If you are working in the health-care field, you should be able to adjust your presentation and health information gathering to match the patient’s physical and cognitive developmental stage. Presented are developmental, learning theories, and short review of depression
Learning Objectives Compare & Contrast Erickson’s, Freud’s and Piaget’s theories of developmental life stages, developmental tasks and major stressors for specific age groups Discuss, for selected age groups, stages, processes and milestones for physical, cognitive, social and emotional development
Each individual will pass through developmental stages, each marked by psychological crisis. Must be resolved before moving on to next stage. If not, will have difficulty in similar situations later in life. If basic needs are met within a reasonable amount of time, child learns to trust the environment and is free to move onto next stage at appropriate time. If not, then mistrust will develop and child will spend too much time/energy worrying about basic needs (feeding/nurturing) Infant must form a loving, trusting relationship with parent or caregiver or will develop a sense of mistrust Mistrust leads to incompetence, aggressiveness and unsympathetic with peers
Child learns to develop physical skills such as walking, grasping, and rectal sphincter control. The child learns control, may develop shame and doubt if not handled well Walking Grasping Rectal sphincter control Child learns to do things on their own, if parents overprotective, child will not learn how or be ashamed of their abilities
The child continues to become more assertive and to take more initiative, but may be too forceful, leading to guilt feelings Play and hero worship shows initiative Child eager for responsibility Child must learn to accept without guilt that there are certain things they can and can’t do. Imagination must also be guilt free
Child needs to be productive and do work on their own. Interaction with other peers also important. Can be achieved through group sports, activities. Needs to discover pleasure in being productive and the need to succeed.
Who am I? Search for identity after overcoming previous conflicts: trust/sense of industry Teenager begins to achieve identity in occupation, sex, politics & religion Begin to set themselves as separate from parents
Young adults must develop intimate relationships or suffer feelings of isolation Intimacy requires personal commitment, giving and sharing without asking what’s in return
Adult concerns include equality for people, future of the environment, what they will leave the next generation Each adult must satisfy and support the next generation What is good for the higher order?
Integrity is the sense of one’s life and sense of accomplishment; feeling fulfilled Accepting responsibility for what you they have done in other’s lives. If not fulfilled and complete, despair will lead to fear of death.
Piaget used cognitive structures as basis for his theory. Cognitive structures are patterns of physical or mental action that underlie specific acts of intelligence and correspond to stages of child development Looking at the biological approach to looking at intelligence Succession of stages Knowledge Intellectual competence Reflexes and instinctive responses, Assimilation and accommodation. Sensorimotor stage (0-2) use of senses to discover relationships between their bodies and environment (object permanance, directed groping) Preoperational Stage (2-6) thinking is self centered (egocentric) No understanding from another point of view Collective monologs
Concrete operations (7-12) child begins to reason logically and organize thoughts coherently. Actual, physical objects/no abstractions (example: cannot group items they have not heard, seen or touched) Formal operations (12 – adult) Not all will reach this stage Ability to formulate hypotheses and test out, argue contrary to fact
Stages based upon particular erogenous zones, unsuccessful completion will result in fixation at that stage Child focused on oral pleasures (sucking); too much or too little result in oral fixation or oral personality
Focused on pleasure on retaining or eliminating feces. Anal-retentive or anal-expulsive if not achieved in balance
Pleasure zone switched to genitals. Boys develop sexual desires for mothers, rival fathers for affection; fear of fathers for these feelings (Oedipus Complex). Boys decide to identify with father instead of fight against, develop sense of maleness Electra complex (girls desiring fathers) rebel against mothers because born mis-shapen (penis envy)
Sexual urges repressed, children play with own sex
Sexual urges on the alert stage again, focus on opposite sex peers, primary focus of pleasure on genitals (if successful with previous stages)
Id is basic survival, based on pleasure principle, no consideration for reality of situation Ego: reality principle, understands that others have needs and desires. Ego is strongest force. Uses defense mechanisms (denial, intellectualization, projection, rationalization, regression, repression) when can’t maintain balance between id and superego Job of ego is to meet needs of id while looking at situation realistically Superego: moral and ethical part. Consciousness dictates right and wrong.
What are the rules of the game? Preconventional level Up to age 9 Morality is self focused: avoid punishment gain reward Conventional level Age 9-adolescent Other-focused morality gain approval and avoid punishment duty and guilt Post-conventional Adulthood Higher-focused morality agreed upon rights personal moral standards
Women thinking more about caring thing to do rather than right thing to do. Focus on connections among people; ethic of caring Preconventional goal is individual survival, transition is from selfishness to responsibility to others Conventional goal is self-sacrifice is goodness; transition from goodness to truth (you are a person deserving goodness too) Postconventional goal is principle of non-violence
Ivan Pavlov – classical conditioning – occurs when a natural reflex responds to a stimulus. (Biologically “wired” so that a certain stimulus will produce a specific responses) Learn by association; Example: child cries at sight of Dr/MA because remembers pain of shots Operant conditioning – also known as behavioral conditioning Occurs when a response to a stimulus is reinforced: Basically: simple feedback system. If a reward or reinforcement follows the response to a stimulus, then the response becomes more probable in the future Learning due to natural consequence Response precedes reward because of previous experience; responses can be altered by positive or negative reinforcement Example: Trying to get a child to sit still for examination by giving a reward (reinforcement) after good behavior, child in the future will sit still (wait for reward?, eventually will establish new pattern of behavior) Reinforcement – any stimulus that increases probability of specific response; requires schedules positive, negative
Maslow believed that human needs are grouped into five levels and that people are driven to achieve maximum potential unless obstacles in the way. Low-level needs must be met before higher-level needs are pursued. Example: Physiological needs – food, water, rest, warmth, health, reproductive function Safety needs – sense of well-being, freedom from threats, comfort, peace, free from anxiety and fear Belonging needs – acceptance, group membership, love and affection (both giving and receiving), friends Esteem needs – self respect, recognition of strength/intelligence, prestige, status Self-actualization needs – achievement of our potential by working with challenging projects, opportunities for innovation and creativity, learning at high level Understanding this hierarchy helps to assess a patient’s needs. If the most basic of needs are not met, it is unlikely that a patient can be successful with any treatment protocol.
2-6 years-Biosocial (learns how to act with others), cognitive (begins to learn either by classical, operant or reinforcement), psychosocial (begins independence, takes initiative) Growth-three inches a year Genes, nutrition, and healthcare factors normal growth Prelogical thought (Piaget) center on one feature instead of whole picture (see’s big dog and all child can talk about is the dogs big teeth) PLAY IS WORK through sensorimotor play, mastery play, rough & tumble play (physical development) Gender role Social interaction “ Theory of mind”-effort to comfort, irritate, or deceive by understanding that other people have emotions and believe that others think the way they do May start to develop antisocial behavior and phobias
Puberty: growth spurts start at extremities then toward center of body (all legs and arms), height and weight gains, internal organs grow Adolescent Egocentrism – ability to think logical but don’t always do so; more important, more drama than anyone else Invincibility fable – immune to laws of mortality and probability Personal fable – see themselves destined for great fame and fortune
Adjustments: To changes in physical strength and general health To death of partners, sibling, friends To retirement, reduced income, and role of elder member of the family Health and Aging Age is modulator of illness Change in function-mobility, cognition, and nutrition Lower expectations to functions Taken less seriously by physicians Fear of institutionalization Strain on income Increase in dementia Societal restrictions Withdrawal, isolation, depression
Whole body illness negatively affects how you feel, think and behave toward others Strike anytime, but most often from 24-44 years old Is treatable, (80-90% treated improve significantly)
Symptoms of depression: Loss of interest or pleasure in addition to five or more of the following: Changes in appetite Insomnia or oversleeping Loss of energy or increased fatigue Restlessness or irritability Feelings of worthlessness or guilt Difficulty thinking, concentrating, making decisions Thoughts of death or suicide Depression diagnosed only if above symptoms not due to other conditions/illnesses, side effects of medications or substance abuse People with depression often try to self-medicate (drugs, alcohol)
Difficult to diagnose because illness, dementia or other stressors present Most elderly prefer to seek help from primary care provider Treatment problems with elderly: body mass, body fat hinder absorption/distribution of medication; brain disorders increase sensitivity to drugs; drug-drug interactions
