Child Development: Tewfik Daradkeh, M.D. Division Psychiatry Department of Neuroscience Just
Child Development: Tewfik Daradkeh, M.D. Division Psychiatry Department of Neuroscience Just
Child Development: Tewfik Daradkeh, M.D. Division Psychiatry Department of Neuroscience Just
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 2s)
Dimensions of Development
Physical growth and motor skills Temperament Cognition and intelligence Language Social relations and attachment
Boys
Age in Years
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
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.
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
Original Setup
Alter as Shown
Conservation of liquid
Has more Do they both weigh the same, or does one weigh more than the other?
Conservation of mass
Weighs more
Conservation of number
Are there still as many pennies as nickels, or more of one than the other?
More
Conservation of length
Conservation of length
logic to abstract thinking (thinking about thinking) Ifthen Alternatives Future perspective Shades of Gray Empathy & Perspective
Responses to One of Kohlbergs Moral Dilemmas by People at Six Levels of Moral Reasoning The dilemma: Heinzs wife was near death from cancer. A druggist had recently discovered a drug that might be able to save her. The druggist was charging $2000 for the drug, which cost him $200 to make. Heinz could not afford to pay for it, and he could borrow only $1000 from friends. He offered to pay the rest later. The druggist refused to sell the drug for less than the full price paid in advance: I discovered the drug, and Im going to make money from it. Late that night, Heinz broke into the store to steal the drug for his wife. Did Heinz do the right thing
Responses to One of Kohlbergs Moral Dilemmas by People at Six Levels of Moral Reasoning The dilemma: Heinzs wife was near death from cancer. A druggist had recently discovered a drug that might be able to save her. The druggist was charging $2000 for the drug, which cost him $200 to make. Heinz could not afford to pay for it, and he could borrow only $1000 from friends. He offered to pay the rest later. The druggist refused to sell the drug for less than the full price paid in advance: I discovered the drug, and Im going to make money from it. Late that night, Heinz broke into the store to steal the drug for his wife. Did Heinz do the right thing
Language Development
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
12 - 17 months
Reacts to loud sounds. Turns head toward a sound source. Watches your face when you speak
Attends to a book or toy for about two minutes. Follows simple directions accompanied by gestures. Answers simple questions nonverbally.
6 - 11 months
Understands "no-no". Babbles (says "ba-ba-ba" or "mama-ma"). Tries to communicate by actions or gestures. Tries to repeat your sounds.
(Source: http://www.nidcd.nih.gov/health/voice/speechandlanguage.asp#mychild)
2 - 3 years
Enjoys being read to. Follows simple commands without gestures. Points to simple body parts such as "nose." Understands simple verbs such as "eat," "sleep." Says 8 to 10 words (pronunciation may still be unclear).
Knows some spatial concepts such as "in," "on and pronouns such as "you," "me," "her." Knows descriptive words such as "big," "happy. Says around 40 words at 24 months. Answers simple questions. Begins to use more pronouns such as "you," "I." Speaks in two to three word phrases.
Understands more than 2,000 words. Understands time sequences (what happened first, second, third, etc.). Carries out a series of three directions.. Uses imagination to create stories.
Social Development
John Bowlby (1907-1990)
studied attachment from multiple perspectives (psychology; evolution; ethology) Need secure relationship with caregivers to ensure normal social and emotional development;also adaptive/protective b/c attachment keeps protectors near Bonding involves active, reciprocal interactions and these social interactions with attachment figures lead to the development of an internal working model of social relationships
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:
Dance of Attachment/Bonding
Full-Term Newborn
Parent
has organized states attends selectively behaves in interpretable ways systematic responses to parents acts in temporarily predictable ways learns from, adapts to parents behavior
helps regulate states provides necessary stimuli searches for communicative intent wants to influence newborn and feel effective adjusts to newborns temporal rhythms acts repetitively and predictably
Separation-Individuation
Margaret Mahler Children learn to identify the boundaries between self-caretaker, and negotiate a balance between attachment and independence. Coined terms of differentiation, separation individuation, practicing, 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
Separation anxiety
Also known as
Mom cant leave the room phase Terrible twos night light phase band-aid phase
AGE
10-16 months
Psychosocial Development
Psycho-analyst and contemporary of Anna Freud 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.
Observation
Gross and fine motor functions Language and communication Social behavior Bonding Delayed development (e.g. MR) Abnormal development (e.g. PDD) Poor bonding (e.g. neglect, abuse)
Observe milestones Assess what child talks and thinks about (e.g. through play) Parent-child relations
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
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
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.
Building an eight-cube tower Climbing stairs Domestic mimicry Playing interactive games Pulling on clothes Referring to self by name Separation anxiety is diminishing Using fifty words and word combinations
Building a ten-cube tower Drawing a circle Feeding self Going up stairs using alternative feet Putting on shoes Riding tricycle Unbuttoning Understanding on taking turns
Brushing teeth Copying a cross Counting three objects Playing cooperative game Walking down stairs Washing and drying face
Controlling sphincters Drawing a square Drawing a recognizable person Counting ten objects Dressing and undressing self