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Infancy to Toddlerhood Infancy: Birth to 15 months Toddlerhood: 15 to 36 months Jean Piaget: Theory of intelligence:...

Infancy to Toddlerhood Infancy: Birth to 15 months Toddlerhood: 15 to 36 months Jean Piaget: Theory of intelligence: ◦ Adaptation to one's environment, balance between needs/demands, cognition moves us past action into symbolic thought, organization (schemes), adaptation (assimilation vs. accommodation) ‣ Assimilation: knowing what a cat is and thinking dogs are cats because they're similar (small, four legs, etc.) ‣ Accommodation: Learning the difference between cats and dogs to be able to better recognize differences next time Cognitive Development: Sensorimotor Period (Birth-2 years) ◦ Exercising reflexes (0-1 month) ‣ Reflex activity, sensorimotor ◦ Primary circular reactions (1-4 months) ‣ Activities with own body repeated, coordination ◦ Secondary circular reactions (4-8 mo) ‣ Actions to make interests persist, involve events or objects ◦ Coordination of secondary schemes (8-12 mo) ‣ Combining schemes to obtain goal ◦ Tertiary circular reactions (12-18 months) ‣ Trial and error, goal seeking for novel results ◦ Intention of new means through mental combinations (18-24 mo) ‣ Representational thought begins Preoperational Period (2-7 years) ◦ Acquire language and symbolic functions PLAY Play promotes understanding and symbolic thought Sensorimotor (banging objects, combining objects to create relationships, relational activities, symbolic/pretend play) Increasingly complex play ◦ Peek-a-boo at 6.5 months, mirror play at 9 months  Erik Erikson Trust vs. Mistrust (Infancy through 1-2yr) ◦ Leading to the virtue of Hope ◦ Parental nurturing and care, primary event = feeding ◦ Development of a sense of basic trust in the world and ability to affect events around ‣ Consistency of caregiving: predictable, reliable, leading to feeling secure even when threatened ◦ Failure equals a lack of confidence in the world and own abilities Autonomy vs. Shame (Toddlerhood, 18mo-2/3 years) ◦ Leading to the virtue of Will ◦ Ability to do things independently, primary event = toilet training ◦ Development of a sense of self control, personal control over environment ‣ Bodily functions, eating, toys/play, clothing leading to feelings of secure confidence, separateness ◦ Failure equals a sense of inadequacy and self-doubt The Preschool Years General Preschool Info: 3-6 y/o, emerging from toddler years Becoming more mobile, verbal, and explorative Traits of independence and courage, socialization Preparation for school, confronting and mastering new challenges, accomplish tasks and start new ones Gain 4-5#/year, grow 2-3 in./year, have all 20 primary teeth by 3 Sleeps 11-13 hours/day (usually w/o a nap) Developmental Theory: 1. Psychosocial - Erikson A. Each stage as a crisis that has to be worked out and a virtue that is obtained in working on the crisis B. Achievement of working out the crisis allows further, but failed in the crisis results in the continued problems C. 3-6yrs: Initiative vs. guilt, learn virtue of Purpose, family=significant relationship; Existential Question: Is it ok for me to do, move, and act? 2. Cognitive - Piaget A. Children's growth based on their cognitive ability to understand themselves and the world B. Pre Operational (2-7yrs): understands world through language and mental images a. Logic is not yet in place, egocentric (unable to imagine the perspective of others), magical thinking (I was naughty so dad got cancer), body integrity (my arm is broken, therefore I am broken) 3. Psychosexual - Freud A. Our physical area of pleasure is the driver B. Phallic stage (3-5 years): becomes aware of difference between sexes, genitals are associated with pleasure (masturbation leads to anxiety/guilt) C. Oedipus complex: kids in phallic stage, falls in love with mom, wants to kill dad (competition), kid fears being castrated and gives up D. Electra complex: falling in love with a man just like your father E. Resolution: development of superego or conscience 4. Moral - Kohlberg Moral Development: Pre-Conventional: I tell the truth because I want my teacher to think i am good; I tell the truth because I don't want to get into trouble; I tell the truth because... just because that is what you're supposed to do! Preschoolers love to learn! Open/honest communication = important Routines/responsibilities = important Teach child to be independent and safe Learn to be a good friend = skill that needs to be learned Latency/School Age Describe the physical, sensorimotor, cognitive, self-care, and play tasks of middle childhood Compare the thought and executive functions of school age and younger children Describe the role of peer relations and social behavior in middle childhood Latency: ~7-11 years, also known as "school-age" and in developmental terms, roughly corresponds to middle childhood Child will be learning and performing things with age-peers (school) which brings about their first experience with competition and evaluation by others Will be receiving feedback from adults who aren't their parents, thus feeling weight of society's demands School becomes a conduit of culture it's embedded in, whereas previously parents were primary source of this Adolescence 12(ish)-20 years Learning Objectives: 1. Identify adolescent psychosocial developmental miles tones 2. Understand how classic theories explain adolescent development (psychosocial - Erikson, cognitive - Piaget, psychosexual - Freud, moral - Kohlberg) 3. Identify common parenting issues and interventions in this age group Gender dysphoria: distress/discomfort arising form incongruence between birth-assigned sex and gender identity (DMS V) Based on population-based studies: ◦ 0.17 to 1.3% of youth ◦ 1.8% of high school youth ◦ 0.5-1.2% of adults Transgender Discrimination Survey: 25% reported harassment in medical setting 50% taught their provider about transgender health 25% reported postponing/delaying preventative/sick care Piaget: 11-13 years: ◦ Between Piaget's stages of concrete operation and formal operational thinking ‣ Can verbalize what is the best action, but may not be able to make the decision in the heat of the moment Moodiness!; more likely to express feelings by actions than words Kohlberg: 11-13 years: ◦ Moral principles mirror the primary developmental task of this age-to separate oneself from dependence on caregivers and family ◦ Move toward an autonomous moral cod that has validity with both authority and the individual's own beliefs of right/wrong ‣ Preconventional --> conventional morality (stages 3/4) ◦ Because they are starting to have abstract thought, kids this age can start to juggle more complex moral issues ‣ "It's not fair" of grade school --> WHY things are unfair and rule flex ◦ Teenagers often "test" their parents' moral code ◦ Selects role models based on realistic and hoped- for ideals, talents, and values (versus younger children who choose heroes with superhuman powers  no Adolescence 2 Late Adolescence: Most have an adult physical appearance (Stage V Tanner Stage) Concerned w/ serious relationships, clear sexual identity, capacities for tender/sensual love By 19, most have had had sexual intercourse Ability to think abstractly, delay gratification, and be future oriented Continued maturation of pre-frontal cortex into 20s Improved impulse control, analytical skills, and better judgment Young Adulthood (20-40) Learning Objectives: 1. Discuss characteristics of the transition from adolescence to adulthood 2. Identify major young adult milestones and developmental tasks of young adulthood 3. Understand societal and cultural shifts in expression of young adult milestones 4. Appreciate how illness or life circumstances can derail development **Physical, sexual, emotional, social, and moral capacities are remarkably similar across cultures Transition Characterized by: separation from parents and beginning to function independently Family dynamics shift Development of values and ideas with less influence from parents Five features of "Emerging Adulthood (18-25): ◦ Identity exploration, instability, self0focus, feeling in-between, possibilities 30s: Stage of early adulthood characterized by: ◦ autonomy, authority, self-sufficiency, may lead to crisis d/t marital difficulties, job, depression/anx Erikson: Young adulthood = STAGE 6: Intimacy vs. Self-absorption/Isolation ◦ Virtue = love Adult Friendships/Parenthood Develops Difficulties of parenthood: ◦ economic burden, investment of time, loss of independence, continual processes of letting go, children may reawaken conflicts parents experienced themselves as children Consequences of perinatal mental illness: ◦ associated with lower birth weight and premature delivery, decreased bonding by mother, difficulty with infant attachment, etc. If parents are separated, children do better when both parents are involved **Children raised by same sex parents are no more likely to develop emotional problems or identify as gay/lesbian than in traditional families Career Consolidation Proposed by George Valiant as an additional developmental task after Intimacy vs. Isolation Stage which involves expanding one's personal identity to assume as social identity within the world of work Core identity often tied to occupation Mid - Adulthood (40-60ish) Learning Objectives: 1. Understand typical mid-adult tasks and milestones 2. Appreciate physical changes in mid-adulthood 3. Understand how typical aging affects clinical interactions Transition There is no clear demarcation from young to mid adulthood Generativity vs. Stagnation Virtue: Care Erikson: "Generativity is primarily the concern for establishing and guiding the next generation" ◦ Not just rearing/teaching your own kids ◦ Protective concern for ALL generations and social institutions ◦ Emphasis on importance of feeling needed ◦ If can't achieve true generativity may stagnate ‣ drug, ethos abuse, infidelities, midlife crisis Capable of intimacy, now invests emotional energy to include groups, organizations, & society Sexuality: Maintain intimacy in face of physical, psychological, environmental pressures For intimacy to continue, partners must: ◦ accept appearance of mid-age body of partner ◦ continue to find it sexually stimulating ◦ Accept normative changes that occur in sexual functioning (decrease in sex drive/ mechanical problems) ‣ Men: greater difficulty in getting and sustaining erection, longer refractory period ‣ Women: decreased estrogen, thinning of vaginal mucosa, decrease in secretions, fewer contraction at orgasm Diminished ability compensated for by feelings of love/tenderness generated over years Summary: Developmental Tasks: Integrate potential for attachment and loss Accept aging body Accept time limitations and personal death Reappraise relationships: let kids go, accept new family members Accept role reversal with elderly parents Develop midlife friendships Become generative mentor and plan for retirement Giveaway new meanings and purposes Become a grandparent **Think about Webcast about MCW Staff's husband's sudden death Late Adulthood 65+ Learning Objectives: 1. Appreciate the interrelationship between psychosocial and medical issues 2. Demonstrate knowledge of normal human development, behavior, and aging 3. Communicate effectively and respectfully Psychosocial Development: Erik Erikson: ◦ Crisis: integrity vs. despair ‣ Integrity: sense of satisfaction that life has been productive and worthwhile A sense of contentment about life and one's role in it Enjoy fruits of one's labor - work, grandkid, etc Acceptance of who one is in history and the life cycle An ability to accept and face death ‣ Despair: loss of hope and sense that life has no purpose or meaning Contemptuous for people A sense that life is meaningless A belief that they have not contributed A fear of death ◦ Virtue: Wisdom ‣ Knowledge that is gained by having many experiences in life ‣ The natural ability to understand things that most other people cannot understand (insight) ‣ Knowledge of what is proper or reasonable ‣ Good sense or judgment Death and Dying Learning Objectives: 1. Review Dr. Kubler-Ross and Erikson's Theories 2. Discuss Death in the US 3. List Barriers to getting a "desired" death 4. Define Hospice and Palliative Medicine 5. Review Changes Seen Before Death 6. Describe Grief, Mourning, and Bereavement US Culture and Dying Death is not something to be talked about, it is something to be avoided rather than a natural part of life Death is a failure of our medical care Death of a patient is a negative reflection on the physician Dr. Kubler-Ross: Psychiatrist and thanatologist, studied the reactions of patients with terminal illnesses Felt that modern technology was to blame for the increase fear of death and dying Death is the opposite to our culture's defining values, like youth, progress, and achievement ◦ Stages (no sequence!): ‣ 1: Denial ‣ 2: Anger ‣ 3: Bargaining ‣ 4: Depression ‣ 5: Acceptance Erikson's Stage 8: The Golden Years: Integrity vs. Despair Despair: ◦ Loss of hope, a sense that life has no purpose or meaning, left with feelings of bitterness, fear of death Integrity: ◦ A sense of satisfaction that life has been productive and worthwhile; the ability to enjoy the fruits of one's labor, work, grandkids, etc. ; acceptance of who one is in history and the life cycle; active participation in the process of losing independence; an ability to accept and face death What is A "Good Death" For US Patients? Being in control, being comfortable, having trust in care providers, recognition of impending death, burden minimized, relationships optimized Most Pts Die: 85+: in a nursing home all people : home 46% of families of patients who died in hospital reported dissatisfaction with: sx control, level of participation in decision-making, and communication with clinicians Difficult Conversations Improve Outcomes! Language is Important! We don't "withdraw care", we focus on comfort Bereavement Phase 1: Denial/Shock Phase 2: Preoccupation with the Deceased Phase 3: Resolution