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Author: Michael Jibson, M.D., Ph.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share.

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Presentation on theme: "Author: Michael Jibson, M.D., Ph.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share."— Presentation transcript:

1 Author: Michael Jibson, M.D., Ph.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share Alike 3.0 License: We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

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3 Child Development M2 Psychiatry Sequence Michael Jibson Fall 2008

4 Outline zIntroduction/Principles zStages of development zTheories of development zTemperament zClinical application zConclusion

5 Principles: zDevelopment is continuous and lifelong, but most dramatic early in life zNeonatal brain weighs 350g, triples by 18m, and nearly adult size at 1350g by 7y zNeurogenesis mostly complete at birth zSynaptogenesis and axonal/dendritic arborization and pruning are active throughout childhood and beyond ythese processes are markedly influenced by environment and life experience

6 Principles: yHuman infant born completely reliant on caretaker yProlonged state of dependency  Developmental outcome is product of active interplay between individual’s genetic make-up and unique environmental influences (nature vs nurture)

7 Assessment of Normal Development yAge based cross-sectional perspective yLongitudinal developmental-line approach xMotor xLanguage xCognitive xSocial/Emotional

8 Newborn (Birth – 2 weeks) Competencies yReflexes: Involuntary, physical responses to stimuli xMaintain adequate supply of oxygen (hiccup, sneeze, spit- up) xMaintain constant body temperature (cry, shiver, tuck legs) xEnsure adequate nourishment (sucking, rooting, swallowing) ySocial Orientation xLooking/snuggling/responsiveness xAdaptive impact on caregiving environment

9 Infancy (0-2 years) Developmental Tasks yPhysiologic Stability yProgressive Physical and Motor Development yBonding/Attachment yLanguage Development

10 Infancy (0-2 years) Physical and Motor Development yBody Growth: Cephalocaudal and Proximo- Distal yBrain Growth and Maturation: neurons increase in size and in density of connective networks that transmit messages yMotor Development xSequence of hand skills (ulnar grasp – pincer grasp) xLocomotion (crawling --- walking) yPerceptual and Sensory Development

11 Infancy (0-2 years) Cognitive Development yPiaget’s Stage Theory (cognitive-structural) xSchemas xAssimilation, Accomodation xSensorimotor Period yLearning/Social learning xOperant Conditioning (rewards, punishments, shaping) xClassical Conditioning (associations) xInstruction xImitation

12 Infancy (0-2 years) Language Development yCooing and Babbling yHolophrases/Telegraphic Speech yParent/Infant Interaction

13 Infancy (0-2 years) Social, Emotional, Personality Development yErikson – Example of a Stage Theory xTrust versus Mistrust (primary caretaker) xAutonomy versus Shame and Doubt yAttachment (Bowlby, Ainsworth) x“Strange Situation” – observe infant in varying situations (mother, mother and stranger, stranger, mother returns, etc. ); code attachment x Approximately 60% infants coded as “secure attachments” by age 24 months

14 Infancy (0-2 years) Social, Emotional, Personality Development ySpitz – Social responses xFirst “social” smile (Approx. 2 months) xStranger Anxiety (Approx. 6 – 8 months) yFreud – Oral stage xMouth is primary organ of exploration and gratification yTemperamental Differences/Goodness of Fit between parent and child ySocial Learning: Reinforcers, modeling, imitation

15 Preschool (2-6 years) Developmental Tasks yProgressive motor development (increasingly active participant!) yRapid language development ySymbolic thought development ySeparation from primary caregiver/socialization beyond family yGender identity

16 Preschool (2-6 years) Motor Development yProgressive improvement in tone/strength yProgressive improvement in motor skills xDrawing, Climbing stairs xJumping, Hopping yControl of bowel and bladder yPeriod of ambulation and high activity level

17 Preschool (2-6 years) Cognitive/Language Development yReceptive language increases; vocabulary increases, sentence structure more elaborate yPiaget’s Preoperational Stage xSymbolic thought xEgocentrism, animism, imitation yCognitive-Processing Perspective xAttention span improves xSelective attention improves yImportance of Play

18 Preschool (2-6 years) Social/Emotional/Personality Development yErikson’s Psychosocial Stage Theory xAutonomy vs. Doubt (1-3 years) xInitiative vs. Guilt (3-6 years) ySocialization/Sex-Role Development xParenting Styles xSociocultural Influences xSocial Learning

19 School Age (6-12 years) Developmental Tasks yProgressive Motor Development yMastery of Concrete Information about World/Culture yBeginning Movement away from Nuclear Family ySocialization with Peers

20 School Age (6-12 years) Motor Development yImproved Balance xRiding bike, skating yImproved Coordination xGross motor xFine motor (writing)

21 School Age (6-12 years) Cognitive Development yPiaget’s Stage Theory: Concrete Operations xAssembling, classifying, compartmentalizing large amounts of information xEstablishing concept of conservation (number, class, length, weight) yCognitive-Processing Changes xAttention/Sustained attention xMemory strategies xProblem-solving

22 School Age (6-12 years) Movement away from family yIncreasing independence from parents ySchool and neighborhood influences xPeer groups: companionship, information, cooperative play, independence from adults xDiscipline and Social Norms xClub Formation xSex Stereotyping xNew Adults and Role Models

23 School Age (6-12 years) Emotional/Personality Development yPsychosocial Stage theory (Erikson) xIndustry vs. Inferiority ySocial Learning Theory (Bandura) xObservational Learning xCognitive characteristics important Intellectual ability, personal goals Expectancies, plans, interpretation of events

24 Adolescence (12-18 years) Developmental Tasks yAdjust to Biologic Changes xTiming of Puberty: Early vs. Late Maturation xGrowth Spurt: Rapid height and weight gain xBody Image (size, appearance, sexuality) ySeparation/Individuation from Parents yDevelop Abstract Thinking Abilities yContinue Developing Identity

25 Adolescence (12-18 years) Cognitive Development yPiaget’s Stage Theory (Formal Operational Thought) xImproved Logic, abstract thinking, reasoning xPotential versus Performance yElkin: Adolescent Egocentrism (perceive selves as more central & on “social stage” than actually are) xImaginary Audience xInvincibility Fable

26 Adolescence (12-18 years) Social/Emotional/Personality Development yIdentity Development xDefine self as unique person xErikson’s Psychosocial Stage: Identity vs. Role Diffusion ySocial Influences: Rites of Passage yPeer Influences xChanging Definitions of Friendship xSocial Structure of Peer Groups: Crowds & Cliques xGraduation Transition to Sexual Intimacy yParental Influences x“Generation Gap?” xParenting Styles/Limit-Setting/Values

27 Attachment Theory - John Bowlby xReciprocal biopsychological process xDriven by evolution xAttachment behaviors xMary Ainsworth - “Strange Situation” ~ 60% secure attachment

28 Psychosexual Model - Freud yOral Phase 0-1 y yAnal Phase 1-3 y yOedipal Phase 3-6 y yLatency 6-11 y

29 Psychosocial Model - Erickson yBasic Trust vs. Mistrust 0-1 y yAutonomy vs. Shame/Doubt 1-3 y yInitiative vs. Guilt 3-6 y yIndustry vs. Inferiority 6-12 y yIdentity vs. Role Confusion y

30 Cognitive Model - Piaget ySensorimotor Stage 0-18m yPreoperational 2-6 y yConcrete Operations 7-11 y yFormal Operations 12+ y

31 Temperament Chess and Thomas ySpeaks to individual styles or the “how” of behavior yDescribed nine dimensions of temperament yDefined three temperament styles x“Difficult” ~ 20% x“Easy” ~ 40% x“Slow-to-warm up” ~ 17%

32 Dimensions of Temperament yActivity level yRhythmicity yApproach/withdrawl to novelty yAdaptability to change yIntensity of reaction yResponse threshold yMood quality yDistractibility yAttention span/persistence

33 Child Abuse yPhysical/sexual abuse and/or neglect yImpacts over 1 million children each year yOver 3000 deaths each year (most commonly due to head trauma) yRisk factors include low birth weight, handicapped and behaviorally disordered yAbuser most commonly a parent/relative

34 Sexual Abuse yPerpetrator is known to victim in vast majority of cases (80%)  Median age of victim 9-10 y

35 Physical/Sexual Abuse Leads to Increased Rates: yDepression yAnxiety yConduct disturbance yHyperactivity ySubstance abuse ySuicidality yNeuronal Loss/Inhibited Neurogenesis

36 Conclusion zTHANKS! yPlease stay tuned for Child Psychopathology Lecture.


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