CHILD & ADOLESCENT PSYCHIATRY 2

Elmeida Effendy Psychiatric Department FK USU

1

Psychosocial development from Erik Erikson

Based on the concept of epigenesis His epigenetic principle holds that development occurs in sequential, clearly defined stages, & that each stage must be satisfactorily resolved for development to proceed smoothly

Eight Stages of the Life Cycle

1. Trust vs Mistrust (birth-18 months) 2. Autonomy vs Shame & Doubt (18 months-3 years) 3.Initiative vs Guilt (3-5 years) 4.Industry vs Inferiority (5-13 years) 5.Identity vs Role Confusion (13-21 years) 6.Intimacy vs Isolation (21-40 years) 7. Generativity vs Stagnation (40-60 years) 8. Integrity vs Despair (60-death) 3

1. Basic trust vs basic mistrust (birth-18 months)

Trust depends not an absolute quantities of food or demonstrations of love, but rather on the quality of maternal relationship Social modality : taking & holding on to things Associated virtue : hope Trust will predominate over mistrust, & hope will crystallize Related forms of psychopathology : psychosis, addictions, depression

2. Autonomy vs Shame & Doubt (18months-3 years)

Social modalities : holding on & letting go Associated virtue : will When that ratio is favorable, the child will develop an appropriate sense of autonomy & the capacity to have and to hold Related forms of psychopathology :paranoia, obsessions, compulsions, impulsivity
5

3.Initiative vs Guilt (3-5 years)

Increasing mastery of locomotor & language skills Jealousy & rivalry for a favored position with one of the parents Associate virtue : purpose Related forms of psychopathology : conversion disorder, phobia, psychosomatic disorder
6

4.Industry vs Inferiority (5-13 years)

Develops industry by learning new skills & takes pride in the things made Associated virtue : competence Related forms of psychopathology : creative inhibition, inertia

5.Identity vs Role Confusion (13-21 years)

Primarily concerned with what they appear to be in the eyes of others compared to what they feel they are, & with the question of how to connect the roles & skills cultivated earlier with the occupational prototypes of the day Associate virtue : fidelity Related forms of psychopathology :delinquent behavior, gender related identity disorder, borderline psychotic episodes

Jean Piagets Psychocognitive Development

Childs intelligence development basically from the virtue of progressive network of a pattern where its base is assimilation and accomodation process

There are 4 primary factors according to Piaget :

1. Existence of organic development & maturation from the endocrine & nervous system 2. The influence & role of experience and practice which obtained from conducted actions to physical object. 3.There are social interactions & social transmissions There is a continuous effort to maintain the equlibrium
10

In each development level, problems in forming of equilibrium, where former concept will represent base in forming of ready ness here & after, and will culminate in logical thinking when adulthood Child stay in a conceptual equilibrium, and if he obtain experience which doesnt match with his owned equilibrium, child will reside in unpleasant state, which is a disequilibrium situation & child will perform a changes in conceptual framework
11

which he owned, so that he stayed in a level will more go forward to face the problem. And this means the child returns in equilibrium state , and meaning that the child have earned to live with the problem

12

Child mental development bounce from a level/ plain/ plateau to higher level, and child perform changes to conceptual framework which he owned, by doing accomodation process in facing the problems/ experiences & new difficulties

13

If the child accept some experience or problem, however it is still in the same level or plateau, hence the child will do the assimilation process

14

Psychocognitive Development from Jean Piaget : 1. Sensorymotor Stage (birth-2 years) 2. Stage of Preoperational Thought (2-7 years) 3. Stage of Concrete Operations (7-11 years) 4. Stage of Formal Operations (11-end of adolescence)

15

Sensorymotor Stage (birth-2 years)

: object permanence or the schema of the permanent object Ability to understand that objects have an existence independent of the childs involvement with them Symbolization : at about 18 months infants begin to develop mental symbols & use words
16

Stage of Preoperational Thought (2-7 years)

Unable to think logically or deductively, concepts are primitive They can name the object but not classes the object Events are not linked by logic If children drop a glass that then breaks, they have no sense of cause & effect
17

They believe that the glass was ready to break, not that they broke the glass Immanent justice : the belief that punishment for bad deeds is inevitable Egocentric: they see themselves as the center of the universe, they have a limited point of view, unable to take the role of another person

18

E.g : children are not being negativistic when they do not listen to a command to be quiet cause their brother has to study. Instead, egocentric thinking prevents an understanding of their brothers point of view

19

magical thinking = phenomenalistic causality: events that occur together are thought to cause one another (e.g : thunder causes lightning, bad thoughts cause accidents) animistic thinking : tendency to endow physical events & objects with lifelike psychological attributes, such as feelings & intentions

20

Semiotic function : children use a symbol or sign to stand for something else. Children can represent something such as an object, event, conceptual scheme with a signifier, which serves a representative function (e.g. language, mental image, symbolic gesture) Drawing is a semiotic function initially done as playful exercise but eventually signifying something else in the real world
21

3. Stage of Concrete Operations (711years)

egocentric thought is replaced by operational thought: children operate & act on the concrete, real & perceivable world of objects & events syllogistic reasoning : in which logical conclusion is formed from 2 premises, eg: all horses are mammals (premise), all mammals are warm blooded (premise); therefore all horses are warm blooded (conclusion)

22

Conservation : the ability to recognize that although the shape of objects may change, the object still maintain or serve other characteristics that enable them to be recognized as the same, eg : if a ball of clay is rolled into a long, thin sausage shape, children recognize that each form contains the same amount of clay

23

Reversibility : the capacity to understand the relation between things, to realize that one thing can turn into another & back again, e.g : ice & water

24

Stage of Formal Operations (11-end of adolescence) :

Operates in a formal, highly logical, systematic & symbolic manner Ability to think abstractly, to reason deductively & to define concepts & also by the emergence of skills for dealing with permutations & combinations : can grasp the concept of probabilities

25

Attempt to deal with all possible relations & hypotheses to explain data & events during this stage Language use is complex, follows formal rules of logic & is grammatically correct Abstract thinking is shown by adolescents interest in a variety of issues- philosophy, religion, ethics & politics

26

Hypotheticodeductive thinking : the highest organization of cognition & enables persons to make a hypothesis or proposition & to test it against reality Deductive reasoning moves from the general to the particular and is more complicated process than inductive reasoning, which moves from the particular to the general

27

Diagnostic classification according to ICD-10

I.Disorders of psychological development

1. Specific developmental disorders of speech & language

1. Specific speech articulation disorder 2. Expressive language disorder 1. 2. 3. 4. Specific Specific Specific Specific reading disorder spelling disorder disorder of arithmetical skills scholastic skills disorder
28

2. Specific developmental disorders of scholastic skills

3. Specific developmental disorder of motor function 4. Mixed specific developmental disorder 5. Pervasive developmental disorder
1. Childhood autism 2. Retts syndrome 3. Aspergers syndrome

6. Other disorders of psychological development 7. Unspecified disorder of psychological development

29

II. Behavioral & emotional disorders with onset usually occurring in childhood & adolescence

1. Hyperkinetic disorders
1. Disturbance of activity & attention 2. Hyperkinetic conduct disorder

2. Conduct disorder 3. Mixed disorders of conduct & emotions 4. Emotional disorders with onset specific to childhood

1.Separation anxiety disorder of childhood

30

5. Disorders of social functioning with onset specific to childhood & adolescence

1. Elective mutism 2. Reactive attachment disorder of childhood

6. Tic disorders
1. Transient tic disorder 2. de la Tourettes syndrome

31

7. Other behavioral & emotional disorders with onset usually occurring in childhood & adolescence
1. non organic enuresis 2. non organic encopresis 3. feeding disorder of infancy & childhood 4.stuttering

32

Attention Deficit Hyperactivity Disorder

Diminished sustained attention, higher level of impulsivity in a child or adolescent than expected for someone of that age & developmental level 3-7 % of pre pubertal elementary school Boys : girls : 2-9 : 1 Symptoms must be present before age 7 ( usually by age 3)
33

Autistic Disorder

= early infantile autism = childhood autism = Kanners autism

Characterized by deviant reciprocal social interaction, delayed & aberrant communication skills & a restricted repertoire of activities & interests
34

Qualitative impairment in social interaction Qualitative impairment in communication Restricted repetitive & stereotyped patterns of behavior, interests & activities

35

Qualitative impairment in social interaction

Marked impairment in the use of multiple non verbal behaviors such as eye to eye gaze, facial expression, body postures Failure to develop peer relationships appropriate to developmental level A lack of spontaneous seeking to share enjoyment interests or achievements with other people
36

Qualitative impairment in communication

Delay in the development of spoken language In individual with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others Stereotyped & repetitive use of language or idiosyncratic language Lack of varied, spontaneous make-believe play appropriate to developmental level
37

Restricted repetitive & stereotyped patterns of behavior, interests & activities

stereotyped & repetitive motor mannerism : hand or finger flapping or twisting or complex whole body movements Persistent preoccupation with parts of objects

38

Treatment

Depends on the type of the disorders If the obtained symptom came from environment or family, hence the effectiveness of treatment determined by family or environment that concerned in the treatment strategy

39

Treatment for child could be in form of :

1. Family therapy 2. Environmental manipulation 3. Play therapy 4. Behaviour therapy 5.Pharmacological therapy 6. Psychotherapy
40

For child with education problems should be overcome with special school

41

For several cases may be :

1. Cannot overcome the environment 2. Environment as the root cause of the problems experienced by child 3. Dangerous child hurting others or own self For these kind of child treated in special place.
42

43