BEHAVIORAL SCIENCE

2. school age to late adulthood, aging, death and bereavement

Literature: B Fadem: Behavioral science, 2017, Chapters 2-3

School age: 7-11 years: social
• Interacting with children of the same gender
• Gender identification
• Relationship with adults other than parents
• Moral sense of right and wrong
• Following rules
• Begins to understand that death is final and finally understands at the age of 11
• Interviewed and examined by the doctor with the mother present
School age: 7-11 years: cognitive
• Organized
• Logical thought, understands that objects have more than one property
• Concepts of conservation and seriation
a. conservation: quality of a substance remains the same regardless of the size or
shape of the container
b. Seriation: ability to arrange objects according to their sizes or other qualities
Early adolescence: 11-14 years
Early adolescence: 11-14 years
Puberty:
• development of secondary sex characteristics, increased skeletal growth
• First menstruation (11-14) / first ejaculation (12-15)
• Cognitive maturation, formation of personality
• Sexual practicing behavior with same or opposite sex peers
Peer opinion is very important
Alterations in expected patterns of development (acne, obesity, etc)
Middle adolescence: 15-17 years
• Great interest in gender roles
• Body image, popularity
• Crushes
• Attempts of adopting fashion
• Conflict with parents
• Risk-taking behavior:
a. Challenging parental rules (reckless driving, smoking, unprotected sex)
How to prevent: focus on short term disadvantages and benefits
Late adolescence: 18-20 years
• Development of ethics, moral, self-control, realistic appraisal of their own abilities
• Concerns about global issues
• Abstract reasoning
• Identity crisis: role confusion, belongingness, behavioral problems, criminality,
interest in cults
• why?
Teenage sexuality
• Use of contraceptives: lack of access, lack of education
• Physician may counsel minors (18>) and provide with contraceptives without
parental knowledge
• Provide treatment for sexually transmitted diseases, drug abuse and pregnancy
• Sexual issues are discussed without parental presence.
• Physical examination is done without parental presence
Teenage pregnancy issue
Special issues during
childhood/adolescence
Illness and hospitalization:
• Toddlers (2.5 years) are more scared of separation than pain
• Preschool children’s biggest fear is bodily harm
• School age children cope well with hospitalization
• Adolescents may challenge the authority of doctors/adults
• A child with Ill sibling/parent can act out at school or home
Adoption
• Adoptive parent is legal parent
• Adopted children are at higher risk for behavioral problems
• Child should be told that they are adopted
Adulthood
early adulthood: 20-40 years
• Development of an intimate relationship
• Erikson’s stage of intimacy vs isolation
Middle adulthood: 40-65 years
• Biggest power and authority throughout the whole life
• Erikson’s stage of generativity vs stagnation
• Midlife crisis (awareness of aging and death)
Climacterium
• Men: decreased muscle strength, physical endurance, sexual performance
• Women: menopause: menstruation stops in late 40s to early 50s. Absence of menstruation for 1 year = end
of menopause. Menopause is accompanied with physical and psychological problems. Hot flashes
Aging
• Gerontology: study of aging
• Geriatrics: care of aging people. Major aim: keep elderly patients mobile and
active, prevent rapid impairments
Somatic and neurological changes:
• Physical health and strength decline
• Decreased brain weight, enlarged ventricles, decreased cerebral blood flow
• Neurochemical changes: decreased availability of neurotransmitters
(norepinephrine, dopamine, acetylcholine) , decreased responsiveness of
neurotransmitter receptors.
Aging
Cognitive changes:
• intelligence remains the same, learning speed can decrease
• Memory problems
Psychologival changes
• Erikson’s ego integrity vs despair
• Depression, suicide, anxiety, fears, alcohol abuse,
• Depression may mimic and misdiagnosed as Alzheimer’s disease
• Pseudodementia
• Can be managed by psychotherapy + pharmacotherapy
• Changes in sleep
• Psychoactive agents may affect differently as expected
• Important to evaluate familiar surroundings of elderly patient
Aging
Life expectancy and longevity
• US:77 years. Varies by gender and ethnicity
Factors associated with longevity:
• Family history of longevity
• Physical activity
• Advanced education
• Social support, marriage
Death
5 stages of process of dying (Elisabeth Kübler-Ross)
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Bereavement (normal grief) vs
complicated bereavement (depression)
Normal grief:
• Initial shock and denial
• May experience an illusion about the deceased person being still present
• Subsides after 1-2 years, some features continue longer
• Mortality rate is high for closed relatives (especially widowed men) in the first year of
bereavement
Physician’s response to death:
• Give support to the dying patient and their family
• Make patients completely aware of the diagnosis (first ask how much they want to know)
• Avoid sense of failure > emotional detachment > can play negative role in treatment