HUMAN DEVELOPMENT THROUGHOUT THE LIFE CYCLE (0-18 years old) Tjhin Wiguna Gitayanti Hadisukanto Child and Adolescent Psychiatry Division Department of Psychiatry University of Indonesia

PRENATAL PERIOD, INFANCY, AND CHILDHOOD Fetal Life Behavior Nervous System Maternal Stress Genetic Disorders Maternal Drug Use

CAUSES OF HUMAN MALFORMATIONS OBSERVED DURING THE FIRST YEAR OF LIFE Suspected Cause % total Genetic: autosomal genetic diseases 15-20 cytogenic (chromosomal abnormalities) 5 Unknown: polygenic, multifactorial, spontaneous error of dev, synergistic interactions of teratogens) Environmental: maternal conditions 4 maternal infections 3 mechanical problems (deformations) 1-2 Chemicals, drugs, radiation, hyperthermia <1 Preconception exposures <1 (excluding mutagens and infectious agents)

INFANCY Developmental Landmarks Temperamental Differences Attachment Reflexes & Survival Systems At Birth Language And Cognitive Development (Piaget) Emotional & Social Development Temperamental Differences Attachment Social Deprivation Syndromes & Maternal Neglect Fathers And Attachment Stranger Anxiety Infant Care Parental Fit Good-enough Mothering

TODDLER PERIOD Developmental Landmarks Parenting Language And Cognitive Development Emotional And Social Development Sexual Development Sphincter Control And Sleep Parenting

PRESCHOOL PERIOD Developmental Landmarks Language & Cognitive Development Emotional & Social Behavior Sibling Rivalry Play Imaginary Companions Television

Developmental Landmarks MIDDLE YEARS Developmental Landmarks Language & Cognitive Developmental Chum Period (bersahabat, bergaul) School Refusal

OTHER ISSUES IN CHILDHOOD Sex Role Development Dream & Sleep Spacing Of Children Birth Order Children And Divorce Stepparents Adoption Family Factors In Children Development Family Stability Other Family Factors Parenting Styles

PUBERTY Onset Of Puberty Changes In Hormones Psychosexual Development Menarche Neurological Changes Cognitive And Personality Development Negativism Peer Group Parenting Development Of Morals Choice Of Occupation Risk-taking Behavior Use Of Drugs Pregnancy Abortion

THE HUMAN LIFE CYCLE

Definition A change of human needs and functions : A process of change throughout the years of life to the progression from birth to death. A change of human needs and functions : Physical Development Psychosocial Development (Erik H.Erikson’s Theory) Psychosexual Development (S. Freud’s Theory) Cognitive Development (Jean Piaget’s Theory) Moral Development (Lawrence Kohlberg’s Theory’s)

Influential factors: Intrinsic : genetic/disposition, as a function of age Extrinsic : society, environment & culture

Understanding the human life cycle To better understand the patient’s individual needs at various stages of life. To develop a better doctor-patient relationship To identify and assess various problems more appropriately and realistically. To set up a more realistic & problem oriented treatment plan.

Erikson’s Theory of Psychosocial Development Basic principles: Stresses the psychosocial drives rather than the psychosexual drives the crisis of development originates in the personal goals to social expectation; not simply the inhibition of psychosexual drives.

Erikson’s Theory of Psychosocial Development The “Epigenetic Principle” The notion that development proceeds from a universal plan that continually builds upon itself at appropriate times. 'anything that grows has a ground plan, and out of this ground plan the parts arise, each part having its time of special ascendancy, until all parts have arisen to form a functional whole'

Erikson’s Theory of Psychosocial Development The psychosocial crises, universally determined crisis, that builds on and incorporates previous experiences, current cultural influences and biological change. Unresolved crises may result in personality psychopathology which may persist in adulthood. Eight stage sequence of development ranging from birth to old age: the stages are not strictly tied to chronological age, nor are they always easy to separate.

Stages of Psychosocial Development Stage 1 – Oral Sensory Stage 2 – Muscular-Anal Stage 3 – Locomotor Stage 4 – Latency Stage 5 – Adolescence Stage 6 – Young Adulthood Stage 7 – Middle Adulthood Stage 8 – Maturity Trust v Mistrust Autonomy v Shame & Doubt Initiative v Guilt Industry v Inferiority Identity v Role Confusion Intimacy v Isolation Generativity v Stagnation  Integrity v Despair

Stage 1 – Oral Sensory birth to 1 year (infancy) basic conflict is trust vs. mistrust the important event is feeding and the important relationship is with the mother the infant must develop a loving, trusting relationship with the mother/caregiver through feeding, teething and comforting failure to resolve this conflict can lead to sensory distortion, and withdrawal

Stage 2 – Muscular-Anal age 1 to 3 years (toddler) Basic conflict is autonomy vs. shame/doubt The important event is toilet training and the important relationship is with the parents The child’s energy is directed towards mastering physical skills such as walking, grasping and muscular control The child learns self control but may develop shame, doubt, impulsivity or compulsion if not handled well

Stage 3 – Locomotor age 3 to 6 years (preschool) basic conflict is initiative vs. guilt the important event is independence and the important relationship is family the child continues to become more assertive in exploration, discovery, adventure and play the child may show too much force in this stage causing feelings of guilt failure to resolve this conflict can lead to ruthlessness and inhibition

Stage 4 – Latency age 6 to 12 years (school age) the basic conflict in this stage is industry vs. inferiority the important event is school and the important relationships are teachers, friends and neighbourhood the child must learn to deal with new skills and develop a sense of achievement and accomplishment failure to do so can create a sense of inferiority, failure and incompetence

Stage 5 – Adolescence age 12 to 20 years (adolescent) the basic conflict is identity vs. role confusion the important event is development of peer relationships and the important relationships are peers, groups and social influences The teenager must achieve a sense of identity in occupation, sex roles, politics and religion. In addition, they must resolve their identity and direction. Failure to make these resolutions can lead to the repression of aspects of the individual for the sake of others (fanaticism)

Piaget’s Theory of Cognitive Development Basic principles Intelligence as a particular instance of biological adaptation to the environment → A process of equilibration

Piaget’s Theory of Cognitive Development cont The content of intelligence: ‘what’ The Structure of Intelligence : ‘how’and ‘why’ Through interaction of the mind with the external world fits the world (external structures & organization) into his own mental framework (cognitive structure) Two important points in the building of cognitive structures : The person is actively involved in the building process An environment with which it interacts is necessary for structural development (stimulation )

1. Sensori-Motor Stage (0-2 years old) Sensory contact understanding. The child explores the world surrounding them using it’s senses Initially sucking/grasping reflex and moving onto reaching for objects out of reach. Major development within this stage: object permanence Initially the baby cannot understand a object exists out of sight. As the baby reaches around 7/8 months a child will begin to understand the object/person still exists when out of sight.

Pre-Operational stage (2-7years old) Toddler can understand the use of symbols and language. This is an example of symbolic thinking i.e. pretend play Language is now understood Development of: Animism…child understands ‘bad table’, believes inanimate objects have feelings as they do. Egocentricism…Can only see the world from their own point of view All these developments take place in the Pre-Operational Stage. Theory of mind (understanding of mental processes)

Pre-Operational stage (2-7years old) Still very egocentric Mountain task

Concrete Operational Stage (7-11 years) The children are now able to conserve Conservation: the awareness that a quantity remains the same despite a change in its appearance They understand that although the appearance has changed the thing it self does not. ₌ → →

Kohlberg’s Theory of moral development Definition of morality The ability to distinguish between right from wrong. Involving: Cognition : role taking, reasoning, decision making. Feelings : empathy, altruism and care Behaviors : helping others, resisting temptation, etc. A person described as having a high moral standards is: Aware of the needs and feelings of others (cognition) Concerned about others (affective), and likely to respond on it appropriately Display that awareness and concern in dealing with other people (behavior)

Kohlberg’s Theory of moral development cont Deficiencies in any of the three moral dimensions would indicate a “less than perfect” moral character.  Theories regarding perspectives on moral development : Social learning theory, emphasizes on behavioral dimensions Psychoanalytic Theory, emphasizes on the affective dimension Cognitive theory, emphasizes on the cognitive dimension

Kohlberg’s Theory of moral development cont Level I – Preconventional Stage 1. Punishment and obedience orientation Stage 2. Concern with satisfying own needs Level II – Conventional Stage 3. “good boy good girl” orientation Stage 4. “law and order” orientation Level III – Postconventional Stage 5. The social contract Stage 6. The universal good

The Life Cycle and the Care Profession. Familiarity with the life cycle is extremely important to doctors/nurses The changing flow of life provides both challenge and opportunity to those who are in the care professions Knowledge of the development stages will give you insight Into what is important to the patient How she/he might respond to care The integration of an individual’s physical, social, sexual, cognitive and moral components results in a person different from any other individual Optimal effective care should be tailored to the unique characteristics of its recipient. Design care that will meet the unique needs of the ill individual

CHILD and ADOLESCENT PSYCHIATRY PSYCHIATRIC DISORDERS IN CHILD AND ADOLESCENT

Disorders of Infancy, Childhood, and Adolescent Mental Retardation Learning Disorders Motor Skills Disorder: Developmental Coordination Disorder Communication Disorders Pervasive Developmental disorders Disruptive Behavior Disorders Feeding and Eating Disorders of Infancy and Early Childhood Tic Disorders Elimination Disorders Other Disorders of Infancy, Childhood, and Adolescence: separation anxiety disorder, selective mutism, reactive attachment disorder of infancy or early childhood

Mood disorders and Suicide in Children and Adolescents Early-onset Schizophrenia Adolescent Substance Abuse Additional Conditions that may be a focus of clinical attention: Borderline intellectual functioning Academic problem Childhood or adolescent antisocial behavior Identity problem

References Hughes FP, Noppe LD, Noppe IC. Child development. Prentice Hall : New Jersey, 1996. Ellis JR, Nowlis EA. Nursing, a human needs approach. 3rd ed. Houghton Mifflin Co. : Boston, 1985. Kaplan HI, Sadock BJ. Synopsis of psychiatry. 8th ed. Lippencott Williams & Wilkins, 1998.

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