Docstoc

human behavior and child development

Document Sample
human behavior and child development Powered By Docstoc
					         Child Development
         February-20-2008

Regina Bussing, M.D., M.S.H.S.
Division of Child and Adolescent Psychiatry
Department of Psychiatry
University of Florida
                    Goals
   Develop an understanding of different
    dimensions of development
   Identify developmental concepts that will
    be important in future clinical work
   Provide “roadmap” for the behavioral
    assessment of children, based on
    understanding of “normal” development
   Stimulate your interest in learning more
    about this exciting topic, beyond the lecture
  Developmental Considerations
“Is the child at an age-appropriate level?”
Issues:
 Chronological age (CA) versus mental age (MA)
 Developmental “milestones”, e.g. DENVER
 Developmental theories of Piaget, Erikson,
   Mahler etc.
 Age-appropriate problem-phases (e.g. terrible
   2’s)
    Dimensions of Development
   Physical growth and motor skills
   Temperament
   Cognition and intelligence
   Language
   Social relations and attachment
                        Growth in Height and Weight from 2-18 Years
                                  Height                                                       Weight
              190                                74.9                        90                                 194.0

              180                 Boys           70.9                        80                                 176.3
                                                                                               Boys
              170                                66.9                        72                                 158.7
Centimeters




              160                                63.0                        64                                 141.1
              150                                59.0                        56                                 123.4




                                                                                                                        Pounds
                                                                 Kilograms
              140                                55.1                        48                                 105.8

                                                        Inches
              130                                51.2                        40                                 88.2
              120                                47.2                        32                                 70.5
              110                                43.3                        24                                 52.9
                                         Girls
              100                                39.4                        16                                 35.3
                                                                                                        Girls
               90                                35.4                        8                                  17.6
               80                              31.5                          0                               0
                    2    4   6 8 10 12 14 16 18                                  2   4   6 8    10 12 14 16 18
                             Age in Years                                                 Age in Years
Milestones of Motor Development
          Motor Skills-Summary
Age 2-up stairs w/o help

  Age 3-tricycle, copies circle

     Age 4-hops, copies square

          Age 5-skips, copies triangle
       Developmental Milestones
   Developed by Arnold Gesell and Colleagues
   Objective observation of large numbers of children at
    various ages
   Assessment of gross and fine motor, personal-social, and
    language domains
   DENVER II Developmental Screening Test provides
    age ranges of normal appearance of various milestones up
    to age 6 years
   Recently revised and restandardized; very widely used
The Concept of Temperament
   Pioneers of Temperament research: Thomas and Chess (New York
    Longitudinal Study: 85 middle-class families with 133 children)
        Nine relatively stable dimensions:
                Activity level; rhythmicity; approach/withdrawal; adaptability;
                 intensity; responsiveness threshold; mood quality; distractibility;
                 attention span and persistence
         Three recognized clusters:
                Easy child (Positive mood; regular; adaptable; low intensity; positive to
                 novelty)
                Difficult child
                Slow-to-warm-up (Negative response to novelty; mild intensity;
                 gradual adaptation after repeated contact)
   Contemporary research (e.g., Goldsmith; Rothbart; Buss & Plomin):
         fewer dimensions than Thomas & Chess
                emotional processing, self-regulation; effortful control; activity level
Traditional Development Models
      Age                 Piaget                    Erikson
                   Cognition/Intelligence         Psychosocial
0 - 12 months     Sensorimotor              Trust vs. Mistrust

1 - 2 years       Sensorimotor              Autonomy vs. Shame
                                            and Doubt
2+ - 7 years      Preoperational            Initiative vs. guilt

7 - 11/12 years   Concrete operations       Industry vs. inferiority

11/12 years       Formal operations         Identity vs. role
onward                                      confusion
     Theory of Cognitive Development
   Pioneered by Jean Piaget (1896-1980)
   Theory assumes that cognitive development is
    influenced by maturation, experience, and
    social learning, and constructed through self-
    motivated action in the world.
   Original theory proposed 4 stages; neo-piagetian
    researchers have challenged the number and
    definitions of stages; other cognitive
    developmentalists have challenged stage theory
    and propose more domain-specific knowledge
    development.
Piaget’s original four stages
   Sensorimotor stage: from birth to age 2 years (children
    experience the world through movement and senses and
    learn object permanence)
   Preoperational stage: from ages 2 to 7 (acquisition of
    motor skills; egocentric stage)
   Concrete operational stage: from ages 7 to 11 (children
    begin to think logically about concrete events, develop
    understanding of conservation, seriation, reversibility)
   Formal operational stage: after age 11 (development of
    abstract reasoning).
   Cognitive Development
Sensorimotor Stage: Object Permanence
                                                                             Usual Answer of Pre-
                   Original Setup   Alter as Shown                           operational Child
                                                          Ask Child


 Conservation of
                                                     Which has more
 liquid                                              liquid?
                                                                                 Has more


                                                     Do they both weigh
                                                     the same, or does
Conservation of                                      one weigh more
mass
                                                     than the other?
                                                                               Weighs more



                                                     Are there still as
                                                     many pennies as
 Conservation of
 number
                                                     nickels, or more of
                                                     one than the other?
                                                                                   More



                                                     Are they the same
                                                     length, or is one
 Conservation of
 length                                              longer?
                                                                                 Is longer



                                                     Is one pencil as long
 Conservation of                                     as the other, or is
 length                                              one longer?
 Formal Operations Stage
      “Thinking in a New Key”

Concrete  logic to abstract thinking
    (“thinking about thinking”)
 If…then
Alternatives
Future perspective
Shades of Gray
Empathy & Perspective
Language Development
   About 8,000 languages in the world, each with rules for
       phonology (phonemes or speech sounds [~ 70] or, in the case of
        signed language, hand-shapes),
       morphology (word formation),
       syntax (sentence formation),
       semantics (word and sentence meaning),
       prosody (intonation and rhythm of speech),
        pragmatics (effective use of language).
   Baby able to detect any possible phoneme; within months
    start to specialize according to input patterns of “mother
    tongue”
   Phonetic maps are created, and eventually only phonemes
    represented on map can be “heard”
    Milestones of Language Development
   (Source: http://www.nidcd.nih.gov/health/voice/speechandlanguage.asp#mychild)
Birth to 5 months                            12 - 17 months
   Reacts to loud sounds.                     Attends to a book or toy for about
   Turns head toward a sound source.           two minutes.
   Watches your face when you speak.          Follows simple directions
   Vocalizes pleasure and displeasure          accompanied by gestures.
    sounds (laughs, giggles, cries, or         Answers simple questions
    fusses).                                    nonverbally.
   Makes noise when talked to.                Points to objects, pictures, and
                                                family members.
                                               Says two to three words to label a
6 - 11 months                                   person or object (pronunciation
   Understands "no-no".                        may not be clear).
   Babbles (says "ba-ba-ba" or "ma-           Tries to imitate simple words.
    ma-ma").
   Tries to communicate by actions or
    gestures.
   Tries to repeat your sounds.
Milestones of Language Development
18 - 23 months                          2 - 3 years
   Enjoys being read to.                   Knows some spatial concepts
   Follows simple commands                  such as "in," "on” and pronouns
    without gestures.                        such as "you," "me," "her."
   Points to simple body parts such        Knows descriptive words such as
    as "nose."                               "big," "happy.“
   Understands simple verbs such as         Says around 40 words at 24
    "eat," "sleep."                          months.
   Says 8 to 10 words (pronunciation       Speech is becoming more
    may still be unclear).                   accurate but may still leave off
   Asks for common foods by name.           ending sounds.
   Starting to combine words such as       Answers simple questions. Begins
    "more milk.“                             to use more pronouns such as
                                             "you," "I."
    Begins to use pronouns such as         Speaks in two to three word
    "mine."                                  phrases.
                                            Begins to use plurals such as
                                             "shoes" or "socks" and regular
                                             past tense verbs such as "jumped."
Milestones of Language Development
3 - 4 years                               4 - 5 years
   Groups objects such as foods,            Understands spatial concepts such
    clothes, etc.                             as "behind," "next to."
   Identifies colors.                       Understands complex questions.
   Strangers are able to understand         Speech is understandable but
    much of what is said.                     makes mistakes pronouncing
                                              long, difficult, or complex words
   Able to describe the use of objects
    such as "fork," "car," etc.              Says about 200 - 300 different
                                              words.
   Has fun with language. Enjoys
    poems and recognizes language            Uses some irregular past tense
    absurdities such as, "Is that an          verbs such as "ran," "fell.“
    elephant on your head?"                   Describes how to do things such
   Expresses ideas and feelings              as painting a picture.
    rather than just talking about the        Defines words.
    world around him or her.                 Lists items that belong in a
   Answers simple questions such as          category such as animals,
    "What do you do when you are              vehicles, etc.
    hungry?"                                 Answers "why" questions.
   Repeats sentences.
   Milestones of Language Development
5 years
   Understands more than 2,000        Want to learn more?
    words.                              Brain expert Dr. Patricia Kuhl, co-
                                         director of the Institute for Learning
   Understands time sequences
                                         and Brain Sciences at the University
    (what happened first, second,
                                         of Washington, talks about the innate
    third, etc.).
                                         learning ability of infants and
   Carries out a series of three        children. Internationally recognized
    directions.                          for her research on early language and
   Understands rhyming. Engages in      brain development, Dr. Kuhl focuses
    conversation.                        on language and social interaction in
   Sentences can be 8 or more words     the learning process.
    in length.                          Video is about 60 minutes, with
   Uses compound and complex            excellent footage of infant research
    sentences.                           techniques, and great slides.
   Describes objects.
   Uses imgination to create stories.  http://www.youtube.com/watch?v=Fc
                                              b8nT0QC6o
    Social Development
 John Bowlby (1907-1990)
      studied attachment from multiple perspectives (psychology; evolution; ethology)
      Proposes that infant need a secure relationship with adult caregivers to ensure normal
       social and emotional development.
      Infant attachment behavior serves to ensure protection from danger, by keeping
       parents close and interested.
      Bonding involves active, reciprocal interactions between infant and caregivers
      Social interactions with attachment figures lead to the development of an internal
       working model of social relationships
   Innate nature of attachment behavior
       Attachment occurs in spite of maltreatment, inanimate objects can serve for attachment
       Attachment assessment through “strange situation protocol” (Ainsworth)
       Not all forms of attachment are equal:
           Secure
           Avoidant -Insecure
           Ambivalent
           Disorganized-Insecure
        “Dance” of Attachment/Bonding
   Full-Term Newborn                        Parent
       has organized states                     helps regulate states
       attends selectively                      provides necessary stimuli
       behaves in interpretable ways            searches for communicative
       systematic responses to parents           intent
       acts in temporarily predictable          wants to influence newborn and
        ways                                      feel effective
       learns from, adapts to parent’s          adjusts to newborn’s temporal
        behavior                                  rhythms
                                                 acts repetitively and predictably
    Separation-Individuation
  Margaret Mahler developed her concepts based on infant
observation.
 Children learn to identify the boundaries between self-
caretaker, and negotiate a balance between attachment and
independence.
 Coined terms of differentiation, separation – individuation,
practicing, refueling, rapprochement, object constancy.
     –   Object permanence = Piagetian term (out of sight….)
     –   Object constancy = frustrating mother and comforting mother
         are the same person
   Separation-Individuation
Birth  to 5 months: symbiosis
5-10 months: Differentiation (explore body; stranger
anxiety)
10-15 months: Practicing (walking; exploration; separation
anxiety)
18-24 months: Rapprochement (self-awareness develops;
conflict over closeness/exploration)
24-36 months: Consolidation and object constancy (internal
representation of mother; tolerates separation, knowing
reunion will occur)
 Age-appropriate “Problem-Phases”
Problem                 “Also known as…”         AGE


Separation anxiety      “Mom can’t leave the    10-16 months
                        room phase”


Defiance                “Terrible two’s”       18-30+ months


Dear of darkness        “night light phase”     2-8 years


Fear of bodily injury   “band-aid phase”        5-7 years
        Psychosocial Development
   Pioneered by Erikson (1902 – 1994)
        Psycho-analyst and contemporary of Anna Freud
        Taught at several prestigious US Universities (Harvard, Yale,
         UC Berkeley)
        Proposed that developmental phases continue throughout life.
        Major themes have to be successfully negotiated in each phase,
         and resolution of conflict results in “virtue” or psychological
         capacities.
        Outcomes of prior phases influence how a person masters the
         next level.
                   Erikson’s Psychosocial Stages
Late Adulthood                                                                     Integrity vs.
60s and over                                                                       Despair

Middle Adulthood                                                  Generativity vs. Stagnation
40s and 50s

Young Adulthood                                                     Intimacy vs. Isolation
20s and 30s

Adolescence                                          Identity vs. Role Confusion
12 - late teens

Middle Childhood                                   Industry vs.
6/7 - 11/12 yrs                                     Inferiority

Early childhood             Initiative vs. guilt
2 - 6/7 yrs

Infancy                   Autonomy vs.
1 - 2 yrs                 Shame/doubt

Infancy             Trust vs. Mistrust
0 - 1yrs
    Erikson’s “Virtues” in 8 Stages
   Hope - Basic Trust vs. Mistrust (Are caregivers believed to be reliable?)
   Will - Autonomy vs. Shame and Doubt (Is child allowed to explore the world?)
   Purpose - Initiative vs. Guilt (Can the child do things on his own and not feel
    guilty?)
   Competence - Industry vs. Inferiority (How does child compare self worth to
    others?)
   Fidelity - Identity vs. Role Confusion (Can teenager work out where and how to
    fit in?)
   Love - Intimacy vs. Isolation (Making choices and commitments in intimate
    relationships, work and family)
   Caring - Generativity vs. Stagnation (How does adult view his/her
    accomplishments and failures? Midlife-crisis?)
   Wisdom - Ego Integrity vs. Despair (How do elderly view death and finite
    nature of accomplishments of their life time?)
    Shifting Focus of Assessment:
          Infants and Toddlers
   Observation
       Gross and fine motor functions
       Language and communication
       Social behavior
       Bonding
   Common referral reasons:
       Delayed development (e.g. MR)
       Abnormal development (e.g. PDD)
       Poor bonding (e.g. neglect, abuse)
        Shifting Focus of Assessment:
                 Preschoolers
   Observation, personal interview
        Observe milestones
        Assess what child talks and thinks about (e.g. through play)
        Parent-child relations

   Common referral reasons:
        Delayed development (e.g. MR),Abnormal development (e.g. PDD),
         Poor bonding (e.g. neglect, abuse)
        Speech-language delays
        Hyperactivity
        Aggressive/defiant behaviors
        Excessive anxiety
        Toilet training
        Shifting Focus of Assessment:
               School-age Child
   Observation, interviews, reports from school
        How does child function in family?
        How does child function in school?
                (behavior and academics)
        What kind of peer relations?
        Formal psychological and academic testing
   Common referral reasons:
        Learning problems
        Externalizing conditions (ADHD, ODD)
        Separation anxiety
                   Summary
   Understanding of normal development is essential
    for child psychiatric evaluation.
   Child psychiatric assessment techniques need to
    be adjusted for developmental level.
   Integrate developmental assessment into
    observations and interviews, obtain collateral
    information from schools and testing as needed to
    aid in diagnosis.
Questions after lecture?
   Please e-mail (rbussing@ufl.edu) or call
    (392-8315)
   Interested in learning more about child
    psychiatry?
       Join us for your third year major rotation
       Consider a fourth year elective

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:805
posted:3/30/2008
language:English
pages:33