1. Developmental Stages of
the Learner
Ellie Borre, Knia Frank, Erica Pueblos

2. Agenda:
● Introductions
● Objectives
● Key terms
● Developmental Characteristics
● Developmental Stages of Childhood
○ Infancy
○ Early Childhood
○ Middle & Late Childhood
○ Adolescence
● BREAK!
● Developmental Stages of Adulthood
○ Young Adulthood
○ Middle-Aged Adulthood
○ Older Adulthood
● Family Role in Patient Education
● Evidence/Research
● Summary

3. ELLIE BORRE, OTS
●Education: B.S. in Leisure Studies emphasis on Therapeutic Recreation from The University of Iowa
●Experience: 2 TR internships. 2 years as a Recreation Therapist at a residential treatment facility in Chicago,
OT volunteer hours at Niles school district, Athletico, Helping Hand school for children with Autism and IBJI.
●Likes: Sports, hiking, camping, snowboarding, STL Cardinals
and the Chicago Blackhawks
●Fun fact: I can unicycle

4. KNIA FRANK, OTS
● Education: B.A. in Broadcast Journalism with a minor in Nonprofits, Volunteerism, and Philanthropy
● Experience: 1 year Behavior Interventionist for SNN. OT volunteer for Atwater Park Center. Secretary for
Northeast Community Clinics Board of Directors. Substitute Teacher for Los Angeles Unified School District.
● Likes: Working out, experimenting with hair, people watching, singing
● Fun fact: Was featured on KTLA for a story on my hair

5. ERICA PUEBLOS, OTS
● Education: B.A. in Human Development from CSULB
● Experience: Downey Unified School District, Rancho Los Amigos Rehab, Special
Olympics World Games Los Angeles 2015, Special Olympics Southern California -
LA/SGV Regions,, High Hopes Head Injury Program, Special Olympics Coach
● Likes: Eating, working out, reading, going to the beach, Dodgers, Lakers, UCLA
football & baseball
● Fun fact: I was a teacher’s pet throughout elementary school

6. Learning Objectives:
1. Identify the physical, cognitive, and psychosocial characteristics of learners that
influence learning at various stages of growth and development
2. Recognize the role of health professionals in assessing stage-specific learner needs
according to maturational levels
3. Determine the role of the family in patient education
4. Discuss appropriate teaching strategies effective for learners at different
developmental stages

7. Key Terms
Pedagogy
Object permanence
Causality
Animistic thinking
Syllogistic reasoning
Conservation
Imaginary audience
Personal fable
Andragogy
Dialectical thinking
Ageism
Gerogogy
Crystallized intelligence
Fluid intelligence

8. Sample question…
Knia’s undergraduate degree from USC was in Broadcast Journaling. She
enjoys experimenting with hairstyles, and was featured on KTLA for her
hair. Which of the following is something else that Knia enjoys?
a. Hiking
b. Eating
c. People watching
d. Going to the beach

9. Developmental Characteristics
●What influences a person’s ability
& readiness to learn?
○Growth and development interact
with experiential background
○Physical & emotional health status
○Personal motivation
○Environmental factors
● Major factors associated with
learner readiness:
○Physical
○Cognitive
○Psychosocial

10. Developmental Characteristics
3 Phases of Learning:
1. Dependence
2. Independence
3. Interdependence

11. Developmental Stages
of Childhood

12. Infancy and Toddlerhood
(first 12 months of life)
Pedagogy = the art and science of helping children to learn
Name: Oatea
Background: was forced to leave home after
9 months

13. Infancy and Toddlerhood
Growth and development is highly complex
Main focus of instruction for health maintenance is geared toward the
parents, who are considered the primary learners
Older toddler can be included in health care teaching and education process

14. Physical Development
●Exploration of self and environment
○ Sensorimotor period (Piaget) - coordination & integration of motor
activities with sensory perceptions
○ Object permanence = realizing that objects and events exist even
when they cannot be seen, heard, or touched
○ Encourage parents to create a safe environment for exploration

15. Cognitive Development
●Basic reasoning, understands object permanence, has beginnings of
memory, and develops an elementary concept of causality
○Causality = the ability to grasp a cause-and-effect relationship between two
paired, successive events
○Short attention spans & easily distracted
○Language skills develop rapidly
○Ask tons of questions!
○Respond to simple, step-by-step commands & obey directives

16. Psychosocial Development
●Trust vs. Mistrust
○Children develop sense of trust with
primary caretaker
●Autonomy vs. Shame & Doubt
○Learn to balance feelings of love and hate
and learn to cooperate
●Routines give sense of security

17. What do you think?
Two-year-old Oatea is seen playing with blocks alongside her older brother.. Oatea’s
mother tries to encourage her to interact with her brother so they can play together, but
Oatea seems uninterested. Based on her age, what type of play is Oatea participating in?
a. Cooperative Play
b. Solitary Play
c. Associative Play
d. Parallel Play

18. Teaching Strategies
●Teach aspects of normal development, safety, health promotion, and
disease prevention
●Assess the parents’ and child’s anxiety levels
●Establish a relationship with child and parents
●Teach in familiar environment

19. Short-Term Learning
●Read simple stories with lots of pictures
●Use dolls or puppets to act out feelings and
behaviors
●Role-play to bring imagination to reality
●Give simple, concrete explanations with visual
and tactile experiences
●Brief teaching sessions

20. Long-Term Learning
●Focus on rituals, imitation, and repetition of information
○Words and actions to hold child’s attention
●Use reinforcement as an opportunity for children to achieve
permanence of learning
●Parents as role models → their values and beliefs serve to reinforce
healthy behaviors

21. What do you think?
An OTR has the knowledge to direct parents to effectively manage their child’s
development and teach aspects of safety, health promotion, and disease prevention.
When a child is ill or injured, what is the first priority of an OT for teaching
interventions?
a. Assess the parents’ anxiety levels
b. Assess the child’s anxiety levels
c. Develop a rapport with the child
d. All of the above

22. Early Childhood
(3-5 yo)
WHAT DOES LEARNING LOOK LIKE?
●Interactions
●Mimicking/Modeling
- Oatea is now 4 years old.
- She enjoys playing Vet, since
thats moms job.
- Oatea has developed
independence with dressing
and toileting

23. Physical Development
●Fine and gross motor skills become refined

24. Cognitive Development
● Piaget: Preoperationalstage
● Egocentric
● Precausal thinking allows young children to
understand that people can make things happen
● Animistic thinking—the tendency to endow
inanimate objects with life and consciousness

25. Psychosocial Development
● Eriksons stage initiativeversus guilt.
- Expanding imagination and
creativity
- Impulsive
- Curious about almost everything
- Interacting with playmates
- Role-playing

26. Barriers to learning
●Fear
●Impulsive
●Limited sense of time
●Lack of concrete understanding

27. Teaching strategies
●Teach the parents
●Reassure the child
●Use friendly terminology
●Short and simple

28. Short Term Learning
● Provide physical and visual stimuli
● Keep teaching sessions short
● Relate information
● Encourage the child to choose
● Small group sessions
● Allow the child to manipulate
equipment
● Use storybooks
- Give praise and approval
- Give tangible rewards

29. Long Term Learning
●Enlist the help of parents
●Reinforce positive health behaviors
●Reinforce acquisition of specific skills

30. What do you think?
3 ½ year old Oatea was brought into the ER by her mother with difficulty breathing. The doctor ordered the child
receive a chest x-ray to make sure there was nothing blocking her airway. The nurse came in to take the child to
the radiology. The child started screaming and would not let go of mom. What is the best way to tell the child
what is going on?
a. Tell the mother what the plan is and ask her to calm Oatea down
b. Reassure Oatea that she will be okay and that her mom will be waiting for her in the room when shes
done
c. Tell Oatea she’s going to get a giant picture taken to help her feel better, and when she gets back from the
picture her favorite juice will be waiting for her
d. Inform the mother of the procedure, and tell Oatea she will be right back

31. Middle and Late Childhood
(6-11 yo)
What does learning look like?
●Minds are open
●Motivated to Learn
●Period of great change
- Oatea is now in elementary
school full day, which she loves
- Oatea comes home everyday
telling mom about what she
learned
- Oateas biggest concern is play
and learning

32. Physical Development
- Motor abilities more coordinated
- Physical growth is highly variable
- Girls > Boys

33. Cognitive Development
- Piaget concreteoperations.
- Logical and rational thought processes
- Syllogistic reasoning—that is, they can consider two
premises and draw a logical conclusion from them
- Conservation, which is the ability to recognize that the properties
of an object stay the same even though its appearance and position may
change, are beginning to be mastered.

34. What do you think?
Which of the following is a good example of syllogistic reasoning?
a. A lizard is a reptile, a crocodile is a reptile therefore they are both green
b. Water can be hot, water can be cold, so water changes
c. I swim in water, fish live in water, therefore fish swim
d. The sky is blue, the clouds are white so the clouds aren’t in the sky

35. Psychosocial Development
●Eriksons industry vs inferiority
●Gain awareness of uniqueness
●Develop self-concept
●Fear failure of being left out

36. Barriers to Learning
● Children develop at different rates
● Frustration tolerance
● Limited understanding of consequence

37. Teaching Strategies
●Include them in the entire process
●Keep terms simple and logical
●Observe the child’s reaction
●Parents should to taught to help foster independence
●Gear towards fostering normal development

38. Short Term Learning
●Take responsibility
●Sessions can be longer
●Use A/V
●Clarify terminology
●Use analogies
●Show peers undergoing similar
situations
- Individual/Group instruction
- Provide time
- Prepare them in advance
- Encourage participation
- Provide nurture and support

39. Long Term Learning
●Help child acquire new skills
●Assist in teaching them to maintain own well-being
●Incorporate positive health actions into daily lives

40. What do you think?
Oatea is 6 year-old girl. Her teachers report that she is displaying impulsive behaviors including
grabbing toys from peers, and incapable of sitting still for more than 10 minutes. The teacher is
looking to the mother for assistance with Oatea’s behavior since it is affecting her learning. What
might be good techniques to use with Oatea?
a. Provide Oatea with a star chart in which she can earn rewards for appropriate behavior
b. Use analogies to help Oatea understand why she needs to do things
c. Help teach Oatea how to maintain her own behaviors through deep breathing
d. Engage in role-playing activities to help her understand the teacher's point of view

41. Adolescence
(12-19 yo)
What does learning look like?
●Period of transition
●Many healthcare issues
●At risk population
- Oatea is in high school just about to
get her driver's license.
- Oatea has a wonderful group of
friends she spends most of her time
with
- Oatea biggest concern is fitting in, but
has recently been tempted by friends
to drink alcohol

42. Physical Development
●Fine and gross motor skills fully developed
●Period of transitioning
●Preoccupation with appearance
●Sexual Urges

43. Cognitive Development
● Piaget: Formaloperations
● Higher-order level of reasoning, capable of abstract thought
● Imagery Audience: social thinking that has influence over behavior
● Personal fable: leads to adolescents to believe they are invulnerable
● 15 yo+ are not as susceptible to personal fable

44. Psychosocial Development
●Eriksons identity vs role confusion
●Seeking independence and autonomy
●Conform to peers
●Need to develop coping skills

45. Barriers to Learning
●Rebellious
●Concern with fitting in
●20% have serious health issues
●Imaginary audience
●Personal fable

46. Teaching Strategies
●Develop trusting relationship
●Use peers going through similar experiences
●Use a variety of tools

47. Short Term Learning
● Use one-to-one instruction
● Choose peer group discussion sessions
● Use face-to-face or computer group
discussion, role-playing, and gaming as
methods
● Employ adjunct instructional tools
● Clarify terminology and medical jargon
- Share decision making
- Include them
- Suggest options
- Give a rationale
- Approach them with respect
- Expect negative responses
- Avoid confrontation

48. Long Term Learning
● Accept adolescents’ personal fable and imaginary audience as valid
● Acknowledge their feelings are real
● Allow them the opportunity to test their own convictions.

49. What do you think?
Oatea is grounded for sneaking out to go out with friends. While she was out Oatea had
engaged in some recreational activities. When you try to talk to her about it Oatea runs
upstairs slamming her door, saying “you don’t understand anything.” How would you go
about teaching Oatea the harms of recreational activities?
a. Take her to an AA meeting so she can see the potential repercussions
b. Get literature about the risks of drugs and leave them under her door
c. Take time to sit with her and talk through her concerns before trying to teach
d. Storm upstairs after her yelling that you need to talk

50. BREAK TIME!

51. Developmental Stages
of Adulthood

52. Adulthood
Andragogy = the art and science of teaching
adults-Theory by Knowles Retrievedfromshutterstock
More learner centered and less teacher centered

53. Assumptions of Knowles’s framework
1. His or her self-concept moves from being a dependent personality to
an independent, self-directed human being
2. He or she accumulates a growing bank of previous experience that
serves as a rich resource for learning
3. Readiness to learn becomes depends on tasks of social roles
4. Learning is problem centered as opposed to subject centered

54. Paradoxical Learners
Adults are said to be autonomous, self-directed and independent
BUT
Learners want and often need structure, clear concise specifics, and
guidance

55. 12 Learning Principles
1. Related to immediate problem or
deficit
2. Voluntary or self-initiated
3. Person & problem centered
4. Self- controlled & self-directed
5. Teacher is facilitator
6. Information and assignments are
pertinent
7. New material draws on past experiences
8. Threat to self is reduced to minimum
9. Learners is an active participant
10. Able to learn in a group
11. Nature of learning and activity changes
frequently
12. Reinforced by application and prompt
feedback

56. Why Adults Learn
1. Goal oriented
Retrieved from firstshowing.net

57. Why Adults Learn
2. Activity Oriented
Retrieved from iransafebox.net

58. Why Adults Learn
3. Learning Oriented
Retrieved from justjaredjr.com

59. Young Adulthood (20-24 yr olds)
-Establish long term relationships
-Deciding on an occupation
-Can be stressful
-Oatea just celebrated her 23rd
birthday
-She’s been applying to grad
schools and is anxious about
getting in
-Long term bf wants to propose
but she wants to finish school first

60. Development
Physical: Physical abilities are at their peak and body at its optimal
functioning capacity
Cognitive: Capacity fully developed, but with maturity
can accumulate new knowledge
Piaget: formal operations
Psychosocial: Erikson’s intimacy vs. isolation
Retrieved from pinterest.com

61. Teaching Strategies
-Health professional educators give this period the least amount of
attention
- Find a way to reach out and communicate about health promotion and
disease prevention measures.
-Know the individual’s lifestyle in order to help figure out what to focus
education measures on
-Allow for mutual collaboration and make it convenient

62. What Would You Do?
Oatea came in for her physical for grad school. You notice her blood pressure is abnormally
high. She revealed to you that she is in a rush to get to brunch at her favorite soul food
spot. How would you proceed?
A. Quickly tell her that her brunching habits are unhealthy.
B. Ask her to come in again before brunch next week to discuss concerns
C. Ask about what she orders for brunch and possibly offer healthier alternatives
D. Wait until she comes in again to bring up concern because she’s currently in a rush

63. Middle Adulthood (41-64)
-Transition between young adult
and older adulthood (⅕
population)
-Starting later and lasting longer
-Highly accomplished in careers,
sense of who they are, grown
children
-Oatea is the mother of 2 children
over the age of 25
- She just had her 3rd article
published in AJOT on her new
intervention for dementia
-She is preparing for her home for
her mother’s arrival

64. Development
Physical: Skin and muscle tone decreases, metabolism slows, body weight tends to
increase, energy levels lessen & hormonal changes bring about variety of symptoms. Visual
and hearing acuity start to diminish
Cognitive: Piaget: formal operations. Cognitive development stops here (abstract thinking)
Critics believe in postformal operations known as
Dialectical thinking- ability to search for complex and changing understandings to find a
variety of solutions to any given situation or problem (see the bigger picture)
Psychosocial: Erickson’s generativity vs. self-absorption and stagnation

65. Teaching Strategies
-Stress may interfere with motivation for learning
- Many want and need information related to chronic illnesses that can
arise at this phase of life
-Reinforcement for learning is internalized
-Instructional methods and tools similar for young adults
But content coincides with concerns and problems specific to this group

66. What Would You Do?
Oatea is taking medication for her high blood pressure, but when she came in for her
annual physical she tells you she is stressed about work and caring for her mother. You
have 15 minutes to spend with her.
A. Let her vent about her stressors to you as actively listen
B. Inform her that her high levels of stress and high blood pressure can lead to a stroke
C. Teach her some stress reduction techniques
D. Offer her caregiving strategies to implement with her mother

67. Older Adulthood (65 years -)
The young old (65-74)
The old-old (75-84)
Oldest old (85 and older)
85 and older make up the fastest growing segment today
In 2006, 40% of the federal budget allocated for Medicare, Medicaid, Social
Security
16% have a college degree at the bachelor’s level or higher

68. Older Adulthood
Gerogogy- the teaching of older persons. Accommodates normal cognitive,
psychosocial, and physical changes at this phase of development
Ageism- prejudice against older adult perpetuates negative stereotype of
aging as period of decline
● https://www.youtube.com/watch?v=J6zenOjPC1A

69. Development
Physical: Sensory declines (mainly visual & auditory)
Organ functioning, decreased cardiac output, lung capacity, metabolic rate

70. Development
Cognitive: Actual loss of neurons with no regenerative powers
Crystallized intelligence- absorbed over a lifetime
Fluid intelligence- capacity to perceive relationships to reason and to
perform abstract thinking ( 5 negative effects)

71. Development
Psychosocial; Erikson’s ego integrity vs. despair
Most common psychosocial tasks:
-Retirement
-Illness or death of a spouse, relative or friend
- Moving away from loved ones
-Relocation to and unfamiliar environment (extended care, senior living)

72. Development
Traits regarding goals and values that impact motivation and learning
1. Independence
2. Social acceptability
3. Adequacy of personal
resources
1. Coping Mechanisms
2. Meaning of Life
-Oatea lost her mother and
husband this year
-Her children and grandchildren
moved out of state
-She retired and now enjoys
cooking

73. Teaching Strategies
-Understand older person’s developmental tasks
-Older person’s may delay medical attention
-Reminiscing is a beneficial approach to use to establish a therapeutic
relationship
-Talking about patient’s life can speak to their abilities and concerns

74. Helpful Tips
Physical Needs:
-Teach in brightly lit room (no glare), large print, well spaced letters
-Eliminate extraneous noise, don’t cover mouth when speaking, Speak
slowly
-Keep sessions short, frequent breaks, comfortable seating
-Don’t confuse loss of energy for lack of motivation

75. Helpful Tips
Cognitive Needs:
1. Allow time for processing and reacting
2. Be aware of effects of medications
3. Be certain ask of prior knowledge on a topic to avoid patronizing
4. Any information that upsets established habits are hard to teach
5. Brief sessions that are relevant and focused on here and now
6. Have a summary with time for Q&A at the end

76. Helpful Tips
Psychosocial Needs:
1. Assess family relationships
2. Determine availability of resources
3. Encourage active involvement
4. Identify coping mechanisms

77. Senior Myths
Seniors are not senile just because they are old
There are many seniors who are not cranky
Rather than being lonely, older adults report their satisfaction with life
continues at a steady level throughout the period of adulthood
Contact with significant others remains constant over time

78. What Would You Do?
Oatea came to your office with her great nephew and expressed interest in coming to your
cooking group. The group is held on Tuesday evenings across town. Oatea has poor vision
and doesn’t like to drive on the freeway. What do you do?
A. Offer a different topic group that meets earlier on her side of town
B. Offer to livestream the class for Oatea
C. Help Oatea figure out the bus route to get to the group on Tuesdays
D. Ask the great nephew to accompany Oatea to the cooking class

79. The Role of Family in
Patient Education
●Provide emotional, physical, and social support
●Determine who will be primary caregiver
●Explore caregiver learning style preferences, cognitive abilities, fears
and concerns, and current knowledge
●Family is single most significant determinant of success or failure of
the education plan

80. State of the Evidence
●Need more research on how teaching and learning are affected by
situational variables, by personality traits, by temperament responses,
and by sociocultural influences
●Importance of support systems on the success of educated people of
all ages to maintain and improve health status

81. Summary
●Understand specific and varied tasks associated with each
developmental stage to individualize the education approach
●Readiness to learn in children is subject centered
●Motivation to learn in adults is problem centered and more oriented to
psychosocial tasks
●OTR must facilitate the teaching-learning process along with the client

82. What do you think?
As an OT, you have the potential to work with clients of all ages and abilities. What
are the three major stage-range factors associated with learner readiness that
must be taken into account at each development period throughout the life cycle?
a. Physical, sensorimotor, and cognitive
b. Physical, cognitive, and psychosocial
c. Cognitive, psychosocial, moral development
d. Cognitive, sensorimotor, moral development

83. Reference
Bastable, B. & Dart, M. A. (2011). Developmental Stages of the Learner. In Health Professional
as educator: principles of teaching and learning. (pp. 151-197). Jones & Bartlett Learning.