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WHO/Rutter et al. 1975
Clinical Psychiatric Syndrome.
Specific delays in development.
Physical condition e.g. cerebral palsy.
Psychosocial problems e.g. divorce.
Anxiety. Depression. OCD. Hysteria, Phobia
A persistent pattern of conduct, in which the basic rights
of the others or major age appropriate norms or rules
Juvenile Delinquency: A behavior leading to convection of
a young person of criminal offence, or am offence which
would be criminal in an adult.
Isle of Wight
Physical health, including education, Psychological difficulties.
10-11 years old.
Parents and Teachers questionnaires:
Screened children → Ψ. Psychological tests and parents
1 year prevalence: 7%
Rate in boys twice as high as girls.
No correlation with Social Class.
Increase prevalence with decrease I.Q.
Association with physical handicap
CNS and fits.
Psychiatric illness was related to the severity of brain
damage and not site.
Mental retardation and conduct disorders.
CAUSES OF PSYCHIATRIC DISORDERS
The effects of chromosomes abnormalities.
The consequences of intrauterine damage.
The result of birth injury.
Physical disease and injury.
Regularity in biological functions. Positive approach to new
stimuli. High adaptability to change. Mild or moderate mood
intensity which is predominantly positive. 40%
in biological functions. Negative withdrawal
response to new stimuli. Non or slow adaptability to change.
Intense mood expressions which are frequently negative. 10%.
Slow to warm-up:
Negative responses of mild intensity to new stimuli, with slow
adaptability after repeated contact. Mild intensity of reactions
generally. Less irregularity of biological functioning than the
difficult children. 15%
Family. Wider social setting, sheltered ground, miniature
society where learns to live as a member of the Group,
Attitudes are formed.
Disagreements/Arguments/Angry with each other.
Repression by parents of negative emotions—poor preparation for
realities of life.
Stability of family group.
General Systems theory– family is a unit. Its own unwritten rules
and ways of functioning. Its parts are members which are
dynamically interrelated and interdependent.
Boundary—rigid, well defined DISENGAGEMENT or weak/blurred
FUNCTIONS OF THE FAMILY
COMMUNICATION AND EXCHANGE OF INFORMATION.
Goodness of fit.
Chess and Thomas emphasize the importance of the goodness,
or poorness of fit between children and environment.
They make it clear that there is no “optimal” temperamental
style that ideally all children should display, nor is there one
ideal environment for children’s development.
Acquiring sense of self worth is a major developmental task of
Starts in infancy and continues throughout childhood and
Good feelings of self worth is one of the major developmental
Developments depends on:
Parents child relationship.
Temperament of the parents and child.
Parental attitudes, opinions and behavior.
Value the child gives to the significant others e.g. mother vs.
High Self esteem:
Total acceptance of children by their parents.
Clearly defined and enforced limits.
Respect for individuals actions within limits.
Positive Self esteem requires the experience of mastering
the environment, in ways which provides feelings of
satisfaction and appropriate affirming feedback from the
Smile regularly at any one.
Types of Developments
– Motor development
Social & Emotional development
Pen and Paper
2. Can draw a line.
3. Can draw a circle.
4. Can draw a Square
5. Can draw a Star.
Plays parallel to other children.
Active co-operative play.
According to rules.
NORMAL CHILD DEVELOPMENT
Motor functioning. (3/52. Social Smile. 6-12/52. Smiles regularly at
anyone. 12-20/52. Selective smiling).
Attachment and Bonding Behavior.
Features of attachment behavior: Crying, Calling, Stranger anxiety,
Separation anxiety– all bringing proximity to the attachment
Infants attachment results primarily from the availability of a
familiar figure. Increased social interaction results in increased
attachment. IT DOES NOT DEPEND ON GRATIFICATION OF
NORMAL CHILD DEVELOPMENT
Learns to walk and talk
Anal stage: Learns bladder control.
THE PRE SCHOOL PERIOD. (2-5 YEARS)
Further intellectual development e.g. language.
Increase in socialization.
Identification with parents-motivation to do certain things.
Beginning of conscience formation. The establishment of
defense mechanism to deal with anxiety and guilt.
The development of patterns of behavior towards those
outside the family.
MIDDLE CHILDHOOD. (5-10 YEARS)
Latency period. Clear conception of position in the family
and well defined identity as a boy of girl.
Learns the fundamentals of technology.
Learns to cope with more complex and less supportive
Learns to deal with defense mechanisms of anxiety and
Duration: Girls (12-21) Boys (14-25)
Era of : Storm & Stress
Changing from being nurtured and cared for to being able to
nurture and care for others.
Becoming materially self-sufficient.
Accepting adult sexual role and coping with heterosexual
Moving out of the family of origin to form a new family of
RESOLUTION OF ADOLESCENCE
Attainment of separation and independence from parents.
Establishment of sexual identity.
Commitment to work.
Development of a personal moral system.
The capacity for lasting relationships, and for both
tender and genital sexual love in heterosexual
The return to the parents in a new relationship based on
Factors favorably influencing behavior and attainments were:
A reasonable balance between intellectually able and less able
The ample use of rewards, praise and appreciation by teachers.
A pleasant, comfortable and attractive school environment.
Plenty of opportunity for children to be responsible for and
participate in the running of the school.
An appropriate emphasis on academic matters.
Good models of behavior provided by teachers.
The use of appropriate group management skills in classrooms.
Firm leadership in the school, combined with a decision making
process involving all staff and leading to a cohesive approach in
which staff members support each other.
ATTACHMENT THEORY. J. BOWLBY.
Attachment occurs when there is a warm, intimate and
continuous relationship with the mother in which both find
satisfaction and enjoyment.
The amount of time together is less important than the
amount of activity between the two.
Bonding concerns the mother’s feelings towards the
infant. Its not dependent on the feeling of security.
Skin to skin contact.?
Signs of distress in the infant that prompt a behavioral
response from the mother.
Three types of crying. 1. Hunger. 2. Anger. 3. Pain.
Smiling, Cooing and Looking.
Demonstrated the emotional and behavioral effects in monkeys
who were isolated from birth and were thereby kept from
The isolates were
UNABLE TO RELATE TO PEERS,
UNABLE TO MATE AND
INCAPABLE OF CARING FOR THEIR OFFSPRING.
PREATTACHMENT STAGE. Birth – 8 or 12 weeks.
Baby orientates to its mother, follows her with over 180
degrees range, turns towards and rhythmically with her
ATTACHMENT IN THE MAKING. 8 or 12 weeks-6
months. Baby attaches to me or more persons in the
CLEAR CUT ATTACHMENT. 6 - 24 months. Infant cries
and shows other signs of distress when separated from
Child protests against separation by crying, calling out and
searching for the lost person.
Child appears to lose hope that the mother will ever
Child emotionally separates itself from its mother. Child
responds in an indifferent manner when the mother
Mother has not been forgotten, but the child is angry at
her for having gone away in the first place and fears that
she will go away again.
Piaget COGNITIVE DEVELOPMENT
Birth – 2 years.
Differentiates self from objects.
Recognizes self as agent of action.
Begins to act intentionally.
Achieves object permanence.
Achieves object constancy.
PRE OPERATIONAL STAGE.
2-7 YRS. Learns to use language.
EGOCENTRIC THINKING. Sees himself as center of the
ANIMISM. Objects having thought/feelings.
PRECAUSAL REASONING. Irrational explanations.
AUTHORITARIAN MORALITY. Behavior is seen as good or
bad, black and white.
CONCRETE OPERATIONAL STAGE
Can think logically about objects/events.
Achieves conservation of numbers, mass and weight.
Classifies objects according to several features & can
arrange them in series along single dimension e.g. size.
FORMAL OPERATIONAL STAGE.
Can think logically & test hypothesis systematically.
Becomes concerned with future & ideological problems.
Freud. 1916. MODEL OF MIND:
The ID which contains the instinctual or psychic energy
necessary to drive the whole system. This is entirely UC
and obeys the PLAESURE PRINCIPLE, BY WHICH
TENSION IS REDUCED AS RAPIDLY AS POSSIBLE,
WITHOUT REGARD TO CONSEQUENCES. Its mode of
operation is described as PRIMARY PROCESS
The EGO, which develops from the ID, obeys the
REALITY PRINCIPLE. It seeks gratification but takes
SECONDARY PROCESS HINKING.
The SUPEREGO is the conscious of the individual and
incorporates the society’s moral standard.
STAGES OF PSYCHOSEXUAL
ORAL (0-1 YR.) child gains maximum pleasures from oral
activities such as sucking and feeding.
ANAL (1-2 YR.) Here the activity centers around the retention
and elimination of feces.
PHALLIC. (3-5 YR.) The genitalia become the focus of attention
and the child enters a crisis phase described as the OEDIPAL
COMPLEX. The child is attracted to the parent of the opposite
sex, conflicts results because of the risk of punishment.
LATENCY. (5-12 YR.) No major psychosexual development takes
place in this phase.
GENITAL. This is the final stage in which the individual achieves
full heterosexual development.
MORAL REASONING: KOHLBERG.
Pre conventional Morality:
Punishment orientation. Obeys rules to avoid punish confirms to
to have favors returned.
Good-boy/Good-girl orientation: Confirm to avoid
disapproval of others.
Upholds laws and social rules to award censure of
Post conventional morality:
Social – contract orientation. Actions guided by
principles commonly agreed on as essential to
public welfare, respect of peers.
Ethical principle. Orientation. Actions guided by
self chosen ethical principles, (that usually value
justice, dignity and equality), principles upheld
to avoid self condemnation.
Persistent reluctance or refusal to got school in order to sty with major
Not at home.
Kept at home
Emotion dis. With pwerts
Fear of travel
General social with drawal
specific fear at
Prevalence in general population not known. 3% I.W. Age of presentation: 5-7, 11×14.
Equal sex distribution. Increase in decrease S.E. Class.
Repeated episodes of abrupt awakening lasting 1-10 minutes
occurring between 30-180 minutes after onset of sleep.
Usually begin with panicky scream.
Signs of autonomic arousal – tachycardia, rapid breathing,
dilated pupil etc.
Relatively unresponsive to others.
Confusion, disorientation and preservation of movements.
Typically occurs during stages 3 & 4 sleep.
Repeated episodes of arising from bed during sleep walking
about for several minutes and remaining unresponsive to the
efforts of others .
Can be woken with great difficulty.
Amnesic on waking.
Usually occurs between 30-180 minutes after onset of sleep
EEG – delta activity, stages 3+4.
Between 1- 4% of children experience at some time.
Isolated episodes even increase frequent.
Usually disappears in adolescence.
THE CONCEPT OF INVULNERABILITY
Some children survive GROSS DEPRIVATION & SEVERE
PSYCHOLOGICAL STRESS, WITHOUT DEVELOPING psychiatric
disorder. Vulnerable but invincible-an important study of children’s
resilience and invulnerability.
Longitudinal study of 698 Hawaiian island by Werner and Smith. 1982.
What distinguished the resilient high-risk children? They:
Had few serious illnesses in their first 2 decades, and recovered
quickly from those they had.
Were perceived to be “very active” and “socially responsive”as
Showed advanced self-help, sensorimotor and language development
I the 2 year of life.
PERVASIVE DEVELOPMENTAL DISORDERS
Other childhood disintegrative disorder overactive
disorder with mental retardation and stereotyped
Atypical autism pervasive developmental disorder not
Speech and language disorder
Obsessive desire for sameness
Bizarre behavior and mannerisms
Sudden anger or fear without any reason over-active,
distractible, poor sleep, soil or wet themselves.
Between 10 and 20 percent of children with childhood
autism begin to improve between the ages of about four
and six years. And are able to attend an ordinary school.
10-20 percent can live at at home but cannot work and
need to attend a special school or training centre.
60 percent improve little and are unable to lead an
independent life, may need long-term residential care.
Communication skills, social skills, and play, and repetitive
or other abnormal behavior
Stage of social development in relation to age, mental
age, and stage of language development
Associated medical conditions
Management of abnormal behavior
Arrangement for social and educational services
Help for the family
A ten years old boy has been brought to you by his
mother complaining that he lies, steals and damages
house hold items. There have been repeated complaints
from the school for the last 04 years about his poor
performance academically and refusal to follow rules.
The child was cooperative during the interview expressing
his unhappiness with school authorities and his parents
who quarrel all the time paying little attention to him.
Psychological testing showed no evidence of any
WHAT ARE OTHER CONDITIONS WHICH CAN
CO EXIST WITH THIS DISORDER?
Attention deficit hyperactivity disorder
Specific learning disabilities.
WHAT ARE YOUR TREATMENT OPTIONS?
Family therapy – changes in family system and setting up of
Changes in school environment may be change of
Residential case program.
It has to be a multidisciplinary approach.