What’s physical development like during middle childhood?

Children enter middle childhood still looking very young, and end the stage on the cusp of adolescence. Most children have gone through a growth spurt that makes them look rather grown-up. The obvious physical changes are accompanied by changes in the brain. While we don’t see the actual brain changing, we can see the effects of the brain changes in the way that children in middle childhood play sports, write, and play games.

Learning Objectives

  • Describe physical growth during middle childhood
  • Examine health risks in school-aged children
  • Evaluate the impact of labeling on children’s self-concept and social relationships
  • Describe autism spectrum disorders
  • Identify common learning disabilities such as dyslexia and attention deficit hyperactivity disorder

Growth Rates and Motor Skills

Rates of growth generally slow during middle childhood. Typically, a child will gain about 5-7 pounds a year and grow about 2 inches per year. Many girls and boys experience a prepubescent growth spurt, but this growth spurt tends to happen earlier in girls (around age 9-10) than it does in boys (around age 11-12). Because of this, girls are often taller than boys at the end of middle childhood. Children in middle childhood tend to slim down and gain muscle strength and lung capacity making it possible to engage in strenuous physical activity for long periods of time.

The brain reaches its adult size at about age 7. That is not to say, however, that the brain is fully developed by age 7. The brain continues to develop for many years after it has attained its adult size. The school-aged child is better able to plan, coordinate activity using both left and right hemispheres of the brain, and to control emotional outbursts. Paying attention is also improved as the prefrontal cortex matures. As the myelin continues to develop throughout middle childhood, the child’s reaction time improves as well.

During middle childhood, physical growth slows down. One result of the slower rate of growth is an improvement in motor skills. Children of this age tend to sharpen their abilities to perform both gross motor skills such as riding a bike and fine motor skills such as cutting their fingernails.

Losing Primary Teeth

smiling boy on a swing with gap in teeth
Figure 1. A toothless smile is typical of middle childhood.

Deciduous teeth, commonly known as milk teeth, baby teeth, primary teeth, and temporary teeth, are the first set of teeth in the growth development of humans. The primary teeth are important for the development of the mouth, development of the child’s speech, for the child’s smile, and play a role in chewing of food. Most children lose their first tooth around age 6, then continue to lose teeth for the next 6 years. In general, children lose the teeth in the middle of the mouth first and then lose the teeth next to those in sequence over the 6-year span. By age 12, generally, all of the teeth are permanent teeth; however, it is not extremely rare for one or more primary teeth to be retained beyond this age, sometimes well into adulthood, often because the secondary tooth fails to develop.

Health Risks: Childhood Obesity

Nearly 20 percent of school-aged American children are obese, which is defined as being in the 95% or above in body weight (CDC, 2021). The percentage of obesity in school-aged children has increased substantially since the 1960s. Obesity is multifactorial: it’s influenced by many different factors, such as genetics, metabolism, eating and activity behaviors, community and neighborhood design and safety, sleep, and childhood events. Kids gained weight faster during the COVID-19 pandemic. The rise in childhood obesity is attributed to the introduction of a steady diet of television and other sedentary activities along with high fat, fast foods as a culture. Pizza, hamburgers, chicken nuggets, and “Lunchables” with soda have replaced more nutritious foods as staples.

School Lunches

School lunches must meet the applicable recommendations of the Dietary Guidelines for Americans. These guidelines state that no more than 30 percent of an individual’s calories should come from fat and less than 10 percent from saturated fat. Regulations also state that school lunches must provide one-third of the recommended dietary allowances of protein, Vitamin A, Vitamin C, iron, calcium, and calories. School lunches must meet federal nutrition requirements over the course of one week’s worth of lunches. However, local school food authorities may make decisions about which specific foods to serve and how they are prepared.

Many children in the United States buy their lunches in the school cafeteria, so it might be worthwhile to look at the nutritional content of school lunches. You can obtain this information through your local school district’s website. An example of a school menu and nutritional analysis from a school district in north-central Texas is a meal consisting of pasta alfredo, breadstick, peach cup, tomato soup, and a brownie, and 2% milk. Students may also purchase chips, cookies, or ice cream along with their meals. Many school districts rely on the sale of dessert and other items in the lunchrooms to make additional revenues and many children purchase these additional items so our look at their nutritional intake should also take this into consideration.

Consider another menu from an elementary school in the state of Washington. This sample meal consists of a chicken burger, tater tots, fruit and veggies, and 1% or nonfat milk. This meal is also in compliance with Federal Nutrition Guidelines but has about 300 fewer calories. And, children are not allowed to purchase additional desserts such as cookies or ice cream.

Michelle Obama has been a recent advocate for nutritional school lunches. Since the Healthy, Hunger-Free Act of 2010, she has worked diligently to defend the importance of healthy school lunches but has largely not been successful in her efforts. Schools in the United States are having difficulty enforcing nutrition values in fear of being wasteful because some of the new standards such as whole grains, more vegetables, and reduced sodium levels initially resulted in fewer children eating their lunches. Children are eating 16% more vegetables and 23% more fruit during lunches, and over 90% of schools report that they are meeting the new nutritional guidelines.

One consequence of childhood obesity is that children who are overweight tend to be ridiculed and teased by others. This can certainly be damaging to their self-image and popularity. In addition, obese children run the risk of suffering orthopedic problems such as knee injuries, and an increased risk of heart disease and stroke in adulthood. It may be difficult for a child who is obese to become a non-obese adult. In addition, the number of cases of pediatric diabetes has risen dramatically in recent years.

Dieting is not really the solution to childhood obesity. If you diet, your basal metabolic rate tends to decrease thereby making the body burn even fewer calories in order to maintain the weight. Increased activity is much more effective in lowering the weight and improving the child’s health and psychological well-being. Exercise reduces stress and being an overweight child, subjected to the ridicule of others can certainly be stressful. Parents should take caution against emphasizing diet alone to avoid the development of any obsession about dieting that can lead to eating disorders as teens. Again, increasing a child’s activity level is most helpful.

Organized Sports: Pros and Cons

Children playing soccer. A green team and a yellow team, both boys and girls, run towards the ball.
Figure 2. Organized sports like soccer are especially popular during middle childhood.

Middle childhood seems to be a great time to introduce children to organized sports. And in fact, many parents do. Nearly 3 million children play soccer in the United States. This activity promises to help children build social skills, improve athletically, and learn a sense of competition. It has been suggested, however, that the emphasis on competition and athletic skill can be counterproductive and lead children to grow tired of the game and want to quit. In many respects, it appears that children’s activities are no longer children’s activities once adults become involved and approach the games as adults rather than children. The U.S. Soccer Federation recently advised coaches to reduce the amount of drilling engaged in during practice and to allow children to play more freely and to choose their own positions. The hope is that this will build on their love of the game and foster their natural talents.

Another concern is cost. A 2019 analysis estimated the youth sports industry was worth $19.2 billion; for context, the most profitable professional league, the NFL, was worth an estimated $15 billion (Ryssdal & McHenry, 2022). The cost of participating in youth sports, from league fees and equipment to tournaments and travel, has increased dramatically and become inaccessible for many families. What can be done? Journalist Linda Flanagan suggests a solution at the micro- and exosystem levels: “I think it has to start in individual homes, and perhaps parents can organize and join leagues and teams and be on those boards to shape the conduct of those organizations” (para. 18).

Developmental Psychopathology

Girl screaming with anger and frustration as she works on some homework.
Figure 6. What are the pros and cons of labeling a child with a learning disability?

Developmental psychopathology is the approach to investigating the processes and pathways to typical and atypical development (Eme, 2017). The goal is to better understand the development of developmental disorders and the best ways to help children. Many childhood developmental disorders reflect brain-based differences, which is why we’re covering this section in the physical domain. It’s a good example of dynamic systems theory: physical changes in the brain interact with changes in how children think (cognitive) and their relationships and environmental supports (psychosocial).

Children’s cognitive and social skills are evaluated as they enter and progress through school. Sometimes this evaluation indicates that a child needs special assistance with language or in learning how to interact with others. Evaluation and diagnosis of a child can be the first step in helping to provide that child with the type of instruction and resources needed. In the U.S., a diagnosis or label is often required to get access to adequate funding and treatment.

But diagnosis and labeling also have social implications. It is important to consider that children can be misdiagnosed and that once a child has received a diagnostic label, the child, teachers, and family members may tend to interpret the actions of the child through that label. The label can also influence the child’s self-concept. Consider, for example, a child who is misdiagnosed as learning disabled. That child may expect to have difficulties in school, lack confidence, and out of these expectations, have trouble indeed. This self-fulfilling prophecy, or tendency to act in such a way as to make what you predict will happen, comes true, calls our attention to the power that labels can have whether or not they are accurately applied.

It is also important to consider that children’s difficulties can change over time: a child who has problems in school may improve later or may live under circumstances as an adult where the problem (such as a delay in math skills or reading skills) is no longer relevant. That person, however, will still have a label as learning disabled. It should be recognized that the distinction between abnormal and normal behavior is not always clear; some abnormal behavior in children is fairly common. Misdiagnosis may be more of a concern when evaluating learning difficulties than in cases of autism spectrum disorder where unusual behaviors are clear and consistent.

Keeping these cautionary considerations in mind, let’s turn our attention to some developmental and learning difficulties.

Think It Over: Disability Inclusion

Some disabilities are very apparent and such as a person being in a wheelchair.  However, there are also many invisible disabilities that may not be apparent went first looking at a person. How would you react to seeing a person with a disability? How would you interact with them? It is important to remember that children will model the behavior that they see. We must actively teach children about disability inclusion and how to treat people with all abilities with respect.  Watch this video of a mom who has a daughter with special needs talk about her 5 Tips for disability inclusion.

Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior. The estimate published by the Center for Disease Control (2018) is that about 1 out of every 59 children in the United States has been diagnosed with Autism Spectrum Disorder (ASD), which covers a wide variety of ranges in ability, from those with milder forms (formerly known as Asperger’s Syndrome) to more severe deficits in communication.

Link to Learning

Learn more about Autism Spectrum Disorders at Autism Speaks, or the Autistic Self Advocacy Network.

A person with autism has difficulty with and a lack of interest in learning language. An autistic child may respond to a question by repeating the question or might rarely speak. Sometimes autistic children learn more difficult words before simple words or can complete complicated tasks before they are able to complete easier ones. The person often has difficulty reading social cues such as the meanings of non-verbal gestures such as a wave of the hand or the emotion associated with a frown. Intense sensitivity to touch or visual stimulation may also be experienced. Autistic children often have poor social skills and are often unable to communicate with others or empathize with others emotionally. People with autism often view the world differently and learn differently than people who do not have autism. Autistic children tend to prefer routines and patterns and become upset when routines are altered. For example, moving the furniture or changing the daily schedule can be very upsetting.

Many children with ASD are not identified until they reach school age, although our ability to diagnose children earlier continues to improve. In the 2017-2018 school year, about 710,000 children on the spectrum received special education through the public schools. These disorders are found in all racial and ethnic groups and are more common in boys than in girls. All of these disorders are marked by difficulty in social interactions, problems in various areas of communication, and in difficulty with altering patterns or daily routines. There is no single cause of ASD and the causes of these disorders are to a large extent, unknown. In cases involving identical twins, if one twin has autism, the other is also autistic about 75 percent of the time. Rubella, fragile X syndrome and PKU that have been untreated are some of the medical conditions associated with risks of autism.

Some individuals benefit from medications that alleviate some of the symptoms of ASD, but the most effective treatments involve behavioral intervention and teaching techniques used to promote the development of language and social skills. Children also excel when they are in structured learning environments that accommodate the needs of children on the spectrum.

Impaired Theory of Mind in Individuals with Autism

People with autism or an autism spectrum disorder (ASD) typically show an impaired ability to recognize other people’s minds. Under the DSM-5, autism is characterized by persistent deficits in social communication and interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. These deficits are present in early childhood, typically before age three, and lead to clinically significant functional impairment. Symptoms may include lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with unusual objects.

About half of parents of children with ASD notice their child’s unusual behaviors by age 18 months, and about four-fifths notice by age 24 months, but often a diagnosis comes later, and individual cases vary significantly. Typical early signs of autism include:

  • No babbling by 12 months.
  • No gesturing (pointing, waving, etc.) by 12 months.
  • No single words by 16 months.
  • No two-word (spontaneous, not just echolalic) phrases by 24 months.
  • Loss of any language or social skills, at any age.

Children with ASD experience difficulties with explaining and predicting other people’s behavior, which leads to problems in social communication and interaction. Children who are diagnosed with an autistic spectrum disorder usually develop the theory of mind more slowly than other children and continue to have difficulties with it throughout their lives.

For testing whether someone lacks the theory of mind, the Sally-Anne test is performed. The child sees the following story: Sally and Anne are playing. Sally puts her ball into a basket and leaves the room. While Sally is gone, Anne moves the ball from the basket to the box. Now Sally returns. The question is: where will Sally look for her ball? The test is passed if the child correctly assumes that Sally will look in the basket. The test is failed if the child thinks that Sally will look in the box. Children younger than four and older children with autism will generally say that Sally will look in the box.

CONNECT THE CONCEPTS: Emotional Expression and Emotion Regulation

Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by repetitive behaviors and communication and social problems. Children who have autism spectrum disorders have difficulty recognizing the emotional states of others, and research has shown that this may stem from an inability to distinguish various nonverbal expressions of emotion (i.e., facial expressions) from one another (Hobson, 1986). In addition, there is evidence to suggest that autistic individuals also have difficulty expressing emotion through tone of voice and by producing facial expressions (Macdonald et al., 1989). Difficulties with emotional recognition and expression may contribute to the impaired social interaction and communication that characterize autism; therefore, various therapeutic approaches have been explored to address these difficulties. Various educational curricula, cognitive-behavioral therapies, and pharmacological therapies have shown some promise in helping autistic individuals process emotionally relevant information (Bauminger, 2002; Golan & Baron-Cohen, 2006; Guastella et al., 2010).

Emotional regulation describes how people respond to situations and experiences by modifying their emotional experiences and expressions. Covert emotion regulation strategies are those that occur within the individual, while overt strategies involve others or actions (such as seeking advice or consuming alcohol). Aldao and Dixon (2014) studied the relationship between overt emotional regulation strategies and psychopathology. They researched how 218 undergraduate students reported their use of covert and overt strategies and their reported symptoms associated with selected mental disorders and found that overt emotional regulation strategies were better predictors of psychopathology than covert strategies. Another study examined the relationship between pregaming (the act of drinking heavily before a social event) and two emotion regulation strategies to understand how these might contribute to alcohol-related problems; results suggested a relationship but a complicated one (Pederson, 2016). Further research is needed in these areas to better understand patterns of adaptive and maladaptive emotion regulation (Aldao & Dixon-Gordon, 2014).

Learning Disabilities

What is a learning disability? If a child is mentally disabled, that child is typically slow in all areas of learning. However, a child with a learning disability has problems in a specific area or with a specific task or type of activity related to education. A learning difficulty refers to a deficit in a child’s ability to perform an expected academic skill (Berger, 2005). These difficulties are identified in school because this is when children’s academic abilities are being tested, compared, and measured. Consequently, once academic testing is no longer essential in that person’s life (as when they are working rather than going to school) these disabilities may no longer be noticed or relevant, depending on the person’s job and the extent of the disability.

Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. Dyslexia is one of the most commonly diagnosed disabilities and involves having difficulty in the area of reading. This diagnosis is used for a number of reading difficulties. For example, the child may reverse letters, may have difficulty reading from left to right, or may have problems associating letters with sounds. Dyslexia appears to be rooted in some neurological problems involving the parts of the brain active in recognizing letters, verbally responding, or being able to manipulate sounds (National Institute of Neurological Disorders and Stroke, 2006). Treatment typically involves altering teaching methods to accommodate the person’s particular problematic area.

Attention Deficit Hyperactivity Disorder (ADHD) is considered a neurological and behavioral disorder in which a person has difficulty staying on task, screening out distractions, and inhibiting behavioral outbursts. The most commonly recommended treatment involves the use of medication, structuring the classroom environment to keep distractions at a minimum, tutoring, and teaching parents how to set limits and encourage age-appropriate behavior (NINDS, 2006). Some people say that the term Attention Deficit is a misnomer because people who suffer from ADHD actually have great difficulty tuning things out. They are bombarded with information… their brains are trying to pay attention to everything. They do not have a deficit of attention- they are trying to pay attention to too many things at once, so everything suffers.

Recent research suggests that several brain structures may be implicated in ADHD. These studies have mainly focused on the frontal lobe and prefrontal cortex. Some studies suggest that the frontal lobe is underdeveloped in children and adults with ADHD. The frontal lobe is involved in executive function, attention, planning, impulse control, motivation, and decision making. In some cases the development is delayed, but catches up to expected standards by adulthood; in other cases, the frontal lobe never fully develops.

Link to Learning

How is ADHD diagnosed? The DSM-V lists the criteria that must be present in order for a diagnosis to be made and an official diagnosis must be made by a qualified mental health professional.  It is also important to note that the term ADD is an older term that has been phased out in the newer versions of the DSM. Review the criteria for ADHD. Do you think that making a diagnosis would be difficult?  Why or why not?

In general, ADHD is treated with stimulants. While this may seem counter-intuitive (why give a hyperactive child a stimulant?), when you understand the neurological processes involved, it makes a lot of sense. There are two ways that stimulants may work to help people with ADHD focus. Some researchers have found that the stimulants activate the underdeveloped parts of the brain (prefrontal cortex and frontal lobe) thereby making these brain areas function more as they should. This allows the child or adult to focus properly. Other researchers suspect that the stimulants affect the way the neurotransmitters function in these brain areas, leading to better function in those areas.

There is still a lot of controversy about medicating children with ADHD. While there is clear evidence that medication works to control the negative effects of ADHD, there are also negative side effects that must be dealt with including problems sleeping, changes in appetite, headaches, and more. Further, the long term effects of medicating young children are not well understood. For these reasons, many parents prefer an intervention that does not involve medication. The most common non-pharmaceutical intervention for ADHD is Cognitive Behavioral Therapy (CBT). CBT works by helping children to become aware of their thought processes, and then to learn to change those thought processes to be more beneficial or positive. CBT can also help by educating parents about ways to help their children learn about self-control and discipline. There is very good evidence that CBT is an effective strategy in treating ADHD. Indeed, in some studies, children treated with CBT have better long-term outcomes than children treated with medication. Some studies show that a combination of medication and CBT is most beneficial because the medication helps with behavior change more quickly, allowing for the child to learn through CBT more quickly. The CBT then helps with longer-term behavior change so that the child can stop taking medications and deal effectively with their ADHD symptoms based on what they have learned through CBT.

DIG DEEPER: Why Is the Prevalence Rate of ADHD Increasing?

Many people believe that the rates of ADHD have increased in recent years, and there is evidence to support this contention. In a recent study, investigators found that the parent-reported prevalence of ADHD among children (4–17 years old) in the United States increased by 22% during a 4-year period, from 7.8% in 2003 to 9.5% in 2007 (CDC, 2010). Over time this increase in parent-reported ADHD was observed in all sociodemographic groups and was reflected by substantial increases in 12 states (Indiana, North Carolina, and Colorado were the top three). The increases were greatest for older teens (ages 15–17), multiracial and Hispanic children, and children with a primary language other than English. Another investigation found that from 1998–2000 through 2007–2009 the parent-reported prevalence of ADHD increased among U.S. children between the ages of 5–17 years old, from 6.9% to 9.0% (Akinbami, Liu, Pastor, & Reuben, 2011).

A major weakness of both studies was that children were not actually given a formal diagnosis. Instead, parents were simply asked whether or not a doctor or other health-care provider had ever told them their child had ADHD; the reported prevalence rates thus may have been affected by the accuracy of parental memory. Nevertheless, the findings from these studies raise important questions concerning what appears to be a demonstrable rise in the prevalence of ADHD. Although the reasons underlying this apparent increase in the rates of ADHD over time are poorly understood and, at best, speculative, several explanations are viable:

  • ADHD may be over-diagnosed by doctors who are too quick to medicate children as a behavior treatment.
  • There is greater awareness of ADHD now than in the past. Nearly everyone has heard of ADHD, and most parents and teachers are aware of its key symptoms. Thus, parents may be quick to take their children to a doctor if they believe their child possesses these symptoms, or teachers may be more likely now than in the past to notice the symptoms and refer the child for evaluation.
  • The use of computers, video games, iPhones, and other electronic devices has become pervasive among children in the early 21st century, and these devices could potentially shorten children’s attention spans. Thus, what might seem like inattention to some parents and teachers could simply reflect exposure to too much technology.
  • ADHD diagnostic criteria have changed over time.


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Human Growth and Development Copyright © 2022 by Ryan Newton is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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