HUMAN DEVELOPMENT THROUGHOUT THE LIFE CYCLE(0-18 YEARS OLD)

Tjhin WigunaGitayanti Hadisukanto

Child and Adolescent Psychiatry DivisionDepartment of PsychiatryUniversity of Indonesia

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

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

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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8

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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