CHILD & ADOLESCENT

PSYCHIATRY 2
Elmeida Effendy
Psychiatric Department
FK 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, clearly
defined stages, & that each stage must be
satisfactorily resolved for development to
proceed smoothly

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 of

food 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

2. Autonomy vs Shame & Doubt

(18months-3 years)

Social modalities : holding on & letting go

Associated virtue : will
When that ratio is favorable, the child will
develop 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 & language

skills
Jealousy & rivalry for a favored position with
one of the parents
Associate virtue : purpose
Related forms of psychopathology :
conversion disorder, phobia, psychosomatic
disorder
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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

5.Identity vs Role Confusion (13-21

years)

Primarily concerned with what they

appear to be in the eyes of others
compared to what they feel they are, &
with the question of how to connect the
roles & skills cultivated earlier with the
occupational prototypes of the day
Associate virtue : fidelity
Related forms of psychopathology
:delinquent behavior, gender related
identity disorder, borderline psychotic
episodes

Jean Piagets Psychocognitive

Development

Childs intelligence development

basically from the virtue of
progressive network of a pattern
where its base is assimilation and
accomodation process

There are 4 primary factors according to

Piaget :

1. Existence of organic development &

maturation from the endocrine & nervous
system
2. The influence & role of experience and
practice which obtained from conducted
actions 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 in

forming of equilibrium, where former
concept will represent base in forming of
ready ness here & after, and will
culminate in logical thinking when
adulthood
Child stay in a conceptual equilibrium, and
if he obtain experience which doesnt
match with his owned equilibrium, child
will reside in unpleasant state, which is a
disequilibrium situation & child will
perform a changes in conceptual
framework
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which he owned, so that he stayed in a

level will more go forward to face the
problem. And this means the child returns
in equilibrium state , and meaning that the
child have earned to live with the problem

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Child mental development bounce from a

level/ plain/ plateau to higher level, and
child perform changes to conceptual
framework which he owned, by doing
accomodation process in facing the
problems/ experiences & new difficulties

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If the child accept some experience or

problem, however it is still in the same
level or plateau, hence the child will do
the assimilation process

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Psychocognitive Development from Jean

Piaget :
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 of
adolescence)

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Sensorymotor Stage (birth-2 years)

: object permanence or the schema of the

permanent object
Ability to understand that objects have an
existence independent of the childs
involvement with them
Symbolization : at about 18 months
infants 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 classes
the 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 to

break, not that they broke the glass
Immanent justice : the belief that
punishment for bad deeds is inevitable
Egocentric: they see themselves as the
center of the universe, they have a limited
point 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 to
be quiet cause their brother has to study.
Instead, egocentric thinking prevents an
understanding of their brothers point of
view

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magical thinking = phenomenalistic

causality: events that occur together are
thought 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 representative
function (e.g. language, mental image,
symbolic gesture)
Drawing is a semiotic function initially
done as playful exercise but eventually
signifying something else in the real world
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3. Stage of Concrete Operations (711years)

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 are
mammals (premise), all mammals are warm
blooded (premise); therefore all horses are
warm blooded (conclusion)

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Conservation : the ability to recognize that

although the shape of objects may
change, the object still maintain or serve
other characteristics that enable them to
be recognized as the same, eg : if a ball of
clay is rolled into a long, thin sausage
shape, children recognize that each form
contains the same amount of clay

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Reversibility : the capacity to understand

the relation between things, to realize that
one thing can turn into another & back
again, 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 reason
deductively & to define concepts & also by
the emergence of skills for dealing with
permutations & combinations : can grasp
the concept of probabilities

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Attempt to deal with all possible relations

& hypotheses to explain data & events
during this stage
Language use is complex, follows formal
rules of logic & is grammatically correct
Abstract thinking is shown by adolescents
interest 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 or
proposition & to test it against reality
Deductive reasoning moves from the
general to the particular and is more
complicated process than inductive
reasoning, which moves from the
particular 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.
2.
3.
4.

Specific
Specific
Specific
Specific

reading disorder
spelling disorder
disorder of arithmetical skills
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 with

onset 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 to
childhood

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 disorders

with 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 & aberrant
communication skills & a restricted
repertoire 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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Qualitative impairment in social

interaction

Marked impairment in the use of multiple

non 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 share
enjoyment interests or achievements with
other people
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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 a
conversation with others
Stereotyped & repetitive use of language or
idiosyncratic language
Lack of varied, spontaneous make-believe play
appropriate to developmental level
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Restricted repetitive & stereotyped

patterns of behavior, interests &
activities

stereotyped & repetitive motor

mannerism : hand or finger flapping or
twisting or complex whole body
movements
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 the
effectiveness of treatment determined by
family or environment that concerned in the
treatment strategy

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Treatment for child could be in

form of :

1. Family therapy
2. Environmental
manipulation
3. Play therapy
4. Behaviour therapy
5.Pharmacological
therapy
6. Psychotherapy
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For child with education problems should be

overcome 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 special
place.
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