Developmental Psychology

Adolescence
● Introduction to Adolescence
● Puberty & Health
● The brain, cognitive, and moral development
● Self and Identity
● Family
● Peers
● Gender
● Sexuality

Theories of adolescent development

Psychoanalytical theories: Freud, Blos, Erikson
➢ Freud’s psychosexual stages: oral, anal, phallic, latency, genital.Fixations could
happen in each stage in one’s future. These fixations represent a deficiency in one of
the stages.
➢ Erikson’s psychosocial stages : 8 stages

➢ Psychosexual development: Genital stage

Stanley Hall: Sturm and Drang (1916)
According to Hall there are three key aspects of psychosexual development in
adolescence: Conflict with adults and authoritative figures , Mood disruptions , Risky
behavior
➢ James Marcia the four identity statuses
➢ Freud’s structure of personality: Id, Ego, Superego
Main developmental task: Blos and Anna Freud
➢ Anna Freud (ambivalence) PG 28
➢ Peter Blos (regression) PG 28
*CHECK FROM BOOK, NOT IN THESE NOTES*

Cognitive theories:
➢ Piaget : Four stages ( sensorimotor, preoperational, concrete operational,
formal operational) PG 30
➢ Vygotsky: Sociocultural cognitive theory PG 31
➢ Selman : Perspective taking developmental theory (3-15yrs) PG 137

➢ Elkind : Adolescent egocentrism PG 122

➢ Kohlberg’s Three Levels & Six Stages

Behavioral and social cognitive theories:

➢ Skinner : Operant conditioning PG 32
➢ Bandura : Social cognitive theory PG 32

Ecological contextual theories:

➢ Urie Bronfenabber: Ecological theory (five env systems : microsystem,
mesosystem, exosystem, macrosystem, chronosystem) PG 32/33
Introduction to Adolescence (READ BOOK INTRO)
Adolescence is the stage where there is a struggle between the need to stand out, and the
need to belong. Adolescence starts from around age 10 till 22. In this stage, the physical,
sexual, socio-emotional, and cognitive, factors are developing. In this stage, we also start to
develop our identity. This causes us to start identifying ourselves within social contexts in our
family, peer groups, and school environments. Childhood and youth are only a few centuries
old. The idea of childhood and youth did not exist before the 16th century. The end of the
Victorian era: child legislation especially labor laws and compulsory education, children had
an economic value eg in farming communities. Laws that prolong the age of dependence
have been introduced creating the period of adolescence.
During the nineteenth century, the growing acceptance of this new ideal among the middle
class was evident in the prolonged residence of young people in the parental home, longer
periods of formal schooling, and increasing consciousness about the stages of young
people’s development. The invention of adolescence came around the turn of the twentieth
century.

The boundaries of adolescence :

➢ Chronological
➢ Biological
➢ Emotional
➢ Cognitive
➢ Interpersonal
➢ Social
➢ Educational
➢ Legal
➢ Cultural
➢ Historical
➢ Policy

Sub Stages of Adolescent and youth development :

Early, Middle, Late, Yout, Emerging Adulthood.

Adolescents and young people face a range of developmental issues such as in: work
and relationships (Havinghurst 1952), Exploration (Levinson 1978), Intimacy and
commitment to goals (Erikson 1968), and vocational choices.
Older adolescents and young adults enter transitions with the goal of becoming
independently functioning adults, as they strive to meet evolving personal and career-related
needs. This creates independence.

The psychological effects of transitioning:

Life transitions are periods in time when individuals experience major changes. Transitions
may occur during periods between two relatively stable states of human development.
● The associated changes with the transition bring instability as the person passes
through the period.
● During this period, the individual is typically required to make major adjustments, to
develop new skills, or learn to cope with new experiences.
● A successful transition to young adulthood will form a foundation for the individual in
future stages of development and transitions.
● Discontinuity with the past
● Self-concept is challenged
● Growing up in a different world than that experienced by previous generations
● Impression of having control over the timing and routing of their journeys but still
being constrained by a variety of structural variables
● Individualization
● Young people embark on journeys into adulthood that involve a wide variety of
routes, many of which appear to have uncertain outcomes.
● PROTRACTED (to prolong in time or space) TRANSITIONS
● Restructuring of the labor market and the need for specialized workers have
increased the time when youth are dependent (Furlong and Cartmel, 1999)
● Today youth have to negotiate a set of risks that were not there in their parent's
generation.
● Points of reference are no longer there – increase stress and vulnerability.
● Stages of dependency: An extension of the period during which young people still are
dependent on their parents/guardians.
● Adult status is based on the successful completion of a series of linked transitions.

Three main transitions (Coles)

1) Transition from school to work
2) Domestic transition – move from family of origin to family of destination
3) Housing transition – a move to a residence away from the parental home
The extension of transitions, together with changes in the typical sequence of events has
implications for the establishment of identity. All three transitions have become more
complex and difficult to negotiate.

Types of transitions :
● Traditional transitions
● Extended or protracted transitions
● Fractured transitions
● Yo yo transitions

A critical look at the transition concept :

The concept suggests an image of a fluid and steady process… this implies steady
progression through identifiable stages to a set point (adulthood). However, transitions may
not always be a fluid and steady process. There are multiple processes and dimensions of
transition before becoming an adult. Growing up happens in bits and pieces.

Stereotyping Adolescents CONTINUE FROM THE BOOK PG 6

Puberty and Health

Stress and resilience: Cskszentmihali and Shmidt 1998

● Adolescence is the best age period of life
● Physical eg. Speed, strength
● cognitive eg. Information processing, memory
● Psychological - Ability to turn negative conditions into positive ones eg. Negative
emotions last longer in adults.
● Limitations of social systems result in stress
● Social limitations eg. restrictions on freedom, absence of responsibility, lack of
control, isolation from adult role models, problems of sexuality

Puberty: What is puberty?

Puberty is the period of rapid physical maturation involving hormonal and bodily changes
that take place primarily in early adolescence.
1) Determinants of Puberty
A number of complex factors are involved (Blakemore, Berenbaum, & Liben, 2009;
Divall & Radovick, 2008):
● Changes in the endocrine system
● Weight
● Body fat
● Leptin (hormone your body releases that helps it maintain your normal weight
on a long-term basis)

(Susman & Dorn, 2009).

There is increased interest in the role that birth weight, rapid weight gain in infancy,
obesity, and sociocultural factors might play in pubertal onset and characteristics.

Heredity
Recently, scientists have begun to conduct molecular genetic studies in an attempt to
identify specific genes that are linked to the onset and progression of puberty (He &
others, 2010; Paris & others, 2010)Puberty is not an environmental accident.

Programmed into the genes of every human being is the timing for the emergence of
puberty (Kaminski & Palmert, 2008).Puberty does not take place at two or three
years of age and it does not occur in the 20s.Puberty takes place between about 9
and 16 years of age for most individuals. Environmental factors can also influence its
onset and duration (van den Berg & Boomsma, 2007).

Hormones
Powerful chemicals secreted by the endocrine glands; carried through the body by
the bloodstream (Divall & Radovick, 2008).

a) Androgens: The main class of male sex hormones.Testosterone is an

androgen that plays an important role in male pubertal development.

b) Estrogens: The main class of female sex hormones.Estradiol is an estrogen

that plays an important role in female pubertal development.Plays an
important role in female pubertal development.As estradiol levels rise
changes in girls occur:
➢ Breast development
➢ Uterine development
 ➢ Skeletal changes
➢ The identity of hormones that contribute to sexual desire and activity
in adolescents is less clear for girls than it is for boys (Cameron,
2004).

The Endocrine system’s role in puberty involves the interaction of:

● Hypothalamus: A structure in the higher portion of the brain. Monitors eating,
drinking, and sex.
● Pituitary Gland: Regulates other glands.
● Thyroid Gland: Interacts with the pituitary gland to influence growth.
● Gonads, or Sex Glands: Testes, ovaries.,Secretes sex hormones.

How does the endocrine system work?

Adrenarche and Gonadarche
● The pituitary gland send a signal via gonadotropins (hormones that stimulate sex
glands) to the testes or ovaries to manufacture the hormone
● The pituitary detects the optimal level of hormones and maintains it.

Adrenarche - “the awakening of the adrenal gland.” The adrenal gland is responsible for
making hormones including androgens — sex hormones that cause changes such as the
development of pubic hair, oily skin, oily hair, and body odor.
involves hormonal changes in the adrenal glands. From about six to nine years of age in
girls and about one year later in boys before what is generally considered the beginning of
puberty (Dorn & others, 2006).
● During Adrenarche and continuing through puberty, the adrenal glands secrete
adrenal androgens, such as dehydroepiandrosterone (DHEA) (Miller, 2008).
● Weight, body fat, and the hormone leptin are hypothesized to trigger the onset of
menarche (menstruation) in girls.

Gonad Arche- refers to the earliest gonadal changes of puberty.

● Follows adrenarche by about two years.
● Is the period most people think of as puberty.
● Involves the maturation of primary sexual characteristics:
➢ Ovaries in females, testes in males.
● Secondary sexual characteristics: pubic hair, breast, and genital development (Dorn
& others, 2006).
● “The hallmark of gonadarche is the reactivation of the hypothalamic-pituitary-gonadal
axis (HPG). . . . The initial activation of the HPG axis was during the fetal and
neonatal period” (Dorn & others, 2006, p. 35).
● In the United States and Europe, the gonadarche period begins at approximately 9 to
10 years of age in girls, and 8 to 9 years in African American girls (Herman-Giddens,
Kaplowitz, & Wasserman, 2004).
● In boys, gonadarche begins at about 10 to 11 years of age.

Menarche- The first menstrual period.Occurs in mid- to late-gonadarche in girls.

Spermarche- In boys, the first ejaculation of semen. Occurs in early- to mid-gonadarche in

boys.

Weight, body fat, and Leptin: trigger the onset of menarche/spermarche

● Higher weight, especially obesity, is linked to earlier pubertal development
(Kaplowitz, 2008).
● A body weight of 106 +/- 3 pounds (48 kilos) may trigger menarche and the end of
the pubertal growth spurt (Friesch, 1984).
● Some scientists have hypothesized that the onset of menarche is influenced by the
percentage of body fat in relation to total body weight. A minimum of 17 percent of a
girl’s body weight must be comprised of body fat.
● Boys' undernutrition may delay puberty (Susman, Dorn, and Schiefelbein, 2003).
 ● The hormone leptin may signal the beginning and progression of puberty.
● Low birth-weight girls experience menarche approximately 5 to 10 months earlier
than normal birth-weight girls.
● Low birth-weight boys are at risk for small testicular volume during adolescence
(Ibanez & de Zegher, 2006).
● Researchers also have found that rapid weight gain in infancy is related to earlier
pubertal onset (Dunger, Ahmed,& Ong, 2006).
● Leptin (Greek leptos meaning thin) is a 16 kDa protein hormone that plays a key role
in regulating energy intake and energy expenditure, including appetite and
metabolism

What causes puberty?

Three structures are primarily responsible for puberty
a.Hypothalamus: A part of the brain that produces chemicals called releasing factors
b.Pituitary gland: A small gland at the base of the brain that is stimulated to produce
gonadotropins.
c.The gonads/sex organs: Testes in males, ovaries in females.

Sociocultural and environmental factors

● Recent research indicates that cultural variations and early experiences may be
related to earlier pubertal onset.
● Adolescents in developed countries and large urban areas reach puberty earlier than
their counterparts in less developed countries and rural areas (Graham, 2005).
● Children who have been adopted from developing countries to developed countries
often enter puberty earlier than their counterparts who continue to live in developing
countries (Teilmann & others, 2002).
● Early experiences that are linked to earlier pubertal onset include adoption, father
absence, low socioeconomic status, family conflict, maternal harshness, and child
maltreatment (Arim & others, 2011; Deardorff & others, 2011; Ellis & others, 2011)

Growth Spurt
● Slows throughout childhood.
● Puberty brings forth the most rapid increases in growth since infancy.
● Occurs two years earlier for girls (age 9) than boys (age 11) on average.
● The peak of pubertal change occurs at 11.5 years for girls and 13.5 years for boys.
● Girls increase in height by about 3.5 inches per year; boys by about 4 inches.
● Weight gain follows roughly the same timetable as height gain.
 ● Girls gain hip width while boys gain shoulder width.
● The later growth spurt of boys produces a greater leg length in boys than in girls.
● Boys’ facial structure becomes more angular during puberty, whereas girls’ facial
structure becomes rounder and softer.

Sexual Maturation
● Males Females

➢ Increase penis and testicle size. ➢ Breasts enlarge.

➢ Appearance of straight pubic ➢ Pubic hair.
hair. ➢ Armpit hair.
➢ Minor voice change. ➢ Growth in height.
➢ Spermarche. ➢ Hips become wider than
➢ Appearance of kinky pubic hair. shoulders.
➢ Onset of maximum growth. ➢ Menarche occurs rather late in
➢ Armpit hair. the pubertal cycle.
➢ More detectable voice changes. ➢ No voice changes occur that are
➢ Facial hair. comparable to those in pubertal
males.

Secular Trends in Puberty

The secular trend in puberty is the pattern of decreased age of onset sexual maturation in
adolescence. Adolescence is the time following the onset of puberty when a child transitions
into a mature adult. This means there is a trend of children starting puberty at a much
younger age than their ancestors did. There are many factors that could be contributing to
this trend including increased obesity, nutrition, exposure to synthetic chemicals, and socio-
economic influences.
There may be wide individual variations in the onset and progression of puberty
● Precocious puberty: The very early onset and rapid progression of puberty
● Characteristics of precocious puberty (Blakemore & others, 2009, p. 58):
○ Pubertal onset that occurs before the age of 8 in girls and before the age of 9
in boys (Dorn & Biro, 2011.
○ Occurs approximately 10 times more often in girls than in boys
○ Treated by medically suppressing gonadotropic secretions, which temporarily
stops pubertal change (Kaplowitz, 2009)
Secular growth trends in girls
During female puberty, the hormone estrogen is produced resulting in changes in breast
tissue and the uterus. Initially, breast tissue growth will occur, and usually, the first menses
will begin within two years. In girls, the first sign of puberty is the development of breast
tissue.

In the late nineteenth century, puberty in girls would not begin until about 17 years of age.
However, by the mid-twentieth century, the average age of puberty was 13. Recent data has
indicated female breast development begins as early as 10 to 11 years old with the onset of
menstruation beginning around 12 to 13 years of age. This trend shows breast development
beginning at a younger age in girls than in their female ancestors.

The secular growth trend indicates girls begin puberty at an earlier age in American and
Western European countries.

Secular growth trends in boys

In male puberty, the hormone testosterone is produced causing the testicles to grow,
followed by the penis. The growth of body hair will increase, and the voice will deepen.
Increased volume of the testicles is considered an indicator of beginning puberty.

Although there are fewer studies on early puberty in boys, recent data have indicated
testicular growth in boys beginning between 12 to 13 years of age. There are not many
studies about boys beginning puberty at an earlier age. Due to this, there is not a definitive
indication of a secular trend in boys beginning puberty at an earlier age.

Studies conducted before, from the 1960s to the 1990s, indicated no secular trend to
puberty beginning at an earlier age in boys. However, it was reported that there was a slight
decline in age by 3 months.

Psychological Dimensions of Puberty

● Body Image

➢ Adolescents are preoccupied with their bodies (Lawler & Nixon, 2010;
Markey, 2010) This affects self-esteem and self-concept.
➢ Gender differences
➢ In general, throughout puberty, girls are less happy with their bodies and have
more negative body images than boys (Crespo & others, 2010)
 ➢ As pubertal change proceeds, girls often become more dissatisfied with their
bodies, probably because their body fat increases (Markey, 2010; Yuan,
2010)
➢ In contrast, boys become more satisfied as they move through puberty,
probably because their muscle mass increases
➢ Events like puberty produce a different body that requires considerable
change in self-conception, possible resulting in an identity crisis.
➢ Early/Late Maturation: Many studies have been done on the effects of this.
➢ Complexity of On-time/Off-time: Adolescents can be at risk when the
demands of a particular social context do not match their physical and
behavioral characteristics
➢ Are effects exaggerated? For some people transition to puberty is stormy, but
for most, it is not
➢ The goodness-of-fit model (Lerner, 1985), according to which a good fit
between characteristics of the adolescent and his or her social context is
important for psychological well-being.

Early and Late Maturation

Recent research confirms that at least during adolescence, it is advantageous to be an
early-maturing rather than a late-maturing boy (Graber, Brooks-Gunn, & Warren, 2006;
Petersen, 1987). Early-maturing girls have more problems in school, are more independent,
and are more popular with boys than late-maturing girls.
Early maturation increases girls’ vulnerability to a number of problems (Graber, 2008): more
likely to smoke, drink, be depressed, have an eating disorder, request earlier independence
from their parents, and have older friends, earlier dating, and earlier sexual experiences.
● When adolescents mature earlier or later than their peers, they often perceive
themselves differently (de Rose & others, 2011; Graber, Nichols, & Brooks-Gunn,
2010; Negriff, Susman, & Trickett, 2011)
● The Berkeley Longitudinal Study found that early-maturing boys perceived
themselves more positively and had more successful peer relations than did late-
maturing boys.
● An increasing number of researchers have found that early maturation increases
girls’ vulnerability to a number of problems (de Rose & others, 2011; Graber, Nichols,
& Brooks-Gunn, 2010; Negriff, Susman, & Trickett, 2011)
Hormones and behavior
● Hormonal factors are thought to account for at least part of the increase in negative
and variable emotions that characterize adolescents (Vermeersch & others, 2008).
● In boys, higher levels of androgens are associated with violence and acting-out
problems (Van Goozen & others, 1998).
● Hormones do not function independently.
● Hormonal activity is influenced by many factors, including parent-adolescent
relationships, stress, eating patterns, sexual activity, and depression can activate or
suppress various aspects of the hormone system (DeRose & Brooks-Gunn, 2008).

Is Puberty’s Effect Exaggerated?

● Puberty affects some adolescents more strongly than others, and some behaviors
more strongly than others.
● Body image, interest in dating, and sexual behavior are affected by pubertal change.
● For some young adolescents, the path through puberty is stormy, but for most, it is
not.
● Each period of the human life span has its stresses and puberty is no different.
● Although adolescence poses new challenges, the vast majority of adolescents
weather the stresses effectively.

Health
Adolescence: A Critical Juncture in Health
● Adolescence is a critical juncture in the adoption of behaviors that are relevant to
health (Lara-Torre, 2008; Sirard & others, 2008).
● Many of the behaviors that are linked to poor health habits and early death in adults
begin during adolescence.
● The early formation of healthy behavior patterns, such as regular exercise and a
preference for foods low in fat and cholesterol, not only has immediate health
benefits but helps in adulthood to delay or prevent disability and mortality from heart
disease, stroke, diabetes, and cancer (Hahn, Payne, & Lucas, 2009).
● Experts’ goals are to:
1) Reduce adolescents’ health-compromising behaviors, such as drug abuse,
violence, unprotected sexual intercourse, and dangerous driving.

2) Increase adolescents’ health-enhancing behaviors, such as exercising, eating

nutritiously, wearing seat belts, and getting adequate sleep.
Risk-taking behaviors
● One type of health-compromising behavior that increases in adolescence is risk-
taking (Clark, Mangram, & Dunn, 2008; Steinberg, 2008, 2009). Beginning in early
adolescence, individuals seek experiences that create high-intensity feelings . . .
adolescents like intensity, excitement, and arousal.“Adolescence is a time when sex,
drugs, very loud music, and other high-stimulation experiences take on great
appeal.”
● “It is a developmental period when an appetite for adventure, a predilection for risks,
and a desire for novelty and thrills seem to reach naturally high levels.”
● “While these patterns of emotional changes are evident to some degree in most
adolescents, it is important to acknowledge the wide range of individual differences
during this period of development” (Dahl, 2004, p. 6).
● Researchers also have found that the more resources there are in the community,
such as youth activities and adults as role models, the less likely adolescents are to
engage in risky behavior (Jessor, 1998; Yancey & others, 2010)
● Recently, neurobiological explanations of adolescent risk-taking have been proposed
(Steinberg, 2009):
➢ The Prefrontal cortex, the brain’s highest level that is involved in reasoning,
decision making, and self-control, matures much later than the amygdala,
which is the main structure involved in emotion in the brain.

➢ The later development of the prefrontal cortex combined with earlier maturity
of the amygdala may explain the difficulty younger adolescents have
(Steinberg, 2008).

Leading causes of death

● The three leading causes of death in adolescents and emerging adults are
unintentional injuries, homicide, and suicide (National Vital Statistics Reports,
2008).
● Almost half of all deaths from 15 to 24 years of age are due to unintentional injuries,
approximately three-fourths of them involving motor vehicles.
● Risky driving habits, such as speeding, tailgating, and driving under the influence of
alcohol or other drugs, may be more important contributors to these accidents than
lack of driving experience.
 ● In about 50 percent of motor vehicle fatalities involving adolescents, the driver has a
blood alcohol level of 0.10 percent—twice the level needed to be designated as
“under the influence” in some states.
● Homicide is also another leading cause of death in adolescence and emerging
adults, especially among African American males who are three times more likely to
be killed by guns than by natural causes.
● Suicide is the third-leading cause of death in adolescence and emerging
adulthood.
● Since the 1950s, the adolescent and emerging adult suicide rate has tripled, although
it has declined in recent years (Ash, 2008).
● Emerging adults have more than twice the mortality rate of adolescents (Park &
others, 2006).

Emerging Adults’ Health

● Emerging adults have few chronic health problems, and they have fewer colds and
respiratory problems than when they were children (Rimsza & Kirk, 2005).
● Few emerging adults stop to think about how their personal lifestyles will affect their
health later in their adult lives (Sakamaki & others, 2005).
● Not eating breakfast, not eating regular meals, relying on snacks as our main food
source during the day, eating excessively to the point where we exceed the normal
weight for our age, smoking moderately or excessively, drinking moderately or
excessively, failing to exercise, getting by with only a few hours of sleep at night
(American College Health Association, 2008; Talbott & others, 2008).

Nutrition
● Nutrition is an important aspect of health-compromising and health-enhancing
behaviors (Schiff, 2009; Wardlaw & Smith, 2009).
● The eating habits of many adolescents are health-compromising and an increasing
number of adolescents have an eating disorder (Field & others, 2008; Klein, Lytle, &
Chen, 2008).
● A special concern in American culture is the amount of fat in the diet (Di Noia,
Schinke, & Contento, 2008).
● Many of today’s adolescents virtually live on fast-food meals, which contributes to the
high-fat levels in their diet (Ebbeling & others, 2004).
Exercise and Sports
● Researchers have found that individuals become less active as they reach and
progress through adolescence (Butcher & others, 2008; Cox, Smith, & Williams,
2008).
● A recent national study of U.S. 9- to 15-year-olds revealed that almost all 9- and 11-
year-olds met the federal government’s moderate to vigorous exercise
recommendations per day (a minimum of 60 minutes a day), but only 31 percent of
15-year-olds met the recommendations on weekdays and only 17 percent met the
recommendations on weekends (Nader & others, 2008).
● Exercise is linked to a number of positive physical outcomes (Dugan, 2008;
Lumpkin, 2008).
● Studies that support the benefits of regular exercise:
➢ A recent study revealed that regular exercise from 9 to 16 years of age
especially was associated with regular weight in girls (McMurray & others,
2008).
➢ Other positive outcomes of exercise in adolescence are reduced triglyceride
levels, lower blood pressure, and a lower incidence of type II diabetes
(Butcher & others, 2008).
➢ Physical fitness in adolescence was linked to physical fitness in adulthood
(Mikkelsson & others, 2006).

● Studies that support the benefits of regular exercise:

➢ Physical exercise might act as a buffer against the stress adolescents

experience and improve their mental health and life satisfaction (Butcher &
others, 2008).
➢ A 9-month physical activity intervention with sedentary adolescent girls
improved their self-image (Schneider, Dunton, & Cooper, 2008).
➢ Higher physical activity at 9 and 11 years of age predicted higher self-esteem
at 11 and 13 years of age (Schmalz & others, 2007).
➢ High school seniors who exercised frequently had higher grade point
averages, used drugs less frequently, were less depressed, and got along
better with their parents than those who rarely exercised (Field, Diego, &
Sanders, 2001).
● Sports play an important role in the lives of many adolescents.
● Sports can have both positive and negative influences on adolescent development.
 ● Many sports activities can improve adolescents’ physical health and well-being, self-
confidence, motivation to excel, and ability to work with others (Cornock, Bowker, &
Gadbois, 2001).
● Adolescents who spend considerable time in sports are less likely than others to
engage in risk-taking behaviors, such as taking drugs.
● Sports can have negative outcomes for children:
➢ The pressure to achieve and win.
➢ Physical injuries.
➢ A distraction from academic work.
➢ Unrealistic expectations for success as an athlete (Lovell & Fazio, 2008;
Metzl, 2008).
➢ Pressure by parents and coaches to win at all costs.
➢ Participation in competitive sports is linked with competition anxiety and self-
centeredness (Smith & Smoll, 1997).
➢ Female athlete triad (Misra, 2008). (disordered eating, amenorrhea,
osteoporosis)
● Another problem that has surfaced is the use of performance-enhancing drugs, such
as steroids, by adolescent athletes (Elliot & others, 2007; Vandenberg & others,
2007).

Families
● Parents play an important role in influencing adolescents’ exercise patterns (Corbin &
others, 2008; Dugan, 2008).
● Nine- to 13-year-olds were more likely to engage in physical activity during their free
time when the children felt safe, had a number of places to be active, and had
parents who participated in physical activities with them (Heitzler & others, 2006).

Schools
● Some of the blame for the poor physical condition of U.S. children and adolescents
falls on schools, many of which fail to provide physical education classes on a daily
basis (Floriani & Kennedy, 2008; Rink, 2009; Wuest & Bucher, 2009).
● Other research studies have found positive benefits for programs designed to
improve the physical fitness of students (Timperio, Salmon, & Ball, 2004; Veugelers
& Fitzgerald, 2005).
TV/Computers
● Watching television and using computers for long hours may be involved in lower
levels of physical fitness in adolescence (Leatherdale & Wong, 2008; Rey-Lopez &
others, 2008).
● The more adolescents watched television and used computers, the less likely they
were to engage in regular exercise (Chen, Liou, & Wu, 2008).

Sleep
● There has been a surge of interest in adolescent sleep patterns (Alfano & others,
2008; Liu & others, 2008; Loessi & others, 2008; Moore & Meltzer, 2008, Tarokh &
Carskadon, 2008).
● Mary Carskadon and her colleagues (2002, 2004, 2006; Jenni & Carskadon, 2007;
Tarokh & Carkskadon, 2008) have conducted a number of research studies on
adolescent sleep patterns. They found that when given the opportunity adolescents
will sleep an average of 9 hours and 25 minutes a night.
● Most adolescents get far less than nine hours of sleep, especially during the week.

Cognitive factors related to adolescents’ health

● Concepts of Health Behaviour in adolescents’
➢ Concept of illness develops through stages of cognitive development (Piaget)
➢ Early adolescence: concrete thinking about health
➢ Late adolescence: formal operational thinkers (describe health in
psychological, emotional, social components)
➢ Beliefs about Health
➢ Underestimate their vulnerability to harm
➢ Health Knowledge
➢ Generally poorly informed about health issues

Social factors related to adolescents’ health

➢ Social Poverty
➢ Cultural and ethnic variations
➢ Income
➢ Family environment /peers
➢ Schools
➢ Physical education
➢ Positive health role models
➢ Lunch break
 ➢ Gender: Males underreport physical symptoms + Males are less willing to change
health attitudes/behaviors

The brain: cognitive and moral development in adolescence.

The brain: adolescent’s brain is different from a child’s brain, and in adolescence, the brain
is still growing.
● Myelination of axons continues to increase through adolescence and emerging
adulthood.
● A significant developmental change in adolescence is the increase in white matter
(Gogtay & Thompson, 2010)
● Most accounts emphasize that the increase in white matter across adolescence is
due to increased myelination, although a recent analysis proposed that the white
matter increase also might be due to an increase in the diameter of axons (Paus,
2010)
● Pruning/Neuroplasticity: The brain overproduces the number of brain cells and
connections between cells - neurogenesis. Pruning of these connections may occur
during adolescence. Drug use in adolescence is more likely to lead to dependence.
● Adolescent brain is more neuroplastic (NIDA) A drug that produces neuroadaptation
does this faster and longer duration.
● Studies indicate that the adolescent brain is very sensitive to acute ethanol inhibition
of neurogenesis.
● Loss of neurons but strengthening of others.
● Genes determine the onset of the timing of pruning which increases coordination
between neurons.
● Can new brain cells be generated in adolescence?
➢ Researchers have recently discovered that people can generate new brain
cells throughout their lives (Marlatt & others, 2010). Decreases in the
transition to adulthood
➢ Currently, researchers have documented neurogenesis in only two brain
regions: the hippocampus and the olfactory bulb (Arenkiel, 2010; Zou &
others, 2010)
➢ Exercise might increase neurogenesis in the hippocampus (van Praag, 2008).
 ● With the onset of puberty, the levels of neurotransmitters—chemicals that carry
information across the synaptic gap between one neuron and the next—change
➢ For example, an increase in the neurotransmitter dopamine occurs in both the
prefrontal cortex and the limbic system during adolescence (Ernst & Spear,
2009)
➢ Increases in dopamine have been linked to increased risk taking and the use
of addictive drugs (Stansfield & Kirstein, 2006; Wahlstrom & others, 2010)
➢ Researchers have found that dopamine plays an important role in reward-
seeking (Doremus-Fitzwater, 2010; Ernst & Spear, 2009)

Scientists have recently discovered that adolescents’ brains undergo significant structural
changes (Blakemore & others, 2011; Luna, Padmanabhan, & O’Hearn, 2010; Smith &
others, 2011). The most important structural changes in the brain during adolescence are
those involving:
1. The corpus callosum : This thickens in adolescence to process information more
effectively. CC is larger in females after. The female cerebral hemispheres are more
extensively interconnected
2. The prefrontal cortex: Doesn’t finish developing until emerging adulthood
3. The Amygdala
4. Limbic system: This system is almost completely developed by early adolescence.

● Although adolescents are capable of very strong emotions, their prefrontal cortex
hasn’t adequately developed to the point at which they can control these passions
(Nelson, 2003). Recent research by Lawrence Steinberg and his colleagues, show a
preference for immediate rewards increased from 14 to 16 years of age and then
declined

● Can the adolescent’s brain recover from an injury?

➢ In childhood and adolescence, the brain has a remarkable ability to repair
itself (Nelson, 2011)
➢ Although the brain retains considerable plasticity in adolescence, the earlier a
brain injury occurs, the greater the likelihood of a successful recovery (Yen &
Wong, 2007)
Cognitive development
The Cognitive Developmental View
1) Piaget’s Theory
The best-known, most widely discussed theory of adolescent cognitive development
According to his theory, adolescents are motivated to understand their world because
doing so is biologically adaptive. To make sense of the world, adolescents organize
their experiences and adapt their thinking to include new ideas.

Cognitive Processes
A) Schema: A concept or framework that exists in the individual’s mind to
organize and interpret information.
B) Assimilation: The incorporation of new information into existing knowledge.
C) Accommodation: An adjustment to new information, causing the schema to
change.
D) Equilibration: When adolescents experience cognitive conflict, they resolve
conflict to reach a balance.
Major components of the formal operational stage:
● Conceptions of possibilities
Adolescents can conjure up make-believe situations
or events that are purely hypothetical possibilities or strictly abstract propositions
and try to reason logically about them eg God. An example of formal operational
thought would be imagining the outcome of a particular action that has yet to be
undertaken

● Hypothetical deductive reasoning

The ability to develop systematic, problem-solving strategies.A problem-solving style
that allows adolescents to choose between possible solutions and then pick the best
one. Helps in emotional development and emerging values
Example: Child ponders, “Do I not follow the crowd or do I want to fit in?”
 1. Form many hypotheses and evaluate each hypothesis
2. Select a hypothesis to be tested
3. Generate predictions from hypothesis
4. Use experiments to check whether predictions are correct
5. If the predictions are correct, then the hypothesis is confirmed. If not, the
hypothesis is disconfirmed.

● Interpropositional thinking
Verbal problem-solving ability (A=B, B=C…..therefore A=C)Allows a child to relate
one or more parts of a proposition or situation to another part to arrive at a solution to
a problem. Applicable to complex movement eg chess
Example: The position of two players represents the onset of a particular play. The
ability to ‘read’ interrelationships (i.e., possible movement patterns) facilitates better
counterplay. Verbal problem-solving ability. (A=B, B=C…..therefore A=C)

● Combinatorial or systemic thinking

Systemic thinking is a thinking technique for gaining systemic (situation-wide)
insights into complex situations and problems. It combines analytical thinking with
synthetical thinking. Analytical thinking is thinking about the parts or elements of a
situation. Synthetical thinking is thinking about how those parts or elements work
together.

● Metacognition – thinking about thought

Metacognition involves thinking about one's own thinking process such as study
skills, memory capabilities, and the ability to monitor learning.
Metacognitive knowledge is about one's own cognitive processes and the
understanding of how to regulate those processes to maximize learning.

● Domain specificity develops

● Not all adolescents are full-fledged formal operational thinkers

● Some developmentalists argue that formal operational thought consists of two
subperiods (Broughton, 1983)
1) Early formal operational thought: Newfound ability to think in hypothetical
ways produces thought that is unconstrained, too subjective, and too
idealistic; assimilation is the dominant process
 2) Late formal operational thought: Through accommodation, intellectual
balance is restored as adolescents test their reasoning against reality
● Many college students and adults do not think in formal operational ways, either

Contributions of Piaget’s theory

● We owe to Piaget the current field of cognitive development, as well as the current
vision of children as active, constructive thinkers (Miller, 2011).Piaget was a genius
when it came to observing children
● We owe to Piaget the current belief that a concept does not emerge all of a sudden,
fully developed, but develops instead through a series of partial accomplishments
that lead to an increasingly comprehensive understanding.

Criticisms of Piaget’s theory

● Some cognitive abilities have been found to emerge earlier than Piaget had thought
(Miller, 2011)
● Other cognitive abilities often emerge later than Piaget indicated
● Adolescents’ cognitive development is not as stage-like as Piaget thought
● Neo-Piagetians conclude that Piaget’s theory does not adequately focus on attention,
memory, and cognitive strategies that adolescents use to process information, and
that Piaget’s explanations of cognitive changes are too general
● Culture exerts stronger influence on development than Piaget envisioned

Cognitive changes in Adulthood

Realistic and pragmatic thinking (Labouvie-Vief, 1986)
Reflective and relativistic thinking (Perry, 1970, 1999)
● Labouvie-Vief (2006) recently proposed that the increasing complexity of cultures in
the past century has generated a greater need for more reflective, complex thinking
that takes into account the changing nature of knowledge and challenges
● Labouvie-Vief and colleagues (2009, 2010) also argue that to understand cognitive
changes in adulthood it is necessary to consider how emotional maturity might affect
cognitive development.
● Is There a Fifth, Postformal Stage?
➢ Postformal thought is (Sinnott, 2003): reflective, relativistic, and contextual;
provisional; realistic; and recognized as being influenced by emotional effort
to assess post formal thinking is the 10-item Complex Postformal Thought
Questionnaire (Sinnott & Johnson, 1997)
 ➢ Researchers have found that emerging adults are more likely to engage in
post formal thinking than adolescents are (Commons & Richards, 2003)

Wisdom
● Expert knowledge about the practical aspects of life that permits excellent judgment
about important matters (Baltes and colleagues, 2006)
● Baltes and colleagues (2006, 2007, 2008) have found that:
High levels of wisdom are rare. The time frame of late adolescence and early
adulthood is the main age window for wisdom to emerge. Factors other than age are
critical for wisdom to develop to a high level. Personality-related factors, such as
openness to experience and creativity, are better predictors of wisdom than cognitive
factors such as intelligence.

2) Vygotsky’s Theory
● Views knowledge as situated and collaborative (Gauvain, 2008; Holtzman,
2009).
● Knowing can best be advanced through interaction with others in cooperative
activities.
● Vygotsky’s view of the importance of sociocultural influences on children’s
development fits with the current belief that it is important to evaluate the
contextual factors in learning
 ● Zone of proximal development (ZPD): Learning is cognitive development
through social interaction. tasks too difficult for an adolescent to master alone
but can be mastered with guidance.

● Vygotsky’s theory is a social constructivist approach

● Emphasizes the social contexts of learning and the construction of knowledge
through social interaction
● The end point of cognitive development can differ, depending on culture
● Children and adolescents construct knowledge through social interaction (Holtzman,
2009)
● Implication for teaching is that students need many opportunities to learn with the
teacher and more-skilled peers (Daniels, 2011)

Criticisms of Vygotksy’s Theory

● Not specific enough about age-related changes (Gauvain, 2008).
● Not adequately describing how changes in socioemotional capabilities contribute to
cognitive development (Gauvain, 2008).
● Overemphasized the role of language in thinking.
● Vygotsky’s theory has not yet been evaluated as thoroughly as Piaget’s theory, even
though the theories were proposed about the same time.
Contemporary concepts of cognitive development

1. SCAFFOLDING: changing level of support over the course of teaching

2. COGNITIVE APPRENTICESHIP: expert supports the novice’s understanding
through activity
3. TUTORING: cognitive apprenticeship between expert and novice, adult and
adolescent, skilled adolescent and less skilled adolescent
4. COOPERATIVE LEARNING: students learn in small groups
5. RECIPROCAL TEACHING: students take turns in leading a small group

The Information Processing View

How information gets into an adolescent’s mind, how it is stored, and how it is retrieved to
think and solve problems. Information processing changes as children make the transition
from adolescence to adulthood
Some basic concepts of the information-processing view:

1. Cognitive Resources: Capacity and speed of processing (Frye, 2004).

➢ Information processing is influenced by both the capacity and speed of processing
(Frye, 2004)
➢ Most information-processing psychologists argue that an increase in capacity
improves the processing of information (Halford & Andrews, 2011)
 ➢ There is abundant evidence that the speed with which tasks are completed improves
dramatically across the childhood and adolescent years (Hommel, Li, & Li, 2004;
Kail, 2007; Kuhn, 2009)

2. Attention and Memory: Individuals can allocate attention in different ways. Focusing
mental effort that depends on selective and shifting capacities and action planning.
● Attention is a cognitive process of selecting certain information from among
many and focusing mental resources on those selected.
1. Selective attention
2. Divided attention: If a key task is at all complex and challenging, multitasking
significantly reduces attention to the key task (Myers, 2008)
3. Sustained attention
4. Executive attention: An increase in executive attention supports the rapid increase in
effortful control to effectively engage in complex tasks (Rothbart, 2011).
➢ special effort is called executive attention.
➢ Imagine leaving a parking lot to drive home in the evening. If your usual
routine is to drive straight home, then executive attention is needed to
intervene and activate the thought of going first to, say, a grocery store. The
automatic process of driving home must be inhibited or else it will control
behaviour.
➢ Executive attention is always needed when (i) planning or making decisions,
(ii) correcting errors, (iii) the required response is novel or not well-learned,
and (iv) conditions that are dangerous.

Memory is central to mental life and to information processing.

➢ Short-term memory: A limited-capacity system in which information is retained for as
long as 30 seconds unless the information is rehearsed, in which case it can be
retained longer. Researchers have found that short-term memory increases
extensively in early childhood and continues to increase in older children and
adolescents but at a slower pace
➢ Working memory: A kind of mental “workbench” where individuals manipulate and
assemble information when they make decisions, solve problems, and comprehend
written and spoken language (Baddeley, 2008, 2010a, 2010b).A recent study found
that the prefrontal cortex plays a more important role in working memory in late
adolescence than in early adolescence (Finn & others, 2010).The adolescent years
 are likely to be an important developmental period for improvement in working
memory
➢ Long-term memory: A relatively permanent memory system that holds huge amounts
of information for a long period of time.Long-term memory increases substantially in
the middle and late childhood years and improvement likely continues during
adolescence, although this has not been well documented by researchers.Long-term
memory depends on the learning activities engaged in when an individual is learning
and remembering information (Pressley & Hilden, 2006)

3. Cognitive Control: Involves effective control and flexible thinking in a number of areas,
including
● controlling attention,
● reducing interfering thoughts, and
● being cognitively flexible (Diamond, Casey, & Munakata, 2011)
● Across childhood and adolescence, cognitive control increases with age (Casey,
Jones, & Somerville, 2011; Luna, Padmanabhan, & O’Hearn, 2010)
● The increase in cognitive control is thought to be due to the maturation of brain
pathways and circuitry.
● Controlling attention is a key aspect of learning and thinking in adolescence and
emerging adulthood (Bjorklund, 2012)
● Cognitive flexibility involves being aware that options and alternatives are available
and adapting to the situation

4. Executive Functioning: Once adolescents attend to information, retain it, and engage in
cognitive control, they can use the information to engage in a number of higher-order
cognitive activities, such as making decisions, thinking critically, thinking creatively, and
engaging in metacognitionExecutive functioning becomes increasingly strong during
adolescence (Kuhn, 2009; Kuhn & Franklin, 2006). Adolescence is a time of increased
decision-making (Albert & Steinberg, 2011a, 2011b)In some reviews, older adolescents are
described as more competent than younger adolescents, who in turn are more competent
than children (Keating, 1990)However, older adolescents’ decision-making skills are far from
perfect, but of course, we also are not perfect decision makers as adults (Kuhn, 2009).
Most people make better decisions when they are calm rather than emotionally aroused,
which may especially be true for adolescents (Rivers, Reyna, & Mills, 2008; Steinberg &
others, 2009). The social context plays a key role in adolescent decision-making (Albert &
Steinberg, 2011a, 2011b)
● Recent research reveals that the presence of peers in risk-taking situations increases
the likelihood that adolescents will make risky decisions

➢ Higher-order, complex cognitive processes.

➢ Critical and Creative Thinking
➢ Allows adolescents to engage in decision-making, evaluating the options, weighing
the choices, and making a competent choice.

5. Metacognition: Cognition about cognition, or “knowing about knowing” (Flavell,

2004). Metacognition includes knowledge about strategies.
In the view of Michael Pressley (2003), the key to education is helping students learn
a rich repertoire of strategies that result in solutions to problems. Metacognition is
increasingly recognized as a very important cognitive skill not only in adolescence
but also in emerging adulthood. Compared to children, adolescents have an
increased capacity to monitor and manage cognitive resources to effectively meet the
demands of a learning task (Kuhn, 2009). This increased metacognitive ability results
in improved cognitive functioning and learning.

6. Critical and creative thinking

● Critical thinking—thinking reflectively about information, objectively
conceptualizing evidence.
● Creative thinking—restructuring information in novel ways to form unique
solutions.

7. Social Cognition
How individuals conceptualize and reason about their social world, the people they
watch and interact with, their relationships with those people, the groups they
participate in, and the way they reason about themselves and others.
A) Adolescent Egocentrism (David Elkind)
● Refers to the heightened self-consciousness of adolescents (others
are interested in them)
● Imaginary Audience: attention-getting behaviour, desire to be noticed,
‘on-stage’
 ● Personal fable: adolescent’s sense of uniqueness, the belief that no-
one understands how they feel. Might invent fantasy stories about
themselves in an effort to feel unique (diary)
● Is Social Media an Amplification Tool for Adolescent Egocentrism?

B) Perspective taking (Selman 1980)

● Refers to the ability to assume another person’s perspective and
understand his/her thoughts/feelings
● Move from egocentric perspective of young children to interdependent
perspective of adolescents
● Impulsiveness of children -> collaborative orientation of adolescents

Selman’s Stages of Perspective Taking

C) Implicit personality theory

Refers to lay person’s conception of personality

Children Adolescents

● Rely on concrete info at hand ● Consider previous/current

● Think that personality always info
stable ● Detect situational variability
● Accept surface traits as ● Look for deeper hidden
someone’s personality causes of personality
8. Moral Development
● Thoughts, feelings, and behaviours regarding standards of right or wrong
● Intrapersonal dimension
● Interpersonal dimension
● Reason and thinking
● Behaviour
● Feelings and values

Piaget Cognitive disequilibrium theory (1932) : If children come across a new situation or
task that they do not understand, Piaget called this disequilibrium. This occurs when a child
is unable to use existing schema to understand new information to make sense of objects
and concepts.

1) Heteronomous morality
● The first stage of moral development in Piaget's theory, occurs at 4 to 7 years of age.
Justice and rules are conceived of as unchangeable properties of the world, removed
from the control of people. The consequences and not intention are used for
judgment. Immanent justice. Piaget's concept is that if a rule is broken, punishment
will be given out immediately. The person equates morality with the rules and
principles of his or her parents and other authority figures.

2) Autonomous morality
● The second stage of moral development in Piaget's theory, is displayed by older
children (about 10 years of age and older). The child becomes aware that rules and
laws are created by people and that, in judging an action, one should consider the
actor's intentions as well as the consequences. The stage of autonomous morality is
also known as moral relativism – morality based on your own rules. Children
recognize there is no absolute right or wrong and that morality depends on intentions,
not consequences.
● Intentions are considered and Rules can be changed.

Martin Hoffmann's cognitive disequilibrium theory (1980)

Hoffman's theory that adolescence is an important period in moral development, in which,
because of broader experiences associated with the move to high school or college,
individuals recognize that their set of beliefs is but one of many and that there is
considerable debate about what is right and wrong.

Kohlberg’s Method : The story of Heinz's dilemma (Heinz stealing a drug to save his wife
from cancer) The Heinz dilemma is a frequently used example used to help us understand
Kohlberg's stages of moral development. Should Heinz disobey the law and steal the drug
(moral justice for his wife) or should he not steal the drug because it is against the law (moral
obedience)? He was not really interested in whether the subject said "yes" or "no" but in the
reasoning. Why the subject thinks Heinz should or should not have stolen the drug.
The interview schedule then asks new questions which help one understand the child's
reasoning. For example, children are asked if Heinz had a right to steal the drug, if he was
violating the druggist's rights, and what sentence the judge should give him once he was
caught.

He postulated this theory based on the thinking of younger children throughout their growing
period as adults. He conveyed that younger children make judgments based on the
consequences that might occur and the older children make judgments based on their
intuitions.

Kohlberg’s Three Levels & Six Stages

Various questions were asked about the dilemma: Should Heinz have stolen the drug? Why
or why not? Should he have stolen the drug if the sick person was not his wife? Why …?
What if the sick person was his enemy? Why …? Would a good person steal it? Why …?

People can only pass through these levels in the order listed. Each new stage replaces the
reasoning typical of the earlier stage. Not everyone achieves all the stages.

Reasons given by participants as to why the decision was good or bad were classified
Into 3 Levels, each with 2 stages (A total of 6 stages)

Level 1: Pre-conventional Morality

Children don't have a personal code of morality, and instead moral decisions are shaped by
the standards of adults and the consequences of following or breaking their rules.
Stage 1 - Obedience and Punishment (Blind egoism)
 Children see rules as fixed and absolute. Obeying the rules is important because it
is a means to avoid punishment.

Stage 2 - Individualism and Exchange (Instrumental egoism)

Rules are followed because they benefit the individual; they are obeyed because
one receives rewards E.g. in the Heinz dilemma, the best course of action was
whichever best-served Heinz’s needs.

Level 2. Conventional Morality

An acceptance of society's conventions concerning right and wrong. At this level, an
individual obeys rules and follows society's norms even when there are no consequences for
obedience or disobedience.

Stage 3 - Interpersonal Relationships (Social relationships perspective)

The "good boy-good girl" orientation; is focused on living up to social expectations
and roles. There is an emphasis on conformity, being "nice," and consideration of
how choices influence relationships.

Stage 4 - Maintaining Social Order (Social systems perspective)

At this stage people begin to consider society as a whole when making judgments.
The focus is on maintaining law and order by following the rules, doing one’s duty,
and respecting authority.

Level 3. Post-conventional Morality

Occurs when an individual develops their own set of ethics and morals to drive their
decisions and actions. This is the highest stage of morality.

Stage 5 - Social Contract and Individual Rights (Contractual perspective)

The laws of society as an instrument for ensuring respect for people’s rights. A law
may be unfair and need to be changed to ensure justice. Need to maintain the
social contract with fellow citizens, but the possibility of changing existing laws through a
new agreement.

Stage 6 - Universal Principles (Mutual respect as a universal principle)

The universal ethical principle orientation. At this highest stage, the morality of an
 action is judged according to universal ethical principles: Laws that violate such
principles are disobeyed. Judgment is according to one’s individual conscience.

Kohlberg’s position:
● Universally valid across societies
● Invariable sequence: someone progressing to a higher stage of moral reasoning
cannot skip stages
● Based on justice: equality and reciprocity
● As a general hypothesis, he proposes that moral behavior is more consistent,
predictable. and responsible at the higher stages (Kohlberg et al., 1975), because the
stages themselves increasingly employ more stable and general standards.

Criticism:
● A main criticism of Kohlberg's theory is that it was initially developed based on
empirical research using only white male participants and emphasizes individual
rights to the exclusion of other values.

● Carol Gilligan (1992) has argued that Kohlberg's theory is overly androcentric, and
does not adequately describe the concerns of women. She developed an alternative
theory of moral reasoning based on the ethics of caring and avoiding harm to others.

● Dilemmas are artificial: Most of the dilemmas are unfamiliar to most people (Rosen,
1980). For example, it is all very well in the Heinz dilemma asking subjects whether
Heinz should steal the drug to save his wife. However, Kohlberg’s subjects were
aged between 10 and 16. They have never been married and have never been
placed in a situation remotely like the one in the story. How should they know
whether Heinz should steal the drug?

● Dilemmas are hypothetical

● Are there distinct stages of moral development?
Kohlberg claims that there are, but the evidence does not always support this conclusion.
For example, a person who justified a decision on the basis of principled reasoning in one
situation (post-conventional morality stage 5 or 6) would frequently fall back on conventional
reasoning (stage 3 or 4) with another story.
In practice, it seems that reasoning about right and wrong depends more on the situation
than on general rules.
What is more, individuals do not always progress through the stages and Rest (1979) found
that one in fourteen actually slipped backward.

● The evidence of moral development looks very weak, and some would argue that
behind the theory is a culturally biased belief in the superiority of American values
over those of other cultures and societies.

Self and Identity

The Self: The adolescent’s self-understanding becomes more introspective, but is not
completely interiorized.
● Self-concept
● Self schemata (schema of self): a cognitive structure that represents knowledge
about a concept or type of stimulus including its attributes (Fiske and Taylor, 1991)
Simple and holistic cognitive representations of the social world act as relatively
enduring templates for interpretation of stimuli or self.
● Important for adjusting through transitions
● Cognitive self: Self-understanding is the adolescent’s cognitive representations of the
self, the content of the adolescent’s self-conceptions
● Emotional self
● Behavioural self

Dimensions of adolescent self-understanding (Cognitive)

A) Abstract and idealistic: distinguish between the real (abstract) self and the idealistic
self. Ex: I am a human being, I am indecisive, I don’t know who I am.
B) Real and ideal, true and false selves
● Discrepancy between real and ideal = maladjustment
● Possible self = What individuals might become, what they would like to
become, and what they are afraid of becoming.
● False self–strategic self-presentation – self-verification (a sign of
maladjustment: Rogers)
 C) Differentiated self
Descriptions within contextual or situational dimensions – multiple roles of identity
within the self (have to differentiate between selves in different situations)

D) Contradiction
Contradiction within the self – differentiated into different roles = experience of
contradictions between these differentiated selves: moody-understanding

E) Self-integration (Comes in later adolescence)

The differentiated parts of the self are more systematically pieced together.

F) Social comparison
Comparing self to others

G) Self-conscious
Preoccupied with their own self-understanding

H) Self-protective
Protecting the self through affirmations, boundaries, etc

Identity Semantic Issues ( Latin root - idem = the same)

● Identity is difficult to define semantically.
● Identity is what a thing is

Identity
● A person's identity is a claim to his or her own sense of continuity of self; of who they
are. For example, your identity concerns your ideology, your work, and your social
relationships
● The way you perceive yourself, your actions, your thoughts, and your interactions
with others are all influenced by this identity.
● Erikson on identity
➢ A process located in the core of the individual and yet also in the core of his
communal culture.
➢ A PROCESS
➢ Identity involves interaction between the interior development of the individual
(PSYCHO) and the growth of a sense of selfhood that arises from
participating in society and playing different roles and identities (SOCIAL)
 ➢ Psychosocial perspective.
➢ Erik Erikson was one of the earliest psychologists to be explicitly interested in
identity.
➢ "a subjective sense as well as an observable quality of personal sameness
and continuity, paired with some belief in the sameness and continuity of
some shared world image. ….this can be gloriously obvious in a young
person who has found himself as he has found his communality. In him we
see emerge a unique unification of what is irreversibly given--that is, body
type and temperament, giftedness, and vulnerability, infantile models and
acquired ideals--with the open choices provided in available roles,
occupational possibilities, values offered, mentors met, friendships made, and
first sexual encounters." (Erikson, 1970.)

The Eriksonian framework rests upon a distinction among:

➢ The psychological sense of continuity, known as the ego identity

(sometimes identified simply as "the self");
➢ The personal idiosyncrasies (unique to an individual) that separate one
person from the next, known as the personal identity
➢ The collection of social roles that a person might play, known as either
the social identity or the cultural identity.
➢ Erikson's work, in the psychodynamic tradition, aimed to investigate the
process of identity formation across a lifespan

Erikson’s psychosocial stages of development

He argued that, although early years are important, identity is not fully formed at the end of
adolescence and further development is achieved in adulthood.

● There are eight different stages of development, with each stage being characterized
by a crisis. Crisis refers not just to emotional turmoil but also to possibilities for
growth.

● There are two possible outcomes in every stage and the individual actually
experiences both sides of the conflict. The bipolar nature of the social crisis gives
each stage its name.
1) Trust VS Mistrust (0-18 months/1 year ½)
● The development of trust includes trusting others and developing a sense of one's
own trustworthiness.
● This sense of trust facilitates later development.
● The necessary prerequisite for the development of trust is maternal love and care, a
consistent and predictable pattern through which infants’ basic needs are satisfied.

2) Autonomy VS Shame and Doubt (1 ½ - 3 ½ )

● The main issue in the second step of the cycle is between becoming an autonomous,
creative individual or a dependent, inhibited and shameful individual, filled with self-
doubt.
● Although still dependent on others, children will start to develop autonomous
choices.
● Exaggerated signs of autonomy may include temper tantrums, “yes-no” games, and
mastery of self-control.

3) Initiative VS Guilt (3 ½ - 6)
● At this stage, the child is driven by an intense need to actively and curiously explore
and conquer the world in an energetic fashion.
● If this curiosity is interpreted as intrusion or aggression by the parent, and the child is
punished or inhibited, the initiative may wane and a sense of immobilization (through
fear or guilt) may develop.

4) Industry VS Inferiority (6-12)

● The period between school entry and puberty is an intense time of learning and
mastery of societal skills.
● Children will learn to take pride in their work and will seek to work hard to achieve a
sense of success.
● This period is often described as “the apprenticeship for life”.

5) Identity VS Identity Confusion (12+) Primary developmental challenge of

adolescence
● During this period, the adolescent struggles to search for personal identity and seeks
to answer questions such as “Where did I come from?”; “Who am I?”; “What do I
want to become?”
● Erikson stated that the adolescent works to establish both a sexual identity and an
occupational identify.
 ● Identity must be acquired through sustained individual effort. Failure to actively work
on identity formation may result in identity confusion.
● Preparing to meet adulthood with a cohesive and comfortable set of self-perceptions
and aspirations
● “The wholeness to be achieved at this stage I have called a sense of inner
identity…….. Individually speaking, identity includes but is more than, the sum of all
the successive identifications of those earlier years (Erikson, 1968: 87).”
● At this time, individuals are faced with finding out who they are, what they are all
about, and where they are going in life.

● Moratorium is the gap between childhood security and adult autonomy throughout
identity exploration.(A moratorium is a state in which adolescents are actively
exploring options but have not yet made commitments) transition a young person
faces when childhood security is slowly being replaced by adult autonomy (identity
crisis and exploration) . Young people may act inconsistently until they go through
the crisis process. Erikson believed that some form of crisis is necessary for the
young person to resolve the identity issue

● Identity achievement - fidelity- crisis/commitment

● Fanaticism – repudiation (the rejection or renunciation of a duty or obligation)
/diffusion ( Identity diffusion is a state of not developing or possessing a distinct
identity.) “my way or high way”
● Identity diffusion/repudiation - uncertain about oneself and one’s possibilities in life -
this interferes with effective functioning

● Four major components to identity diffusion/repudiation

1) Lack of Intimacy - fear of loss of identity : stereotyped formal relations/ ‘improbable
partners’
2) Time perspective - difficult to plan for the future
3) Industry - difficulty to harness resources
4) Negative identity - opposite to that wished by significant others (people pleasing)

The opposite of this is fanaticism (my way or the high way-too much ego identity)
● Role diffusion -> Identity diffusion
a) Self destructive, one sided preoccupation or activity
b) Morbidly preoccupied with the opinion of others
c) Withdraw to drugs or alcohol to alleviate anxiety
 d) Act out anxiety = delinquent behaviour
e) Suicide or suicide attempts

The remaining three stages are worked through in adulthood:

6. Intimacy vs Isolation (Young Adulthood).

● Intimacy is where deep relationships can be formed because people are vulnerable
to adulthood, from young adulthood to later on in life.
● Isolation is when people don't foster relationships, and socially isolate themselves,
consequently leading to feelings of loneliness.
● Those who have intimacy are successful in their ability to open up to others about
their lives and ability to have personal, romantic relationships.
● Examples of isolation include depression, lack of close friends, separation from
family, and loneliness

7. Generativity vs Stagnation (Adulthood).

● Between ages 40 and 65, this period is characterized by the conflict between
generativity (nurturing the next generation) and stagnation (failing to leave a lasting
impact beyond yourself).
● Parenthood is a big event in the generativity vs. stagnation stage (for those that
become parents.)
● With a new generation starting to enter the identity vs. role confusion stage, people in
this stage begin to reflect on their lives and think about what they are leaving for the
next generation.

8. Integrity vs Despair (Old Age).

● Characteristics of integrity include acceptance, a sense of wholeness, lack of regret,
a feeling of peace, a sense of success, and feelings of wisdom and acceptance.
● Despair refers to looking back on life with feelings of regret, shame, or
disappointment.

Identity formation
 ● Achieving a clear sense of identity is usually the last step in a several-year transition
from childhood to adulthood
● Starts in infancy
● A sense of identity consists of being reasonably sure of what kind of person you are,
what you believe in, and what you want to do with your life.

James Marcia (1980:159)

Identity is a self-constructed dynamic organization of drives, abilities, beliefs, and individual
history. The better developed this structure is, the more aware individuals appear to be to
others of their own strengths and weaknesses. The less developed the structure the more
confused individuals seem to be………..

Marcia’s four statuses of development:

1) Identity achievement: Marcia's term for having undergone a crisis and made a
commitment. This induces maturity, self-confidence, and self-directedness. This
makes an adolescent capable of intimacy later in life.
2) Identity diffusion: Marcia's term for the state adolescents are in when they have not
yet experienced a crisis or made any commitments. No firm commitments have been
made yet and the adolescent hasn’t started considering such commitments yet. This
induces immaturity, low self-esteem, low self-control, and the risk of developing
psychological disturbance.
3) Identity foreclosure: Marcia's term for the state adolescents are in when they have
committed but have not experienced a crisis. The adolescent latches on to a
convenient set of beliefs and life goals that aren’t theirs. This induces conformity,
 dependence, impulsivity, easily influenced, anxiety, and uncomfortable in unexpected
situations (cannot rely on self)
4) Identity moratorium Marcia's term for the state of adolescents who are in the midst
of a crisis, but whose commitments are either absent or are only vaguely defined.
Reflection on what long-term commitments they might like to make. This induces
anxiety and ambivalence, no fixed opinions, and self-esteem issues.

Why is identity such an issue in adolescence?

● What is identity? – the establishment and re-establishment of sameness with
previous experiences and a conscious attempt to make the future a part of one’s
personal life plan
● Body image changes rapidly – physiological revolution
● Genital maturation stimulates sexual fantasies
● Intimacy becomes a possibility – personal feedback shared in love relationship aids
the individual in defining and revising his own self-definition
● Cognitive changes
● Expectations of others
● At risk later on if identity is not established
● Fidelity contributes to ego strength – the search for something and somebody to be
true to.
● Love, work, and Ideology

Identity is composed of pieces such as vocational/career identity, political identity, religious

identity, relationship identity, achievement identity, cultural identity, and physical identity.

Major dimensions to identity achievement

People achieve identity to the extent that they are able to invest in themselves in a relatively
stable set of commitments. Commitments in relation to three areas:
1) Identity formation influenced by intrapersonal, interpersonal, and cultural factors.
2) Trying roles: The commitment to trying different roles to choose which best suits
you. Identity-Foreclosure status is the status for those who have made a commitment
to an identity without having explored the options. The individual has not engaged in
any identity experimentation and has established an identity based on the choices or
values of others.
3) Clear sense of identity: Committing to establishing your own distinct identity
through realistic appraisal (an act of assessing someone) of the self.
The process of identity formation never really ends.
The timing of identity formation begins in late adolescence (15-18) and requires previous
adaptations. The rapidity of social change, exposure to various secular and religious value
systems, and modern technology make the world seem overwhelming and too complex
without having a secure frame of reference for the future. This can hinder adolescents from
going through the identity formation process. The self is seen as a reflexive project for which
the individual is responsible.
Family Relationships:
Autocratic - foreclosure
Democratic - moratorium + achievement
Permissive - diffusion

Aspects of identity: Social identities, whether based on ethnicity, gender, disability or other
factors should be seen as:
● Identities are plural
Every person has a range of identities, according to how they see themselves (and
how others see them) in terms of gender, ethnicity, sexuality, age, and so on. This
means that seeing an individual in terms of one aspect of their identity – as a black
person, for example, rather than as (say) a black working-class woman who is also a
social worker, a mother, and a school governor – is inevitably reductive and
misleading.

● Identities are dynamic

The identities people assume, and the relative importance they attach to them,
change over time because of both personal changes in their lives and change in the
external world (for example, as a result of changing ideas about disability).
Consequently, identity should not be seen as something ‘fixed’ within people.

● Identities have different and changing meanings

Aspects of identity may have different meanings at different times in people's lives,
and the meanings that they attribute to aspects of their identity (for example,
ethnicity) may be different from the meaning it has for others (for example, being gay
may be a source of pride for you, but the basis of someone else's negative
stereotyping).

● Identities are contextual and interactional

Different identities assume greater or less importance, and play different roles, in
different contexts and settings, and in interactions with different people. Different
 aspects of people’s identity may come to the fore in the workplace and in the home,
for example, while people might emphasize different aspects of themselves to
different people (and different people may see different identities when they meet
them).

● Identities are negotiated

People always negotiate their identities, in the context of the different meanings
attached to them. Others confirm or reject identity claims.

Self-Esteem
Referred to as self-worth or self-image. It is the global evaluative dimension of the self.
For example, an adolescent or emerging adult might perceive that she is not merely a
person, but a good person.

Measuring self-esteem and self-concept

Susan Harter (1989) developed a measure for adolescents: The Self-Perception Profile for
Adolescents. It assesses eight domains:
1. Scholastic competence
2. Athletic competence
3. Social acceptance
4. Physical appearance
5. Behavioral conduct
6. Close friendship
7. Romantic appeal and job competence
8. Global self-worth

Behavioural indicators of self-esteem

 ● Self-esteem can be associated with parenting practices that allow the expression of
affection and freedom within limits in decision-making
● For most adolescents low self-esteem results in only temporary emotional discomfort
● Implicated with adjustment problems

Perception and reality

Self-esteem reflects perceptions that do not always match reality (Krueger, Vohs, &
Baumeister, 2008).

● Narcissism
A self-centered and self-concerned approach toward others. Narcissists are
excessively self-centered and self-congratulatory, viewing their own needs and
desires as paramount. Narcissists rarely show any empathy towards others.
 Narcissists often devalue people around them to protect their own precarious self-
esteem.

Sources of Self-Esteem
1) Reflected appraisals
2) Social comparisons intensify during early adolescence.

● Does Self-Esteem Change During Adolescence and Emerging Adulthood?

Self-esteem fluctuates across the lifespan. During and just after many life transitions,
individuals’ self-esteem often decreases. A current concern is that too many of
today’s college students grew up receiving empty praise and as a consequence have
inflated self-esteem (Graham, 2005; Stipek, 2005).

● Is Self-Esteem Linked to Success in School and Initiative?

School performance and self-esteem are only moderately correlated, and these
correlations do not suggest that high self-esteem produces better school
performance (Baumeister & others, 2003). Efforts to increase a student’s self-esteem
have not always led to improved school performance (Davies & Brember, 1999).
High-self-esteem adolescents are prone to both prosocial and antisocial actions.

● Are Some Domains More Closely Linked to Self-Esteem Than Others?

Physical appearance is an especially powerful contributor to self-esteem in
adolescence (Harter, 2006). Self-esteem issues among females in emerging
adulthood may be due to conflict with peers.

Social Contexts and Self-esteem

● Social contexts such as family, peers, and schools contribute to the development of
an adolescent’s self-esteem (Dusek & McIntyre, 2003; Harter, 2006).
● Peer judgments gain increasing importance in adolescence (Brown & others, 2008).
● School transitions are associated with lowered self-esteem (Harter, 2006).

The Cycle of low self-esteem

Self Discrepancy Theory (Higgins,1989)
The theory links the perception of discrepancies between a person’s self-concept and
various self-guides to specific negative emotional states. Carl Rogers argued that a strong
discrepancy between the real and ideal self is a sign of maladjustment
Actual self = self-concept
Self guides = standard to which you strive

Self Awareness Theory

Self-awareness theory, developed by Duval and Wicklund in their 1972 landmark book A
Theory of objective self-awareness, states that when we focus our attention on ourselves,
we evaluate and compare our current behavior to our internal standards and values.
The theory that self-focused attention leads people to notice self discrepancies, thereby
motivating an escape from self-awareness or a change in behaviour
‘Shape up’ or ‘ship out’

● Awareness of What Others Say and Think About You. The first dimension of self-
awareness is being aware of how you impact other people. ...
● Awareness of the Thoughts and Feelings You Have About Yourself. ...
● Awareness of Who You Really Are. ...
● Awareness of Who You Want to Become.
Private self-awareness: Being able to notice and reflect on one's internal state. Those who
have private self-awareness are introspective, approaching their feelings and reactions with
curiosity. For example, you may notice yourself tensing up as you are preparing for an
important meeting.

Self-awareness stems from reflecting on three aspects of the 'Self':

1) 'I-Self' – This aspect answers the question, 'How do I see myself? ...
2) 'Me-Self' – This answers the question of 'How do others see me? ...
3) 'Ideal-Self' – This answers the question of 'How do I want others to see me?

Consequences of Low Self-Esteem

For most adolescents, the emotional discomfort of low self-esteem is temporary.
Low self-esteem has been implicated in depression, suicide, anorexia nervosa, delinquency,
and other adjustment problems, and even suicide.
(Swann, Chang-Schneider, McClarty, 2008; Van Voorhees & others, 2008).

Self-Enhancement: 4 main methods

1. biased self-serving cognitions
● take credit for success and distance themselves from failure (Schlenker et al, 1990)
● Unrealistically optimistic (Kunda, 1987)
● a type of cognitive bias in which an individual distorts reality in order to protect their
ego. This bias frequently manifests as a tendency to attribute success to the self and
failure to external causes.

2. Self-handicapping (self-sabotage)
● Behaviour designed to sabotage one’s own performance in order to provide a
subsequent excuse for failure (Berglas and Jones, 1978)
● Two benefits (a) a defensive excuse in case you fail (b) Enhanced credit if you
succeed.

3. Reflection
● Basking in reflected glory (BIRGing) is a self-serving cognition whereby an individual
associates themselves with known successful others such that the winner's success
becomes the individual's own accomplishment.

4. Downward comparison
 ● a defensive tendency that is used as a means of self-evaluation. When a person
looks to another individual or group that they consider to be worse off than
themselves in order to feel better about their self or personal situation, they are
making a downward social comparison.

Family : The adolescent and the family

● Major developmental task - The attainment of independence

● Freedom within the family to make decisions
● Emotional freedom to make new relationships
● Personal freedom to take care of oneself in such things as education, political beliefs,
responsibility and future career

● Psychodynamic tradition - need to break free of infantile ties with the parents
● Social psychological perspective – change in role and status which lead to a
redefinition of the individual’s place in the social structure

● Research indicates that family relationships have important effects:

➢ autonomy and later independence of the individual (Coleman & Hendry, 1990)
➢ adolescent self esteem (Rosenberg and Kaplan, 1982)
➢ individual psychopathology (Scott & Scott, 1987)
➢ problem behaviour (Barnes, Ferrel and Windle, 1990)
➢ delinquent behaviour and drug abuse (Laub and Sampson, 1982)

7 Dimensions of healthy family functioning

1. individuation vs enmeshment
2. mutuality vs isolation
3. flexibility vs rigidity
4. stability vs disorganisation
5. clear vs distorted perceptions
6. clear roles vs conflictual roles
7. clear vs diffuse generation boundaries

Family processes
1) Reciprocal socialization
● process by which children and adolescents socialize with their parents just as
parents socialize with them.
● Traditional view of attitude transmission derived from childhood socialization
theory
● Examples : Parents’ inclusion of adolescents’ opinions in financial decisions,
Parents’ interest in popular culture
● Experiment : Still face experiment

2) Family as a system
● Family = constellation of subsystems defined in terms of generation, gender,
and role.
● Divisions of labour among family members define particular subunits, and
attachments define others.
● Each family member is a participant in several subsystems—some dyadic
(involving two people), some polyadic (involving more than two people).
● The father and adolescent represent one dyadic subsystem, the mother and
father another; the mother-father-adolescent represent one polyadic
subsystem, the mother and two siblings another.
● Family is a natural living system
● There are three forms in which the family exists and functions:
1) Independent, self aware and self directed individuals
2) Social positioning within the family – roles
3) Larger social system (bronfenbrenner)... PG 32/ 33 ON BOOK :
Microsystem,
mesosystem,exosystem,macrosystem,chronosystem
The Ecological Systems Theory has contributed to our
understanding that there are multiple levels of influence on an
individual's development, rather than just individual traits or
characteristics.Bronfenbrenner contributed to the understanding that
parent-child relationships do not occur in a vacuum, but are
embedded in larger structures.
● The emergence of adolescence is likely to test the adaptability of the family system
● Adolescent behaviour is both a reaction to and a stimulus in the family system
Family Sub-Domains
1) The parental marital relationship domain
➢ Marital conflict is associated with the child’s delinquency and drug use
(Robins, 1980)
➢ Parental conflict may be a greater risk factor than structural variables, such as
parental absence (Farrington, Ghallager, Morley, Ledger, and West, 1985).
➢ The most consistent findings are that happily married parents are more
sensitive, responsive, warm, and affectionate toward their children and
adolescents (Grych, 2002).
➢ Marital satisfaction is often related to good parenting.
➢ The marital relationship is an important support for parenting.
➢ When parents report more intimacy and better communication in their
marriage, they are more affectionate to their children and adolescents (Grych,
2002).

2) Parental behaviour domain

➢ Parental drug use is related to the child’s drug use.
➢ Parental attitudes toward drug use also play a role with parents who are
tolerant of drug use being more likely to have children who use drugs (Barnes
and Welte, 1986)
 3) Parent adolescent relationship domain
➢ Mutual attachment influential in terms of adolescent deviance.
➢ Parents of well functioning adults, report greater warmth (more child
centeredness, affection and communication) and less conflict in their
relationship with their children.
➢ Discipline: structured discipline serves as a barrier to adolescent problem
behaviour (Kandel & Andrews, 1987)
➢ Appropriate parental monitoring is effective in reducing drug use and other
problem behaviour (Patterson, Chamberlain & Reid, 1982).
➢ Authoritarian or power assertive techniques may be detrimental (Brook &
Brook, 1986)

4) Sibling
➢ Several investigators have found that an adolescent with a sibling who uses
drugs has an increased probability of drug use.
➢ Brook et al (1981): a sibling relationship characterized by conflict, less
admiration, less satisfaction and less sibling identification is related to inner
tension and psychic distress, less conventional attitudes and consequently
more drug use.
➢ A good sibling relationship may buffer against the effects of a bad parental
relationship.

Gulotta et al 1994
Some of the main risk factors relating to the familial domain, leading to vulnerability:

● Being born into poverty

● Living with chronic familial tension and discord
● Having dysfunctional parents who are physically or sexually abusive, who abuse
substances and who suffer from serious mental illness
● Membership in a family where there is little warmth, support or positive bonding and
there is parental non directiveness, permissiveness and inadequate supervision
● Experiencing the death of a significant adult before a child has reached the age of
eleven
● Living in a neighborhood where there is a great deal of violence and turmoil
(Gullotta et al, 1994:51)
 3) Maturation (and multiple developmental trajectories)
➢ Adolescents change as they make the transition from childhood to adulthood,
but their parents also change during their adult years.
➢ Adolescent changes that can influence parent-adolescent relationships:
Puberty, Expanded logical reasoning, Increased idealistic thought, Changes
in schooling, Peers, friendships, Dating, Movement toward independence.
➢ Parental changes that contribute to parent-adolescent relationships:
Marital satisfaction,Economic burdens, Career reevaluation, Time perspective,
Health and body concerns (Collins & Laursen, 2004).
➢ For most parents, marital satisfaction increases after adolescents or emerging adults
leave home (Fingerman, 2006).

The generation Gap implies: Connger and Peterson (1984)

1) Discrepancy of viewpoints
● Mundane issues, not big ones(eg curfew, leisure time, cleaning room etc)
● Disagreements stem from different perspectives on issues
● Parents see issues as a matter of right or wrong (social conventions or moral
issues)
● Teens see issues as a matter of personal choice eg how to dress

2) Conflict
● Parent-Adolescent Conflict
● Most adolescents and their parents have similar beliefs about the value of
work, achievement, and career aspirations (Gecas & Seff, 1990).
● Most adolescents and their parents often have similar core values - religious
and political beliefs.
● Not much of a gap in values – rather a gap in personal taste
● Early adolescence is a time when parent-adolescent conflict escalates
beyond parent-child conflict (Allison & Schultz, 2004; Smetana, 2008b).

About 20 percent of families, parents and adolescents engage in prolonged, intense,

repeated, unhealthy conflict (Montemayor, 1982).

Prolonged, intense conflict is associated with a number of adolescent problems:

● Moving away from home.

● Juvenile delinquency.
 ● School dropout rates.
● Pregnancy and early marriage.
● Membership in religious cults.
● Drug abuse (Brook & others, 1990

Parenting styles (Diana Baumrind 1971,1991) - Four styles

1) Authoritarian
A restrictive, punitive style. Lead to social incompetence in adolescence.

2) Authoritative
Encourages independence but still places limits and controls on their actions. This is the
most effective parenting style because :
● Balance between control and autonomy -> independence with guidance
● Engage in verbal give-take and allow kids to express views
● Warmth and parental involvement make child more receptive to parental influence

3) Neglectful
Parent is very uninvolved in the adolescent’s life.

4) Indulgent
Parents are highly involved with their adolescents but place few demands or controls on
them.
The Cambridge study in delinquent development
5 major factors were found to have a significant association with the development of
delinquency :
1. being born into a low income family
2. forming part of a large sized family
3. having parents who are unable to perform satisfactorily their child rearing duties
4. being of below average intelligence
5. having a parent with a criminal record

Parents’ roles : Gender, Parenting, Co-parenting

● Managers of adolescents’ opportunities.
● As monitors of adolescents’ social relationships.(Parke & Buriel, 2006).
● Mothers are more likely than fathers to have a managerial role in parenting.

Adolescents’ willingness to disclose information to parents also is related to responsive

parenting and a higher level of parental behavioral control, which are components of a
positive parenting style, authoritative parenting.
 The Mother’s Role The Father’s Role

The mother’s role brings with it benefits as
well as limitations. Although most women
do not devote their entire lives to
motherhood, for most mothers, it is one of
the most meaningful experiences of their
lives.
● Has undergone major changes
(Parke & Buriel, 2006).
● Although fathers have increased the
amount of time they spend with their
children and adolescents, it is still
less time than mothers spend (Parke
& Buriel, 2006; Parke & others,
2008).
● Spend 1/3 to ¾ as much time with
adolescents as mothers do (has
increased)
● Social development can benefit from
a nurturing father who fosters a
sense of trust and confidence

Co-Parenting
Conditions that place children and adolescents at developmental risk (Feinberg & Kan, 2008;
Karreman & others, 2008; McHale & others, 2009):
● Poor coordination
● Active undermining and disparagement of the other parent.
● Lack of cooperation and warmth.
● Disconnection by one parenting partner.

Conditions that show clear ties to children’s and adolescents’ prosocial behavior and
competence in peer relations (McHale & others, 2002):

● Parental solidarity
● Cooperation
● Warmth
When parents show cooperation, mutual respect, balanced communication, and attunement
to each others needs, these attributes help children and adolescents to develop positive
attitudes toward both males and females.

Autonomy and Attachment : The importance of finding a comfortable middle ground.

AUTONOMY ATTACHMENT

● self direction and independence ● connectedness to parents

● the adolescent often does not have
the knowledge to make appropriate
or mature decisions in all areas of
life.
● Emotional autonomy is the capacity
to relinquish childlike dependencies
on parents
● De-idealize parents, see them as
people, less dependent on them for
emotional support
● Boys generally given more
independence than girls
● As child pushes for autonomy, the
wise adult relinquishes control in the
areas that the adolescent can
handle
● facilitates the social competence of
adolescents
● self esteem and emotional
adjustment
● Serves the adaptive function of
providing a secure base from which
adolescents can explore and master
new environments and a widening
social world
● Buffer against anxiety and emotional
distress.
● Secure attachment to parents in
adolescence can facilitate the
adolescent’s social competence and
well-being (Hilburn-Cobb, 2004).
● Securely attached adolescents have
somewhat lower probabilities of
engaging in problem behaviors such
as juvenile delinquency and drug
abuse (Allen, 2007).

The old model of parent-adolescent relationships suggested that:

As adolescents mature, they detach themselves from parents and move into a world of
autonomy apart from parents.Parent-adolescent conflict is intense and stressful throughout
adolescence.

The new model emphasizes that:

Parents serve as important attachment figures, resources, and support systems as
adolescents explore a wider, more complex social world. In the majority of families, parent-
adolescent conflict is moderate rather than severe and that everyday negotiations and minor
disputes are normal.
Adult Attachment Interview (AAI) - (George,Main & Kaplan, 1984)
Individuals are classified as secure-autonomous or as being in one of three insecure
categories:

1. Dismissing/avoidant attachment
● Individuals deemphasize the importance of attachment.
● Associated with rejection by caregivers.

2. Preoccupied/ambivalent attachment
● Hypertuned to attachment experiences.
● May occur because parents are inconsistently available.

3.Unresolved/disorganized attachment
● Unusually high level of fear.
● Disoriented.
● Can result from traumatic experiences such as abuse or parent’s death.

The new model of parent-adolescent relationships emphasizes that parents serve as

important attachment figures, resources, and support systems as adolescents explore a
wider, more complex social world.

Secure Attachment
● Securely attached people tend to agree with the following statements: "It is relatively
easy for me to become emotionally close to others. I am comfortable depending on
 others and having others depend on me. I don't worry about being alone or having
others not accept me."
● This style of attachment usually results from a history of warm and responsive
interactions with relationship partners.
● Securely attached people tend to have positive views of themselves and their
partners. They also tend to have positive views of their relationships. Often they
report greater satisfaction and adjustment in their relationships than people with other
attachment styles.
● Securely attached people feel comfortable both with intimacy and with independence.
Many seek to balance intimacy and independence in their relationship.
● Leading experts, Mario Mikulineer and Phillip Shaver (2007), concluded the following
about the benefits of secure attachment:
➢ a well-integrated sense of self-acceptance, self-esteem, and self-efficacy.
➢ They have the ability to control their emotions, are optimistic, and are
resilient.
➢ Facing stress and adversity, they activate cognitive representations of
security, are mindful of what is happening around them, mobilize effective
coping strategies.

Emerging Adults’ relationship with Parents

● Improve when they leave home.
● Grow closer psychologically to their parents and share more with them (Arnett,
2007).
● Separate from their family of origin without cutting off ties completely
● Many emerging adults no longer feel compelled to comply with parental expectations
and wishes.
● They shift to learning to deal with their parents on an adult-to-adult basis, which
requires a mutually respectful form of relating.

Sibling relationships
● Siblings can serve as a source of emotional and school-related support
● Negative sibling relationships can be harmful to adolescent development
● Birth order also plays a role in siblings’ relationships with each other (Vandell,
Minnett, & Santrock, 1987).
1. Firstborns have been described as: More adult oriented.Helpful,
conforming.Anxious.Self-controlled.Less aggressive than their siblings.
Divorced Families
● Adolescents from divorced families have poorer adjustment
BUT
● Eighty percent of children from divorced families become well-adjusted adults
(Desrochers, 2004)
● Factors innvolved in the adolescent’s individual risk vulnerability in a divorced family?
➢ Adolescent’s adjustment prior to the divorce.
➢ Personality and temperament.
➢ Developmental status.
➢ Gender and Custody.
➢ Relocation.

● Those who experienced multiple divorces are at greater risk to have:

➢ Academic problems and /or drop out of school.
➢ Externalized problems.
➢ Internalized problems.
➢ Less-competent intimate relationships.
 ➢ Become sexually active at an earlier age.
➢ Drug related problems.
➢ Associate with antisocial peers.
➢ Lower self-esteem (Conger & Chao, 1996; Hetherington, 2005; Hetherington,
2005, 2006; Hetherington & Kelly, 2002).

Should parents stay together for the sake of their children?

The most commonly asked question about divorce (Hetherington, 2005, 2006).
An unhappy, conflicted marriage that erodes the well-being of the children and adolescents
are reduced by the move to a divorced, single-parent family, divorce might be advantageous.

StepFamilies :
● Children in simple stepfamilies have better adjustment than those in complex
families,
● Younger adolescents may experience more difficulty than older adolescents (APA,
2004)
● Boundary ambiguity can make adjustment difficult.

Three types
1) Step Father
2) Step Mother
3) Blended or complex
a) Blended : A blended family or stepfamily forms when you and your partner
make a life together with the children from one or both of your previous
relationships. The process of forming a new, blended family can be both a
rewarding and challenging experience.

b) Complex : Half-siblings share/have one biological parent in common. A

complex stepfamily occurs when both partners have children from a prior
relationship while a simple stepfamily occurs when only one adult is a
stepparent in the stepfamily.
Working Parents
● Maternal employment does not negatively impact adolescent development
● Maternal employment may better prepare adolescents for their adult roles (Hoffman,
1989)
● A consistent finding is the children (especially girls) of working mothers engage in
less gender stereotyping and have more egalitarian views of gender (Goldberg &
Lucas-Thompson, 2008).

Latchkey Adolescents
Some children cope well without supervision when left alone for less than three hours.
However, children being left alone for more than three hours often present with low self
esteem, low academic efficacy and high levels of depression.
● unsupervised for 2 to 4 hours a day
● can lead to drug and alcohol use, stealing, vandalizing and other negative behaviors
● parental monitoring and authoritative parenting can help adolescents to avoid these
problems.

Adoption
● In general adopted adolescents have more psychological and school-related
problems (Bernard and Dozier, 2008)
● Adopted siblings are less withdrawn and demonstrate more prosocial behavior
● Later adoption is associated with more adjustment problems than early adoption
● Most adopted children are well-adjusted
 ● A research review of 88 studies revealed no difference in the self esteem of adopted
and non adopted children adolscence, as well as no difference between transracial
and same race adoptions (Juffer and Ijzendoorn, 2007)
● Parenting of adopted children:
➢ recognizing the differences of the adopted family
➢ support communication about these differences
➢ demonstrate respect for the birth family
➢ support the child’s search for identity

Gay and Lesbian Parents

● About 20% of lesbians and 10% of gay men are parents
● They have children through previous marriages, donor insemination, and adoption

● There are few differences in the adjustment and mental health of adolescents in gay
or lesbian families and those in heterosexual families (Paterson 2013)
● There are no differences in the adjustment and mental health(Hyde and DeLameter,
2011)
● Most identify as heterosexual

Peers

What are peer relationships?

● Individuals who are about the same age or maturity level
● Interactions of people of approximately the same age and status, (Siegler, Deloache
& Eisenberg 2006)
● Peer relationships differ from friendship in that friendships are intimate & reciprocal
relationships between two or more people, (Siegler, Deloache & Eisenberg 2006)
Peer relations:
1) Peer group functions
● Horizontal relationships - The age & status proximity offers the psychological
feeling of equality
● The sense of equality enables peers to express their feelings & views more
freely than with non-peers
● Adolescents have strong needs to be liked and accepted by friends and the
larger peer group.
● To many adolescents, how they are seen by peers is the most important
aspect of their lives.
● Primary groups – essential to the shaping of personality as the family is in
childhood
● Instrumental and emotional support
● Affirm individual members as distinctive personalities
● Provides opportunity for establishing romantic contacts
● Provide young people with room to develop an identity of their own, using the
vehicle of group identity
● the opportunity to learn how to interact with others
● autonomy without the control of adults and parents
● opportunities for witnessing the strategies others use to cope with similar
problems, and for observing how effective they are
● building and maintaining friendships (Atuater, 1988)
● provide a source of information about the world outside the family.
● Developmental changes in time spent with peers:
➢ Boys and girls spend an increasing amount of time in peer interaction
during middle and late childhood and adolescence.
➢ In one investigation, over the course of one weekend, young
adolescent boys and girls spent more than twice as much time with
peers than with parents (Condry, Simon, & Bronfenbrenner, 1968).

● Are peers necessary for development?

➢ Good peer relations might be necessary for normal social development in
adolescence.
➢ Social isolation is linked with many different forms of problems and disorders,
ranging from delinquency and problem drinking to depression (Dishion,
Piehler, & Myers, 2008).
● Learning through peer relations:
➢ Through peer interaction children and adolescents learn the symmetrical
reciprocity mode of relationships.
➢ Adolescents explore the principles of fairness and justice by working through
disagreements with peers.
➢ They also learn to be keen observers of peers’ interests and perspectives in
order to smoothly integrate themselves into ongoing peer activities.
➢ Adolescents learn to be skilled and sensitive partners in intimate
relationships.

● Negative Peer Relations

➢ Being rejected or overlooked by peers leads some adolescents to feel lonely
or hostile.
➢ Rejection and neglect by peers are related to an individual’s subsequent
mental health and criminal problems (Bukowski, Brendgen, & Vitaro, 2007).
➢ Time spent hanging out with antisocial peers in adolescence was a stronger
predictor of substance abuse than time spent with parents (Nation &
Heflinger, 2006).

2) Family-Peer Linkages

● Parents’ choices of neighborhoods, churches, schools, and their own friends

influence the pool from which their adolescents select possible friends (Cooper &
Ayers-Lopez, 1985).
● Parents can model or coach their adolescents in ways of relating to peers.
● Secure attachment to parents is related to the adolescent’s positive peer relations
(Allen & Antonishak, 2008).
● Homophily : the principle that a contact between similar people occurs at a higher
rate than among dissimilar people. The pervasive fact of homophily means that
cultural, behavioral, genetic, or material information that flows through networks will
tend to be localized.

For example, a classic example of homophily might be the tendency for

schoolchildren to form friendships within the same grade level than across grade
levels.
3) Peer pressure
➢ Young adolescents conform more to peer standards than children do.
➢ Around form 1 and 2, conformity to peers—especially to their antisocial
standards—peaks (Berndt, 1979; Brown & Larson, 2009; Brown & others,
2008).
➢ A recent study revealed that 14 to 18 years of age is an especially important
time for developing the ability to stand up for what one believes and resist
peer pressure to do otherwise (Steinberg & Monahan, 2007).
➢ Social psychological studies on conformity – more subtle pressures – two
types of social influence
➢ Perceptions of social norms may not always be correct

● Sources of peer influence:

Very best friends,Cliques,Romantic partners ,Popular youth ,Aggregated peers eg
prison inmates , group therapy members, classrooms,Peers depicted in the media –
reference groups.

● Which adolescents are most likely to conform?

Cohen & Prinstein, 2006; Prinstein, 2007; Prinstein & Dodge, 2008 have concluded
the following adolescents are more likely to conform:
➢ Adolescents who are uncertain about their identity.
➢ Have low self-esteem.
➢ Have high social anxiety.

4) Peer statuses
● The term sociometric status is used to describe the extent to which children and
adolescents are liked or disliked by their peer group.

● Assessed by asking children to rate how much they like or dislike each of their
classmates.
● Also assessed by asking children and adolescents to nominate the peers they like
and those they like the least.
● Moodier and emotionally negative individuals experience greater rejection by peers.
● Emotionally positive individuals are more popular.
 ● Developmentalists have distinguished five types of peer statuses (Wentzel & Asher,
1995).
1) Popular children
Are frequently nominated as a best friend and are rarely disliked by their peers.

2) Average children
Receive an average number of both positive and negative nominations from their
peers.

3) Neglected children
Are infrequently nominated as a best friend but are not disliked by their peers.

4) Rejected children
Are infrequently nominated as someone’s best friend and are actively disliked by
their peers.

5) Controversial children
Are frequently nominated both as someone’s best friend and as being disliked.

Age and Social Skills

● Social-skills training programs have generally been more successful with children 10
years of age or younger than with adolescents (Malik & Furman, 1993).
● Peer reputations become more fixed as cliques and peer groups become more
significant in adolescence.
● Once an adolescent gains a negative reputation among peers as being “mean,”
“weird,” or a “loner,” the peer group’s attitude is often slow to change, even after the
adolescent’s problem behavior has been corrected.

Strategies for improving social skills

● Conglomerate strategies (coaching)
Involves the use of a combination of techniques, rather than a single approach, to
improve adolescents’ social skills.
● A conglomerate strategy may consist of:
➢ Modeling of appropriate social skills.
➢ Discussion.
➢ Reasoning about the social skills.
➢ Reinforcement for enactment in actual social situations.
Friendship
● Friends are a subset of peers who engage in mutual companionship, support, and
intimacy.
● Relationships with friends are much closer and more involved than is the case with
the peer group.
● Some adolescents have several close friends, others one, and yet others none.

The functions of friendship

1. Companionship
2. Stimulation
3. Physical support
4. Ego support
5. Social comparison
6. Intimacy/affection

Harry Stack Sullivan’s (1953) Ideas on Changes in Friendship in Early Adolescence

Sullivan argued that friends are important in shaping the development of children and
adolescents. During adolescence, said Sullivan, friends become increasingly important in
meeting social needs. Sullivan argued that the need for intimacy intensifies during early
adolescence, motivating teenagers to seek out close friends.
● If adolescents failed to forge such close friendships, they experience loneliness and a
reduced sense of self-worth.
● Through friendship adolescents learn symmetrical recipricol mode of relationship

Competencies of friendship
● The greater intimacy of adolescent friendships demands requires learning a number
of close relationship competencies, including:
➢ Knowing how to self-disclose appropriately.
➢ Being able to provide emotional support to friends.
➢ Managing disagreements in ways that do not undermine the intimacy of the
friendship.
Mixed-Age Friendships
Some adolescents become best friends with younger or older individuals. Do older friends
encourage adolescents to engage in delinquent behavior or early sexual behavior?

● Adolescents who interact with older youths do engage in these behaviors more
frequently.
● It is not known whether the older youth guide younger adolescents toward deviant
behavior or whether the younger adolescents were already prone to deviant
behavior.

Loneliness
● For some individuals loneliness is a chronic condition.
● Chronic loneliness is linked with impaired physical and mental health (Karnick, 2008).
● It is important to distinguish loneliness from the desire for solitude.

Adolescent Groups
a) Cliques
➢ are small groups that range from 2 to about 12 individuals and average about
5 to 6 individuals.
➢ Members are usually of the same sex and are similar in age.
➢ Adolescents engage in similar activities.
➢ Being in a club together or on a sports team.

b) Crowds
➢ Crowds are less personal than cliques
➢ Defined by the activities adolescents engage in

c) Gender : Gender plays an important role in the peer group and friendships
(Blakemore, Berenbaum, & Linden, 2009).
● Group size
➢ Boys are more likely than girls to associate in larger clusters.
➢ Boys are more likely to participate in organized games and sports than
girls are.
● Interaction in same-sex groups
➢ Boys are more often likely than girls to engage in competition, conflict, ego
displays, and risk taking and to seek dominance
 ➢ Girls are more likely to engage in “collaborative discourse,” in which they talk
and act in a more reciprocal manner.

d) Culture
● In some countries, adults restrict adolescents’ access to peers.
● Interaction with the other sex or opportunities for romantic relationships are
restricted (Booth, 2002).
● Japanese adolescents seek autonomy from their parents later and have less
conflict with them.
● The peer group was more important to U.S. adolescents than to Japanese
adolescents (Rothbaum & others, 2000).

Dating and Romantic relationships

Functions of Dating
● Dating is a relatively recent phenomenon.
● In the 1920s, it became a reality.
● Its primary role was to select and win a mate.
● Dating has evolved into something more than just courtship for marriage.
● Eight functions
➢ Recreation.
➢ Source of status and achievement.
➢ Part of the socialization process.
➢ Involves learning about intimacy.
➢ Context for sexual experimentation and exploration.
➢ Provide companionship.
➢ Identity formation and development.
➢ A means of mate sorting and selection.

● Romantic relationships: Early romantic relationships serve as a context for

adolescents to explore:
➢ how attractive they are,
➢ how to interact romantically,
➢ Only after adolescents acquire some basic competencies in interacting with
romantic partners does the fulfillment of attachment and sexual needs
become a central function of these relationships (Furman & Wehner, 1998).
➢ Recently, researchers have begun to study romantic relationships in gay
male, lesbian, and bisexual youth (Diamond & Savin-Williams, 2009).
 ➢ The average age of the initial same-sex activity for females ranges from 14 to
18 years of age and for males from 13 to 15 (Diamond & Savin-Williams,
2009).
➢ The most common initial same-sex partner is a close friend.
➢ More lesbian adolescent girls have sexual encounters with boys before same-
sex activity, whereas gay adolescent boys are more likely to show the
opposite sequence (Savin-Williams, 2006).
➢ limited opportunities and the social disapproval of such relationships may
generate from families & peers (Diamond & Savin-Williams, 2009).
➢ Stigma
➢ Coming out
➢ The legal and social context of marriage creates barriers to breaking up that
do not usually exist for same-sex partners.
➢ But in other ways researchers have found that gay male and lesbian
relationships are similar—in their satisfactions, loves, joys, and conflicts—to
heterosexual relationships (Hyde & DeLamater, 2008; Kurdek, 2006; Peplau
& Fingerhut, 2007).
➢ Lesbian couples especially place a high priority on equality in their
relationships (Peplau & Fingerhut, 2007).
➢ Gay male and lesbian couples are more flexible in their gender roles than
heterosexual individuals are (Marecek, Finn, & Cardell, 1988).
➢ A recent study of couples revealed that over the course of ten years of
cohabitation, partners in gay male and lesbian relationships showed a higher
average level of relationship quality than heterosexual couples (Kurdek,
2007).

Ethnicity and culture

● The sociocultural context exerts a powerful influence on adolescent dating patterns
and on mate selection (Booth, 2002; Stevenson & Zusho, 2002).
● Values and religious beliefs of people in various cultures often dictate:
➢ The age at which dating begins.
➢ How much freedom in dating is allowed.
➢ The extent to which dates are chaperoned by parents or other adults.
➢ The respective roles of males and females in dating.
Gender and Sexuality

● Sexuality is a normal part of adolescence.

● Much of what we hear about adolescent sexuality involves problems, such as
adolescent pregnancy and sexually transmitted infections
● Although there are significant concerns, it is important not to lose sight of the fact that
sexuality is a normal part of adolescence (Tolman & McClelland, 2001)

The Sexual Culture

A special concern in the way sex is portrayed in the media.
● Ward Et Al (2006)
The messages conveyed about sexuality (in the media) are not always ideal….. And
they are often limited, unrealistic and stereotypical. Dominating is a recreational
orientation to sexuality in which courtship is treated as a competition, a battle of the
sexes, characterized by dishonesty, game playing and manipulation…. Also
prominent are stereotypical sexual roles portraying women as sex objects , whose
value is based solely on their physical appearance, and men as sex driven players
looking to ‘score’ at all costs.
● Sex is explicitly portrayed in movies, videos, lyrics of popular music, MTV, and
Internet websites (Bersamin & others, 2010; Nalkur, Jamieson, & Romer, 2010;
Strasburger, 2010; Tolman & McClelland, 2011)
● Adolescents increasingly have had access to sexually explicit websites
● Adolescents and emerging adults use the Internet as a resource for information
about sexuality.

Developing a Sexual Identity

Mastering emerging sexual feelings and forming a sense of sexual identity is multifaceted
(Diamond, & Savin-Williams, 2009).
● Sexual identity emerges in the context of physical factors, social factors, and cultural
factors. It is strongly influenced by social norms related to sex
● Involves an indication of sexual orientation and involves activities, interests, and
styles of behavior

Obtaining Information about Adolescent Sexuality

Assessing sexual attitudes and behavior is not always a straightforward matter.
● Assessing sexual attitudes and behavior is not always a straightforward matter
(Hock, 2010; Saewyc, 2011)
● Research is limited by the reluctance of some individuals to answer candid questions
about extremely personal matters
 ● When asked about their sexual activity, individuals may respond truthfully or they
may give socially desirable answers
● Boys tend to exaggerate their sexual experiences to increase perceptions of their
sexual prowess, while girls tend to play down their sexual experience so they won’t
be perceived as irresponsible or promiscuous (Diamond & Savin-Williams, 2009)

CONTINUE FROM LECTURE PPT + BOOK (I am tired.)

Adult Development
● Introduction to adult development & aging
● Biopsychosocial perspectives
● Models of Development
● Psychological Disorders in older adults
● Personality development & Aging
● Personality disorders in adulthood
● Psychological disorders and ageing
● Neurocognitive Disorders
● Cognitive development in adulthood
● Schaie Seattle Longitudinal Study of Adult IQ ScoresFile
● Successful cognitive aging
● Creativity across the lifespan

Adult Development
Introduction to adult development & aging
The aim of adult developmental psychology is to continue to study human development
within a lifespan perspective focusing on adult development and aging. This unit aims to
adopt a critical approach to the major theoretical teets of adult development and
aging within a Biopsychosocial perspective. The aim is also to enhance self
understanding and growth through personal reflection on the main issues in adult
development and aging.

The Study of Adult Development at Harvard University (Bock & Heath, 1939), set out to
study the well , not the sick. The study aimed to “analyse the forces that have produced
normal young men.. All of us need more do’s and a fewer don’ts” (Bock,1938)

Refer to PPT.
“To know how to grow old is the master-work of wisdom, and one of the most difficult
chapters in the great art of living”

Biopsychosocial perspectives; Aging population in the world and Malta;

The perspective that development is a complex interaction of biological, psychological, and

social processes and ageing is not a simple progression through time.

Development is:
● Intra-dimensional: personal context looking inwards
● Inter-dimensional: social context looking outwards.
● Multi-dimensional and multi-directional rather than linear
● Multidisciplinary
● Contextual
● Biological process: change in body structure & function with time ; genetics
➢ Vascular ad respiratory changes with age
➢ Cardiovascular functions change
➢ Functional difficulties (sight,hearing, walking, speech)
➢ Auditory and visual changes
❖ Bromley (1988) states that 75% of elderly need glasses
❖ Visual changes occur due to a decrease in: light entering the eye, lens
elasticity, darkness adaptation, receptor number, recovery from glare,
visual acuity, accommodation speed.
❖ 46% of older adults have serious hearing impairment.
❖ Auditory changes occur due to loss of auditory neurons, middle ear
bones stiffen, poor transmission, high-frequency sounds, poor pitch
discrimination. Interpersonal communication becomes difficult.
➢ Balance (dizziness and vertigo)
➢ Decreased brain weight; communication between neurons and
neurotransmitters reduced.
➢ Blood flow can be reduced due to shrinkinng arteries in the brain.
➢ Structural changes in the brain: brain ventricles enlarge, meninges thicken,
minor & selective loss of neurons, reduced dendritic processes & synaptic
connections, decreased cortical grey matter.
➢ Neurotransmitter changes : decrease in dopamine, decrease in acetylcholine,
reduced cholinergic binding. These all lead to psychological consequences.
● Psychological process: cognitive,affective,behavioural,personality changes
➢ Intellectual function declines in later old age.
➢ Cognitive functions decrease due to physical challenges also such as sensory
loss, mental and physical health difficulties, etc.
➢ Decreased working memory
➢ Loss of flexibility in problem solving but increased wisdom.
➢ Selection – reduce the range
➢ Optimization – practice more
➢ Compensation – find a different way
➢ Encapsulation – areas that are important or special to the person show
growth and maintenance of function
➢ Emotional regulation
➢ Alexithymia (Darmanin-Kissaun & Catania, 2016): having difficulties with
expressing emotions that are deemed socially appropriate, such as happiness
on a joyous occasion. Others may have trouble identifying their emotions.
Such individuals don't necessarily have apathy.
➢ Personality and behavioural changes such as increased cautiousness and
rigidity
➢ Emotional problems resolve

● Social process: Cultural, historical,interpersonal,influences, family, work,

relationships, institutionalization.
➢ Change in social status
➢ Change in relationships (family, family life cycle, friends)
➢ Work
➢ Suffer the effects of ageism
➢ Ageism (Butler 1969) : Reflects a deep-seated uneasiness on the part of
the young and the middle-aged – a personal dislike to and distaste for
growing old, disease, disability, and fear of powerlessness and
death.Stereotypes (how we think), prejudice (how we feel), and discrimination
(how we act) towards others or ourselves based on age. Ageism is pervasive,
affects people of all ages from childhood onward, and has severe and far-
reaching consequences for people's health, well-being, and human rights.
 ➢ Possible reasons for its occurrence:
1. Terror management theory
According to Terror Management Theory as applied to ageism, older
adults may be associated with mortality, thereby generating death-
thought accessibility, stereotypes, and mixed emotions among
younger adults. Ageism can be a way of managing the fear of growing
old and death.

2. Modernization Hypothesis
Modernization theory argues that older people in modern times are not
as respected and valued as they were in the past. Cowgill and Holmes
(1995) argue that the concept and definition of old age are relative to
the degree of modernization that a particular society has under-gone.

3. Multiple Jeopardy Hypothesis

The double jeopardy hypothesis posits that racial minority elderly
suffer a double disadvantage to health due to the interactive effects of
age and race. Empirical examinations have found mixed support for
the proposition that the aging process heightens the health
disadvantage for racial minorities compared to whites.

4. Age-as-a-leveler view
The age-as-leveler hypothesis predicts that age moderates the
relationship between income and mortality.

5. Inoculation hypothesis
According to the inoculation hypothesis (Norris & Murrell, 1988), prior
disaster experience acts to protect older people from distress and
strong emotional reactions to subsequent disasters.

What is successful/active aging?

WHO defines active aging as “the process of optimising opportunities for health,
participation, and security in order to enhance the quality of life as people age.”
Social factors, Health care, and Economical determinants are as important as the physical
environment.
The optimum stage: is the absence of disease and disability, high cognitive and
physical functioning, and engagement with life (Rowe & Kahn, 1998).
Vahia et al 2012, found that women (n=1,950) highest in subjectively rated successful aging
had high scores in:
● Self-efficacy
● Optimism
● Positive attitudes towards aging
● Resilience
● Low scores in Depression

Determinants of active aging (WHO model): WHO Policy framework 2002 https://
www.who.int/ageing/publications/ active_ageing/en/

● Economic determinants
● Health and social services
● Behavioural determinants
● Personal determinants
● Physical environment
● Social and cultural determinants

Major tasks of old age (Bergman 1978)

● Accepting the proximity of death
● Coping with and adjusting to physical disabilities and ill-health
● Achieving rational dependence on medical, social and family support and identifying
and exercising available choices to maximise satisfaction
● Sustaining mutually emotionally gratifying relationships with friends and relatives

Malta National Strategic Policy for Active Ageing 2014-2020

The first step in attempting to successfully implement active ageing principles. Policy
responses to population ageing were integrated together with concerns of older persons into
national development frameworks. Aims at improved levels of positive, productive and
successful living in later life - To add life to years. (Formosa, 2013)
NSPAA 2014-20
The National Strategic Policy for Active Ageing: Malta 2014-2020 is premised upon
three major themes:
1) Active participation in the labour market
2) Participation in society
● The notion of social participation is a recurring motif in policy statements
advocating active ageing. The concept of active ageing aspires to a
continuous and active participation of older persons in social,
economic, cultural and civic affairs. The National Strategic Policy for
Active Ageing offers the following policy recommendations to improve social
inclusion in later life:
➢ ensuring a safe, adequate and sustainable income for all older
persons
➢ providing financial and social resources for vulnerable older persons
➢ recognising the social benefits arising from older volunteering and
grandparenthood
➢ strengthening opportunities for learning, digital literacy, active
citizenship and intergenerational solidarity in later life
➢ providing further support to informal carers of older persons.

3) Independent living.
● Transforming society’s perception of ageing from one of dependency to
active ageing requires a paradigm shift that enables independence and
dignity with advancing age. Society must not be content solely with a
remarkably increased life expectancy, but it must also strive to extend
healthy life years and then provide opportunities for physical and
mental activities adapted to the capacities of older individuals.
Strengthening measures of health promotion, care and protection aids older
persons in ensuring high physical and mental functioning that fosters
independent living.
● The National Strategic Policy for Active Ageing offers the following policy
recommendations to improve independent living in later life:
➢ improving services in health prevention and promotion
➢ acute and geriatric rehabilitation
➢ mental health and wellbeing and community care services targeting
older and ageing adults
 ➢ supporting initiatives that facilitate the creation of age-friendly and
dementia-friendly communities and services maximising autonomy in
long-term care
➢ raising awareness of elderly abuse and neglect investing further in
end-of-life care.
➢ https://family.gov.mt/en/Documents/ Active%20Ageing%20Policy%20-
%20EN.pdf

Active ageing refers to the situation where older and ageing persons continue to have an
opportunity in participating in the formal labour market, as well as engaging in other unpaid
productive activities, that may range from care provision for family members to volunteering,
whilst living healthy, independent and secure lives as they age. NSPAA, 2013

Policy recommendations:
● to strengthen the levels of older and ageing workers continuous vocational training
for older adults
● improving healthy working conditions, age management techniques, and employment
services
● taking a constructive stand against ageism and age discrimination; implementing a
tax/benefits system
● encouraging mentoring schemes in occupational organisations strengthening the
available measures reconciling work and informal care.

Four Principles of Biopsychosocial perspectives on adult development and aging

1) Continuity principle of change over the lifespan

The continuity theory of normal aging states that older adults will usually maintain
the same activities, behaviours, relationships as they did in their earlier years
of life. Continuity refers to the view that development is a gradual, continuous
process and is affected by biological factors that exist internal to the
individual.
● Continuous VS discontinuous development
● Changes in old age occur against backdrop of prior history
● People feel they are the “same” inside even though they change on the
outside
● Older adults have survived threats of life and thus are a select group
 ● Health habits such as healthy lifestyle and social support explain some of the
inndividual differences in the rate of illness and death occurring in adulthood.

2) Factors affecting lifespan

● Body weight
● Exercise and physical activity
● Drinking and driving
● Diet
● Smoking
● Genetics
● Socioeconomic status

3) Individual differences must be recognised

● Inter-individual differences
Inter-individual variability refers to differences in the expression of one or
more behaviors between members of a population. For instance, some
people express a shyer attitude than others, take more risks, or are more
attracted to immediate gains.

● Intra-individual differences
Intra-individual differences are differences that are observed within the same
person when they are assessed at different times or in different situations.
The variations between two or more traits, behaviors, or characteristics of a
single person.

4) Normal aging is different from disease

● Normal/primary ageing – changes built into the ageing process. age related
changes that are intrinsic, universal & progressive

● Impaired/secondary ageing – due to disease. changes which occur with

greater frequency such as disease, but are not a necessary accompaniment

● Tertiary Ageing- refers to the rapid and marked physical deterioration

immediately prior to death

● Optimal Ageing - refers to the optimal/successful ageing. Age-related

changes that improve the individual’s functioning.Age-related losses due to
 primary,secondary or tertiary ageing eventually overtakes age-related gains
unfortunately.

When does one become an adult?

3 major phases:
1) Young adulthood (20-40) - (18-29 emerging adulthood)
2) Middle adulthood (40-65)
3) Late adulthood (65+)

4) Young old - 65-74

5) Old old 75-84
6) Oldest old 85+
7) Centenarians 100+
8) Supercentenarians 110+

When do you become an adult?

Alterative indices of age to the physical body and number:
● Biological age
● Psychological age
● Social age

Life VS Health expectancy

● Life expectancy is the average number of years of life remaining to the people born
within a similar period of time.
VS
● Health expectancy estimates whether or not longer life is accompanied by an
increase in the time lived in good health (the compression of morbidity scenario) or
in bad health (expansion of morbidity)
Local demographics
● Life expectancy in Malta was 43 for males and 46 for females in 1948. In 2016 it was
84.4 for females and 80.6 for males. (NSO, 2018). It is projected to increase to 89.1
in females and 85.1 in males by the year 2060. (Formosa, 2018)
● Health expectancy in EU countries is 63.3 for females and 62.2 for males. In Malta it
is 74.6 for females and 72.6 for males. 1st place!!!!! (Formosa, 2018)

Why are there gender differences in life expectancy?

● Women outlive men in all Western countries.By the age of 70, there are
approximately six women for every five men and by the age of 80 there are four
women for every two men. In Malta there are twice as many women as there are
men in the 90+ cohort
● Reasons for sex differences: Disease?Stress? Lifestyle factors? Childbirth? Genetic
factors? Biological factors?

Activities of Daily Living

Increased focus on functional impairment
Basic activities of daily living (ADLs)
– essential to independent living
– e.g. get out of bed, bathe, feed, dress
– 15-20% of those aged 85+ have problems with ADLs
Physical Exercise
● Exercise improves mood & cognition. !Physical benefits as strong in those aged 80+
● Paffenberger et al. (1986) study of physical exercise on 17 000 male graduates aged
35-74.
- Moderate exercise 21% lower mortality risk
- Strenuous exercise 50% lower mortality

Models of Development
Three models of developmental science

1) Organismic Model
An approach to psychology that emphasizes the total organism, rejecting distinctions
between mind and body. It embraces a molar approach that takes account of the interaction
between the organism and its environment. This model proposes that heredity drives the
course of development throughout life. Change occurs because the individual is
programmed to exhibit certain behaviors at certain ages with distinct differences
between stages of life. This model involves biological theories and some psychological
theories.
● Biological approaches
➢ Programmed Ageing theories
Modern biological theories of aging in humans fall into two main categories:
programmed and damage or error theories. The programmed theories imply
that aging follows a biological timetable, perhaps a continuation of the one
that regulates childhood growth and development.

➢ Good genes gone bad

Diseases can also be the result of good genes gone bad because of
interference from something in the environment. Rather than inviting exotic
medical interventions, diseases caused by environmental interference with
gene behavior may be preventable if the contaminant can be identified and
the exposure eliminated. And please note that this isn't about mutation. The
DNA sequence doesn't change. It isn't originally a “bad” gene, but rather one
that's been hijacked.
 ➢ Theory of Replicative Senescence
Replicative senescence refers to the process by which normal somatic cells
reach an irreversible stage of cell cycle arrest following multiple rounds of
replication; this end stage is associated with marked changes in gene
expression and function

➢ Random Error theories

based on the idea that errors can occur in the transcription of the synthesis of
DNA. These errors are perpetuated and eventually lead to systems that do
not function at the optimum level. The organism's aging and death are
attributable to these events (Sonneborn, 1979).

● Psychological approaches
➢ Erikson’s psychosocial theory stages of development : The stages
through adulthood :
❖ Identity vs diffusion
❖ Intimacy vs isolation
❖ Generativity vs stagnation
❖ Ego integrity vs despair

➢ Piaget’s theory of cognitive stages development:Sensorimotor stage,

Pre-operational period, Concrete Operational phase, Formal Operations
stage.

➢ Freud’s psychosexual stages: Primary narcissism, Oral sensory (0-1), Anal

muscular (18 months-3 years) , Phallic (3-6), Latency (6-puberty), Genital
(puberty-death)

2) Mechanistic Model
The mechanistic model compares human activities to processes which take place
within a machine. These processes are to be analyzed as a collection of elements, each of
which is to be causally explained. In the organismic model human activities are compared
to processes within a living organism.People’s behaviour changes gradually over time,
shaped by the outside forces that cause them to adapt to their environments.Growth through
life occurs through exposure to experiences that present new learning opportunities.
Exposure is gradual there are no clear-cut or identifiable stages according to this model.
Approaches:
 ● Learning theory, behaviourism
➢ The three types of learning in psychology are classical conditioning,
operant conditioning, and observational learning.

● Sociocultural models of development

➢ Ecological Perspective (Bronfenbrenner, 1994) : the microsystem, the
mesosystem, the exosystem, the macrosystem , the chronosystem
https://www.simplypsychology.org/bronfenbrenner.html

➢ The Life-course perspective

Each life stage influences the next, and together the social, economic and
physical environments in which we live have a profound influence on our
health and the health of our community

➢ Activity Theory
Proposes that older adults are happiest when they stay active and maintain
social interactions. These activities, especially when meaningful, help the
elderly to replace lost life roles after retirement and, therefore, resist the social
pressures that limit an older person's world.

➢ Disengagement Theory
Refers to an inevitable process in which many of the relationships between a
person and other members of society are severed & those remaining are
altered in quality. Withdrawal may be initiated by the ageing person or by
society, and may be partial or total.

➢ Continuity Theory (life continues)

In making adaptive choices, middle-aged and older adults attempt to preserve
and maintain existing internal and external structures; and they prefer to
accomplish this objective by using strategies tied to their past experiences of
themselves and their social world.

3) Interactionist Model
Genetics and environment interact in complex ways to produce their effects on the
individual. The individual can actively shape own development. The biopsychosocial
perspective in line with this model because it considers multiple influences on development
and views the individual as an active contributor to change.

Psychological Disorders in older adults

1) Major Depressive Disorder: Extremely sad mood for most of the time for at
least 2 weeks that is not typical of the individual’s usual mood:
● Sleep changes: Difficulty falling asleep, Waking in the middle of the night and
not being able to get back to sleep , Sleeping more than usual
● Activity changes: Feeling tired all of the time, Feeling less energetic than
usual, Feeling nervous or unable to sit still
● Appetite change: Loss of appetite, Finds that food no longer tastes good,
Increased appetite and weight gain
● Sad feelings: Feeling sad or blue most of the day nearly every day, Feelings
of hopelessness or worthlessness or guilt
● Troubled thoughts: Difficulties making decisions, Death wishes, Suicidal
thoughts, Difficulties with attention or concentration
● Personality changes: Irritability, Loss of motivation,Loss of temper more easily
than usual, Loss of interest in things that he or she used to enjoy

Major Clinical Features in Late Life (MDD)

Two key symptoms that distinguish late-life depressive disorders in older people
1) Complaint of sadness less prominent ‘depression without sadness’
2) Excessive concern with physical health

Distinctive modes of presentation

● Recent somatic concerns
● Sudden onset of anxiety or obsessional symptoms
● Medically “trivial” deliberate self-harm
● Prominent cognitive dysfunction (“pseudo-dementia”)* (fake dementia or fake
cognitive decline) occurs when a person is so slowed down from depression or
another psychiatric illness that they present as intellectually or cognitively impaired.
● Recent “out-of-character” behavioural disturbance
● Psychosis, especially in hospitalised adults
*Important to differentiate from neurocognitive disorder*

Risk Factors (MDD)

● Having a chronic medical illness increases a person’s risk of having a depressive
disorder.
● Personal history of: Chronic medical illnesses, especially heart disease, Parkinson’s
disease, Alzheimer’s disease, diabetes mellitus, stroke, hypertension, cancer,
chronic pain.
● Hip fractures
● Tooth loss
● Loss of physical functioning Prior depressive disorders
● Family history of: Recurrent depression, Bipolar disorder, Alcohol abuse or
dependence

Contributing Psychosocial Factors (MDD)

● Functional limitations
● Inability to provide basic self-help tasks Sensory impairments
● Recent significant loss
● Bereavement
● Multiple recent stressors (within past 6 months) Social isolation
● Institutionalisation
● Changes in cognition
● Inability to employ successful coping strategies

Epidemiology and treatment (MDD)

Epidemiology is the method used to find the causes of health outcomes and diseases in
populations. In epidemiology, the patient is the community and individuals are viewed
collectively.
● 16.6% of adults estimated to meet criteria over the course of adulthood (lifetime
prevalence)
● In outpatient medical settings, the prevalence of major depression among older
adults is about 12%, Inpatient settings 30%, In nursing homes, it is higher
● Women are 70% more likely than men but by the ages between 60 and 80 the sex
ratio evens itself out
● Average age of onset 32
 ● Treatment: CBT, IPT, PST; Anti-depressants; ECT

2) Bipolar disorder
Bipolar disorder can look very different in different people. The symptoms vary widely in their
pattern, severity, and frequency. Some people are more prone to either mania or
depression, while others alternate equally between the two types of episodes. Some have
frequent mood disruptions, while others experience only a few over a lifetime.There are four
types of mood episodes in bipolar disorder:
1) Mania
2) Hypomania
3) Depression
4) Mixed episodes.
Each type of bipolar disorder mood episode has a unique set of symptoms.

Bipolar Disorder Spectrum

Epidemiology, picture and treatment

● 10% in geriatric inpatient units
● Less than 0.1% in community-dwelling older adults
● Late onset or a continuation of sometimes undiagnosed early onset
● Similar to younger picture but less severe Manic symptoms
● Treatment: Litium and CBT

3) Anxiety Disorders
One of the most prevalent disorders among older adults, yet it is one of the least
researched, compared to the attention given to late-life depression and dementia (Nordhus &
Pallesen, 2003).

1) Social Anxiety Disorders

2) Specific Phobia
3) Agoraphobia : A person with agoraphobia is afraid to leave environments they know
or consider to be safe. In severe cases, a person with agoraphobia considers their
home to be the only safe environment. They may avoid leaving their home for days,
months or even years.
4) Generalised Anxiety Disorder
5) Panic Disorder : People with panic disorder have frequent and unexpected panic
attacks. These attacks are characterized by a sudden wave of fear or discomfort or a
sense of losing control even when there is no clear danger or trigger. Not everyone
who experiences a panic attack will develop panic disorder.

Clinical Symptoms
● Fatigue
● Excess or undue worry or fear
● Disturbed sleep
● Jumpiness, jitteriness
● Trembling
● Muscle aches, tension Dizziness and lightheadedness
● Gastrointestinal upset
● Dry mouth
● Sensation of a lump in the throat and a choking sensation
● Clammy hands and sweating
● Racing heartbeat and chest discomfort
● Shortness of breath

Clinical Picture
• Family history of: Alcohol abuse, Anxiety disorders and Mood disorders
• Personal history of: Depression and Anxiety disorder,Chronic medical illness, especially
diabetes mellitus, Parkinson’s disease, Alzheimer’s disease, congestive heart failure, or
hyperthyroidism, Loss of significant person during childhood, Cognitive impairment
• Alcohol abuse/dependence and Social isolation Other factors: Female gender and
Exposure to traumatic event

Clinical Features and epidemiology

● Within clinical practice there may be a tendency to discount anxiety disorders relative
to other more salient issues associated with ageing.This results in under detection of
the disorder.
● One of the most prevalent anxiety disorders is Generalised Anxiety Disorder,
defined as excessive anxiety & worry about a number of activities or events for
at least six months duration.
● Lifetime prevalence of GAD 5.7% Phobias most common 12.5% among 60+
● Although most older adults with GAD report an onset in childhood or adolescence, as
many as 30 to 40 % report an onset later in life.
● Panic usually less common in older adults
● Treatment: Benzodiazapenes (with caution due to falls and cognitive impairment risk)
CBT and SSRIs

Clinical Features in late life

● The assessment of anxiety in older adults may be challenging because many
symptoms are physical and may be accounted for by medical reasons.
● Distinction between anxiety and agitation in individuals with dementia is difficult.
● Most commonly used assessment is the
➢ Beck Anxiety Inventory
The Beck Anxiety Inventory (BAI) consists of 21 self-reported items (four-
point scale) used to assess the intensity of physical and cognitive anxiety
symptoms during the past week. Scores may range from 0 to 63: minimal
anxiety levels (0–7), mild anxiety (8–15), moderate anxiety (16–25), and
severe anxiety (26–63).
➢ State-Trait Anxiety Inventory
The State-Trait Anxiety Inventory (STAI) is a commonly used measure of trait
and state anxiety (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). It
can be used in clinical settings to diagnose anxiety and to distinguish it from
depressive syndromes. It also is often used in research as an indicator of
caregiver distress (e.g., Greene et al., 2017, Ugalde et al., 2014).Form Y, its
most popular version, has 20 items for assessing trait anxiety and 20 for state
anxiety. State anxiety items include: “I am tense; I am worried” and “I feel
calm; I feel secure.” Trait anxiety items include: “I worry too much over
 something that really doesn’t matter” and “I am content; I am a steady
person.” All items are rated on a 4-point scale (e.g., from “Almost Never” to
“Almost Always”). Higher scores indicate greater anxiety. The STAI is
appropriate for those who have at least a sixth-grade reading level.

4) Psychosis
A class of psychological disorders in which reality contact – the capacity to perceive,
process and respond to environmental stimuli in an adaptive manner - is radically impaired
so that a person cannot meet the ordinary demands of life

Psychosis occurs in:

● Bipolar Disorder
● Delusional Disorder
● Schizophrenia
● Depression

There are four main symptoms associated with a psychotic episode:

1) Hallucinations
➢ Hallucinations are perception-like experiences that occur without an external
stimulus. They are vivid and clear with the full force and impact of normal
perceptions, and not under voluntary control. Hallucinations can occur in any
sensory modality (five senses):
➢ Visual – someone with psychosis may see colours and shapes, or imaginary
people or animals
➢ Auditory – someone with psychosis may hear voices that are angry,
unpleasant or sarcastic (most common)
➢ touch – a common psychotic hallucination is that insects are crawling
on/under the skin (formication)
➢ Olfactory (smell) – usually a strange or unpleasant smell
➢ Olfactory (taste) – some people with psychosis have complained of having a
constant unpleasant taste in their mouth

2) Delusions
➢ Delusions are fixed beliefs that are not amenable to change in light of
conflicting evidence. Their content may include a variety of themes:
➢ Erotomanic
➢ Grandiose
 ➢ Jealous
➢ Persecutory
➢ Somatic
➢ Nihilistic
➢ Delusion of control (insertion, withdrawal, broadcasting)

3) Disorganised thinking (formal thought disorder) : Confused and disturbed

thoughts
➢ People with psychosis often have disturbed, confused and disrupted patterns
of thought. Signs of this include that:
❖ their speech may be rapid and constant
❖ the content of their speech may appear random; for example, they
may switch from one topic to another mid-sentence
❖ their train of thought may suddenly stop, resulting in an abrupt pause
in conversation or activity

4) A lack of insight and self-awareness

➢ People experiencing a psychotic episode are often totally unaware their
behaviour is in any way strange, or their delusions or hallucinations could be
imaginary.
➢ They may be capable of recognising delusional or bizarre behaviour in others,
but lack the self-awareness to recognise it in themselves.
➢ For example, a person with psychosis who is being treated in a psychiatric
ward may complain that all of their fellow patients are mentally unwell while
they are perfectly normal.

Epidemiology and treatment

● 1% population (point prevalence)
● Adults 30-44 - 1.5%
● Adults 65+ - 0.2%
● 15% of adults with S die of suicide 50% suicide attempt
● Most people with S do not survive into old age
● Attention to possibility of delirium in older adults which could account for psychotic
symptoms
● Treatment: anti-psychotic medication
 5) Substance Use Disorder
● Tolerance, as defined by either of the following:
a) a need for markedly increased amounts of alcohol to achieve
intoxication or desired effect
b) markedly diminished effect with continued use of the same amount of
alcohol.

● Withdrawal, as manifested by either of the following:

a) the characteristic withdrawal syndrome for alcohol
b) the same (or a closely related) substance is taken to relieve or avoid
withdrawal symptoms

● Alcohol is often taken in larger amounts or over a longer period than was
intended
● Persistent desire or unsuccessful efforts to cut down or control alcohol use.
● A great deal of time is spent in activities necessary to obtain alcohol, use
alcohol, or recover from its effects.
● Important social, occupational or recreational activities are given up or
reduced due to alcohol use.
● Alcohol use persists despite knowledge of having a persistent or recurrent
physical or psychological problem that has likely been caused or exacerbated
by the excessive use of alcohol (e.g. cocaine- induced depression or ulcer).

Epidemiology
● Overall numbers and percentages of older adults using illegal drugs are on the rise
● In 2008 4.3 million adults aged 50+ (4.7%) had used illicit drugs within the past year
● Older adults particularly at risk of using prescription drugs 0.8% in over 65+
● 14% of older adults in out patient hospital setting use alcohol
● Long-term alcohol abuse may lead to changes in the frontal lobes and cerebellum,
exacerbating the effects of normal ageing on cognitive and motor functioning
● Alcohol Interacts badly with medication
● Severe and prolonged alcohol abuse may lead Korsakoff’s syndrome and early death
(Korsakoff syndrome (also known as Korsakoff's amnesic syndrome) is a memory
disorder that results from vitamin B1 deficiency and is associated with alcoholism.)
6) Suicide

It is difficult for care-workers to diagnose suicidality in older adults because they often show
only mild to moderate symptoms of depression. Other subclinical symptoms may include
hostility, sleep difficulties and anxiety.It is important to consider this and to conduct a
thorough suicide risk assessment

● People age 65 and older accounted for 16% of suicide deaths in 2004 (CDC, 2005).
● 2010 suicide took its toll on 38,364 adults in USA
● The age-adjusted suicide rate in the USA of all age, are and sex groups is highest for
all demographic categories among males aged 75 and older, at 16.3 per 100,000
suicide deaths in the population (CDC, 20102)
● Psychiatric illness is present in 71-97% of suicides in older adults, particularly
depressive disorders
● Up to 75% of older adults who die by suicide visited a physician within a month
before death (Conwell, 2001; NIMH, 2009)

Suicide in Malta
● 635 cases of suicide in Malta between 1995 and 2018 (509 were M and 126 were F)
● 4 age groups
➢ 14-29: 128 individuals – 20.3%
➢ 30-49: 252 individuals – 39.6%
➢ 50-69: 187 individuals – 29.4%
➢ 70-98: 68 individuals – 10.7%

In Malta being widowed did not constitute a risk factor (Renaud, Bettenzana, Darmanin-
Kissaun et. al, 2019)

Suicide Risk Assessment

General factors (biopsychosocial factors)
• Male gender
• Living alone
• Inadequate social support
• Significant loss (for example, bereavement)
• Being single or widowed
• Social isolation
• Cognitive changes and depression
• Chronic medical condition (especially if painful)
• Physical illness and functional limitations
• Alcohol abuse
• Cultural and religious acceptability (in some societies and religions, suicide is more
acceptable than in others)

Psychiatric factors
● Past suicide attempt
● Irritability
● Agitation
● Insomnia
● Guilt
● Hopelessness
● Low self-esteem Hypochondriacal preoccupations
● Alarm bell: even if depression is mild or moderate

Suicide Prevention
• The majority of older people who commit suicide have had a consultation with a primary
care physician within the 3 months prior to death (Cattell & Jolley, 1995).
• In the Gotland study, depression-related suicide rates were reduced after the
implementation of a depression-training programme for primary care physicians (Rihmer et
al, 1995).
• In Italy, a reduction in the elderly suicide rate was demonstrated after the introduction of a
telehelp service, i.e. telephone checking and monitoring of clients at risk (De Leo, 1995).
• The elderly suicide prevention program in Hong Kong was implemented since 2002 (Chiu
et al, 2003). The teams worked in collaboration with the hotline services, NGOs, centers for
the elderly, and GPs to screen for people with depression and those who were at risk to
suicide. A major focus was the provision of training for general practitioners in the detection
and management of depression.
Problem Solving Therapy - PST
PST is a brief structured psychotherapy in which the patient is supported by the therapist in
learning about and applying a structured approach to address problems that are causing
symptoms.PST was found to be more effective than supportive therapy in leading to
remission of depression and that the patients had fewer post-treatment depressive
symptoms as well as disability in a group of depressed elderly subjects with impairment in
executive functions (Alexopoulos et al. 2003)PST involves patients developing new skills
that will empower them to solve any future problems.

Interpersonal Therapy - IPT

IPT is a manual-based psychotherapy. Its therapeutic focus is limited to current interpersonal
relationships in four broad areas: abnormal grief, role transition, role dispute, and
interpersonal deficits.It was found to be more effective than usual general practitioner’s care
for elderly patients with moderate to severe major depressive disorder in real-life general
practice (van Schaik et al. 2006). Therapists from different therapeutic backgrounds can
learn this therapy easily.

Cognitive Therapy - CT
The therapeutic framework emphasises changing dysfunctional thoughts (Maladaptive
values, attitudes, and thinking patterns) rather than attempting to alter depressed mood
directly.
The main strategies used in achieving therapeutic change are: Identifying negative thoughts,
Evaluating their validity, Substituting more positive and realistic thoughts and Modifying
dysfunctional attitudes

Cognitive Behaviour Therapy - CBT

In practice, cognitive therapy (CT) is often combined with behavioural techniques to form
CBT.The behavioural component aims to break a depressive cycle through graded task
assignments that are enjoyable and goal directed, resulting in an increased sense of
achievement and self-esteem.
A course of treatment usually consists of a limited number of sessions (usually about 12 to
16) and may be given on a one-to- one basis or in groups.
Response to CT or CBT is less likely in patients with coexistent personality disorder, rigid
thinking styles, severe depressive disorder, and/or prominent biological symptoms.
Response to these techniques is particularly unlikely in patients with depressive delusions or
hallucinations.
Personality development & Aging

He who is of a calm and happy nature will hardly feel the pressure of age, but to him who is
of an opposite disposition, youth and age are equally a burden.
Plato, 427-346 B.C.

Personality Is a complex pattern of deeply-embedded, long-lasting psychological

characteristics.These characteristics are largely non-conscious and not easily altered.
They express themselves automatically in almost every facet of functioning.These intrinsic,
pervasive traits emerge from a complicated matrix of biological dispositions and experiential
learnings.They comprise the individual’s distinctive pattern of feeling, thinking, coping and
behaving.

Psychodynamic perspectives

1) Ego psychology: Freud, Harmann, Kernberg.

Played an important role in revealing the unobservable (unconscious) parts of personality
(the hallmark of his theory). Later theorists have subsequently revised and reshaped the
body of work which Freud had constructed and created.He made the unfounded claim that
personality does not change after early childhood.Psychoanalysis is of little value to
individuals over 50 as their personalities are so rigidly set that they cannot not be altered.

The topographical theory: The part of personality that was responsible for behaviour, Freud
theorised, was hidden in the unconscious, with the conscious mind being the tip of the
iceberg, concealing a much larger unconscious part. Thus in order for a person to change,
those hidden regions must be altered, and with increasing age they become less and
less amenable to change. Personality becomes more rigid with age.

TRIPARTITE THEORY OF PERSONALITY

1) The Ego, the structure in personality most accessible to conscious awareness,
performs the rational, executive functions of the mind. Uses defence
mechanisms to keep the Id out of conscious awareness and to keep it in check.
● FUNCTIONS OF THE EGO
➢ Cognition: It performs the functions of integration, analysis and synthesis of
thought. It plays a central role in actively directing behaviour. Second-order
thinking.
➢ Defence Mechanisms: Strategies used to protect the conscious mind from
the unwanted material in the unconscious (Freud’s unwanted ideas).
➢ Affect regulation: The ability to regulate emotions
➢ Reality testing: The capacity to evaluate one’s affect, behaviour and
thoughts and to correct them on the basis of observations and cognitive
processes.
➢ Identity integration: Having an integrated concept of self and others,
consistent image of the self and consistent behaviour.

● LEVELS OF EGO FUNCTIONING: The ego functions at different levels:

➢ Neurotic: According to depth psychology, a neurosis is the
expression of an inner psychic conflict caused by the ego's refusal to
acknowledge, confront, and ultimately integrate unwanted affects
rising from the “unconscious” (Jung, 2014, p.

➢ Borderline: They are ego-syntonic, meaning a person with a

personality disorder often doesn't believe they have a problem. The
disorder is consistent with their world view, perception of others and
perception of themselves. Ego-syntonic refers to instincts or ideas that
are acceptable to the self; that are compatible with one's values and
ways of thinking. They are consistent with one's fundamental
personality and beliefs.

➢ Psychotic: psychosis is therefore an 'ego-syntonic' illness, meaning

that the viewpoint embodied in the symptoms coincides with that of
the afflicted party's ego.

● Each level of functioning is characterised (and determined) by:

 1. The type of defence mechanisms deployed by the ego.
2. Whether there is reality testing or otherwise.
3. Whether there is identity integration as apposed to identity diffusion
(Kernberg, 1989).

2) The Id is the deepest part of the unconscious mind – the part of personality
that seeks fulfilment of desires that could lead people to commit unacceptable
aggressive or sexual acts.
3) The Superego is the organised part of the personality, mainly but not entirely
unconscious. It includes the individual's ego ideals, spiritual goals, and the
psychic agency (commonly called "conscience") that criticises and prohibits
his or her drives, fantasies, feelings, & actions.

2) Vaillant’s (2000) Theory of Defence Mechanisms

The psychodynamic theory proposed by George Vaillant (2000) emphasises the
development of defence mechanisms over the course of adulthood – intended to help
protect the conscious mind from the unconscious – they are automatic strategies
which people use.They are present throughout adulthood and may be adaptive or
maladaptive.Unlike Freud who proposed that personality is invariant after childhood, Vaillant
regards the ego defence mechanisms as becoming increasingly adaptive in adulthood -
helping people cope with life's challenges such as stress at work, marital unhappiness etc.

STUDIES BASED ON EGO PSYCHOLOGY: DEFENCE MECHANISMS AND COPING

 ● Older adults: Use of mature defence mechanisms e.g. suppression or sublimation,
are able to cope better with stress, can contain negative affect, put things in
perspective, able to learn from experience.

● Younger adults: Use of more primitive defence mechanisms, e.g. acting out,
projection, denial and regression.

● Vaillant’s study of Adult Development (1993):

In all 3 samples (Harvard Grant, Core City and Terman Group study) many high
correlations were found between between maturity of defences and adult outcomes:
Life satisfaction, Adequate mental health ,Job success and enjoyment, Marital
stability

Erikson’s psychosocial theory of development (biopsychosocial)

TRAIT APPROACHES (perspective)

The 2nd major theoretical approach to personality and the ageing process is that
personality is made up of traits - stable, enduring dispositions that persist over time.
The organisation of these personal dispositions guides the individual's behaviour.
They are at least partially inherited (genetic role) They are the constitutional basis of
personality.

1) THE FIVE-FACTOR MODEL OF PERSONALITY - THE BIG FIVE

 Main empirically based theory – Big Five (Costa & Mc Crae, 1988)
● Openness to experience: Receptiveness to new ideas, approaches, and
experiences.
● Conscientiousness: Organisation, ambition and self-discipline.
● Extraversion: Preference for social interaction and lively activity.
● Agreeableness: Selfless concern for others, trust, and generosity.
● Neuroticism: Tendency to experience psychological distress, over-
reactiveness, and emotional instability.The opposite of emotional stability.

Assumptions of the factor five model:

● Personality reflects inherited dispositions
● Outward changes may occur but traits do not change
● Personality affects choices made in life rather than changing in response to life
events.
● Identity may change even while personality remains stable

LONGITUDINAL STUDY BY COSTA & MCCRAE, 1988

In this study, self-reports (N = 983) and spouse ratings (N = 167) were gathered on the NEO
Personality Inventory (Costa & McCrae, 1985), which measures all five of the major
dimensions of normal personality. Cross-sectional and longitudinal analyses on data from
men and women aged 21 to 96 years showed evidence of small declines in Activity, Positive
Emotions, and openness to Actions that might be attributed to maturation, but none of these
effects was replicated in sequential analyses.
Comparable levels of stability were seen for men and women and for younger and older
subjects. The data support the position that personality is stable after age 30.
(PsycINFO Database Record (c) 2016 APA, all rights reserved)
Costa and McCrae, 1988.

3) TYPE ‘A’ PERSONALITY (FRIEDMAN, 1996)

● Personalities that are more competitive, highly organised, ambitious, impatient, highly
aware of time management and/or aggressive are more inclined to develop heart
disease .A temperament characterised by excessive ambition, aggression,
competitiveness, drive, impatience, need for control, focus on quantity over quality
and unrealistic sense of urgency. It is commonly associated with risk of coronary
disease and other stress-related ailments
● More calm and relaxed personalities are labelled Type ‘B’.
● Type A behaviour pattern together with hostility –linked to depression and
physical health problems (Cardiovascular disease)
● Neuroticism - risk of developing subsequent illness linked to CVD, increased
tendency to smoke and to abuse of heroin and cocaine.
● Low conscientiousness leads to carelessness, higher BMI, weight gain.
● High conscientiousness linked to longevity because of engagement in more
preventive behaviours. Low Neuroticism related to lower mortality rates.

The relationship between personality and health

● Cardiovascular risk factors related to Type A behaviour and anxiety Lower BMI
related to higher levels of conscientiousness
● Drug use and smoking related to lower levels of conscientiousness Lower
mortality related to higher levels of openness
● Risk of Alzheimer’s disease related to conscientiousness and neuroticism.
HYPOCHONDRIASIS, NEUROTICISM AND AGEING
Even among psychiatrically normal individuals, the personality dimension of neuroticism is
systematically related to the number of medical symptoms reported and that neuroticism-
related complaints are best viewed as exaggerations of bodily concerns.
Psychometric data purporting to show that hypochondriasis increases in the elderly are
confounded by real health changes with age, and evidence from longitudinal studies shows
that increases in health complaints probably reflect veridical reports of changing health
status. It is suggested that the stereotype of elderly men and women as hypochondriacs is
unfounded.

PERSONALITY DISORDERS AND AGEING

● Prevalence: 9-15% of general population USA (DSM 5)
● In later life people with personality disorders experience deleterious effects on their
psychological functioning and relationships with others.
● Psychopathy (factor 1 and 2). Factor 1 (F1) encompasses interpersonal and
affective traits (e.g., callousness, shallow affect, grandiosity), Affective traits
may include, inter alia, values, attitudes, motivation, interests, opinions,
preferences, dispositions and moral development (Hohn, 1995:302, Stiggins,
2001:296).Whereas Factor 2 (F2) captures impulsive-antisocial behavior (e.g.
impulsivity, irresponsibility, early behavior problems).
Factor 1 is stable over time
Factor 2 behaviours decrease – possibly because those high on factor 2 have not
made it to old age.
● Borderline Personality Disorder, Histrionic Personality Disorder and
Narcissistic Personality Disorder (all disorders having unstable sense of self,
impulsivity, acting out) improve with age. These individuals become better at
coping with their symptoms especially those that involve acting out (Segal,
2001).Histrionic personality disorder (HPD) is a mental health condition marked
by unstable emotions, a distorted self-image and an overwhelming desire to be
noticed. People with HPD often behave dramatically or inappropriately to get
attention.
● Obsessive-Compulsive, Paranoid, Schizoid and Schizotypal Personality
Disorders seem to worsen and become more rigidly entrenched with age
(Maturity Hypothesis).

EMOTIONS AND AGEING: SOCIO-EMOTIONAL SELECTIVITY THEORY

This theory proposes that there are two type of functions served by interpersonal
relationships:
1. informational function (gain knowledge)
2. emotional rewards (maximise positive feelings)

According to this theory older adults prefer to spend time with the people close to them in
their lives.Maintaining positive relationships and removing the negative ones. Left with a
much smaller but closer network of people in your life. Older adults seem to react more
slowly in emotionally provoking situations. Rather than fly into a fit of rage when provoked,
they are more likely to think twice and maintain emotional control. This may help them
maintain their cognitive focus.

COGNITIVE PERSPECTIVE
Views people as driven by the desire to predict and control their experiences. Emerging from
this perspective are cognitive self theories which propose that people regard events in their
lives from the standpoint of how relevant these are to their own sense of self. Cognitive self
theories place emphasis on coping, the mechanisms people use to manage stress.

THEORIES WITHIN THE COGNITIVE PERSPECTIVE

● Possible selves: We are motivated to achieve a hoped-for self and avoid our feared
self.
● Coping and control: Older adults may be more capable of coping with stress
● Identity process theory: Identity balance and assimilation help older adults maintain
self- esteem.Identity accommodation is related to poorer self-esteem and cognitive
performance

MIDLIFE CRISIS - THEORY AND FINDINGS

● Derived from an age-stage approach to personality in adulthood.
● The term originated in the early 1970s as a description of the radical changes in
personality that supposedly accompanied entry into the midpoint of life (age 40 to
45).Age 40-50 - there is extensive and intensive questioning of goals, priorities, and
accomplishments → self scrutiny → due to the individual's heightened awareness of the
inevitability of death.
 ● The years of the early 40s were marked by inner turmoil and outer acts of
rebellion against the placid, middle-aged lifestyle into which the individual was
destined to enter in to his 50s.(Sheehy, as cited in Krauss Whitbourne and
Whitbourne, 2014).
● Levinson's theory of adulthood is a schema that suggests that adults move
through alternating periods of stability and transition throughout their lives.
Each of these periods involves setting goals for one's life and methods for
meeting them.
● Levinson's theory of adult development is the life structure → the basic pattern or design of a
person's life at a given time. The life structure evolves through an orderly series of
universal stages in adulthood. These stages alternate between periods of
tranquility and transition, and each stage has a specific focus.

THE MIDLIFE CRISIS: CRITIQUES

● Little empirical support has been presented for the existence of the midlife crisis as a
universal phenomenon.
● One of the most significant criticisms was the heavy reliance of Levinson's framework
on age as a marker of development!
● Vagueness on the exact age it is supposed to occur at – people with any problems
between the ages of 30 and 50 can claim to have a midlife crisis.
● People do not all age at the same rate. So specificity of age of the midlife crisis is
weak.
● Other studies have actually found that neuroticism was slightly lower in 43 year olds
from a large sample.
● Problems in the definition of the midlife crisis when presented in questionnaires.

CONCLUSION
Diverse views and theories (from unconscious conflicts and maturation of defences, to
biological influences and stable traits, to cognitive control and achievement of goals).
Consensus that overall personality traits remain relatively stable, but that as we grow
older we become more mature and in control of ourselves. Experiences and contexts
have also an influence on our behaviour and personality (biopsychosocial approach)

Personality disorders in adulthood

● What is personality?
Personality is a complex pattern of deeply embedded,long-lasting psychological
characteristics.These characteristics are largely non-conscious and not easily
altered.They express themselves automatically in almost every facet of
functioning.These intrinsic,pervasive traits emerge from a complicated matrix of
biological dispositions and experiential learnings. They compromise the individual’s
distinctive pattern of feeling,thinking, coping and behaving.

● What are personality disorders?

A personality disorder is an inflexible and maladaptive organizing pattern of
cognitions,emotions and behaviours - the three basic components of
experience, such that the individual experiences significant impairment of his
social or occupational functioning and/or subjective distress (DSM IV TR).
DSM 5; An enduring pattern of inner experience and behaviour that deviates
markedly from the individual’s culture,manifested in two or more of the following
areas: cognition,affectivity (the range,intensity,lability*changes in mood*, and
appropriateness of emotional response) ,interpersonal functioning,impulse
control. The inflexible and pervasive pattern leads to clinically significant distress or
impairment in social,occupational, or other important areas of functioning. This
pattern does not attribute to the physiological effects of a substance or other medical
condition (a personality disorder has to be independent of these factors.) This patten
which is stable and enduring can be traced back to at least adolescence or
early adulthood. According to DSM-5, features of a personality disorder usually
begin to manifest during adolescence and early adulthood. In earlier versions of
DSM, a personality disorder could not be diagnosed in someone under age 18;
however, DSM-5 now allows this diagnosis if the features have been present for at
least one year.

● Freud believed that psychological disorders, and particularly the experience of

anxiety, occur when there is conflict or imbalance among the motivations of the id,
ego, and superego
● How do we distinguish between personality disorders and clinical
syndromes/mental disorders?
● The ten personality disorders according to the DSM 5 (2013) divided into three
cluster; A,B, and C.
1) Cluster A: ODD/ECCETRIC:
➢ Paranoid PD : is a mental health condition marked by a long-term pattern of
distrust and suspicion of others without adequate reason to be suspicious
(paranoia). People with PPD often believe that others are trying to demean,
harm or threaten them.

➢ Schizoid PD: is an uncommon condition in which people avoid social

activities and consistently shy away from interaction with others. They also
have a limited range of emotional expression.

➢ Schizotypal PD : often described as odd or eccentric and usually have few, if

any, close relationships. They generally don't understand how relationships
form or the impact of their behavior on others. Acute discomfort in close
relationships, cognitive or perceptual distortions.
2) Cluster B: Dramatic/Emotional:
➢ Antisocial PD: is a particularly challenging type of personality disorder
characterised by impulsive, irresponsible and often criminal behaviour.
Someone with antisocial personality disorder will typically be manipulative,
deceitful and reckless, and will not care for other people's feelings. Violation
of others rights’.

➢ Borderline PD: Borderline personality disorder is a mental illness that

severely impacts a person's ability to manage their emotions. This loss of
emotional control can increase impulsivity, affect how a person feels about
themselves, and negatively impact their relationships with others.

➢ Narcissistic PD: is a mental health condition in which people have an

unreasonably high sense of their own importance. They need and seek too
much attention and want people to admire them. People with this disorder
may lack the ability to understand or care about the feelings of others.A
pattern of grandiosity and a lack of empathy.

➢ Histrionic PD: is a mental health condition marked by unstable emotions, a

distorted self-image and an overwhelming desire to be noticed. People with
HPD often behave dramatically or inappropriately to get attention

3) Cluster C: Anxious/Avoidant
➢ Avoidant PD : They tend to be shy, awkward, and self-conscious in social
situations due to a fear of doing something wrong or being embarrassed.
They tend to exaggerate potential problems. They seldom try anything new or
take chances. They have a poor self-image, seeing themselves as
inadequate and inferior. Hypersensitivity to negative feedback.

➢ Dependent PD: a type of anxious personality disorder. People with DPD

often feel helpless, submissive or incapable of taking care of themselves.
They may have trouble making simple decisions. But, with help, someone
with a dependent personality can learn self-confidence and self-reliance.
 ➢ Obsessive-Compulsive PD : a mental health condition that causes an
extensive preoccupation with perfectionism, organization and control. These
behaviors and thought patterns interfere with completing tasks and
maintaining relationships.

https://cfhh.ca/blog/what-freud-said-about-personality-disorders/
● Freud believed a balance between the ID, ego, and superego is the key to a healthy,
well-adjusted personality.If you imagine all three personality parts interacting as they
should, Freud believed that a robust and healthy character materialises in this
instance.On the other hand, an imbalance in the personality dynamics would likely
lead to a maladaptive personality.Freud’s personality model may help increase our
understanding of personality disorders and their development.For instance,
according to Freudian theory, if you imagine someone with an uncontrolled or
dominant ID, the person is likely to become uncontrollable, impulsive, and possibly
criminal.
 ● Treatment goals for personality disorders

The focus of treatment is Adaptation ; harnessing more adaptive methods of:

● Managing distress
● Improving interpersonal effectiveness
● Building skills for emotional regulation
For PD’s the goal must be to:
● Increase awareness and understanding
● To gradually exchange new, more adaptive habits of thought and behavior for
existing,maladaptive behaviors and habits (Stone, 1993)
● To prevent further deterioration (Adler 1990)
● This gives rise to the evidence of personality change over lifespan

Neurocognitive Disorders
DSM 5
● Delirium
Delirium is a disturbance in attention i.e. reduced ability to direct, focus, sustain, and
shift attention and awareness i.e. reduced orientation to the environment
● Some of the more common causes include: Alcohol or drugs, either from
intoxication or withdrawal. ...Dehydration and electrolyte imbalances.
Dementia. Hospitalization, especially in intensive care.Infections, such as
urinary tract infections, pneumonia, and the flu.Medicines. ...Metabolic
disorders.
● Symptoms of delirium
➢ Disorientation. Some people may not know where they are or what time of
day it is
➢ Unusual thoughts. Some people may become paranoid (suspicious) and
mistrustful of the people around them
➢ Poor concentration
➢ Memory loss
➢ Sleepiness
➢ Agitation or restlessness
➢ Hallucinations
➢ Sudden changes
Neurocognitive Domains
Neurocognitive disorders include a group of symptoms, the most prominent of which are
difficulties with memory and learning with additional problems in at least one of the following
Neurocognitive Domains:
● Learning and memory
● Complex attention (sustained, divided, selective)
● Executive function (judgment, planning, org)
● Language (naming, word-finding, fluency, grammar
● Perceptual-motor (V.perception/visuo- constructional; praxis and gnosis) abilities
● Social Cognition (recognition of emotions; Theory of Mind)
*theory of mind* : the ability to infer and understand another's mental state (the beliefs,
thoughts, intentions and feelings of another), and use this information to explain and predict
human behavior.

Mild neurocognitive disorder diagnosis requires: DSM 5

1) Evidence of modest cognitive decline from a previous level of performance in one or
more cognitive domains (complex attention, executive function, learning and
memory, language, perceptual-motor or social cognition) based on:
● Concern of the individual, a knowledgeable informant, or the clinician that
there has been a mild decline in cognitive function.
● A modest impairment in cognitive performance, preferably documented by
standardised neuropsychological testing, or, in its absence, another quantified
clinical assessment.
2) The cognitive deficits do not interfere with capacity for independence in everyday
activities (i.e. complex instrumental activities of daily living such as paying bills or
managing taking medications are preserved, but greater effort, compensatory
strategies or accommodation may be required).
3) The cognitive deficits do not occur exclusively in the context of a delirium.
4) The cognitive deficits are not better explained by another mental disorder (e.g. major
depressive disorder, schizophrenia)
Major neurocognitive disorder diagnosis requires:
1) Evidence of significant cognitive decline from a previous level of performance in one
or more cognitive domains (complex attention, executive function, learning and
memory, language, perceptual-motor or social cognition) based on:
● Concern of the individual, a knowledgeable informant, or the clinician that
there has been a significant decline in cognitive function and
● A substantial impairment in cognitive performance, preferably documented by
standardised neuropsychological testing, or, in its absence, another quantified
clinical assessment.
2) The cognitive deficits interfere with independence in everyday activities (i.e. at a
minimum, requiring assistance with complex instrumental activities of daily living
such as paying bills or managing medications).
3) The cognitive deficits do not occur exclusively in the context of a delirium.
4) The cognitive deficits are not better explained by another mental disorder (e.g. major
depressive disorder, schizophrenia).

Mild and major NCD’s are not reversible, they are degenerative diseases of the brain
which progresses over time. For both mild and major ND we need to specify whether
they emerge due to:
● Alzheimer’s Disease (70-80%) : Is a progressive loss of brain cells.The early
symptoms of AD include minor memory problems and difficulty saying the right
words. As the disease progresses symptoms include disorientation, personality and
behavioural change.Causal theories:
➢ Genetic – chromosomal
➢ Chromosomes 19, 21
➢ Presenilin genes 1 and 2 are responsible for the protein APP which
produces beta-amyloid, which causes neurofibrillary tangles and an
increase in amyloid plaques
➢ Medication targets acetylcholinesterase the enzyme that destroys
acetylcholine after its release in the hippocampus.
● Dementia : Not a specific disease but is rather a general term for the impaired ability
to remember, think, or make decisions that interferes with doing everyday activities.
Alzheimer's disease is the most common type of dementia. Though dementia mostly
affects older adults, it is not a part of normal aging.Psychological Interventions for
persons with dementia (NCD):
➢ Reality Orientation
➢ Cognitive Stimulation
➢ Reminiscence Therapy
➢ Validation Therapy
➢ CBT for depression in dementia
➢ Group psychotherapy
➢ Cognitive behavioural family intervention
● Frontotemporal lobe degeneration
● Lewy Body disease : Lewy body dementia (LBD) is a disease associated with
abnormal deposits of a protein called alpha-synuclein in the brain. These deposits,
called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to
problems with thinking, movement, behavior, and mood.
● Vascular disease
● Traumatic or non-traumatic brain injury
● Substance/medication use
● HIV infection
● Prion Disease : Prion diseases are transmissible, untreatable, and fatal brain
diseases of mammals. Their cause is highly unusual: The host's normal prion protein
can, for unknown reasons, malfunction and assemble into structured aggregates
called prions that cause infectious brain disease.
● Parkinson’s Disease: Parkinson's disease is a brain disorder that causes unintended
or uncontrollable movements, such as shaking, stiffness, and difficulty with balance
and coordination. Symptoms usually begin gradually and worsen over time. As the
disease progresses, people may have difficulty walking and talking
● Huntington’s Disease : Huntington's disease (HD) is an inherited disorder that causes
nerve cells (neurons) in parts of the brain to gradually break down and die. The
disease attacks areas of the brain that help to control voluntary (intentional)
movement, as well as other areas.
● Another medical condition
● Multiple aetiologies (causes)
Assessments
1) Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
2) Montreal Cognitive Assessment (MoCA)
3) Mini mental state examination (MMSE)
● Orientation
● Registration
● Attention and calculation
● Recall
● Language (naming and repeating) ! Reading and writing
● Three-stage command
● Reacting
● Copying

Caregivers
● Care of the invisible second patients
● High rates of burden and psychological morbidity, social isolation, physical ill- health
and financial hardship (Schultz & Martire, as cited in Gobey, 2018)
● Psychological Interventions for caregivers
➢ Psychodynamic therapy for recent caregivers
➢ CBT for chronic caregivers (3.5+years)

Cognitive development in adulthood

Currently cognitive development over the life span is being studied in two major ways:
1) Neurological studies on developments in brain structures and processes; and
2) Cognitive studies of intellectual functioning over the life span

Psychological measures of intellectual functioning

1) Psychometric approach: Theories of IQ Testing
a) Spearman’s (1904) “two-factor theory”
This theory proposes that intelligence has two components: general
intelligence ("g") and specific ability ("s"). To explain the differences in
performance on different tasks, Spearman hypothesized that the "s"
component was specific to a certain aspect of intelligence.General
intelligence, also known as g factor, refers to a general mental ability that,
according to Spearman, underlies multiple specific skills, including verbal,
spatial, numerical and mechanical.
 b) Thurstone (1938) Primary mental abilities Theory
Comparing adults of average mental ability, posited 7 primary mental abilites
(PMAS) independent of a higher-order g-factor. Thurstone proposed the
theory in 1930's that intelligence is composed of several different
factors. The seven primary mental abilities in Thurstone's model were
verbal comprehension, word fluency, number facility, spatial
visualization, associative memory, perceptual speed and reasoning.

Decline in fluid intelligence & increase in crystallized intelligence

PRIMARY MENTAL ABILITIES (Thurstone, 1938)
● Spatial reasoning (Fluid)
● Verbal Memory (Fluid)
● Perceptual speed (Fluid)

● Verbal ability (Crystallized)

● Word (verbal) fluency (Crystallized)

General Intelligence: Fluid versus Crystallized intelligence (Cattell, 1963)

● Fluid intelligence (gf): individual’s innate abilities to carry out higher level cognitive
operations, involving the integration, analysis and synthesis of new information.
(Biological)
Intelligence-as-process, typically assessed using tests that require on-the-spot
processing.People use their fluid intelligence when facing situations that require
creating strategies and solving problems.
 ● Crystallized intelligence (gc): the acquisition of specific skills and information
acquired through familiarity with the language, knowledge, and conventions of one’s
culture. (Social)
Intelligence-as-product, typically measured using tests that assess stored knowledge,
such as vocabulary and general facts.The use of crystallized intelligence include
vocabulary exams, remembering history, and recalling formulae to solve
mathematical problems.

Perceptual Speed (PS) is a cognitive ability defined by an individual's accuracy and speed
to scan information while completing visual search tasks.
IQ testing over the lifespan
The Seattle Longitudinal Study Schaie
This study began in 1956 focusing on age differences and age changes in cognitive abilities.
The study has been expanded to investigate various influences on cognitive aging including,
cognitive styles, personality traits, life styles, and family environment.Current interest is also
in the early detection of risk for dementia.

The initial sampling frame in 1956 consisted of approximately 18,000 potential adult
participants.These were stratified by age and sex, with 25 men and 25 women randomly
selected for each year of birth from 1889 to 1939.Testing proceeded in small groups from
ten to thirty persons until a total of 500 persons (25 men and 25 women in each 5-year age
interval from 21 to 70 years) had been tested (cf. Schaie, 1958; Schaie, 2010).

The main SLS database (up to 2005) consisted of the 6000 participants between 22 and 101
years.The study started with 500 participants aged between 22-70 years and has continued
in seven-year intervals since 1956.At each interval, all persons who had previously
participated in the study were asked to participate again: 1963, 1970, 1977, 1984, 1991,
1998, and 2005. Thus 26 persons have been tested for 50 years.In addition at each seven-
year interval until 1998, a new group of people randomly selected from the Group Health
membership have been asked to participate. Approximately 6000 people have now
participated at some time in this study.Of the original participants, 26 people remain who
have now been in the study for 50 years.
Schaie questions
1. Does intelligence change uniformly through adulthood or are there different life course
ability patterns?
2. At what age are there reliably detectable age decrements in ability and what is the
magnitude of these decrements?
3. What are the patterns of generational differences and what is the magnitude of these
differences?
4. What accounts for individual differences in age-related change in cognitive abilities in
adulthood?
5. Can intellectual decline with increasing age be reversed by educational interventions?

Conclusions of Schaie from cross-sectional studies

Reliable decrements cannot be found for all abilities for all persons. Decline is not likely at
all until very late in life. Decline is most evident where speed of response and
peripheral nervous system (PNS) functioning are involved. Average age decrements in
psychometric abilities could not be demonstrated prior to age 60, but that such reliable
decrement may be found for all abilities by age 74. Analyses from the most recent three
cycles, however, suggest that small but statistically significant average decrement for some
abilities can be found for some, but not all, cohorts in the 50s (Schaie, 1996).Analyses
of individual differences, however, demonstrate that, even at age 81, less than half of all
observed individuals experienced reliable decremental change on a particular ability over the
preceding seven years (Schaie, 1984). Average decrement before age 60 amounts to less
than two- tenths of a standard deviation, while by age 81 average decrement rises to
approximately one standard deviation for most variables (Schaie, 1984, 1996).
The magnitude of decrement, moreover, is significantly reduced, when the effects of age
changes in perceptual speed are removed (Schaie, 1989).Cohort effects (e.g.
generational differences in the amount of education) account for more variance in
intelligence than do *ontogenetic* (age-related, maturational) biologically based
factors. Termed the Flynn Effect: trend of increasing IQ scores from one generation to
the next.Individual differences in what skills decline as well as the extent of the
declines are substantial.The Flynn effect refers to a secular increase in population
intelligence quotient (IQ) observed throughout the 20th century (1–4). The changes
were rapid, with measured intelligence typically increasing around three IQ points per
decade.
➢ *Ontogenetic*: Ontogenetic development can be conceptualized as the portion
of physical, cognitive, emotional, and social development that can be
attributed to experiences with the environment and the individuals within the
environment.

2) Information processing approach ex: attention,memory,etc…

Information processing theory is an approach to cognitive development studies that aims to
explain how information is encoded into memory. It is based on the idea that humans do not
merely respond to stimuli from the environment. Instead, humans process the information
they receive.

Four patterns of cognitive aging: These patterns would classify individuals into:
● Those who age successfully (the super-normals),
● Those who age normally ((i) reach a relatively high level of cognitive
functioning who, even if they become physically frail, can remain independent
until close to their demise. (ii) reach a modest asymptote in cognitive
development .. may in old age require greater support and be more likely to
experience a period of institutional care)
● Those who develop mild cognitive impairment (MCI), and
● Those who become clinically diagnosable as suffering from dementia (Schaie,
2015)

Individual differences in patterns of change

The only most clear decline is in perceptual speed
 a) Individual’s health status: Participation in sports was found to be related to scores on
fluid intelligence.Hypertension, sensory functioning as well as arthritis, cancer and
osteoporosis were associated with decline in IQ scores
b) Gender: Women score higher on Digit Symbol (substitution of digits in speeded
coding task - Fluid). Men outperform women on numerical skills (Crystallised) and
spatial orientation (Fluid)

*assoications not necessarialy cause and effect of cognitive aging*

c) Level of education and socioeconomic status
d) Having a stimulating work environment
e) Having a spouse with high levels of education and intelligence
f) Retiring from a boring job is protective, from a stimulating job has negative impact
g) Personality
h) Rigidity-flexibility: more flexible individuals experience less decline
i) Intellectual self-efficacy: optimists declined most, and the pessimists the least

Recent Study confirms Individual Differences (Fiocco, 2009)

The study followed 2,500 people age 70 to 79 for eight years, testing their cognitive skills
several times over the years. 53% showed normal age-related decline and 16% showed
major cognitive decline.However, 30% of the participants had no change or improved on the
tests over the years.

Fiocco’s (2009) profile that differentiated people who maintain cognitive function vs age-
related decline:
● People who exercise moderately to vigorously at least once a week are 30% more
likely to maintain their cognitive function than those who do not.
● Those with at least a high school education are nearly three times as likely to stay
sharp.
● Elderly with a ninth grade literacy level or higher are nearly five times as likely to
stay sharp.
● Non-smokers are nearly twice as likely to stay sharp.
● Finally, people working or volunteering and people who report living with someone
are 24% more likely to maintain cognitive function in late life.

Studies of age effects on MEMORY

Studies have focused particularly on working memory, and long term memory.
Decline in working memory
Many of the cognitive deficits of normal aging (forgetfulness, distractibility, inflexibility, and
impaired executive functions) involve prefrontal cortical (PFC) dysfunction.The PFC guides
behavior and thought using working memory, essential functions in the Information Age.
Many PFC neurons hold information in working memory through excitatory networks that can
maintain persistent neuronal firing in the absence of external stimulation. This fragile process
is highly dependent on the neurochemical environment. (Wang et al., 2011)

The Stroop test

The Stroop test can be used to measure a person's selective attention capacity and skills,
processing speed, and alongside other tests to evaluate overall executive processing
abilities.

Efficacy of inhibition of distractors and span most affected

● Working memory paradigms require individuals to perform mental operations on
items held in conscious awareness, such as reordering words or numbers.
● While there is little evidence that short-term memory per se significantly declines with
normal aging, there is ample evidence that working memory abilities do. Within
working memory, efficacy of inhibition and smaller span are particularly vulnerable to
the effects of aging.

Memory and aging

Although episodic and working-memory performance decline in adulthood and old
age, evidence on the age of onset of decline is mixed.Most cross-sectional studies
suggest linear deterioration in episodic memory performance across the adult life
span, beginning as early as in the 20s.Longitudinal studies that apply appropriate
control for practice effects (i.e., test-retest effects) have yielded a very different
pattern, indicating that episodic memory performance remains relatively stable until
about 60–65 years of age, after which accelerating decline is typically observed
(Nyberg et al., 2012)

Assessment of age-related episodic- and semantic- memory change with cross-

sectional and longitudinal methods (graphs next slide)
(a) Cross-sectional data reveal early onset of decline.
(b) Longitudinal data indicate a positive gradient into high age.
(c) When effects of previous testing are statistically controlled (assessed relative to new
samples at subsequent waves), longitudinal data indicate episodic-memory decline after age
60.
(d) Education-adjusted cross-sectional data portray a similar picture with significant episodic-
memory decline at approximately age 60. (Nyberg et al., 2012) (see next slide)

Interindividual differences
However, there is marked interindividual variability in memory performance and such
differences may be magnified with advancing age.Some individuals may show reliable
decline as early as in their 50s. Conversely, others – in one study 10% - may show relatively
preserved memory functioning well into their 70s.

Long Term memory in aging

Experiment 1 tested episodic memory for surnames and occupations; no disproportionate

loss of name information.

Experiment 2 examined the ability to name photographs of public figures and of uncommon
objects; adults in their 70s did show an impairment in recall of names of known people, but
not of known objects.
Further analyses revealed systematic relations between naming, recognition, and rated
familiarity of the categories used. Familiarity largely determined the proportions of
recognizable items that were named in a prior phase. Overall, little evidence was found for a
disproportionate age-related impairment in naming in either episodic or semantic memory.
[ABSTRACT FROM AUTHOR] (Rendell et al., 2005)

Impact of name descriptiveness and aging on learning new names

26 young and 26 healthy older participants learned visibly- descriptive (e.g., Lengthy for a
giraffe), psychologically- descriptive (e.g., Classy), and non-descriptive (e.g., Sam) proper
names for previously-unknown cartoon characters.
More visibly-descriptive names were learned than psychologically- or non-descriptive
names, which did not differ from each other.
Older adults learned visibly-descriptive names as well as young adults but there were
substantial age-related deficits in learning psychologically- and non-descriptive names.
[ABSTRACT FROM AUTHOR] (Fogler et al., 2008)

Can Intellectual Decline with Increasing Age be Reversed by Educational

Intervention?
Schaie carried out interventions to remediate (1) known intellectual decline, as well as (2) to
reduce cohort differences in individuals who had remained stable in their own performance
over time but had become disadvantaged when compared to younger peers.
The cognitive training studies conducted with longitudinal participants suggested that
observed decline in many community dwelling older people was likely to be a function of
disuse and was therefore reversible for many.

Intervention in spatial tasks (Schaie & Willis, 1986)

Intellectual Decline with Increasing Age can be Reversed by Educational Intervention

Schaie found that:
Approximately two thirds of the experimental participants showed significant
improvement, and about 40% of those who had declined significantly over 14 years
were returned to their pre-decline level (Schaie & Willis, 1986; Willis & Schaie, 1986b).
Training effects were long-lasting with the trained participants still at an advantage over their
controls after 7 and 14 years (Schaie, 1996, 2004; Willis & Schaie, 1994).

Intellectual functioning in adulthood can be improved

● Even simple exercise/practice can produce significant improvement in memory task
performance
● Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)
➢ 2800 adults 65-94 yrs; 10 sessions of 1 hr in memory, or reasoning, or
processing, speed
● Improvement: 87% of participants in speed; 74% in reasoning; 26% in memory skills
● http://www.nia.nih.gov/newsroom/2006/12/mental-exercise-helps-maintain-some-
seniors-thinking-skills

Conclusion: main trends

Intellectual capacity does not generally decline before age 60-70, and different
abilities may show different trajectories.There are substantial differences in the
cognitive development and decline depending on a person’s personality, background
and life experiences.

Successful cognitive aging

Definitions
In quantitative studies: Physical functioning and freedom from disability were included in
nearly every definition, but no other component was present in more than 50% of the
studies. Overall, in 28 studies there were 29 different definitions used for successful aging.
Therefore, little agreement existed among researchers regarding the elements of successful
aging, beyond physical functioning. (Jeste et al., 2010)

Successful aging: different perspectives

● Older adults themselves were much more likely to emphasize adaptation to illnesses
and other psychological traits (e.g., optimism; sense of purpose) as well as
engagement (e.g., social relationships) in their concepts of successful aging.
● Differences also related to the method used, e.g. focus groups emphasized shared
experiences related to aging, whereas individual interviews focused more on
 developmental trajectories; and by culture of origin: e.g., older Japanese people cited
belonging vs. the American emphasis on independence

1) Selective optimization with compensation (Baltes)

Concert pianist Arthur Rubinstein at 80 was asked how he managed to maintain such a high
level of expert piano playing. He hinted at the coordination of three strategies:
a) Selection: he played fewer select pieces
b) Optimization: he practiced these pieces more often; to optimize performance
c) Compensation: to counteract his loss in mechanical speed he now used a kind of
impression management, such as playing more slowly before fast segments to make
the latter appear faster.

Success as defined by adults

Successful aging must ultimately be about what older adults value, rather than the chimera
(cells) of younger adult health in an older adult body (Glass, 2003).
● In a California study, women that were highest in subjectively rated successful aging
had high scores in psychologically protective factors:
➢ Resilience, self efficacy and optimism
➢ High in positive emotional functioning
➢ Low in physical symptoms (Vahia et al., 2012)

WHO policy on active aging

“It is time for a new paradigm, one that views older people as active participants in an age-
integrated society and as active contributors as well as beneficiaries of development”

The National Strategic Policy for Active Ageing: Malta 2023 - 2030
● Premised upon three key themes:
1) social inclusion,
2) healthy ageing,
3) the need to address diversity and inequality.

Active ageing refers to the situation where older and ageing persons have an optimal
opportunity to participate in the social fabric, especially in society’s decision-making
process, age healthily and independently, in a society characterised by social
fairness, equity and justice.
 ● Culture surrounds all individuals and populations, shapes the way in which we age
because it influences all of the other determinants of active ageing.
● Gender is a “lens” through which to consider the appropriateness of various policy
options and how they will affect the well being of both men and women.

Determinants of Active Aging

a. Health and social services: health promotion, disease prevention, equitable access,
long term
b. Behavioural: promote healthy behaviour across the life span – e.g. good diet, exercise,
no smoking
c. Personal: while personal genetic constitution has high impact, for many diseases and
psychological difficulties it is the environment that is mainly responsible
d.Physical environment: can be cause of injuries and enable or disable access
e. Social environment: can be abusive or enabling participation
f. Economic: income, work, and social security. Recognition of how older adults can
contribute to society in both formal and non-formal activities

The UN Decade of Healthy Ageing (2021–2030)

Reduce health inequities and improve the lives of older people, their families and
communities through collective action in four areas:
1) changing how we think, feel and act towards age and ageism;
2) developing communities in ways that foster the abilities of older people;
 3) delivering person-centred integrated care and primary health services
responsive to older people; and
4) providing older people who need it with access to quality long-term care.

Successful cognitive aging beyond IQ scores:

● Wisdom – fundamental pragmatic intelligence ; Multiple intelligences
a) Mechanics of intelligence: fluid intelligence such as cognitive operations of
speed and working memory (‘biological cognitive mechanics’ - Baltes)
vs
b) Pragmatics of intelligence: application of intelligence to the solution of real-
life problems (‘cultural cognitive pragmatics’ - Baltes)

Berlin Wisdom paradigm measures individual levels of wisdom by having participants

provide open-ended responses to scenarios describing fundamental life issues
(Baltes and Smith 1990).He measured levels of wisdom by presenting challenging,
hypothetical life dilemmas to research participants.
● Wisdom as “an expert knowledge system in the fundamental pragmatics of life”
(Baltes & Staudinger, 2000)
● Wisdom involves both specific knowledge about the meaning and conduct of life, and
general knowledge about human nature that transcends given cultural contexts and
historical periods (Baltes & Kunzmann, 2003).
 ● Wisdom as the pinnacle of human thought and judgement about the personal and
common good (Baltes & Kunzmann, 2004).

New models of intelligence (Sternberg) : WICS: Wisdom, Intelligence, Creativity,

Synthesised.
The WICS model is a possible common basis for identifying gifted individuals
(Sternberg, 2003c). WICS is an acronym standing for Wisdom, Intelligence, Creativity,
Synthesized. According to this model, wisdom, intelligence, and creativity are sine
qua nons for the gifted leaders of the future.The basic idea is that one needs these
three components working together (synthesized) in order to be a highly effective
leader.
● You need creative skills to come up with ideas.
● You need analytical skills (intelligence) to evaluate whether they are good ideas.
● You need practical skills (intelligence) to implement the ideas and convince others of
their value.
● You need wisdom to ensure your ideas help achieve a common good over the short
and long terms through the infusion of positive ethical values.

● Wisdom
➢ Caution: People Can Be Smart but Unwise
➢ The “Unrealistic-Optimism” Fallacy The Egocentrism Fallacy
➢ The Omniscience Fallacy
➢ The Omnipotence Fallacy
➢ The Invulnerability Fallacy
➢ The Ethical-Disengagement Fallacy
Multiple Intelligences and Emotional Intelligence
While the idea of the Pragmatics of Intelligence and use of the Wisdom Paradigm have
modified the use of IQ testing, at least three other major notions have impacted the
understanding of human intelligence:

● Multiple Intelligences (Gardner)

Gardner (1983): intelligence as the “ability to solve problems, or to create products, that are
valued within one or more cultural settings.” Eg: if you play a musical instrument, have a
good sense of rhythm and enjoy going to concerts, it may be due to a strong musical
intelligence.If you struggle to talk with and relate to other people and understand their
feelings, your interpersonal intelligence is under-developed.
Gardner proposes 9 key intelligences, which he believes every individual possesses to a
greater or lesser degree. Each and every intelligence can be strengthened or weakened by
our experiences.Gardner suggests that the question we should be asking (particularly in
education), is not ‘How intelligent are you?’, but ‘How are you intelligent?’

● Emotional/Social Intelligence (Salvoney; Goleman)

Two of Gardner’s intelligences can be described as Emotional-social Intelligence
➢ Interpersonal Intelligence -- capacity to detect and respond appropriately to
the moods, motivations and desires of others.
➢ Intrapersonal Intelligence -- capacity to be self-aware and in tune with inner
feelings, values, beliefs and thinking processes.
Also referred to as ‘emotional literacy’ or ‘social emotional learning’ or ‘emotional
competence’, The term embraces an understanding of the importance of social and
emotional development in our general health and well- being as well as learning:
“ Emotional Intelligence is a master aptitude, a capacity that profoundly affects all other
abilities, either facilitating or interfering with them.” (Goleman, 1994, p. 80)

“In navigating our lives, it is our fears and envies, our rages and depressions, our worries
and anxieties that steer us day to day. Even the most academically brilliant among us are
vulnerable to being undone by unruly emotions. The price we pay for our lack of emotional
literacy is in failed marriages and troubled families, in stunted social and work lives, in
deteriorating physical health and mental anguish and, as a society, in tragedies such as
killings...”(Goleman, Report on emotional literacy, 1994)

AREAS OF EMOTIONAL INTELLIGENCE

● Self-awareness--knowing your emotions, recognizing feelings as they occur, and
discriminating between them
● Self regulation--handling feelings so they're relevant to the current situation and
you react appropriately
● Self-motivation--"gathering up" your feelings and directing yourself towards a goal,
despite self-doubt, inertia, and impulsiveness
● Empathy--recognizing feelings in others and tuning into their verbal and nonverbal
cues
● Managing relationships--handling interpersonal interaction, conflict resolution, and
negotiations

SKILLS ASSOCIATED WITH HIGH EMOTIONAL INTELLIGENCE

● Confidence
● Curiosity
● Intentionality
● Self-control
● Relatedness
● Capacity to communicate
● Ability to cooperate

EI can enhance well-being in aging (Chen et al., 2016)

Past literature suggests that emotional intelligence may increase with age and lead to
higher levels of SWB in older adults. A total of 360 Chinese adults (age range: 20 to 79
years old) participated in this study. They filled out questionnaires that assessed their age,
life satisfaction (The Satisfaction with Life Scale), affective well-being (The Positive and
Negative Affect Schedule), and emotional intelligence (The Wong and Law Emotional
Intelligence Scale). Emotional intelligence partially mediated the relationship between age
and life satisfaction, and fully mediated the relationship between age and affective well-
being. The findings suggest that older adults may use their increased emotional intelligence
to enhance their SWB.
 ● Creativity
The ability to produce new products, ideas, or inventing a new, novel solution to a problem.
Evaluation of Wisdom-Based Products ; Extent to which the process of generating the
product takes into account; The common good, Positive ethical values, The long- as well as
the short-term, Intrapersonal, interpersonal, and extrapersonal interests (Sternberg)

Creativity across the lifespan

The creative process

The creative person
The creative product

Creativity is most widely defined as a human capacity to produce ideas and products
that are both novel and useful or appropriate (Karwowski et al., 2016)

Creative person - Creative process - Creative product

Creative Process: Psychologists have disagreed on the nature of creativity.

Until about 1980, research concentrated on identifying the personality traits of creative
people, but more recently psychologists have focused on the mental processes involved.
A growing interest in creativity as a source of competitive advantage has developed in recent
years: not just for the development of new products and services, but also for its role in
organizational decision making and problem solving.Many organizations actively seek a
corporate culture that encourages creativity. There are a number of techniques used to
foster creative thinking, including brainstorming and lateral thinking.Creativity is linked to
innovation, the process of taking a new idea and turning it into a market offering.

The creative process involves reexamining assumptions and reinterpreting facts,

ideas, and past experience.Intellectual process but not necessarily connected to
giftedness. ‘Openness to experience’ ... ‘A special kind of perceptiveness ... can see
the fresh, the raw, the concrete, the idiographic, as well as the generic, the abstract,
the rubricised, the categorised and classified’ (Maslow)
Insight - Aha experience - Incubation
● Creative process as insight: Insight: The “Eureka” Moment
This moment is traditionally referred to as the “insight” stage of the creative process,
or what some have playfully dubbed the “Eureka!” moment. (It's also occasionally
called the illumination stage in the creative process.)As Archimedes stepped into the
bathtub, he noticed that his body, definitely an irregular solid, was displacing water
whose volume he could measure. The usual account has him running naked through
the streets of Syracuse shouting ecstatically "Eureka, I have found it."
● Insight experience: Ideas come suddenly, unexpectedly, and are accompanied by
pleasure, excitement, and confidence in their rightness (Topolinski & Reber, 2010).

Creative process continues to energise older persons

“I think that the biggest satisfaction is just doing and finding out about something in nature
that has never been known before. There is the satisfaction of seeing what some of these
molecules look like. I suppose it is very personal.Other people find satisfaction doing
something that has never been done before, writing music or painting pictures.“ (Outstanding
chemist in her 70s – cited in Csikszentmihalyi, 1985)

Creative persons associated with continuing creativity into old age

Studies of highly successful artists, musicians, performers, writers and scientists and
inventors who continued to produce creatively into their older age.Started by Lehman (1953)

Creative Person/product: Traditional definition

● The ability to produce a notable or extraordinary piece of work, judged as
being novel, useful to society, having an impact on society, and having an
element of surprise.
● This definition was used as a gauge of how age is related to the peak productivity of
artists and inventors.

Simonton, D.K. (1991). Career landmarks in science: Individual differences and

interdisciplinary contrasts.Developmental Psychology. Vol 27(1), Jan 1991, 119-130.

A conceptual framework is introduced for interpreting individual differences in the

developmental location of the first, best, and last contributions of a creative career.
A total of 2,026 scientists and inventors were studied regarding age at career onset, lifetime
productivity, and eminence of products.
Socio-economic and cultural factors
Certain disadvantaged sectors of the population, have less opportunity to achieve good
health and full expression of abilities. E.g. less women listed as creative and productive
achievers (made up 50% of Lehman’s list only in children’s literature)
Lower proportion of African Americans listed.

Characteristics of last works

1. Emergence of new style: eliminates fine details and presents the essence of the work’s
intended meaning more intensely.

2. Swan song phenomenon: A brief renewal of creativity that can stimulate the creation of
new works and a new style of work (e.g. Mozart’s Lachrymosa - in Requiem
https://www.youtube.com/watch?v=k1-TrAvp_xs

3. In scientists and academicians: move from innovation and discovery towards

integration and synthesis of existing knowledge

Improving creativity; Edward Debono:

 ● Thinking is ‘the operational skill with which intelligence acts on experience’
● Thinking skills can be taught;
● One can improve one’s lateral thinking independently of one’s intellectual capacity:
● Thinking is like the driver of a car: whatever the car’s capacity, its driving can be
more or less creative.
● Debono’s thinking skills programme is offered to adults and children of all levels of
intelligence.
● It is presented as an inclusive approach as nobody is left out: even if you are unable
to read, you can still engage in learning to think.

Lateral thinking
Disadvantages of ‘point-to-point’ logical thinking
Lateral thinking enables person to: See things more clearly and more
broadly;See things differently (so lateral thinking)

Thinking tools
Use of acronyms:
● P.M.I.: Plus – Minus – Interesting
● CAF: Consider All Factors
● A.P.C.: Alternatives – Possibilities – Choices F.I.P. : First Important Priorities
● A.G.O.: Aims – Goals – Objectives
● NO vs PO

Six Thinking Hats

1. Information – what we have, what we are doing
2. Feelings, emotions, expression with no inhibition
3. Caution, risk assessment (often overused)
4. Benefits and values
5. New ideas – alternatives, modifications, possibilities
6. Metacognition – management of the thinking process
Physical activity and Open- mindedness best for healthy aging. Personal qualities of
openness and flexibility predict creativity and success in later adulthood. Curiosity, openness
to experience and ideas enables keeping up with the times and adapting to changing
circumstances .Physical exercise is the most consistently associated with healthy physical
and mental aging.
https://www.youtube.com/watch?v=KTx2Su67DUw

Older Adulthood
● Introduction: Existential Challenges of Older Adults
● Relationships and older adults
● Sexuality later in life
● Wisdom

Existential challenges of older adults

Existential approach
● A philosophical theory - Key concepts in Existentialism
● Living in the present
● Increasing self awareness and authentic living
● Finding personal meaning, purpose and values of life ▪Creating an identity and
establishing meaningful relationships ▪Coping with anxiety
● Being aware of death and non being
● Taking responsibility for decisions

Existential Challenges and Older Adults; The aging stage poses important challenges:
▪Coming to terms with the transitory character of life.
▪Coping with the approach of death and parting.
▪Enduring illness and suffering.
▪Being confronted with the question of the meaning of life and ultimate religious questions.
▪Finally, managing problems of loneliness, anxiety and depression.
These challenges are existential in nature.
Existential Dilemmas: The Givens as Dialectics
YALOM (1980) CONCEIVES OF FOUR ‘GIVENS’ OF HUMAN EXISTENCE.
1. Death
2. Loss of Freedom
3. Meaninglessness
4. Isolation

GREENING (1992) UNDERSTANDS THE GIVENS AS EXISTENTIAL DIALECTICS;

Dialectical Theory has its roots in the Chinese philosophy of Yin and Yang -- i.e., all
aspects of the universe contains the seeds of its opposites -- as well as the Western
philosophy that the world is in constant flux (change), with creative and destructive
forces constantly operating upon each other.
1. Life and Death,
2. Freedom and Determinism
3. Meaning and Absurdity
4. Relatedness and Separateness

According to Greenberg psychological health or maturity is the capacity to accept

and creatively respond to all four existential dialects.

1) Dealing with Morality

In older adults, the awareness of death naturally increases, and the elderly devote
more attention to this particular reality.Knowing that the remaining time becomes
shorter and shorter, coping with what is left of life can become a burden or appear to
be senseless.This can create the feeling that everything is in vain and useless, that
nothing is worth the effort any more because everything is transitory and will be
claimed by death.
➢ Dealing with the theme of death
One response is being pessimistic obsessed with dying which results in
withdrawal from life and neglectful of health.A healthy response is to confront
the dialectic of life and death and engage fully in the present moment.It is
important to support the elderly to choose life, to seek involvement with the
world at the same time knowing that one day we all will die.
 2) Older Adults and the Theme of Freedom
Ageing is a stage in one’s life where one is confronted with the dynamic of freedom
and destiny or limitations.One response is despair as result of dysfunctional
identification with limits.Man has to say good-bye to a lot of things in the course of
life, but never more than in old age:
● The loss of physical performance and strength
● The loss of psychological and mental flexibility
● The loss of social and professional rank, financial means
● Passing away of friends and relatives

A creative response is acknowledging one’s limitations and enhance a capacity for meaning
by an exploration of possibilities and spiritual connection in one’s life.

3) Older Adults and the Theme of Meaning

Search for meaning in life at this particular stage becomes central.Losses and
hopelessness make life appear pointless. This feeling of pointlessness in old age is
even increased if the workaholic of the past feels useless, or feels that one is even a
burden on his/her fellow men.So what is this life good for?Life points to the future.
Weakness, frailty, ailing and illness and finally the neediness of the elderly all
indicate that the force of life is broken. The meaning of that the force of life is broken.
The meaning of life seems to be fulfilled - what is left is but waiting for death.The
finding of a personal answer to this limit experience is without doubt one of the
biggest challenges of human life.One response is to assist the elderly in their
quest to actualize their life meanings. It may take many forms such as to find new
ways how to choose and act to make satisfying personal meanings.

4) The Isolation OF Older Adults

Perhaps the biggest problem of old age is the isolation of older adults who, having
left the working process, suddenly find that the contacts with the busy world wane,
that partners and friends die, that sometime or other they will be alone and find no-
one to talk to or no-one would even be interested in talking to.It can sometimes feel
like solitary confinement.Forced to silence without anything to say because you are
not asked any more leads to a dissolution of important relationships in life.This reality
gives way to a loose type of vegetating unless the individual is strong and practiced
enough to exercise and maintain mental activity (reading, art, letters, religion etc.)

The Importance of Relatedness and Separateness in Older Adults

Thus, one can acknowledge the significant importance of relationships and older adults
keeping in mind that: We are social beings conceived, born, raised and fulfilled in
relationships, At the same time, we are separate physical and psychological entities

Reflections:
How do ageing persons find meaning and make sense of this stage in their lives? How do
older adults deal with relatedness and separateness? How can they establish meaningful
relationships and maintain their identity?

Schneider, K.J. & Krug, O.T. (2010). Existential-Humanistic Therapy APA Washington DC.

Relationships and Older Adults

Connection VS Isolation

The Phenomenon of Loneliness

It is incredible how the phenomenon of loneliness is increasing at the same time that we
have a society full of technological means with which we can communicate. So we ask, are
we living in a more impersonal world? Is it true that we have become more concerned about
ourselves and those close to us and much less about others?How is this related to the
elderly?

The Importance of Relationships

Oxford Dictionary defines relationships as the way in which two or more people or
things are connected, or the state of being connected. Social relationships—both
quantity and quality—affect mental health, health behavior, physical health, and
mortality risk.

Social isolation of otherwise healthy, well-functioning individuals eventually results in

psychological and physical disintegration, and even death.For older adults, developing
various positive sources of social support also can reduce stress, ward off anxiety and
depression, and reduce the risk of some physical health concerns.
Social Theories of Ageing
● Disengagement theory: Social interaction declines. Mutual withdrawal between
elders and society takes place in anticipation of death (Cummings & Henry, 1961).
● Activity theory: Emphasizes that social barriers rather than elders’ wishes decline
rates of interaction. It is harmful to the well-being of older adults to force them out of
productive roles (Cavan, Burgess, Havighurst & Goldhamer,1949).
● Continuity theory: Most ageing adults strive to maintain a personal system – an
identity and a set of personality dispositions, interests, roles and skills –that promote
life satisfaction by ensuring consistency between their past and anticipated future
This provides a secure sense of routine and direction in life (Atchley, 1999).
● Socioemotional selectivity theory: According to this view, physical and
psychological aspects of aging lead to an increased emphasis on the emotion-
regulating function of social interaction. Social networks become more selective.
Prefer more high-quality emotionally fulfilling relationships (Carstensen,
1991,1995,1996).
As people age, they tend to spend less time with others. (Carstensen,
1996).According to socioemotional selectivity theory (Carstensen,1991,1995,
1996), older adults become increasingly selective about the people with whom
they spend their time.However they tend to be more satisfied with those they
have. ( Antonucci & Akiyama, 1995).Most older people’s lives are enriched by the
presence of long time friends and family members. Personal relationships continue to
be important.

Relationships: The Family

Cicirelli, 1980 1989b Rossi & Rossi, (1990) state that elderly parents who have a strong
relationship with their middle-aged children out of earlier attachment continues through the
rest of their lives.

● Siblings: For most people relationship with brothers and sisters are long-lasting
(Paul, 1997 cited in Papalia et al 2007). Older people who are close to their
siblings express a sense of peace with life and themselves.
● Sandwich generation: Midlife couple positioned between the needs of children
and the needs of the ageing parents.
● Older adults resume an active parenting role when their children need help such as
financial assistance and serve as care givers.
Grand Parenting
Older adults express their generativity through interacting with the youngest
generation.
● Grandparenting
● Skipped generation family (Bryson& Casper, 1999 cited in Whitbourne 2005)
Raising grand-children; that is taking the responsibility as caregiver for the
grandchild. This unplanned role can create physical, emotional and financial
strains.This can happen for various reasons: such as substance abuse by
parents, child abuse or neglect, failure of parents to handle children and
incarceration of parents.
● Relationships with Grandchildren
➢ Sociologists Andrew Cherlin and Frank Furstenberg (1986) after interviewing
510 grandparents identified three styles of grand parenting:
❖ Remote – interact in an unattached and distant way, little direct
contact with children
❖ Companionate - interact in a relaxed affable manner but take
almost no direct responsibility for them
❖ Involved:- take an active role in raising grandchildren exercising
considerable influence on their socialization and express definite
expectations for their behaviour

● Patterns of Grand parenting

➢ Neugarten and Weinstein, (1964) identified five types of grandparents:
1. The formal grandparent: interested but not overly involved
2. The fun seeker: entertainment for the child
3. The surrogate parent: caretaking role
4. The reservoir of family wisdom: dispenses advice and controls
5. The distant figure: infrequent contact

The Prospect of Dependency Concerning the Family

In a society in which both generations in the family, value independence.One major concern
for the elderly is the dilemma : Between not wanting to be a burden on their children, Yet
Afraid that their children will not take care of them (abandonment)
Friends
Friendship is important to older adults. Many studies have shown the positive benefits of
friendship on social, emotional and physical well-being.Friendships serve a variety of
functions; intimacy and companionship, acceptance, and a link to the larger
community.Having a strong circle of friends can be a good boost for ageing hearts
and can help the body's autoimmune system to resist disease.For retired people, social
capital can decline due to reduced contact with former work colleagues, the deaths of friends
and family members, and loved ones moving away.The loss of social contacts can have a
direct impact on mental and physical well- being. Friendships offers protection from
the psychological consequences of loss.

Hartup and Stevens 1997 cited in Whitebourne 2005 suggested that the major
dimensions that underlies close relationships is reciprocity or a sense of mutuality.
It is a give and take relationship based on:
● The Emotional level involving intimacy, emotional support, sharing and
companionship.
● The Behavioural level which is expressed in actions such as exchanging
favours, gifts, and advice.

Community groups like senior centres offer one source of friendships. Senior living
communities provide multiple opportunities for spending time around other people, including
exercise classes, meals and a variety of other activities such as finding an organization and
volunteering.

Intimacy is important to older adults. They need to know that they are still valued and wanted
despite physical and other losses.Women tend to see their friends a least as often as in
the past.Older men see friends less, see them in groups rather than one to one, and
consider friendship less important (Field and Minkler, 1988).
Older people enjoy time spent with their friends more than spend with their families.
Often friendships are maintained by telephone and mail and tend to be less intimate than in
earlier years.
Living in Institutions
Modernization, industrialization and migration are undermining the extended family
and caring for the elderly.Declines in fertility have resulted in a rapidly aging population
and a shortage of family caregivers.In developed countries residential care increased.
Comprehensive geriatric home visitation program in UK, Denmark and Australia
proved effective in:
● Preventing functional decline
● Decreasing home admissions
● Friendly Visitor Programmes
● Emotional Support
● Listening to the inner life of the elderly

Being with the experience of the elderly

● Share their sense of emptiness
● Evaluating regrets
● Dealing with unfinished business
● Mourning their losses: health, loved ones, youth, dependency ▪Dealing with a sense
of abandonment
● Fear of the future: death, disabilities ▪Coming to terms with a sense of guilt ▪Giving a
new meaning to their lives

Those in close contact with the elderly need to be aware of how the elderly strive to
deal and adjust to such existential realities.

Elder Maltreatment
About 1.5 million Americans over 65 are mistreated by people closest to them every year.
Elder maltreatment take different forms:
● Physical abuse
● Physical neglect (3rd most common)
● Psychological abuse (2nd most common) Emotional abuse such as verbal assaults,
humiliation, and intimidation.
● Sexual abuse
● Financial abuse (most common form)
Risk Factors
● Psychological disturbance and stress of the perpetrator
● Sexual Abuse
● History of family violence
● Institutional conditions
● Dependency of the victim
● Dependency of the perpetrator
● The role of dependency: The more dependent the elder is on the caregiver or the
caregiver on the elder the greater the risk of elder abuse.

Strategies for Prevention of Maltreatment

● Housing Services: Short term day-care facilities and permanent shelter
● Health Services: Home nursing, health care centres
● Home maintenance services: Assistance with housekeeping, shopping Supportive
services: friendly visitor programmes, affordable counselling
● Guardianship and financial services: Protective services for neglected and abused
elders

Reflections; Granny Dumping

Is it an indication of family deterioration?
Is it losing a sense of responsibility or obligation towards the elderly?
Is it a reflection of the health care system strained because of so many needy elders?
What would help families and social institutions to regain their ability to be responsible
caregivers?

Optimal Ageing
Elders who experience optimal ageing have developed many ways to minimize losses and
maximize gains.Societal contexts that permit older adults to manage life changes effectively
foster optimal ageing.These include well-funded social security plans, good health care,
safe adequate housing, social services and opportunities for lifelong learning.
Possibilities to remain gainfully employed. (Those who may call themselves "semi-retired”).
Conclusion
Older adults need to resolve the dialectic of relatedness and separation by feeling connected
in relationships at the same time maintain their sense of self.Older adults need to be treated
with dignity as persons. Attention is given to their holistic experience: physical,psychological,
social, emotional and sexual well being.In our interactions with older adults maltreatment is
never justified and one needs to be careful not to adopt infantilizing behaviour.
Developing various positive sources of support can reduce stress, ward off anxiety
and depression, and reduce the risk of some physical health concerns.Moreover the
right support systems facilitate and promote optimal ageing.

Sexuality in later life

Entering into a new relationship later in life, gives older adults the chance to experience love
and happiness once again, especially after the loss of a partner.

Intimate Relationships in Older Adults

● Marital satisfaction peaks: Less stressful responsibilities, shared leisure activities and
positive communication increase.
● Divorce: Stress is higher for older than for younger adults. Greater financial hardship
and less likely to remarry. Women suffer more than men from late-life divorce.
● Cohabitation: Older adults are choosing cohabitation over remarriage for financial
and personal reasons.
● Widowhood: Wide variation exist in adaptation to widowhood. Age, social support
and personality make a difference. Elders fare better than younger individuals, and
women better than men. Efforts to maintain social ties, an outgoing personality, high
self-esteem and a sense of self-efficacy foster adjustment
● Never-married and childless: Most develop alternative meaningful relationships.

Love
Although love at first sight can happen at any age, it is especially characteristic of young
people.Our youth-obsessed culture pays little attention to the love affairs of the elderly.
Triangular Theory of Love

The Meaning of Love and Older Adults

According to Robert Sternberg’s Triangular theory of love, love has three elements:
1) intimacy,
2) passion
3) commitment.
One pattern of loving is companionate love, in which both intimacy and commitment are both
present.This is a long-term committed companionship, often occurring in marriages in which
physical attraction has died down but in which the partners feel close to each other and have
made the decision to stay together.It is the feelings of being cared for and loved rather
than the quality of sexual performance that matters most. (Bird & Melville, 1994)
Intimacy and Older Adults
● Intimacy may or may not include sexual contact. It includes emotional, social
(based on shared experiences), and physical intimacy (touching, cuddling,
sexual intercourse).
● The need to form strong, stable, close, caring relationships is a powerful
motivator of human behaviour. Thus, intimacy includes a sense of belonging.
● An important element of intimacy is self disclosure. People remain intimate
through shared disclosures, responsiveness to one another's needs, and
mutual acceptance and respect.
● Intimacy is important to older adults. They need to know that they are still valued
and wanted despite physical declines and other losses.
● People tend to be healthier, physically and mentally, and tend to live longer if they
have satisfying, close relationships.

Sexual Activity in Later Life

A prominent stereotype of the elderly is that they are asexual.
The problem of ageism stems from the elderly not being seen as physically attractive.
This is reflected in a study done by Lyons (2009) who had students draw sketches of elderly
people.The students drew images which lacked clear gender, explaining that older people
are seen as sexless, lacking sexual desire, interest, ability, and activity, according to
the stereotypes.

Societal Views: Sexuality and Ageing

● A prominent stereotype of the elderly is that they are asexual.
● Sexuality tends to be associated with youth and beauty rather than old age.
● Ageist humour portrays older adults interested in sex life as “dirty old men”.
● At times even interpreted as perversive sexual behaviour.
● Attitudes regarding the elderly and sexuality are often negative as they are seen as
being asexual after reaching a certain age (Chapman, 1999).
● This stereotype manifests itself in society’s negative reactions, such as
disgust, shame and embarrassment to sexual expression of older people
( Hinchliff & Gott 2011).
● Older people do not receive support from society that wanting a sex life in later
adulthood is normal and healthy.
The Media and Sexuality in Later Life
Media portray sex as being for the young and slim.It rarely shows older adults as being
sexual, unless it is for the promotion of medicine, like Viagra.This reinforces the stereotype
that sexuality diminishes with age with lack of knowledge of this life stage, resulting
in myths and cultural norms being advertised. Due to these myths, ageing is believed to
be a negative event and a life stage to be feared and denied.

Older Adults’ Perceptions of Sex in Later Life

In a study done by the AARP (2005), the participants rated sexual activity as a critical part of
a good relationship and having a satisfying sexual relationship improved their quality of life.
The Maltese context:
● It is interesting to note that in a study by Bonello (2018), the Maltese elderly still
seem to have reserved attitudes towards sex based on their prior Catholic culture
and upbringing.
● Bonello (2018), also states that social class and manner of upbringing were key
elements which affected the perception and attitudes of the elderly towards
sexuality in later life.
● Attard (2011), points out how females viewed sexual activity as being
pleasurable for the males while for females it was more an act of giving
something to their partner rather than pleasure.
● However, according to Stuart-Hamilton (2012), a stereotyped view, that loss of
sexual functioning and a partner is considered as part of ‘normal ageing’ might act as
a comfort and might lessen the negative effects.

Sexual Activity
Studies show how female sexual desire and sexual activeness decreases with age
while for males it increases or remains active. Nappi et. al. (2014), found that sexual
functioning, may be affected by:
● The presence of a partner
● The age and health of the individual and their partner
● The length of the relationship
● The feelings involved

Even though biological factors have an impact on sexual activity, it does not mean that
sexual activity should decline. There are other means of being sexual such as kissing or
hugging and caressing or sexual touching. This was the most frequently mentioned
sexual activity the participants engage in (AARP, 2005).
Physiological Factors
● It is noted that ill health and stress hinder sexual satisfaction (AARP, 2005).
● The elderly's concerns are related to the biological domain, where performance
may be hindered by sexual dysfunctions, hormone deficiencies and poor
health.
● Medication is effective in the majority of cases for treating erectile dysfunction. Yet
certain medication can have a negative effect on sexual activity.
● Men reported less trouble with premature ejaculation, but had more difficulty in
both getting an erection and maintaining it.
● Physiologically women experience difficulty in lubrication and arousal which
hinders their sexual activity (Carpenter et al., 2009).
● The prevailing sexual dysfunctions for the elderly include hypoactive sexual
desire disorder, diminished libido, orgasm problems, vaginismus and pain
disorder (dyspareunia) for women, while men suffer from erectile dysfunction
and premature ejaculation.

Psychological Factors
The following factors impact sexual functioning negatively (McNicoll, 2015 cited in Bonello,
2018).
● Body image, feeling less attractive due to bodily changes
● The feeling of losing one’s femininity or masculinity
● The fear of being rejected by a partner
● Having performance anxiety
● Guilt feelings
● Fear of abandonment and isolation
● Past sexual problems

Psychological and Social Aspects

Psychological Factors such as stress, depression and anxiety interfere with sexual
functioning. Denying the expression of sexuality in the elderly could lead to
“loneliness, withdrawal and depression, with an impaired quality of life” (Melguizo-
Herrera, et al., 2017, pp.7114).

Mental health issues have an impact on sexual functioning, such as dementia; may
express inappropriate sexual behaviours and sexual disinhibition (McNicoll, 2015, cited
in Bonello, 2018).
 ● Females express the desire for sexual activities, however, they worry that their
desire is undignified and disgraceful.
● Marital problems, also having an impact on the couple's sexual activeness.
Being unmarried, widowed or divorced, and having a low education level also
affect the sexual desire and functioning of both men and women.
● External factors, like grandchildren, may affect the relationship of a couple as
energy is reserved for babysitting.

Benefits of Sexual Activity

● Good physical and mental health, a positive attitude toward sex in later life, and
access to a healthy partner are associated with continued sexual activity, and
regular sexual expression is associated with good physical and mental health.
● Studies show that sexually active older people report great satisfaction in whatever
activity they indulge in (Stuart-Hamilton, 2012).
● Elderly who do not have a regular sexual partner, have different attitudes regarding
sex and their outlook on life, compared with those who have a regular sexual
partner being more content and optimistic about current and future situations
show that the latter are at less risk for depression (AARP, 2005).

Conclusion
Sexuality in later life remains a largely unexplored and taboo topic.Furthermore, the
pervasive social influence of the media, reinforces and perpetuates the asexual stereotype in
society by narrowly portraying older adults as asexual.It is important to understand how the
current generation of older adults perceive sex at their age, to be able to shift the attitudes of
the elderly towards more positive talk in regard to sexuality in later life.Furthermore, gaining
knowledge regarding sexuality in later life will prove useful in creating better services to aid
older adults in any sexual issues they experience.This is of significant benefit for both for the
aging generation present today, as well as preparing for those that will come of age in future
years.
Wisdom ; Is wisdom more related with Ageing?

Sources of Wisdom
Modern psychologists who investigate wisdom have drawn on:
● Folk,
● Mythic and philosophical traditions.
● Books of Wisdom: Bible

Definition: Wisdom
Wisdom is a complex, multi-faceted construct and there is no consensus on its
definition, instead there are a variety, of mostly overlapping theories of wisdom.
(Baltes and Staudinger, 2000).

Some theorists view wisdom as a cognitive ability, others as a combination of

intellect and emotion while others focus on the spiritual domain.

Definition: “The quality of having experience, knowledge, and good judgement; the quality of
being wise.” Oxford Dictionary

Key Figures
1) Erik Erikson
➢ In 1950 Erikson suggested that wisdom arose during the eight and final stage of
psychosocial development which he described as “ego integrity vs. despair”.
➢ He stated that if an individual had achieved “ego integrity” over the course of a
lifetime, then the imminent approach of infirmity and death would be
accompanied by the virtue of wisdom.
➢ Erikson’s observations left the door open for the formal study of wisdom.

2) Robert J. Sternberg
➢ “Wisdom is really hard to study - really hard”. Yet he believes it is essential to
the future of society.
3) Vivian Clayton
➢ She is recognized as the first psychologist to ask in scientific terms:“What does
wisdom mean, and how does age affect it?”
➢ In contrast with intelligence which she defined as an ability to think logically and
abstractly she defined Wisdom as an ability to grasp paradoxes, reconcile
contradictions, and make and accept compromises.
➢ Intelligence can figure out how to do something Wisdom asks whether it
should be done. This encompasses moral and ethical implications.

4) John a. Meacham
➢ Who is more likely to be wise the young or the elderly?
➢ Meacham (1990) claims that wisdom is more an attribute to the young. His argument
is that older persons tend to have more experience, yet they might think they know
too much and are too sure of their knowledge.
➢ Wise people challenge their inherent fallibility. (the possibility that someone will make
mistakes or that something will not work as it should)
➢ Wisdom comes from knowing less or becoming less positive of what one
knows and be able to allow the expression of doubts and uncertainties.
Socrates “the wisest man is the one who knows that he knows nothing”

5) Paul Baltes
➢ Wisdom for Baltes, P. is; "Expert Knowledge of the fundamental pragmatics of
life”
➢ What are the 'fundamental pragmatics of life' ?
The fundamental pragmatics of life consist of knowledge and skills that go to
the heart of human condition - the conduct, interpretation and meaning of life.
“Permitting excellent judgment and advice about important and uncertain
matters”. (Baltes1993).
➢ Baltes suggests that knowing how humans think and act gives people the ability to
understand alternative viewpoints on life's problems. This knowledge is formed from
overcoming tough life situations.Baltes also suggests expert knowledge can be
learned from wise teachers or texts. Wisdom becomes apparent when this
knowledge is applied during problem solving. Wise people have the broad
understanding of options and viewpoints needed to formulate the best
possible solution to life's dilemmas.
➢ Explicit Theory of Wisdom; Baltes Group- five Criteria of Wisdom
1. Factual knowledge
2. Procedural knowledge
3. Lifespan contextualism
4. Relativism of values
5. Recognition and management of uncertainty.

➢ ‘Fundamental Pragmatics of Life'; Baltes (1993) states that people who are
wise:
● Develop interest and capacity to exercise judgment.
● Develop insights regarding the finitude of life.
● Have greater appreciation for individual differences in values and
beliefs.
● Gain the ability to recognize and manage uncertainty as a fact of life.

6) Gisela Labouvie-Vief
 ➢ A prominent theorist offers a theory of a cognitive-emotional complexity. (1980).
Defines wisdom as an integration of two modes of Knowing:
1) Objective, analytical and rational (Intellect)
2) Subjective, experiential, and emotional (Affect)
Emphasizes that wisdom encompasses morals and ethics

7) Laura Carstensen
➢ L. Carstensen, PhD. Founding Director of the Stanford Centre on Longevity.
➢ She states that older people in general seem to have a better feel for keeping
the emotions in balance.Carstensen (1996) calls this “socioemotional
selectivity theory”
➢ She states that many elements of emotional regulation seen in older adults are
consistent with qualities identified by the wisdom researchers. One such
theory is Labouvie-Vief’s theory of wisdom.
➢ Emotions and Older People Carsesten (1994); Despite the well-documented
cognitive declines associated, with advancing age older people seem to
manage their emotions in a profoundly important way.They experience
negative emotions less frequently and exercise better control over their
emotions. They rely on a complex emotional and nuanced thermostat that
allows them to bounce back quickly from adverse moments.Thus they strive
for emotional balance which in turn affect the ways their brains process
information from their environment.
➢ “Younger people tend to be either positive or negative at any given point in their daily
life while older people are more likely to experience mixed emotions, happiness and
a touch of sadness at the same time. Having mixed emotions helps to regulate
emotional states better then extremes of emotions.
➢ Younger people tend to cling to negative information neurologically speaking
while older people seem better able to shrug it off and focus more on positive
images. Carstensen says that older people “disattend” negative information.
➢ This influences the motivation to savour the day-to day experiences and allows
one to be more positive.
➢ Unconsciously this is shaped by one’s sense of time. (Existential issue)
 ➢ Wisdom and Spiritual Growth; Studies examining wisdom cross-culturally find that:
Westerners define wisdom using cognitive dimensions (e.g. rationality and
knowledgeable).Eastern societies stress the detachment from conscious mind
as a path to inner spiritual growth.Influenced by the eastern philosophy some
psychologists define wisdom as based on spiritual development and is likely
to develop late in life.

8) Achenbaum and Orwell

➢ Wisdom and Spiritual Development
According to Achenbaum and Orwell, (1991) Wisdom has three interrelated facets:
1. Intrapersonal wisdom: (self examination, self knowledge and integrity)

2. Interpersonal wisdom: (empathy, understanding, and maturity in human

relationships)

3. Transpersonal wisdom: (capacity to transcend the self and strive for

spiritual growth)

➢ Spiritual development may be more associated with later life because of

interiority which is a tendency toward introspection and concern with inner life.

9) D. Jeste and Thomas W. Meeks

➢ In 2009, two American doctors in San Diego set about trying to identify neural
activity associated with wisdom.
➢ In order to do so, Dilip Jeste, a neurologist and Thomas Meeks, a psychiatrist,
conducted a review of the wisdom research literature to date, hoping to find common
characteristics shared amongst the various wisdom models.
➢ Meeks and Jeste synthesise previous definitions of wisdom into a convenient
and helpful short-list of just 6 elements.
 ➢ Attributes of Wisdom; Six subcomponents of wisdom by Meeks and Jeste
(2009)
1. Prosocial attitudes/behaviours: Working towards a common good
2. Social decision making/pragmatic knowledge of life: Practical knowledge,
judgement, life skills etc.
3. Emotional homeostasis: Managing one’s emotions amidst challenging
circumstances
4. Reflection/self-understanding: Self-knowledge
5. Value relativism/tolerance: Able to adopt multiple perspectives
6. Acknowledgment of and dealing effectively with uncertainty/ambiguity:
Effectively navigating uncertainty and the limits of knowledge.

Conclusion

REFER TO BOOK

Research findings on wisdom and age are not clear-cut.Baltes surmises that age may be
conducive to wisdom but has not found confirming data.Research using other definitions or
using other features of wisdom might yield different results.