K-3 Child & Adolescent Psychiatry 2new

7/30/2019 K-3 Child & Adolescent Psychiatry 2new

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CHILD & ADOLESCENT

PSYCHIATRY 2

Elmeida Effendy

Psychiatric DepartmentFK USU


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Psychosocial development from

Erik Erikson Based on the concept of epigenesis

His epigenetic principle holds that

development occurs in sequential, clearlydefined stages, & that each stage must besatisfactorily resolved for development to

proceed smoothly


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Eight Stages of the Life Cycle

1. Trust vs Mistrust (birth-18 months)

2. Autonomy vs Shame & Doubt (18

months-3 years) 3.Initiative vs Guilt (3-5 years)

4.Industry vs Inferiority (5-13 years)

5.Identity vs Role Confusion (13-21 years) 6.Intimacy vs Isolation (21-40 years)

7. Generativity vs Stagnation (40-60 years)

8. Integrity vs Despair (60-death)


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1. Basic trust vs basic mistrust(birth-18 months)

Trust depends not an absolute quantities offood or demonstrations of love, but rather

on the quality of maternal relationship Social modality : taking & holding on to

things

Associated virtue : hope

Trust will predominate over mistrust, &hope will crystallize

Related forms of psychopathology :

psychosis, addictions, depression


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2. Autonomy vs Shame & Doubt(18months-3 years)

Social modalities : holding on & letting go

Associated virtue : will

When that ratio is favorable, the child willdevelop an appropriate sense of autonomy& the capacity to have and to hold

Related forms of psychopathology:paranoia, obsessions, compulsions,impulsivity


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3.Initiative vs Guilt (3-5 years)

Increasing mastery of locomotor & languageskills

Jealousy & rivalry for a favored position withone of the parents

Associate virtue : purpose

Related forms of psychopathology :conversion disorder, phobia, psychosomaticdisorder


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4.Industry vs Inferiority (5-13

years) Develops industry by learning new skills &

takes pride in the things made

Associated virtue : competence Related forms of psychopathology : creative

inhibition, inertia


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5.Identity vs Role Confusion (13-21years)

Primarily concerned with what theyappear to be in the eyes of others

compared to what they feel they are, &with the question of how to connect theroles & skills cultivated earlier with theoccupational prototypes of the day

Associate virtue : fidelity

Related forms of psychopathology:delinquent behavior, gender related

identity disorder, borderline psychotice isodes


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Jean Piagets Psychocognitive

Development Childs intelligence development

basically from the virtue of

progressive network of a patternwhere its base is assimilation andaccomodation process


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There are 4 primary factors according toPiaget :

1. Existence of organic development &maturation from the endocrine & nervoussystem

2. The influence & role of experience andpractice which obtained from conductedactions to physical object.

3.There are social interactions & social

transmissions There is a continuous effort to maintain the

equlibrium


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In each development level, problems informing of equilibrium, where former

concept will represent base in forming ofready ness here & after, and willculminate in logical thinking whenadulthood

Child stay in a conceptual equilibrium, andif he obtain experience which doesntmatch with his owned equilibrium, child

will reside in unpleasant state, which is adisequilibrium situation & child willperform a changes in conceptualframework


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which he owned, so that he stayed in alevel will more go forward to face the

problem. And this means the child returnsin equilibrium state , and meaning that thechild have earned to live with the problem


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Child mental development bounce from alevel/ plain/ plateau to higher level, and

child perform changes to conceptualframework which he owned, by doing

accomodation process in facing the

problems/ experiences & new difficulties


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If the child accept some experience orproblem, however it is still in the same

level or plateau, hence the child will dothe assimilation process


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Psychocognitive Development from JeanPiaget :

1. Sensorymotor Stage (birth-2 years)

2. Stage of Preoperational Thought (2-7

years) 3. Stage of Concrete Operations (7-11

years)

4. Stage of Formal Operations (11-end ofadolescence)


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Sensorymotor Stage (birth-2 years)

: object permanence or the schema of thepermanent object

Ability to understand that objects have anexistence independent of the childsinvolvement with them

Symbolization : at about 18 monthsinfants begin to develop mental symbols &use words


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Stage of Preoperational Thought

(2-7 years) Unable to think logically or deductively,

concepts are primitive

They can name the object but not classesthe object

Events are not linked by logic

If children drop a glass that then breaks,they have no sense of cause & effect


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They believe that the glass was ready tobreak, not that they broke the glass

Immanent justice : the belief thatpunishment for bad deeds is inevitable

Egocentric: they see themselves as thecenter of the universe, they have a limitedpoint of view, unable to take the role of

another person


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E.g : children are not being negativistic

when they do not listen to a command tobe quiet cause their brother has to study.Instead, egocentric thinking prevents an

understanding of their brothers point ofview


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magical thinking = phenomenalistic

causality: events that occur together arethought to cause one another (e.g :thunder causes lightning, bad thoughts

cause accidents) animistic thinking : tendency to endow

physical events & objects with lifelike

psychological attributes, such as feelings& intentions


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Semiotic function : children use a symbol

or sign to stand for something else. Children can represent something such as

an object, event, conceptual scheme with

a signifier, which serves a representativefunction (e.g. language, mental image,symbolic gesture)

Drawing is a semiotic function initiallydone as playful exercise but eventuallysignifying something else in the real world


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3. Stage of Concrete Operations (7-

11years) egocentric thought is replaced by operational

thought: children operate & act on the concrete,

real & perceivable world of objects & events syllogistic reasoning : in which logical conclusion

is formed from 2 premises, eg: all horses aremammals (premise), all mammals are warm

blooded (premise); therefore all horses arewarm blooded (conclusion)


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Conservation : the ability to recognize that

although the shape of objects maychange, the object still maintain or serveother characteristics that enable them tobe recognized as the same, eg : if a ball ofclay is rolled into a long, thin sausageshape, children recognize that each formcontains the same amount of clay


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Reversibility : the capacity to understandthe relation between things, to realize that

one thing can turn into another & backagain, e.g : ice & water


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Stage of Formal Operations(11-end of adolescence) :

Operates in a formal, highly logical,systematic & symbolic manner

Ability to think abstractly, to reasondeductively & to define concepts & also bythe emergence of skills for dealing withpermutations & combinations : can grasp

the concept of probabilities


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Attempt to deal with all possible relations& hypotheses to explain data & eventsduring this stage

Language use is complex, follows formalrules of logic & is grammatically correct

Abstract thinking is shown by adolescentsinterest in a variety of issues- philosophy,religion, ethics & politics


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Hypotheticodeductive thinking : the

highest organization of cognition &enables persons to make a hypothesis orproposition & to test it against reality

Deductive reasoning moves from thegeneral to the particular and is morecomplicated process than inductivereasoning, which moves from theparticular to the general


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Diagnostic classification according

to ICD-10 I.Disorders of psychological development

1. Specific developmental disorders of speech &language

1. Specific speech articulation disorder

2. Expressive language disorder

2. Specific developmental disorders of scholastic skills

1. Specific reading disorder

2. Specific spelling disorder

3. Specific disorder of arithmetical skills

4. Specific scholastic skills disorder


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3. Specific developmental disorder of motor

function 4. Mixed specific developmental disorder

5. Pervasive developmental disorder

1. Childhood autism

2. Retts syndrome

3. Aspergers syndrome

6. Other disorders of psychological

development 7. Unspecified disorder of psychological

development


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II. Behavioral & emotional disorders withonset usually occurring in childhood &

adolescence

1. Hyperkinetic disorders

1. Disturbance of activity & attention

2. Hyperkinetic conduct disorder 2. Conduct disorder

3. Mixed disorders of conduct & emotions

4. Emotional disorders with onset specific tochildhood

1.Separation anxiety disorder of childhood


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5. Disorders of social functioning with onset

specific to childhood & adolescence 1. Elective mutism

2. Reactive attachment disorder of childhood

6. Tic disorders

1. Transient tic disorder

2. de la Tourettes syndrome


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7. Other behavioral & emotional disorderswith onset usually occurring in childhood &

adolescence 1. non organic enuresis

2. non organic encopresis

3. feeding disorder of infancy & childhood

4.stuttering


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Attention Deficit Hyperactivity

Disorder Diminished sustained attention, higher level of

impulsivity in a child or adolescent than

expected for someone of that age &developmental level

3-7 % of pre pubertal elementary school

Boys : girls : 2-9 : 1

Symptoms must be present before age 7

( usually by age 3)


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Autistic Disorder

= early infantile autism

= childhood autism

= Kanners autism

Characterized by deviant reciprocal social

interaction, delayed & aberrantcommunication skills & a restrictedrepertoire of activities & interests


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Qualitative impairment in social interaction Qualitative impairment in communication

Restricted repetitive & stereotyped

patterns of behavior, interests & activities


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Marked impairment in the use of multiplenon verbal behaviors such as eye to eye

gaze, facial expression, body postures Failure to develop peer relationships

appropriate to developmental level

A lack of spontaneous seeking to shareenjoyment interests or achievements withother people

Qualitative impairment in socialinteraction


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Qualitative impairment in

communication Delay in the development of spoken language

In individual with adequate speech, marked

impairment in the ability to initiate or sustain aconversation with others

Stereotyped & repetitive use of language oridiosyncratic language

Lack of varied, spontaneous make-believe playappropriate to developmental level


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Restricted repetitive & stereotypedpatterns of behavior, interests &

activities stereotyped & repetitive motor

mannerism : hand or finger flapping or

twisting or complex whole bodymovements

Persistent preoccupation with parts of

objects


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Treatment

Depends on the type of the disorders

If the obtained symptom came from

environment or family, hence theeffectiveness of treatment determined byfamily or environment that concerned in thetreatment strategy


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Treatment for child could be inform of :

1. Family therapy

2. Environmental

manipulation 3. Play therapy

4. Behaviour therapy

5.Pharmacologicaltherapy

6. Psychotherapy


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For child with education problems should beovercome with special school


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For several cases may be :

1. Cannot overcome the environment

2. Environment as the root cause of the

problems experienced by child 3. Dangerous child hurting others or own

self

For these kind of child treated in specialplace.


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