Dr. Khalid Bazaid, MBBS, FRCPCAssistant Professor & ConsultantChild & Adolescent PsychiatristDepartment of PsychiatryCollege of MedicineKing Saud University

Development → changes in a person’s long-term growth, feelings and pattern of thinking and behavior.

Some developmental changes are relatively specific. Others are more general.

Why Study Development?

1. It can give you realistic expectations for children and adolescents.

2.Knowledge of development can help you respond appropriately to children’s actual behavior.

3.Knowledge of development can help you recognize when departures from normal are truly significant.

4.Studying development can help you understand yourself.

5.Studying development can make you better advocate for the need rights of children.

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55 DaysDays 22 MonthsMonths

11 YearYear2828

YearsYears

Embryo: conception to 8 weeks Fetus: 8 weeks to birth Infancy: birth to 15 months Toddler: 15 months to 2 ½ years Preschool: 2 ½ to 6 years Middle years: 6 to 12 years Adolescence: 12 to 19 years Adulthood: 20 to 65 Late adulthood: old age

Factors Influencing Child Factors Influencing Child DevelopmentDevelopment

1. Genetic Influences: The whole process of normal brain formation and

development is under the control of genetic mechanisms.

However, the expression of the genetic endowment will depend on many environmental constraints.

Physical characteristics have a clear genetic basis and some of these may directly or indirectly affect behavior.

General personality dimensions may have a genetic basis, however, individual cognition, behavior and interpersonal relationship develop from actual experiences.

2. Prenatal Influences: Mother’s age Diet Mental and physical health of the mother External factors such as drugs and

environmental toxins

3. Neonatal Influences:Complications during the process of delivery can affect the physical and psychological well-being of

the baby.

4. Nutrition:Malnutrition appears to have its greatest effects during the later stages of pregnancy and the 1st few months of life when a great deal of brain development occurs.

5. Environmental Chemicals:Some of the chemical products of modern industry and war consequences appear to have a potential harmful effect on the development of the brain mechanisms.

Maternal stress correlates with high levels of stress hormones (epinephrine, norepinephrine, and adrenocorticotropic hormone) .

Mothers with high levels of anxiety are more likely to have babies who are hyperactive, irritable, and of low birth weight and who have problems feeding and sleeping

Smoking during pregnancy is associated with both premature births and below-average infant birthweight

Alcohol use in pregnancy is a major cause of serious physical and mental birth defects in children (Fetal alcohol syndrome)

Most psychologists now tend to be interactionists: E.g., there are interactions between the child's genetic tendencies toward aggression and the child's being exposed to violence on TV.

Violent TV has a greater effect on children who are genetically inclined toward aggression.

6. Physical handicaps and brain injury:These can have lasting influences on psychological development. These effects can be direct or indirect.

7. Critical Periods:

Attachment

Temperamental patterns

Reflexes and survival systems at birth

Language and Cognitive Development

Emotional and Social Development

a. The Newborn: - Many important capacities are present at a

very early stage. - Great difficulty in studying psychological

processes in babies. - Newborns have considerable learning

abilities e.g. buzzer stimulus. - Perceptual abilities are more than imagined

e.g. turning eyes appropriately. - Social behavior is present in the earliest

days of babyhood. e.g. imitate simple facial gesture.

- Making body movement which are coordinated with the speech pattern of adults who talk to them (non-verbal communication).

b. Motor development: - It starts before birth and is effectively

completed in infancy. - Motor skills are a prerequisite to

effective control of the environment and result from a complex interactions between genetic potential, opportunity and personal attributes such as motivation and organizational skills.

- Tables exist which list the average age at which certain motor skills are obtained.

- The sequence and timing of motor development is largely genetically preprogrammed. However, fine motor development is more sensitive to social influence and opportunities.

c. Perceptual Development: - Even in very young babies,

perception is an active process. - Compared with adults, children tend

to cover less of the object and to fixate on details.

- Selective attention is markedly improved between ages of 5 and 7 years.

- There is strong preference for looking at faces from birth but appears about the 4th or 5th month.

Piaget’s Periods of Cognitive Development

Birth to 2 years

Sensori-motorUses senses and motor skills, items known by use

Object permanence learned

2-6 yrsPre-operational

Symbolic thinking, language used; egocentric thinking

Imagination/ experience grow, child de-centers

7-11 yrsConcrete operational

Logic applied, has objective/rational interpretations

Conservation, numbers, ideas, classifications

12 yrs to adulthood

Formal operational

Thinks abstractly, hypothetical ideas (broader issues)

Ethics, politics, social/moral issues explored

Focus on organization and adaptation

d. Cognitive Development:

- There are 4 key concepts in Piaget’s theory and these help describe the way children process information and deal with the world:

1. The schemata are the inferred cognitive structure or internal processes that the child uses in conceptualizing experiences.

2. Assimilation; describes the way in which the child deals with new information.

3. Accommodation; occurs when an existing schema modified to incorporate new information.

4.Equilibrium exist when the two processes are in a state of relative balance.

Children tend to pass through 4 broad stages:

1. Sensorimotor stage – it lasts for the 1st 2 years & infant construct sensorimotor schemata based on his or her interactions with the environment object permanence.

2. Pre-operational thought – between 2 & 7 years. The child begins to use an internal representation of his or her external world. conservational problem.

3. Concrete operations – between 7 & 11 years. Children apply logical reasoning to concrete objects and problems.

4. Formal operations – it begins at about 11 years.- full adults thinking ability.- abstract reasoning skills.

e. Language Development - Language comprises the sum of skills

necessary for the process of communication.

- It consists of the ability to understand and utilize communications, verbal and non-verbal and to make such communications to others with meaning.

- The newborn shows a remarkable ability to distinguish among speech sound e.g. his mother’s voice.

- Speech production lags behind the capacity for recognizing and responding to speech.

- By 3 – 4 months early bubbling usually occurs.

Mother and baby can be observed to be involved in turn-taking conversation.

At about 12 months the 1st words with meaning usually occur.

By 18 months the child is usually generating combinations of words.

By age of 5, the child not only accumulates a large vocabulary but also learns the rules for producing grammatically correct utterances.

Influences on normal language development:

- Genetic factors- Physical factors- Social class- Family size- Multiple births- Gender- Quality of stimulation- Bilingual households

f. Social development - During the 1st few months attachment

will be established. - At age of 8 months, infants begin to show

a definite fear of strangers and not long after this, they will show fear of separation from their caretakers.

- During the preschool years, new behaviors & attitudes develop as children increasingly interact with their social environment as part of a process called socialization.

- One area of behavior during this phase is the gender roles & is mediated through identification.

- Moral constraints on behavior is learned in part through identification with parents.

Women usually detect fetal movements 16 to 20 weeks into the pregnancy

The fetus may be able to hear by the 18th week, and it responds to loud noises with muscle contractions, movements, and an increased heart rate.

The retinal structures begin to function at that time. Eyelids open at 7 months.

Smell and taste are also developed at this time, and the fetus responds to substances that may be injected into the amniotic sac, such as contrast medium.

Reflexes are present at birth.

Survival systems breathing, sucking, swallowing, and circulatory and temperature homeostasis are relatively functional at birth, but the sensory organs are incompletely developed.

The newborn infant is awake for only a short period each day.

Infants 1 day old can detect the smell of their mother's milk, and those 3 days old distinguish their mother's voice.

Guttural or babbling sounds occur spontaneously, especially in response to the mother.

Infants imitate the facial movements of adult caregivers by age 3 weeks.

John Bowlby describes attachment as a complex two-way process in which the child becomes emotionally linked to members of his or her family, usually the mother, father, and sibs.

It is an adaptive, biological process serving the needs of the child for protection and nurture.

Early separation of infants from their mothers had severe negative effects on children's emotional and intellectual development

Stranger anxiety

Separation anxiety

Although it is genetically determined, the behavior of those around the child will influence the security of the attachment.

Failure to establish such close relationship would result in different type of difficulties in personality, relationship and emotional disorders.

Attachment of family members:

As the child has been born, most of the family members especially the mother will show positive warm feelings towards him. They are likely to show:- strong protective feelings.- a need for proximity to the child.- exclusion of other relationship.- empathic feelings with the child.

Attachment of the Child is governed by the child’s level of perceptual and other abilities.

Evidences for attachment include:- Recognition of other family members as special people.- Expression of especially intense feelings towards family members.- Expectation that the family members will meet all needs.- Empathy with the feelings of other family members.

Attachment interaction between child and family members.

- Mutually satisfactory biological rhythms.- Bodily interplay.- Communication interplay.

Factors within the child. Developmental maturity of the child. Temperament. Presence of sensory defects.

Factors within family members, especially parents.

The wish for the child. Parental personality, physical and mental health. Behavior of older brothers and sisters. Quality of family relationships. Living conditions.

Early environment and language. Early environmental stimulation is important for language development.

Temperamental Differences Goodness of fit

Parental Fit

Good-Enough Mothering

The second year of life is marked by accelerated motor and intellectual development.

Toddlers' negativism is vital to the development of independence.

Learning language is a crucial task.

The child looks to parents and others for emotional cues about how to respond to novel events.

Gender identity, the unshakable conviction of being male or female, begins to manifest at 18 months.

Sphincter Control and Sleep.

Characterized by marked physical and emotional growth. They have mastered the tasks of primary socialization Control their bowels and urine Dress and feed themselves Control their tears and temper outbursts

Children's use of language expands, and they use sentences.

Children between are aware of their bodies, of the genitalia, and of differences between the sexes

Children's play behavior reflects their level of social development.

Thinking is egocentric.

Children enter elementary school.

Logical exploration tends to dominate fantasy.

Children are now capable of increased independence, learning, and socialization.

In the middle years, both girls and boys make new identifications with other adults e.g. teachers.

Interest in relationships outside the family takes precedence over those within the family, and prefer to interact with children of the same sex.

Emotions about sexual differences begin to emerge as either excitement or shyness with the opposite sex.

Sex play and curiosity are common.

School Refusal

The period between the end of childhood and beginning of adulthood (12-20 ).

It is a time of great biological, psychological

and social changes.

Puberty is established with characteristic Physical changes.

It is the time for establishing personal identity.

Cognitive and physical changes will give rise to self-awareness.

Peer influence is considerably increased.

Fighting authority control is an important issue.

Oversensitivity to criticism, moodiness and easily provocation are common.

By the end, they will establish personal identity, independence and workable relationship with peers.

works in progress characterized by:

increasing ability for mastery over complex challenges of academic, interpersonal, and emotional tasks,

While searching for new interests, talents, and social identities.

75% of youth, adolescence is a period of successful adaptation to physical, cognitive, and emotional changes, largely continuous with their previous functioning.

20% of the adolescent population experience psychological maladjustment, self-loathing, disturbance of conduct, substance abuse, affective disorders, and other impairing psychiatric disorders emerge.

Erik Erikson characterizes the normative task of adolescence as identity versus role confusion.

Physical development Puberty is the process by which adolescents

develop physical and sexual maturity, along with reproductive ability.

Cognitive maturation Transition from concrete thinking to more abstract

thinking. An increased ability to draw logical conclusions in scientific

pursuits, with peer interactions and in social situations. New abilities for self-observation and self-regulation.

Socialization Ability to find acceptance in peer relationships The development of more mature social cognition. Peer influences are powerful.

Moral development set of values and beliefs about codes of behavior that

conform to those shared by others in society.

Early Adolescence From 12 to 14 years of age Physical changes Criticize usual family habit Insist on spending time with peers Awareness of style and appearance Increase in opposite sex Experiment with cigarettes, alcohol, and

marijuana

Middle Adolescence Between the ages of 14 and 16 Independent Abilities to combine abstract reasoning

with realistic decision-making Sexual behavior intensifies Identify with a group of peers Conflict with families

Late Adolescence Between the ages of 17 and 19 Self and a sense of belonging to certain

groups or subcultures within mainstream society.

Well-adjusted adolescents can be comfortable with current choices of activities, tastes, hobbies, and friendships, yet remain aware that their identities will continue to be refined during young adulthood

Self-Esteem one's sense of self-worth based on

perceived success and achievements, as well as a perception of how much one is valued by peers, family members, teachers, and society in general.

Good SE correlates: +ve physical appearance Academic achievement

Adolescent Sexual Behavior By high school, most male adolescents report experience

with masturbation, and more than half of adolescent girls report masturbation

Close to four of ten girls who had first intercourse at 13 or 14 years of age report it was either not voluntary or unwanted. Three of four girls and over half of boys report that girls who have sex do so because their boyfriends want them to.

In general, adolescents who initiate sexual intercourse at younger ages are also more likely to have a greater number of sexual partners.

In 2003, 47 percent of 9th to 12th grade students reported having sexual intercourse, a decline from 53 percent in 1993

Nearly four of ten teen pregnancies end in abortion The average adolescent mother who cannot care for her

child, has the child either placed in foster care or raised by the teenager's already overburdened parents or other relatives.

Few teenage mothers marry the fathers of their children; the fathers, usually teenagers, cannot care for themselves, much less the mothers of their children. If the two do marry, they usually divorce. Many are more likely to end up on welfare.

The additive effects of more highly educated families, social and religious youth groups, and school-based educational programs can be credited with a decline in high-risk sexual behavior among adolescents.

Responsible sexual behavior among adolescents has been determined as one of the ten leading health indicators for the next decade.

Abortion Nearly four of ten teen pregnancies end in abortion

Alcohol

Nicotine

Cannabis

Violence

Bullying

Prostitution

Tattoos and Body Piercing