed
Enuresis - daytime or more commonly nocturnal wetting
– usually spontaneously remits by adolescence
Encopresis - daytime or nighttime defecation– if regular symptomatic of constipation or emotional
conflicts, particularly re: autonomy
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Age (years) Psychosexual Psychosocial Separation-Individuation (S-I) CognitiveFreud Erikson Mahler Piaget
0-0.5 Infancy Oral (diadic) Trust v Mistrust Autistic (0-1mo.), symbiotic phases Sensori-motor (S-M)0.5-1 " " " S-I phase: hatching S-M1-1.5 Toddler " " S-I phase: practicing S-M: Object permanence 12 mo.1.5-3 " Anal (diadic) Autonomy v Shame & doubt S-I: rapprochement, object constancy Emergence of symbolic thought3-6 Preschool Oedipal/Elektral Initiative v Guilt Pre-operational thought6-12 School Age Latency Industry v Inferiority Operational thought12-18 Adolescence Adolescence Identity v Identity diffusion Formal operations
Young Adulthood Adulthood Intimacy v IsolationAdulthood " Generativity v Self-absorptionOlder Adulthood " Integrity v Disgust,Despair
Age (years) Social Gross Motor Fine Motor Language
0-0.5 Infancy Social smile (2 mo) Roll over at 4 mo. Hands fisted at 4 weeks Coos0.5-1 " Stranger anxiety Sit unassisted at 6 months Grasps cube at 6 months First words1-1.5 Toddler Walk unassisted 12-15 months Tower of 3 cubes by 18 months Increasing words1.5-3 " "No!" Stairs one step/foot at 3 Draws circle at 3 2 word sentences by 2 years3-6 Preschool Age of play Ride tricycle at 3 Draws square at 4 3 word phrases by 3 years6-12 School Age Peers increasing Ride bicycle at 6-7 Knows person, place, time by 8 years12-18 Adolescence Sep.-Indiv. Part 2
Young AdulthoodAdulthoodOlder Adulthood
Notes:Diadic: relationships focused on child and caregiverTriadic: relationships focused on child, caregiver, and another personObject permanence - can find an object hidden under 2 blanketsObject constancy - can retain a positive, sustaining image of primary caregiver
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Interactional Models
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Interactional Models - Example
Rutter's study (England) of effects of coeducational schooling on girls with early puberty adverse effect of coeducation only for low
socioeconomic status (SES) girls (increased risk for delinquency (conduct disorder)
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Interactional Model - Example
Low birthweight (prematurity) and SES 1500 - 2500 g range, low birthweight leads
to decreased cognitive capacity only in low SES group
below 1500 g SES less important than birthweight for cognitive outcome
< 1500 g maternal risk behavior for prematurity at higher rates in low SES groups
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Mediatorsand
Modifiers
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Socioeconomic Status (SES)
A generalizable risk factor
Not to be equated with African-American, Asian-American, Appalachian, Liverpoolian
Each society differs in generalizable effects of race, gender, sexual preference on SES
There are NO generalizable effects of race, part of world, part of country, gender, sexual preference on any of the developmental lines listed above or on risk for psychopathology which are independent of SES effects
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Strengths
Resilience
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Strengths/Resilience Too often we overlook strengths when
considering health or overlook context when considering extent of stressors
Many children grow up healthy even under traumatic experiences
Chronic trauma usually more problematic than acute trauma, largely due to the absence of care correlated with chronic trauma
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Is Impairment an indicator of:
Developmental Failure?
Inadequate Strengths or Resilience?
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Can We Create Strength?
What Fosters Resilience?
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Principles of Mental Healthin Early Childhood
Centrality of early parent-child relationship
Development as transactional process Intergenerational influences Development in context Multiple pathways Adaptation
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Socioemotional Milestones in Young Children
Social reciprocity ( 3-6 mos.) Attachment ( 6-12 mos.) Exploration/mastery (12-18 mos.) Individuation (18-30 mos.) Self-control (30-54 mos.) Cooperative play (30-54 mos.) Empathy (30-54 mos.)
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Infant Characteristics
State regulation Soothability Predictability Temperament Robustness Interest in Exploration Social Responsiveness
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Infant Risk Factors
Difficult temperament Low birthweight Prenatal exposure to substances Gender Developmental delay Physical health problems
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Parenting
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Parenting
Biological Social Child-rearing
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Parenting
Preparation Biology Maturity Modeling Formal Education
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Parenting
Planning Unplanned Planned
Partnerships Alone Mother-father Other models
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Parenting Risk Factors
Young age at first birth History of maltreatment/deprivation Maternal depression domestic violence/marital discord multiple, closely spaced births social isolation poverty
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Parenting
Goodness of Fit: Individual characteristics of each parent Parent-to-parent Parents to child Parents to extended family Child to extended family Parents to community Child to Community
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Dyadic Processes
Reciprocity Emotional engagement Synchrony Goodness of fit attachment
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Parent-Child Contributions to Relationship Processes
PARENT: Emotional
availability Sensitivity Predictability Flexibility Psychological
resources
CHILD: Social
responsiveness Readability Regularity Adaptability Developmental
functioning
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Responsive Parenting
Read cues accurately Interpret appropriately Respond contingently Awareness/responsiveness to child’s
changing developmental needs Attunement to child’s emotional state Packaging stimulation
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Responsive Parenting with Toddlers and Preschoolers
Emotional availability Autonomy support Joint negotiation Consistent limit-setting Flexibility Labelling of emotions Fostering verbal problem-solving
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Discipline
Authoritarian
vs
Authoritative
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How Young Children Learn To Control Their Behavior
Developmental advances Structure and routine Parental guidance and modeling Experience of manageable challenge
and mastery Experience of social problem-solving
and negotiation of conflict
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Child Risk Factors for Developing Behavior Problems
Genetic Prenatal substance exposure cognitive and language delays Temperament: reactive, low
adaptability, social wariness, fussy/irritable
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Family Contributors to Young Children’s Behavior Problems
Exposure to violence Low parental supervision/monitoring Inconsistent, ineffective discipline Unresponsive Parenting Absence of proactive adult input in
learning to manage feelings, tolerate frustration and persist
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Supporting Healthy Emotional Development in Young Children
Providing safe, secure, consistent environments
Fostering exploration and curiousity Building trusting relationships Nurturing families Helping children know “their place” Engendering hope Fostering development of adaptive skills
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Interventions for Young Children
Behavioral Psychotherapeutic Psychopharmacologic
AND
Educational
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A few lessons before closing:
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Provide an appropriate structure
Activity should be qualitatively and qualitatively appropriate
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Provide rules
Not too many
Make them simple and reasonable
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Somethings are hard to teach
They still must be taught so that the child at least has an accurate
understanding of the facts
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Talk is cheap
But, it is better than not talking at all – and conversing is even better
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Be developmentally sensitive
Too much too soon can be as problematic as too little too late
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Might is not always right
But, it is still important to understand differences in adult
and child roles and how that impacts learning
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Personal resources do make a difference
Despite our wishes to the contrary – we all have limits
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We all get angry and frustrated, at least once in a while
Managing frustration is at least as important as managing stress
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Experience does make a difference
Not all experiences are good but there are usually ways to make them have some positive value
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Fostering successful development is never easy
The absence of frustration and failure means that you either:
Did not try hard enough
Or
You are a liar
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Don’t ever under estimate the power of modeling
Both Positive and Negative
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Timing isn’t everything
But, time well spent is pretty important
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Honesty is best policy
Always tell the truth but being brutally frank is not necessary
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Good behavior in the absence of complete comprehension can be
good
And, it may even be adaptive
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What you see is not always what you get
Blind reliance on or exposure to the media can be dangerous
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Biology is not necessarily destiny
Some biological factors can be modified by experience
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The competent, consistent and developmentally appropriate control of the child is never
wrong!
And, contrary to popular opinion, it neither limits development nor
inhibits creativity
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Dreaming is good
It is better to have a dream dashed then to have never
dreamed at all
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Is Is A Little LearningA Little Learning
Such Such AA
Dangerous Thing?Dangerous Thing?
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I hoped you learned a little
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I hope that
You did not feel endangered
AND
You are not dangerous