Historical cognitive developmental theory, all mumbo jumbo?

Piaget (Huitt and Hummel, 2003), Vygotsky (Schultz, 2004), and Erikson (Boeree, 2006) are cognitive developmental theorists. In 2015 is it all mumbo jumbo? Is this even worth looking at from the perspective of a medical educator? Is there anything to be learned from all this effort?

 

Gladwell (2008) studies the occurrence of high performance individuals in populations, and the effect of culture and tradition on human performance. He presents several examples of how circumstances and society’s rules could deflect one’s path towards relative greatness. He illustrates how learned behaviour and cultural tradition can impede performance. His examples are vivid, colourful, and make a good read, but are all observational. Statistics is used. There is little intervention reported, and when it is, it is again uncontrolled. An example would be Korean airlines makeover by an outside agency, enforcing the use of english and specific training in communication for support staff, copilots. There was no control group here.

 

Jensen (2005) makes a full out attempt to read educational, and more to the point, medical neuroscience literature, and apply it to specific learning situations in the classroom. To the extent that the articles he reads are accurate, many of his interventions are at least tangentially based on randomized controlled trials.

 

Evidence based practice principles (Gray, 2002) suggest that practice decisions should be based on the best quality evidence. The lowest quality is expert opinion. The highest, randomized, controlled, blinded trials. Expert opinion is a candle to the sunlight of a large, well done randomized trial.

 

To the extent that Piaget, Vygotsky, and Erikson make observations of developmental stages in some detail, their information is useful. The structures in which they try to explain such development are philosophical musings and serve to illustrate a human being’s need to make sense out of data.

 

I find Gladwell’s outlier theory, recently substantiated by a large (observational, mind you) study (Zoega et al, 2012), and studies of culture, seemingly unsubstantiated except by historical/ observational data to be fascinating. I find Jensen sometimes stretches his applications, but admire greatly his attempt.

 

Piaget, Vygotsky, and Erikson are historical figures who reported observational data, and gave expert opinion on how cognition develops. Should these theorists impact current practice, in the classroom or in my clinic? The level of evidence would indicate, “No”.

 

Irrelevant therefore? Vygotsky’s theory of individual, cognitive development being guided by society would certainly engage Gladwell, and may have inspired his research. Certainly, Gladwell does illustrate how a culture or a society can change interpersonal dynamic. Vygotsky would suggest it changes cognition itself. Piaget’s schema are certainly somewhat related to the way in which the brain engages new information frontally, then “pushes it back” to deeper structures. This could lead to thoughts of “scaffolding” as Jensen describes. Erikson pushes Freud’s five developmental stages to eight, further refining and defining cognitive and emotional, interpersonal growth. He does discuss children as they grow: as such, Gladwell may have found some use for these stages as he was researching youth development in sports, for example. Jensen does discuss how the brain develops in stages during a lifetime, and correlates behaviour and learning with these stages.

 

I find the description of developmental stages to be possibly useful in engaging pediatric patients. It may help my resident. Possibly. One must gear the presentation to the patient’s level. However, I feel that most of this information to be of only historical interest. Strategies that I currently use in communication have worked well for 25 years of practice, and unless I see clear evidence to change my approach, I will not. I start assuming the patient knows nothing, and go very simply. By gauging their responses, listening with my heart and ears, I try to pick up on emotion and label it. I rephrase what they have said and ping pong it back, to check for clarity. In young children, I act like bozo the clown. It works. Capacity for consent varies with age group, and affliction. I let a five year old refuse a bandaid for a scrape. He can’t turn down an iv. Some 12 year olds can be completely independent decision makers for most issues. You have to probe, listen, question, feel. These theorists have helped me in no way with any of this.

 

These early theorists are only of historical interest? Again irrelevant? No! These early theorists serve us a warning. One must be very careful when moving from observation to considerations of etiology, paradigms of structure, or mechanism.

 

It takes a great strength of will to just observe, and report, without trying to find a pattern. Or impose developmental principles.

 

References:

 

Boeree, C. (2006). Erik Erikson 1902-1994. Personality Theories. Retrieved Dec.28, 2012 from

http://webspace.ship.edu/cgboer/erikson.html

 

Gladwell, M. (2008). Outliers: the story of success. New York: Little Brown and Company.

 

Gray, GE.(2002). Evidence-based medicine: an introduction for psychiatrists. J Psychiatr Pract.

Jan;8(1):5-13.

 

Huitt, W., & Hummel, J. (2003). Piaget’s theory of cognitive development. Educational

  Psychology Interactive. Valdosta, GA: Valdosta State University. Retrieved Dec.28, 2012

from http://www.edpsycinteractive.org/topics/cognition/piaget.html

 

Jensen, E. (2005) Teaching with the Brain in Mind. Alexandria, VA.: ASCD.

 

Schutz, R.(2004). Vygotsky and Language Acquisition. Retrieved Dec. 28, 2012 from

http://www.english.sk.com.br/sk-vygot.html

 

Zoega, H., Valdimarsdottir,UA., Hernandez-Diaz,S. (2012, Dec.) Young relative age in the class

is associated not only with lower mathematics and language scores, but increases by 50%

the likelihood of being prescribed stimulants between 7-14. Age, Academic Performance, and

Stimulant Prescribing for ADHD: A Nationwide Cohort Study. Pediatrics. 130(6) 1012-8. doi:

10.1542/peds.2012-0689.

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