8. Psychology of child development and ageing_slides - Tagged.pdf

Genes, Behaviour and Environment 4MBBS103 Neuroscience, Behaviour and Social Science Psychology of child development and ageing Learning objectives 1. Define child development 2. Describe cognitive development in childhood 3. Describe social and emotional development 4. Identify the im...

Genes, Behaviour and Environment 4MBBS103 Neuroscience, Behaviour and Social Science Psychology of child development and ageing Learning objectives 1. Define child development 2. Describe cognitive development in childhood 3. Describe social and emotional development 4. Identify the impact of an ageing population on health care demands 5. Explain biopsychosocial models of ageing 6. Describe clinical impact of: falls, depression, and dementia Psycholog y of child developm ent  Defining development Development is multifaceted and includes the development of the following skills: Motor Perceptual Language Cognitive Social Developmental Psychology includes: scientific study of age-related changes in behaviour, thinking, emotion , personality Defining development is complex: No objective measures Child development is sequential, irreversible, and goal directed. Defining development factors Factors that influence development: Biological Factors: Genetics Prenatal health status of mother and health related behaviours Neonatal Birth complications Childhood illness Social/Environmental influences: Pollution Access to environments that prompt development  Defining development | twin research Monozygotic twins: 100% genetic Dizygotic twins: ~ 50% genetic overlap If a particular illness or condition is influenced by genetics then it should co-occur more frequently in MZ twins compared with DZ twins. Most powerful evidence from MZ twins separated and raised apart Contexts of development Critical/ sensitive periods Defined periods where appropriate stimulation is required to ensure development. Have two main features: Limited time window Learning hard to reverse E.g. - Development of language skills E.g. - Development of emotional attachments How critical? Evidence of plasticity. Cohort effects Group specific changes influenced by historical/cultural factors. Atypical development Mental & physical ill health Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A. Changes in grey matter induced by training. Nature. 2004;427:311. Defining development stages Stages of child development (Santrock 2014): Infancy (0-2) - attachment, maturation of sensory, perceptual & motor functions & understand objects through senses Early childhood (2-6) - locomotion, fantasy play, language development, sex role identification & group play Middle childhood (6-12) - friendship, skill learning, self- evaluation, team play, understand cause & effect & conservation Adolescence (12-18) - physical maturation, emotional development, peer group & sexual relationships, understand abstract thinking. Defining development – New-born Nerve cells present but in an undeveloped state Growth and development occurs in an experience dependent way Perceptual/Motor development - initially limited repertoire but rapid and orderly development - pre-programmed inborn bias Motor development Perceptual development Babies are able to fixate their gaze - focus on areas of contrast Evidence of active not passive – information seeking Babies demonstrate a preference for faces ~ 4- 5 months Move on to scanning the environment Develop appropriate selective attention ~ 6 years – learn which environmental cues warrant perceptual attention Language development – 5 stages Preverbal communication Phonological development Semantic development Syntax and grammar development Pragmatics development e.g. turn taking, use of non-verbal communication skills e.g. eye contact.  Language development – learning words Age 9-13 months: First words Age 12-18 months: children are learning about three new words a month Age 18 month: infants know about 22 words “Naming explosion”: 10-20 words per week Age 6: Vocabulary 10 000 words, five new words a day Clinical implications: Remain sensitive to child’s age and adjust accordingly. Involve care giver to improve sharing of information with child where appropriate. Developing cognitive skills - thinking Jean Piaget (1896-1980) - children go through same kinds of sequential discoveries about world at similar ages and make same mistakes 4 main stages Sensorimotor (0 – 2 years) Preoperational (2-6/7 years) Concrete operations (6/7 – 11/12 years) Formal operations (11/12 years +) Key concepts: Schema, Assimilation, Accommodation, Equilibrium Developing cognitive skills – 4 key concepts Scheme/Schema - internal cognitive structure which provides procedure to use in specific circumstances Assimilation - process of using schema to make sense of event or experience Accommodation - changing schema as result of new information Equilibration - process of balancing assimilation & accommodation to create schemes that fit environment Stage 1: Sensorimotor (0 – 2 years) Initial reflexes via sensory motor schema. Child interacts with environment and manipulates objects. Understanding of object permanence (e.g. objects remain when out of sight) Stage 1: Sensorimotor (0 – 2 years) Stage 2 – Preoperational (2-6/7 years) Internal representation of concrete objects and situations. Child uses symbolic schemes like language Ego centric Reasoning dominated by perception Stage 2 – Preoperational (2-6/7 years) Stage 2 – Preoperational (2-6/7 years) Internal representation of concrete objects and situations. Child uses symbolic schemes like language Ego centric Reasoning dominated by perception Stage 2 – Preoperational (2-6/7 years) Stage 3 – Concrete operations (6/7 – 11/12 years) Reasoning involves more than one salient feature (conservation) Logical reasoning can only be applied to objects that are real or can be seen (e.g. concrete). No longer egocentric – can see other perspectives Understand principles of conservation Stage 4 – Formal operations (11/12 years +) Can think logically about potential events or abstract ideas Can test hypotheses about hypothetical events Application of Piaget’s stage theory Children's understanding of illness: Age (stage of cognitive development) Experience of illness (e.g. children with cancer have > understanding) Communication with children - Modelling the process Social development Early social responsiveness e.g. smiling non-specific Specificity towards main carers About 8 months develop separation anxiety and fear of stranger 10 months – social referencing Attachment: 6 months – 2 years Critical period Social development- Attachment Brain begins by developing areas needed for survival Attachment to carer - basic necessity for survival, along with food and water John Bowlby (1907 -1990) developed theory of attachment based on ethology, psychoanalysis & developmental psychology Attachment = process of proximity seeking to identified attachment figure in situations of distress or alarm for purpose of survival  Emotional availability and contingent responsiveness from primary caregiver Social developme Carer – available, sensitive and responsive nt-Secure Provides safe and secure base from which attachme infant can explore world nt Secure attachment paves way for healthy development and good relationships Social development- Strange Situation 8 episodes of increasing stress in lab, with children ages 12 – 18 months Focus on children’s reaction on reunion with mother Observe: Child with mother, Child with mother & stranger, Child alone with stranger, Child completely alone, Child reunited with mother, Child alone again, with stranger again, reunited with mother Need training to code Strange Situation The Strange Situation - Mary Ainsworth - YouTube Social development- Strange Situation Social development- Strange Situation b 8 episodes of increasing stress in lab, with children ages 12 – 18 months Focus on children’s reaction on reunion with mother Observe: Child with mother, Child with mother & stranger, Child alone with stranger, Child completely alone, Child reunited with mother, Child alone again, with stranger again, reunited with mother Need training to code Strange Situation The Strange Situation - Mary Ainsworth - YouTube  Attachment style guides “internal working model” of social relationships Secure attachment allows a child to learn: Social they are worthy of love others are available in times of need Developm ent Secure attachment associated with (van Londen et al. 2007): Better peer relations Improved self-reliance Improved cognitive function Improved physical health outcomes Psycholog y of ageing Background 10 (14%) million people in the UK are over 65 years old. Similar across the developed world. Since 1930’s population over 65 has doubled with increasing health & social care costs. Projection is that 19 million people 65+ by 2050 in UK. Average family will have more living parents than living children. Gerontologist use sub-groups Young old (60 – 75) Old old (75 – 85) Oldest old ( 85+) Fastest growing segment of population > physical & mental impairments than other groups Population of frail elderly who cannot care for themselves will grow 1995 – 2025 – number of people 90+ will double Characteristics of current 65+, better educated, wealthier than previous generations. Older men more likely to be married and live with spouse. Older women more likely to be widowed and live alone. *Key Issues for the New Parliament 2010 House of Commons Library Research * Key Issues for the New Parliament 2015 House of Commons Library Research Healthcare needs Variability in functional ability increases with age. Compression morbidity 40% NHS budget used for over 65 age group. https://publichealthmatters.blog.gov.uk/2019/01/29/ageing- and-health-expenditure/ Myths and realities of Ageing Looking forward to being an older adult? Older adults are commonly viewed as living with severe limitations in social, physical, and functional capacity (myth). Old age = nursing home + physical disability + intellectual decline (myth) Misrepresents reality for majority of older adults. E.g., 65 fall each year 50% of those aged >80 10-20% result in injury (5% in fracture) 1% hip fracture 21-85% older people report fear of falling Risk factors: previous fall, poor mobility/balance Interventions target “risk factors” e.g. exercise, medication review & psychological factors, effective at preventing falls Post fall syndrome Loss of self confidence and fear of falling following a fall Slow walking speed, poor balance, low activity levels, muscle weakness and lean body mass and frailty = Increased fall risk Increased risk hospitalisation Increased risk of care home admission Falls prevention Fear of falling exceeds actual risk Treatment options: Cognitive behavioural therapy Person – exercise training, strength & confidence building; medication review; improving vision etc Environment – removing hazards in home; non-slip bathmats; grab bars/handrails etc. See Gillespie et al., 2012 review of falls prevention interventions Depression Depression 65 +,is associated with disability, increased mortality, and poorer outcomes from physical illness. Point prevalence of major depression in over 75s ranged from 4.6% to 9.3%* Sub clinical depressive symptoms is higher 4.5% to 37.4%. Under-diagnosed as symptoms of depression (low energy, loss of interest) just part of being older. Depressed women outnumber men 2 to 1 Women respond to accumulation of everyday stressors Men respond to traumatic events – suicide Rodda, J., Walker, Z., & Carter, J. (2011). Depression in older adults. BMJ, 343. Risk factors for Depression in old age More disabling health conditions - more depressive symptoms older adults display. Co-morbid physical illness, cognitive impairment, functional impairment, lack or loss of close social contacts, and a previous history of depression. Other stressors: Inadequate social support Inadequate income Emotional loss of significant others Nagging health concerns Carer burden Financial worries - Living in poverty puts elderly at high risk Dementia 944,000 people in the UK 2050 - predicted to be 1,700,000 Average life expectancy following a dementia diagnosis is 4.5 years 29% of people >85yrs with diagnosis of cancer, circulatory or respiratory disease also affected by dementia Stages of Dementia Mild: retains judgement but effects on memory, work & social activities. signs = repetitive conversation & tests e.g. clock face Moderate: independent living becomes difficult - some supervision with IADL & ADL’s required – Mini Mental State Examination & word lists Severe: severe impairment in all ADL’s & needs constant supervision Care issues Communication Pain – expressing, recognising, assessing Eating and drinking Depression and psychosis Psychosocial – loss of person-hood Informal carer support Caregiver needs Estimated to be 670,000+ people in the UK acting as the primary carers for people with Dementia (Alzheimer's Society, 2012). Communication - about disease, behaviour change, management Practical help – financial, respite, continence equipment, laundry service etc Carer stress: (e.g., Kiecolt-Glaser et al, 1996) Fatigue/sleep deprivation, Financial burden, Fear of future Reduced immunity & poorer physical health Greater proneness to physical & mental health problems Main reason for older adult entering care home Working with older adults b Be aware of own prejudices about old people & ageing – negative stereotypes more often applied to women than men Be aware of significant variance related to ageing and avoid assumptions based on age. Ageism in health care = negative expectations e.g., adherence & less access to treatment Show interest & respect for person’s past Recognise & acknowledge current progress & achievements Set achievable goals in consultation with older person Working with older adults a Where necessary, check patient’s cognitive function and adjust consultation skills accordingly. Allow more time for information to be considered before asking further questions. Don’t fill silences with more questions Consider patient expectations of consultation style Abuse & older adults Not very common (around 3- 5%) & most likely in cases where elder has dementia Abuse by spouse 2x more likely than by children & can occur in care homes Risk factors: mental illness or alcoholism in abuser financial dependency on victim social isolation & external stresses Detecting abuse Watch for ‘red flags’: missed appointments, doctor hopping, unexplained delays in seeking treatment, unexplained or repeated injuries Always talk to the client alone Assess the client for depression, anxiety, withdrawal or confusion Ask the client directly about mistreatment Assess the quality of carer-client interaction Ask the carer if they are experiencing any difficulties providing care Assess the social support system  Summary Child development occurs across the following domains: Motor, Perception, Language, Cognition, Social Piaget’s theory of cognitive development and Bowlby’s theory of social attachment Life expectancy is increasing. Compression of morbidity means that people stay healthier for longer but have a concentration of illness and/or disability at the end of their lives 40% NHS budget used for over 65 age group Falls, depression and dementia are common in elderly populations Consider patient’s abilities and adapt consultation style  In what age range does a child typically develop the concept of object permanence? Quick A: Prenatal quiz 1Q B: 0-2 years C: 2-6 years D: 6-12 years E: 11+ years  In what age range does a child typically develop the concept of object permanence? Quick A: Prenatal quiz 1A B: 0-2 years C: 2-6 years D: 6-12 years E: 11+ years  Humans learn languages best in their childhood. Some research indicates that if a child doesn’t learn to speak a formal language before the age of 6, they may never learn to speak well. This would best illustrate which of the following: Quick A: Critical period quiz 2Q B: Normative age graded changes C: Individual differences D: Cultural specificity  Humans learn languages best in their childhood. Some research indicates that if a child doesn’t learn to speak a formal language before the age of 6, they may never learn to speak well. This would best illustrate which of the following: Quick A: Critical period quiz 2A B: Normative age graded changes C: Individual differences D: Cultural specificity  Grace is a two year old toddler who plays well with toys and explores her playroom when her mother is near, even when a stranger is present. This is an example of _____ attachment. Quick A: Secure quiz 3Q B: Resistant C: Avoidant D : Disorganized-disoriented  Grace is a two year old toddler who plays well with toys and explores her playroom when her mother is near, even when a stranger is present. This is an example of _____ attachment. Quick A: Secure quiz 3A B: Resistant C: Avoidant D : Disorganized-disoriented  Secondary aging refers to: A) Changes in the body that occur during midlife. Quick B) Changes in height and weight that are part of late quiz 4Q adulthood. C) Aging that occurs as a result of mental states or attitudes. D) Changes associated with disease  Secondary aging refers to: A) Changes in the body that occur during midlife. Quick B) Changes in height and weight that are part of late quiz 4A adulthood. C) Aging that occurs as a result of mental states or attitudes. D) Changes associated with disease  What factors need to be considered during consultations with older people? Quick quiz 5Q A) Cognitive function B) Capacity to remember C) Preferred consultation style D) All of the above  What factors need to be considered during consultations with older people? Quick quiz 5A A) Cognitive function B) Capacity to remember C) Preferred consultation style D) All of the above Reading Ayers, S., & De Visser, R. (2017). Psychology for medicine and healthcare. Sage. Ogden, J. (2012). Health psychology: A textbook: A textbook. McGraw-Hill Education (UK).  Useful references Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation.. Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, 380(9836), 37-43. Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane database of systematic reviews, (9). Rodda, J., Walker, Z., & Carter, J. (2011). Depression in older adults. BMJ, 343. Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The gerontologist, 37(4), 433-440. Rowe, J. W., & Kahn, R. L. (2015). Successful aging 2.0: Conceptual expansions for the 21st century. The Journals of Gerontology: Series B, 70(4), 593-596. https://publichealthmatters.blog.gov.uk/2019/01/29/ageing-and-health-expenditure/ Useful references Ayers, S., & De Visser, R. (2017). Psychology for medicine and healthcare. Sage. Plomin, R., Owen, M. J., & McGuffin, P. (1994). The genetic basis of complex human behaviors. Science, 264(5166), 1733-1739. Ainsworth MD, Bell SM. Attachment, exploration, and separation: Illustrated by the behavior of one- year-olds in a strange situation. Child Dev. 1970;41(1):49-67. doi:10.2307/1127388 Bowlby J. Attachment and loss: Retrospect and prospect. Am J Orthopsychiatry. 1982;52(4):664-678. doi:10.1111/j.1939-0025.1982.tb01456.x Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A. Changes in grey matter induced by training. Nature. 2004;427:311 Monique van Londen, W., Juffer, F., & van IJzendoorn, M. H. (2007). Attachment, cognitive, and motor development in adopted children: Short-term outcomes after international adoption. Journal of Pediatric Psychology, 32(10), 1249-1258.