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Introduction to Child and Adolescent Development

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Introduction to Child and Adolescent Development Dr Janie Donnan, Clinical Psychologist Dr Helen Minnis, Consultant Psychiatrist DClinPsy 14/10/05 – PowerPoint PPT presentation

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Title: Introduction to Child and Adolescent Development


1
Introduction to Child and Adolescent Development
  • Dr Janie Donnan, Clinical Psychologist
  • Dr Helen Minnis, Consultant Psychiatrist
  • DClinPsy 14/10/05

2
Aims and Objectives
  • Overview of child and adolescent development
  • Physical Development
  • Cognitive Development
  • Social and Emotional Development
  • Social Cognition
  • Emotional Development
  • Moral Development
  • Development of Identity
  • Factors Influencing Child Development
  • Application of Child Development to Clinical Work

3
What do we mean by child development?
  • Process by which a child grows and changes
    throughout its life span
  • Changes influence how child perceives and
    understands its world

4
How does knowledge of child development inform
clinical practice?
  • Developmental stage of child influences
    assessment, formulation and intervention
  • Enables comparison between childs developmental
    progress and norms (?developmental delay)
  • Identifies need for involvement from appropriate
    services (ie where does problem lie?)
  • Increases awareness of common behavioural and
    emotional problems at different developmental
    stages
  • Developmental delay may have impact on childs
    mental health and relationships

5
Physical Development
6
Physical Development
  • Developmental milestones-most major changes occur
    in first 5 years (guidelines)
  • 9 months first words, crawls
  • 12 months walking
  • 21 months sentences
  • 5-7 years fine tuning and refining motor skills
  • 8-10 years learn additional motor skills
  • Adolescence dramatic physical changes
  • Body size and shape (10-16 years boys 7-14 years
    girls)
  • Reproductive system and secondary sex
    characteristics
  • Changes in functioning of neuroendocrine system,
    heart, cardiovascular system, lungs and
    musculature

7
Cognitive Development
8
Cognitive Development
  • Piagets Stages of Development
  • Describes stages involved in problem solving,
    knowledge acquisition and understanding the world
  • Sensorimotor (birth to 2 years)
  • Pre-operational (2 to 7 years)
  • Concrete operational (7-12 years)
  • Formal Operational (12 years )

9
Piaget
  • Sensori-motor (birth to 2 years)
  • Initially simple and limited reflex behaviours at
    birth
  • Baby learns about the world through actions and
    sensory information
  • Trial and error learning
  • Baby learns to differentiate itself from the
    environment
  • Child begins to understand causality in time and
    space
  • Develops object permanence
  • Internal mental representations emerge
    (imaginative play and symbolic thought)

10
Piaget
  • Pre-operational (2 to 7 years)
  • Further development of symbolic function
    (symbolic use of language and intuitive problem
    solving)
  • Internal representations of the world
  • Engagement in make believe eg symbolic play
  • Can distinguish between make believe and reality
  • Thinking still characterised by egocentric
    thinking, irreversibility and centration
  • Difficulty re-telling a story coherently
  • Inability to focus on more than one aspect of a
    task
  • Begin to develop theory of mind ie others
    perspectives
  • Emergence of social perspective-taking skills
  • Beginning to grasp conservation (conservation
    experiment)

11
Piaget
  • Concrete Operational (7 to 12 years)
  • Developed theory of mind
  • Thinking becomes more flexible
  • Still understands the world in concrete terms
  • Logical reasoning replaces intuitive reasoning
  • Can only do in presence of actual objects
  • Need to look at or manipulate objects
  • Understands conservation of mass, length, weight
    and volume
  • Able to classify and organise objects into
    categories
  • Can consider different aspects of a task at the
    same time
  • Engages in rule-governed games

12
Piaget
  • Formal Operations (12 years )
  • Abstract thinking develops eg can solve algebraic
    equations, can imagine and discuss what has never
    been encountered before
  • Able to develop hypotheses and test these out ie
    manipulate ideas in their mind as well as actual
    objects and people and devise plans to solve
    problems and systematically test out solutions
    (hypothetical-deductive reasoning)
  • Can speculate about the possible ie think about
    ideal characteristics of themselves, others and
    the world
  • Able to carry out complex problem solving and
    planning
  • Able to consider ambiguous situations

13
Piaget - Limitations
  • The nature of the tasks
  • Language development and the understanding of the
    term more
  • Children can solve tasks earlier if they are
    adapted to make human sense ie naughty teddy
    (McGarrigle and Donaldson, 1974)
  • Children are trying to assess the intentions of
    the assessor, by being asked the same question
    twice ie which contains more?, they may assume
    their first answer was incorrect and try
    something else
  • Formal operational thinking may not be
    demonstrated by all adolescents using
    conventional tasks, or across all cultures
  • Intellectual development may not be as stage like
    as Piaget thought, it may be more useful to think
    in terms of individual process and strategies
    (Sternberg, 1990)

14
Information Processing
  • Development of piagetian theory to include use of
    memory on impact of problem solving
  • Memory
  • With increasing age, children learn to apply more
    complex and effective strategies for remembering
    information (rehearsal organisation ie chunking
    and grouping scripts schemas

15
Social Development
16
Social Cognition
  • The processes explaining how children and
    adolescents make sense of their social world
  • Wide variety of theories and constructs
  • Theory of Mind (Baron-Cohen)
  • Attachment Theory (Bowlby)
  • Information Processing
  • Theories tie in to other areas of psychology such
    as theories of cognitive development and the
    development of self identity and self esteem

17
Theory of Mind
  • Baron Cohen and Ring, 1994
  • ToM has been defined as an individuals
    awareness of human behaviour as governed by an
    interconnected network of mental states including
    beliefs, desires and feelings (Premack and
    Woodruff, 1978)
  • Explosion in research into ToM relating to both
    abnormal development of ToM (autistic spectrum
    disorders) and normal development

18
Theory of Mind
  • ToM tasks commonly divided into first order,
    second order and advanced
  • Roughly relate to transitions throughout
    development
  • First Order (passed c. 4 years old)
  • Inferences about one persons mental states eg
    Sally Ann Test (Frith, 1989)
  • Second Order (passed c. 6 years old)
  • Considering embedded mental states ie. Mary
    thinks John thinks eg the Ice Cream Story Task
    (Wimmer and Perner, 1985)
  • Advanced (passed c. 8 years old)
  • Inferring complex mental states such as bluff and
    double bluff in stories eg Happes Strange
    Stories (Happe, 1994)
  • Good evidence for validity and reliability of
    first and second order tests (Hughes et al 2000)

19
Attachment Theory
  • Based on work of John Bowlby
  • Childs internal models of the quality of his or
    her relationship with others influence later
    social relations and emotional regulation
  • Secure attachment may play a key role in
    developing the ability to consider and reflect on
    mental states of self and other (Fonagy and
    Target 1997)

20
Information Processing
  • Largely extrapolated from adult models of biased
    thinking in emotional disorders (eg Beck)
  • More recently looking at relationship between
    self and other cognitions and emotional and
    behavioural disorders (Stallard 2002 for review)
  • Dodge (1985) looked at relationship between
    biased social information processing and
    development of aggressive behaviour in young
    people
  • Still need for more integration of research into
    cognitive development, information processing and
    emotional/behavioural disorders

21
Developmental trends in Relationships
  • Interactions with other children increases during
    the first 5 years
  • Tolerance for cross-gender play in middle
    childhood (8-11 years) but diminishes in
    adolescence
  • Competitive rivalry an important aspect of peer
    interactions in boys in middle childhood
  • Early adolescence onwards, family relationships
    become less salient than peer relationships

22
Emotional Development
23
Emotional Development
  • Range of emotions displayed by children increases
    over first few years
  • Anger and anxiety are 2 emotions of particular
    clinical significance
  • Throughout middle childhood (8 to 11 years) more
    complex emotions such as pride, shame and guilt
    develop

24
Anger
  • Anger outbursts/temper tantrums peak at 2 years
  • Outbursts displayed mainly to elicit care and/or
    attention and/or as sign of frustration
  • Between 3 and 7 years, anger used less frequently
    to gain attention but more frequently in
    retaliation (eg response to peer provocation)
  • Increasingly able to control emotions and know
    which are socially acceptable to express
  • By 9 years, can attribute intentional and
    accidental incidents and are able to express
    empathy

25
Anxiety / Fear(adapted from Carr 1999)
Age Principle Sources of Fear Principle Anxiety Disorders
6 to 12 months Strangers Seperation Separation Anxiety
2 to 4 years Imaginary Creatures Potential Burglars The dark Separation Anxiety Nightmares
5 to 7 years Natural disasters Injury and Death Animals Media-based fears Animal Phobias Blood Phobias Separation Anxiety Nightmares
8 to 11 years Poor academic performance Poor athletic performance Peer Rejection Separation Anxiety Test Anxiety School Phobia Generalised anxiety / panic Obsessions and Compulsions
Adolescents Peer Rejection Social Phobia Panic Disorder Agoraphobia Generalised Anxiety
26
Moral Development
27
Moral Development - Piaget
  • Investigated how the childs moral knowledge and
    understanding changes with age
  • The childs ideas about the rules of a game
  • The childs moral judgements
  • The childs conception of punishment and justice
  • Concluded
  • The child under 8 years (approximately) is
    heteronomous or subject to anothers laws or
    rules
  • The child above 8 years (approximately) is
    autonomous or subject to his or her own laws or
    rules

28
Moral Development - Piaget
  • The younger childs moral knowledge and
    understanding are objective and absolute laws,
    rules and punishments exist almost as things.
    They come from external sources and either exist
    or do not exist. Obedience is a virtue and good
    in itself. Moral Realism
  • The older child gradually comes to realise that
    morality is not a matter of obeying external
    authorities but of evolving and agreeing about
    principles for achieving mutually agreed and
    valued ends. Moral Relativism
  • Moral thinking of a child is always a mixture of
    moral reality and moral relativism but it is a
    matter of which one predominates
  • Developments in moral thinking parallel
    developments in thinking about other situations
    such as the move from egocentrism to operational
    thought which enables childern to see things from
    others perspectives

29
Moral Development-Kohlberg
  • 6 stages of moral development
  • Like Piaget, thought cognitive development a
    necessary but not sufficient condition of moral
    development ie cognitive development does not
    guarantee a particular level of moral development
  • Kohlberg began to refine and elaborate Piagets
    ideas in 1955 and studied moral development by
    presenting subjects with moral dilemmas. Like
    Piaget, he was interested in how people think
    rather than what they think
  • Based on the logic or reasoning revealed by their
    answers, Kohlberg classified people according to
    their level of moral development

30
Moral Development-Kohlberg (6 stages)
  • Preconventional
  • Stage 1 heteronomous morality
  • Stage 2 Individualism, instrumental purpose and
    exchange
  • Conventional
  • Stage 3 Mutual interpersonal expectations,
    relationships and interpersonal conformity
  • Stage 4 Social System and conscience
  • Postconventional or Principled
  • Stage 5 social contract or utility and
    individual rights
  • Stage 6 (hypothetical) Universal ethical
    priniciples

31
Moral Development-Kohlberg (6 stages)
  • Example of Kohlbergs Moral Dilemmas
  • In Europe, a woman was dying from cancer. One
    drug that might save her was a form of radium
    that a druggist in the same town had recently
    discovered. The druggist was charging 2000, 10
    times what the drug cost him to make. The sick
    womans husband, Heinz, went to everyone he knew
    to borrow the money, but he could only get
    together about half of what it cost. He told the
    druggist that his wife was dying and asked him to
    sell to cheaper or let him pay later. But the
    druggist said no. The husband got desperate
    and broke into the mans store to steal the drug
    for his wife.
  • Should Heinz have done it?
  • Was it actually right or wrong? Why?
  • Is it a husbands duty to steal the drug for his
    wife if he cant get it another way? What if the
    dying person were a stranger? Should he have
    stolen the drug anyway?
  • Would a good husband do it?

32
Identity Development
33
Identity Development
  • Encompasses overall idea of sense of self
    including body image, development of
    self-knowledge, self-evaluation and self esteem
    and self-control
  • Self-knowledge all that child knows about
    themselves and how they function in their social
    world. Concrete to abstract self descriptions
  • Self-evaluation how a child judges themselves
    against others in different domains. Early
    adolescence consider how others judge them
  • Self-control degree to which child can regulate
    their emotions and/or behaviour, particularly
    when solving problems
  • Main theorists Erikson, Marcia, Harter, Offer

34
Erikson
  • Viewed life as a series of stages, each with a
    particular developmental task
  • Infancy (0-2 years) Trust vs mistrust (maternal
    relationship particularly important)
  • Early Childhood (2-4 years) Autonomy vs shame
    and doubt
  • Middle Childhood (4-6 years) Initiative vs guilt
  • Late Childhood (7-11 years) Industry vs
    inferiority (education particularly important)
  • Adolescence Identity vs role confusion

35
Identity Development
  • Key task of adolescence
  • Adolescence is time of change and consolidation
    of self concept due to major physical changes,
    cognitive development, increasing emotional
    dependence and approach of fundamental decisions
    eg jobs, sexual behaviour etc.
  • Therefore results in marked increase in
    introspection
  • This attempt to understand the emerging self can
    result in adolescent becoming increasingly
    preoccupied with their inner world and seeming
    egocentric and self absorbed

36
Identity Development
  • Adolescent development of more complex and
    abstract sense of self reliant on cognitive
    development
  • Adolescents more likely to define aspects of the
    self in relation to specific events
  • Child I am lazy I am sporty
  • Adolescent I am chatty with people I know but
    quiet when I only know 1 or 2 people
  • Adolescents more likely than child to include a
    notion of who they are describing
  • my parents see me as quiet and shy but my
    friends know that I can be quite the opposite

37
Identity Development
  • Adolescents able to better organise and integrate
    different aspects of the self
  • Child more likely to respond to a question
    asking them to describe themselves using a list
    of attributes in no particular order or relation
    to each other
  • Adolescent shows evidence of a need to organise
    traits so that they become linked together and
    form a coherent whole
  • Harter and Monsour (1992) asked teenagers to
    describe themselves using series of concentric
    circles from most important to least important
    aspect. Found most teenagers found themselves
    having conflicting attributes and being different
    sorts of people in different situations this
    can cause problems for adolescents and their
    families as they can find it difficult to
    understand why they suddenly change in different
    situations

38
Clinical Applications of Developmental Theories
39
Clinical Relevance
  • Assessing against Normality
  • Developmental History Taking
  • Common Difficulties at particular Developmental
    Stages
  • Communication with child / young person

40
Developmental History Taking
  • Essential part of assessment and formulation
  • Enables comparison with the norm and indicates
    developmental delay
  • Influences choice of intervention
  • Guides interact ional style

41
Common Difficulties Infancy (0 4 years)
  • Separation Anxiety
  • Sleep Problems
  • Feeding Problems
  • Temper Tantrums

42
Common DifficultiesEarly Childhood (5 7 years)
  • Sleep Problems
  • Toileting Problems
  • Learning and Communication Difficulties
  • Autistic Spectrum Disorders
  • Phobias

43
Common DifficultiesMiddle Childhood (8 11
years)
  • Conduct Problems
  • Attention and Over-activity Problems
  • Fear and Anxiety
  • Repetition problems
  • Somatic Problems
  • School Refusal
  • Mood Disorders
  • Self-esteem problems

44
Common DifficultiesAdolescence (12 17 years)
  • Mood Disorders
  • Anxiety Disorders
  • Relationship Difficulties
  • Self-Esteem Problems
  • Deliberate Self-harm
  • Eating Disorders
  • Psychosis
  • Substance Abuse
  • Conduct Disorder
  • Sexual Difficulties

45
Communication in Early Childhood (5 7 years)
  • Difficulty with abstract concepts
  • Unlikely to elaborate / give cohesive details
  • Polarised view of self and world
  • Non-verbal techniques (play, drawing)
  • Concrete Examples
  • Short questions
  • Simple Language
  • Avoid Qs on other peoples state of mind

46
Communication in Middle Childhood (8 11 years)
  • Less Egocentric
  • Detailed, cohesive accounts
  • ?Abstract Reasoning
  • Increased problem-solving skills
  • Self-regulation of emotion and behaviour
  • Verbal techniques
  • Sentence completion
  • Worksheets
  • Narrative techniques
  • Role plays
  • Use of repetition to aid recall

47
Communication in Adolescence (12 17 years)
  • Abstract reasoning
  • Theory of mind
  • Problem-solving skills
  • Black and White thinking
  • Identity Development
  • Verbal and non-verbal techniques
  • Complex assessment tools
  • Assessing own attitudes / beliefs
  • Use scales
  • Respect existing skills

48
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