Topics on exams

INTRAUTERINE GROWTH RETARDATION-IUGR

MICROPTHALMIA

MIDFACE HYPOPLASIA

MICROCEPHALY

DELAYED DEVELOPMENT

ATTENTION DEFECIT

LEARNING DISABILITIES

INTELECTUAL DEFICIT AND SIEZURES

LIMB DISLOCATION

PREMATURE BIRTH

• 
  PREMATURITY IS DEFINED AS GESTATION OF LESS THAN 34 WEEKS OR IN WHICH BIRTH WIEGHT IS UNDER 2500GMS.
  
• 
  OCCURS IN 6% IN BIRTHS TO WHITE WOMEN AND 13% OF BIRTH TO AFRICAN AMERICAN WOMEN.
  
• 
  IS ASSOCOATED WITH:
  

• 
  LOW INCOME
  
• 
  MATERNAL ILLNESS OR MALNUTRITION
  
• 
  YOUNG MATERNAL AGE
  

• 
  PREMAURITY AND INCREASED RISK TO INFANT:
  

• 
  EMOTIONAL PROBLEMS
  
• 
  BEHAVIORAL PROBLEMS
  
• 
  LEARNING PROBLEMS
  
• 
  PHYICAL DISABILITY
  
• 
  MENTAL RETARDATION
  
• 
  INCREASED RISK OF ABUSE
  

POSTPARTUM REACTION
POSTPARTUM BLUES (BABY BLUES)

• 
  SEEN WITH 33-50% OF PREGNANCIES
  
• 
  ONSET IS WITHIN FEW DAYS AFTER DELIVERY
  
• 
  SYMPTOMS LAST UPTO I WEEK AFTER DELIVERY
  
• 
  DUE TO PSYCHOLOGICAL AND PHYSIOLOGICAL FACTORS
  
• 
  CLINICALLY:
  

• 
  EXAGGERATED EMOTIONAL STATE TEARFULNESS
  
• 
  NORMAL INTERACTION
  
• 
  WELL GROOMED
  

TX: JUST PROVIDE SUPPORT , ASK THE PATIENT TO CALL YOU WHEN FEELING DOWN

• 
  MAJOR DEPRESSIVE EPISODE:
  

• 
  SEEN WITH 5-10% OF WOMEN
  
• 
  ONSET WITHIN 4 WKS AFTER DELIVERY
  
• 
  LAST UPTO 3-66 WKS WITH TX AND UPTO 1YR WITHOUT TX\
  
• 
  CLINICALLY:
  

• 
  HOPELESSNESS AND HELPLESSNESS
  
• 
  LACK OF PLEASURE AND INTREST IN USUAL ACTIVITIES
  
• 
  POOR GROOMING
  

• 
  TX:
  

SUPPORTIVE TX & ANTIDEPRESSENTS

• 
  POSTPARTUM PSYCHOSIS:
  

• 
  SEEN IN 0.1-0.2% OF PREGNANCIES
  
• 
  ONSET WITHIN 2-3 WKS AFTER DELIVERY
  
• 
  LAST UPTO ONE MONTH
  
• 
  CLINICALLY:
  

• 
  HALLUCINATIONS
  
• 
  DELUSIONS
  
• 
  OTHER PSYCHOTIC SYMPTOMS
  
• 
  MOTHER CAN EVEN HARM INFANT
  

• 
  TX:
  

• 
  ANTIPSYCHOTIC TX
  
• 
  PROVIDE SUPPORT & OBSERVATION
  

AFFECTS OF CHILD BIRTH CLASSES

• 
  SHORTER LABOR
  
• 
  FEWER MEDICAL COMPLICATIONS
  
• 
  LESS NEED OF MEDICATION
  
• 
  BETTER INITIAL INETERACTION WITH THEIR INFANT (BONDING)
  

GROWTH AND DEVELOPMENT

Cognitive Development

By Jean Piaget
Cognitive Development

• 
  The process of organization information and is in constant adaptation
  
• 
  Schemas – pattern in our heads
  
• 
  Adaptation: occurs through:
  

Assimilation :current models of organization are used to deal with new situations.

Accommodation: schemas are adapted to account for new information and new experiances.

Stages

1. Sensorimotor (birth to 2 y/o)

2. Preoperational thought (2 – 7 y/o)

3. Concrete operations (7 – 11 y/o)

4. Formal Operations (11y/o through the end of adolescence)

Stage 1.
Sensorimotor Stage – Birth to 2 years

• 
  Infants learn through sensory observation, and they gain control of their motor functions through activity, exploration, and manipulation of the environment
  
• 
  Develop learning behavior from the blend of biology and experience.
  
• 
  As children become more mobile, experiences build on one another
  

Sensorimotor Stage

• 
  The critical achievement of this period –
  

• 
  the development of object permanence. Maintain the mental image of an object even when it is not present and visible.
  

• 
  Symbolization (– uses symbolic representations of events and objects
  

Stage 2.
Preoperational Thought – 2 – 7 years

• 
  Use of symbols and language more extensively
  
• 
  No reasoning. No sense of cause and effect
  
• 
  Resolution of separation anxiety
  
• 
  Egocentric: see themselves as the center of the  universe- have a limited point of view
  

Characteristics (preop thoughts)

• 
  Imminent justice: punishment for bad deeds is inevitable
  
• 
  Animistic thinking: physical events and objects are endowed with lifelike psychological abilities such as feelings and intentions
  
• 
  Magical thinking- events that occur together are thought to cause one another 
  even when there is no relationship
  

Stage 3.
Concrete Operations 7 – 11 years

• 
  Egocentric thought is replaced by operational thought
  
• 
  Learn through paying more attention to their environment
  
• 
  Able to understand others point of view
  
• 
  Can serialize, order, and group things according to common characteristics.
  
• 
  6-7 y/o – Law of conservation (changing the shape does not change the quantity)
  

Law of Conservation (6-7 y/o)
number, length, liquid volume



Law of Conservation (7-8, 9-10 y/o)
substance, area


Concrete Operations
CRITICAL ACHIEVEMENT:

• 
  Reversibility – understand the relation between things (ice/ water)
  
• 
  Seriation – putting things in order (by size, volume…). Child is ready for formal education.
  
• 
  Mnemonic Strategies (key words, visual links)
  
• 
  6-7 y/o – Law of conservation (changing the shape does not change the quantity)
  

Concrete Operations

• 
  “Right order” (to eat, to dress…)
  
• 
  Listen to everything you say and point on contradictions.
  
• 
  Personal sense of right and wrong
  

Stage 4.
Formal Operations 11- end of adolescence

• 
  Thinking – formal, highly logical, systematic, and symbolic manner
  
• 
  Can think abstractly, reason deductively and define abstract concepts.
  
• 
  Hypothetical thinking
  
• 
  Deals with past, present, and future
  
• 
  More complex schemas. Larger understanding
  

EMOTIONAL DEVELOPMENT

Emotional Development

Birth Pleasure, surprise, disgust,

distress

6-8 weeks Joy

3-4 months Anger

8-9 months Sadness, fear

12-18 mon. Tender affection, shame

24 months Pride

3-4 years Guilt, envy

5-6 years Insecurity, humility, confidence

THEORIES OF DEVELOPMENT

Margaret Mahler

• 
  Describes early development as sequential process of separation of the child from mother or primary caregiver…..
  

Margaret Mahler.
Stages of Separation-Individuation

• 
  Normal Autism: birth – 2 months.
  

Periods of sleep outweigh periods of arousal

• 
  Symbiosis: 2 – 5 months.
  

Developing ability to distinguish inner from outer world.

Mother-infant – single fused entity.

Stages of Separation-Individuation

3. Differentiation: 5 – 10 months.

Progressive neurological development, increased alertness draw infant attention away from self to the outer world. Physical and psychological distinctiveness from the mother is gradually appreciated.

4. Practicing; 10 – 18 months.

The ability to move autonomously increases children’s exploration of the outer world.

Stages of Separation-Individuation

5. Rapprochement: 18 – 24 months.

As children slow realize their helplessness and dependence, the need for independence alternates with the need for closeness. Children move away from the mothers and come back for reassurance.

6. Object constancy: 2 – 5 years.

Children gradually comprehend and are reassured by the permanence of mother and other important people, even when not in their presence.

Harry Harlow and study of attachment

Harry Harlow

• 
  Studied social learning and effects of social isolation in monkeys
  
• 
  The isolates were withdrawn, unable to relate to peers, unable to mate, and incapable of caring for their offspring
  
• 
  Male were affected more than female by such isolation
  
• 
  Monkeys isolated for less than 6 months can be rehabilitated by playing with normal young monkeys.
  
• 
  Due to such findings , ‘Foster Care System’ was established for young children who do not have adequate home situation .Foster families are approved and funded by state to take care of child in their homes.
  

Sigmund Freud


Sigmund Freud

• 
  Oral stage: birth -18 months. The focus of pleasure is the mouth. Sucking and biting are favorite activities.
  
• 
  Anal stage: 18 months – 3-4 years old. The focus of pleasure through mastery of anal function. The child also experiences the pressure of social expectations related to learning control of anal functions.
  
• 
  Phallic stage: 3 – 6years old. The focus of pleasure is the genitalia. Masturbation is common. Child also learns sexual identification and sexual differentiation.childrens are suffering from oedipal complex. Boys have castration anxiety and girls have penis envy.
  

Sigmund Freud

• 
  Latent stage: 6– 12 years old.
  

• 
  In this stage, the sexual impulse was suppressed as children's are encourage to identify with cultural role models. They also learn acceptable form of expression for aggressive and sexual drives through competitions and sports..
  

• 
  Genital stage: 12+
  

• 
  After having completed all other stages, the individual is now able to redirect his/her urges to genital sexual activity.
  

ERIK ERIKSON

Erik Erikson

Erik Erikson

• 
  Is a Freudian ego-psychologist. He accepts Freud’s ideas as basically correct. However, Erikson is much more society and culture-oriented than most Freudians
  

• 
  He believed that human emotional and social development were dependent not on maturation and control of sexual and aggressive impulses but on the evolution of human interaction.
  
• 
  He divides human emotional and social development into 8 stages.
  

Erik Erikson

• 
  If stage is managed well, we carry away certain virtue or psychosocial strength which will help us through the rest of the stages of our lives.
  
• 
  If we don’t do so well, we may develop maladaptations and malignancies.
  
• 
  Malignancy – is worse of the two, too little of the positive and too much of the negative.
  
• 
  Maladaptation – to much of the positive and but little of the negative
  

Stage I: 0-1 y/o. Infant: Trust vs mistrust

• 
  Oral-sensory stage
  
• 
  The task is to develop trust without completely eliminating the capacity for mistrust.
  
• 
  In this stage child relies on adults to anticipate and care for all of its needs.
  
• 
  Through repeated experience of caring, the child develops a basic trust in others .
  
• 
  If treated right child develops trust in others but if not develop sense of anxiety and or uncertainty about the behavior of others, developing mistrust, depression, paranoia.
  
• 
  If treated well child develops hope & faith
  

Stage II: 2 – 3 y/o. Toddler

Autonomy vs shame and doubt

As parents begin to regulate child behavior (toilet training) , does the child develops a sense of joy& pride as he interacts meaningfully with her body and environment for the first time. OR is the nature of parent interaction is such that either child has few accomplishments or is never rewarded for her accomplishments.

If rewarded child develops sense of autonomy but if not develop a sense that his efforts are useless and ineffectual and thus will always require the intervention of others.

• 
  Impulsiveness – shameless willfulness that lead you, in later childhood and even adulthood, to jump into things without proper consideration of your abilities.
  
• 
  Compulsiveness (too much shame or doubt) – everything must be done perfectly. Take lot of anxiety if things are not done certain manner.
  
• 
  If the proper balance is achieved, the child will develop the virtue of willpower or determination.
  
• 
  “I know I can do it”.
  

Stage III 3/4 - 5/6 y/o. Preschooler.

Initiative vs guilt.

Child who is basically characterized by egocentric thinking and whose development has been yet managed by parents now begins to interact with family and neighborhood.

Goal is to adjust in this expanded environment ,which is not as understanding as parent.

If the child learns to adjust with other people it will increase his confidence and he will form positive relationships. If not will develop sense of guilt , that is he will not be able to adapt properly to society and will invite rejections from others .

• 
  Ruthlessness – too much initiative too little guilt. They do not care who they step on to achieve their goals.
  
• 
  Inhibition – too much guilt. Afraid to try, to lose, to feel. In future: impotent, frigid.
  

Stage IV: 7 – 12 y/o. School age.

Industry vs inferiority.

In this stage the child basically competes with his peers in development of intellectual, social , emotional and physical development.

If the child is able to accomplish these task better than peers it will bring him sense of accomplishment and confidence but if he is not able to compete with his peers it will give him the sense of inferiority.

• 
  If child is allowed too little success, he develops a sense of inferiority or incompetence. Racism, sexism… Success is about who you are rather than how hard you try, then why try?
  
• 
  Narrow virtuosity – too much industry. “Children are not allowed to be children”. Children – musicians, athletes…
  
• 
  Inertia (more common) – too much inferiority. “If at first don’t succeed don’t ever try again!”
  
• 
  Psychosocial virtue - competency
  

Stage V: 12 – 18/20 y/o. Adolescence.

Ego-identity vs role-confusion.

• 
  This stage focuses on development of interpersonal relationships
  
• 
  Primary relationships are with Peers. These relationships become increasingly sexual and intimate.
  
• 
  Individual develops sense of self and is productive, goal directed and able to engage in sexual behavior with peers.
  
• 
  A person who successfully negotiate this phase will actively construct a self identity rather than simply receive passively receive from others.
  
• 
  A unsuccessful person, will be continually confused about his role and abilities in this new peer focused and sexually activated world.
  

• 
  Fanaticism – too much ego identity. No room left for tolerance. Their way is the only way. Do not accept other’s rights to disagree.
  
• 
  Repudiation – lack of identity. “Fuse” with the group: religious cults, militaristic organizations… Destructive activities: drugs, alcohol or withdraw into their own psychotic fantasies.
  
• 
  Psychosocial virtue – fidelity, loyalty, the ability to live by societies standards despite their imperfections
  

Stage VI: the 20’s. Young adult.

Intimacy vs isolation.

• 
  The task is to achieve some degree of intimacy with a life partner, as opposed to remaining in isolation.
  
• 
  Second goal is the choice of a means of livelihood and development of career that will sustain the new couple.
  
• 
  Intimacy – the ability to be close to others, as a lover, a friend, and as participant in society.
  
• 
  Those who are not able to achieve these tasks find themselves increasingly isolated from others on both fronts.
  

Stage VII: late 20’s to 50’s. Middle adult.

Generativity vs Self-absorption.

• 
  The task is to cultivate the proper balance of generativity and stagnation.
  

Generativity – to produce, to generate, to provide for your family. extension of love into the future. It is a concern for the next generation and all future generations.

• 
  Stagnation – self-absorption, caring for no-one.
  

• 
  Overextension – so generative that they no longer allow time for themselves, for rest and relaxation.
  
• 
  Rejectivity – too little generativity and too much stagnation, eventually get isolated.
  
• 
  “Midlife crisis” – “What am I doing for?” Panic of getting older and not having experienced or accomplished what they imagined they would when they were younger, they try to recapture their youth. Men leave their wives, quit their jobs, buy some “hip” clothes, and start hanging around singles bars.
  

Stage VIII: late 50’s and beyond.

Integrity vs despair.

• 
  The task is to develop ego integrity with a minimal amount of despair.
  
• 
  Integrity – the sense of satisfaction that a person feels in reflecting on a life productively lived
  
• 
  Despair – the sense that life has had little purpose or meaning
  
• 
  Those who have found contentment devote themselves not to self interest butt to the passing on of the wisdom of their experiences and culture to others before the end of life.
  

• 
  Sense of usefulness, parenting duties come to close.
  
• 
  Women – menopause. Men – can no longer “rise to the occasion”. Illnesses of old age. Concerns of death.
  
• 
  In response to this despair, some older people become preoccupied with the past. “Things were better”.
  

• 
  Psychosocial virtue – wisdom.
  
• 
  Erik Erikson: “Healthy children will not fear life if their parents have integrity enough not to fear death”.
  

1. There are 4 kids on the playground. They all are

about the same age. There are two boys and two

girls. Each of the girls makes a cake, one boy plays

with a car, and the other boy builds a castle. How

old most likely those children are?

 

• 
  2-3 years
  
• 
  4-5 years
  
• 
  6-7 years
  
• 
  8-9 years
  

E. 10-11 years
The answer is A.

Children demonstrate a parallel play.

Cooperative (joint) play starts at 4 years of

age.

2. A mother brings her 5-months-old infant to the

physician for a well-baby checkup. At this time

the physician should expect to see:

 

• 
  Stranger anxiety
  
• 
  Playing peek-a-boo
  
• 
  Speech using meaningful words
  
• 
  Sitting with support
  
• 
  Stands with help
  

The answer is D.

Child can sit with support, it starts at 4 months

of age.
3. Medical student holds the baby and suddenly

moves his hands down. The baby extends arms

with hands open, flexes legs, then returns arm

forward and starts crying. What reflex student

demonstrates?

 

• 
  Babinski Reflex
  
• 
  Tonic Neck Reflex
  
• 
  Perez Reflex
  
• 
  Galant Reflex
  
• 
  Moro reflex
  

The answer is E.

Child demonstrates Moro reflex.

4. A young child plays with his toys, but often

comes to his mother for comfort and reassurance.

This behavior is most common in children of

what age?

• 
  8 – 11 months
  
• 
  12 – 15 months
  
• 
  16 – 24 months
  
• 
  30 – 36 months
  
• 
  36 – 48 months
  

The answer is C.

Margaret Mahler called the period when the

child moves away but returns to the mother

for comfort and reassurance the

rapprochement phase. This behavior occurs

most commonly in toddlers 16 – 24 months of

age. This is the period when the child begins

to develop physical and emotional distance

from the mother.
5. At which age are children likely to form the

same-sex groups?

A. 2 – 4 years

B. 4 – 6 years

C. 6 – 11 years

D. 11 – 13 years

E. 13 – 16 years
The answer is C.

Latency age children (i.e. those 6 – 11 years of age)

prefer to play with children of the same sex.Younger

children do not have a preference for playing with

same-sex children; adolescents often seek the

company of those of the opposite sex.

6. Which one of the following developmental

theorists described the first month of postnatal

life as the normal autistic phase?

• 
  Mahler
  
• 
  Freud
  
• 
  Erikson
  
• 
  Piaget
  
• 
  Harlowe
  

The answer is A.

Mahler described the first month of postnatal life as the

normal autistic phase because the infant has little interaction

with people or with the external environment at this age.

Freud described early infant development as the oral phase

because the major site of gratification is the mouth. Erikson

described the first year of life as the stage of trust versus

mistrust, when the child learns to rely on and trust the

caregiver to provide for needs. Piaget described the period

from birth to 2 years of age as the sensoriomotor stage, when

the child learns to master her environment through

assimilation and accomodation. Harlowe studied the role of

attachment in early infant development in monkeys.
7. A 7-month-old boy who previously smiled at

everyone begins to cry when he sees an individual

he does not recognize. This behavior

• 
  Is normal
  
• 
  Is more likely to occur in infants who have multiple caregivers
  
• 
  Occurs primary in anxious infants
  
• 
  It is an indication that child in not developing normally
  
• 
  Indicates that the child cannot distinguish between strangers and people that he knows.