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HUMAN DEVELOPMENT THROUGHOUT THE LIFE CYCLE(0-18 YEARS OLD)
Tjhin WigunaGitayanti Hadisukanto
Child and Adolescent Psychiatry DivisionDepartment of PsychiatryUniversity of Indonesia
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PRENATAL PERIOD, INFANCY, AND CHILDHOOD
• Prenatal Period• Fetal Life • Behavior• Nervous System
• Maternal Stress
• Genetic Disorders
• Maternal Drug Use
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CAUSES OF HUMAN MALFORMATIONS OBSERVED DURING THE FIRST YEAR OF LIFE
Suspected Cause % total
Genetic:autosomal genetic diseases 15-20cytogenic (chromosomal abnormalities) 5
Unknown:polygenic, multifactorial, spontaneous error of dev, synergistic interactions of teratogens)
Environmental:maternal conditions 4maternal infections 3mechanical problems (deformations)
1-2 Chemicals, drugs, radiation, hyperthermia
<1 Preconception exposures
<1(excluding mutagens and infectious agents)
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INFANCY
Developmental Landmarks 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
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TODDLER PERIOD
Developmental Landmarks Language And Cognitive Development Emotional And Social Development Sexual Development Sphincter Control And Sleep
Parenting
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PRESCHOOL PERIOD
Developmental LandmarksLanguage & Cognitive DevelopmentEmotional & Social Behavior
Sibling Rivalry Play Imaginary Companions Television
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MIDDLE YEARS
Developmental LandmarksLanguage & Cognitive Developmental
Chum Period (bersahabat, bergaul) School Refusal
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OTHER ISSUES IN CHILDHOOD
Sex Role Development
Dream & Sleep Spacing Of
Children Birth Order Children And
DivorceStepparents
Adoption Family Factors In
Children Development
Family StabilityOther Family
FactorsParenting Styles
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PUBERTY
Onset Of Puberty Changes In
Hormones Psychosexual
Development MenarcheNeurological
Changes Cognitive And
Personality Development
Negativism Peer Group
Parenting Development Of
Morals Choice Of
Occupation Risk-taking
Behavior Use Of Drugs Pregnancy
Abortion
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THE HUMAN LIFE CYCLE
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Definition
A process of change throughout the years of life to the progression from birth to death.
A change of human needs and functions :1. Physical Development2. Psychosocial Development (Erik
H.Erikson’s Theory)3. Psychosexual Development (S. Freud’s
Theory)4. Cognitive Development (Jean Piaget’s
Theory)5. Moral Development (Lawrence Kohlberg’s
Theory’s)
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Influential factors:1. Intrinsic : genetic/disposition, as a
function of age2. Extrinsic : society, environment &
culture
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Understanding the human life cycle
1. To better understand the patient’s individual needs at various stages of life.
2. To develop a better doctor-patient relationship
3. To identify and assess various problems more appropriately and realistically.
4. To set up a more realistic & problem oriented treatment plan.
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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.
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Erikson’s Theory of Psychosocial Development
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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
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• 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.
Erikson’s Theory of Psychosocial Development
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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
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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
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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
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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
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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
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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)
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Piaget’s Theory of Cognitive Development
Basic principles
Intelligence as a particular instance of biological adaptation to the environment → A process of equilibration
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• 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 :1. The person is actively involved in the building
process2. An environment with which it interacts is
necessary for structural development (stimulation )
Piaget’s Theory of Cognitive Development cont
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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.
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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)
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Pre-Operational stage (2-7years old)
• Still very egocentricMountain task
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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.
→ → ₌
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Kohlberg’s Theory of moral development
Definition of moralityThe ability to distinguish between right from wrong.
Involving: 1. Cognition : role taking, reasoning, decision
making.2. Feelings : empathy, altruism and care3. Behaviors : helping others, resisting temptation,
etc.
A person described as having a high moral standards is:a. Aware of the needs and feelings of others
(cognition)b. Concerned about others (affective), and likely to
respond on it appropriatelyc. Display that awareness and concern in dealing
with other people (behavior)
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Deficiencies in any of the three moral dimensions would indicate a “less than perfect” moral character.
Theories regarding perspectives on moral development :1. Social learning theory, emphasizes on
behavioral dimensions2. Psychoanalytic Theory, emphasizes on the
affective dimension3. Cognitive theory, emphasizes on the cognitive
dimension
Kohlberg’s Theory of moral development cont
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Level I – PreconventionalStage 1. Punishment and obedience orientationStage 2. Concern with satisfying own needs
Level II – Conventional
Stage 3. “good boy good girl” orientationStage 4. “law and order” orientation
Level III – Postconventional
Stage 5. The social contractStage 6. The universal good
Kohlberg’s Theory of moral development cont
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The Life Cycle and the Care Profession.A. Familiarity with the life cycle is extremely important to doctors/nurses
B. The changing flow of life provides both challenge and opportunity to those who are in the care professions
C. Knowledge of the development stages will give you insight1. Into what is important to the patient2. How she/he might respond to care
D. The integration of an individual’s physical, social, sexual, cognitive and moral components results in a person different from any other individual
E. Optimal effective care should be tailored to the unique characteristics of its recipient.
F. Design care that will meet the unique needs of the ill individual
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CHILD AND ADOLESCENT PSYCHIATRY
PSYCHIATRIC DISORDERS IN CHILD AND ADOLESCENT
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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
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• 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
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References
1. Hughes FP, Noppe LD, Noppe IC. Child development. Prentice Hall : New Jersey, 1996.
2. Ellis JR, Nowlis EA. Nursing, a human needs approach. 3rd ed. Houghton Mifflin Co. : Boston, 1985.
3. Kaplan HI, Sadock BJ. Synopsis of psychiatry. 8th ed. Lippencott Williams & Wilkins, 1998.
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Thank You