HPsych 6

Question 1

Outline what is meant by ‘attachment’ in terms of infants

Answer 1

Biological system designed to maintain infant proximity to caregiver

Infant displays proximty seeking and contact maintaining behaviour

This biological process also leads to an infant developing a ‘mental model’ of attachment based on interaction with primary caregiver

Critical period for attachment in the 1st year of life, problems may arise if child separated from caregiver before 4yrs old

Question 2

Outline Schaffer’s proposed stages of social development within the first 8 months of life

Answer 2

0-6wks:

Infant shows preference for human faces to inanimate objects, first ‘social smile at 6wks+

Approx 3 months:

Distinguish strangers from non-strangers and show preference (E.g. smiling)

Will allow caring adult to handle them without undue upset

7-8 months:

Specific attachment formed, child will miss key people and show signs of distress in their absence

Wary of strangers touching them or picking them up, even in presence of key figure

Question 3

Describe Mary Ainsworth’s ‘Strange situation’

Answer 3

Mother and child are placed in an attractive environment for the child

Mother and child interact

Stranger enters the room, at first ignoring child, then attempting to interact

Mother leaves the room and stranger continues to attempt to interact

Mother re-enters and stranger leaves (The reunion)

After a while, mother leaves child alone

Stranger enters and attempts to interact

Mother re-enters and stranger leaves (second reunion)

Question 4

What features of a child’s behaviour are of particular interest in the strange situation?

Answer 4

Mother-Child interact (E.g. proximity of child to mother, willingness to explore)

Stranger interaction with mother present (E.g. Withdraw from stranger to mother)

Stranger-child interaction (E.g. Crying, stranger’s ability to console)

Reunion (E.g. Immediate end to crying or protracted crying after mother returns)

These behaviours can help us determine the attachment type of the child (Secure/Insecure)

Question 5

What are the different attachment styles?

Answer 5

Secure

Insecure:

Avoidant

Ambivalent

Disorganised

Question 6

What child/caregiver behaviours are likely to predict secure attachment?

Answer 6

Carer sensitive to child’s signals (rying, smiling, cooing, discomfort)

Rapid, appropriate response to signals

Interactive synchrony

Carer accepts role

Carer has higher self esteem

Question 7

What are the benefits of secure attachment to the child?

Answer 7

Better:

Social competence

Peer relations

Self reliance

Physical and emotional health

Question 8

What behavioural changes might be seen in a child that is separated from its carer?

Answer 8

Separation anxiety

Aggression

Clingy

Bed wetting

Detatchment

Depression

Slower movement

Less play and sleep

Changes in HR and temp

Question 9

What are Bowlby’s 3 stages of separation?

Answer 9

Protest:

Distressed, looking for mother, may cling to substitute

Can last hours/days

Despair:

Signs of helplessness, withdrawn, intermittent crying

Detatchment:

More interst in surroundings, more social, may smile

When carer returns, apathetic and remote

Question 10

In what age group are the most overt signs of distrss upon separation seen?

Why might this be?

Answer 10

6 months to 3 years

Theory:

Lack ability to keep image of carer in mind

Limited language (E.g. tomorrow) and ability to comrehend the abstract

Abandonment may be attributed to own failings (E.g. being naughty)

Question 11

What might be the implications on health outcomes for a child that has been separated from carer?

Answer 11

Adherence to treatment suffers, may impede recovery

Pain may be worsened by anxiety

Stress may adversely affect health

Question 12

Outline the critisisms of attachment theory

Answer 12

Too simplistic

Ignores other carers (focus on mother)

Multiple attachments may be formed, this was not initially explored

Quality of substitute care not considered

Question 13

How might in-patient based care of children minimise the effects of separation from carer?

Answer 13

Allow carer access

Allow attachment objcts (toys)

Reassure child they are not being punished or abandoned

Environment more like home

Stimulating toys and activities

High quality substitute care (specialist nurses)

Continuity of staff

Question 14

Outline Piaget’s theory of cognitie development

Answer 14

Child’s mind develops in stages with distinct differences in thought process

Stages:

Sensorimotor - 0-2 yrs

Preoperational - 2-7 yrs

Concrete operational - 7-12 yrs

Formal operational - 12+ yrs

Question 15

Outline the cognitive developments and limitations that typify a child during the sensorimotor stage of development

Answer 15

Developments:

Develop motor co-ordination

Develop body schema (awareness of self, where they end and world begins)

Develop object permancene (Understands objects exist even when unseen)

Limitations:

No abstract concepts

Babies experience world through senses

Question 16

Outline the cognitive developments and limitations that typify a child during the preoperational stage of development

Answer 16

Developments:

Language development, symbolic thought, able to imagine things

Classification of objects by single feature

Limitations:

Egocentrism (cannot see things from other point of view, e.g. the three mountains task)

Lack the concept of conservation (Cannot undestand the object properties (E.g. number/volume) remain the same even if outward appearance changes)

Question 17

Outline the cognitive developments that typify a child during the concrete operational stage of development

Answer 17

Developments:

Thinking logically

Acheive conservation of mass, volume, number

Classification of object by multiple features

Egocentrism is overcome, can see things from others perspective

Question 18

Outline the cognitive developments that typify a child during the formal operational stage of development

Answer 18

Developments:

Abstract logic

Hypothetic-deductive reasoning

Question 19

What are the critisisms of Piaget’s theory of child development?

Answer 19

Focus on what the child cannot do, rather than what they can achieve

Overlooks the effect of the child’s culture and social situation

Question 20

Outline Vygotsky’s theory of social development

Answer 20

Cognitive development requires social interaction

Child is an apprentice that learns through shared problem solving

With ‘able instruction’ child achieves increase in understanding

The ‘zone of proximal development’ is the difference between what a child can achieve on their own or with a helper

Question 21

What are the implications for practie of the theories of child development?

Answer 21

Don’t assume average ability, assess each child’s understanding and their zone of proximal development and tailor communication (E.g. puppets, videos, books)

Young children may think others know how they feel (Lack theory of mind)

Young children can struggle to articulate feelings

Dangerous to use metaphors that may not be understood (lack of abstract thinking)

Difficultie thinking about the future (issues of consent/adherence)

Question 22

Give 3 examples of good clinical practices that enhance our ability to communicate and teach children

Answer 22

Child pain scale showing faces from smiling to crying in stages for the child to identify their own level of pain

Teddy bear kits that can be used to teach children with diabetes how to inject insulin

Teddy bear hospital, teaching children about hospitals and doctors to reduce anxiety and fear surrounding them

Question 23

How might you approach the beginning of a consultation with a child and carer(s)?

Answer 23

Initial contact is with the parents, gives the child time to relax

Aim to understand their concerns and ideas

This both instills confidence in the carers and by proxy the child is drawn in (taking cues from parents)

Observe, listen and wait. Careful observation and listening can provide valuable information

Question 24

What are the key points on dealing with parents in a consultation?

Answer 24

Understand that there are different levels of understanding:

May be differences between carers on what they understand of the child’s problems or what you say to them

Mother’s are often most ‘in touch’ with their child

Differnces in parents:

May have different levels of emotional understanding

Question 25

What key factor determines how you interact with a child?

Answer 25

Your assessment on their level of understanding

Can reference Piaget’s stages here as a guide for what to expect

However assess each child individually as each is different

Question 26

When assessing how to interact with a child, what do you consider?

Answer 26

Language level (easiest indicator, watch for when english is second language)

Non-verbal cues (body language)

Question 27

How does having a child with special needs affect your assessment and interactions with the child?

Answer 27

Need to assess level of understanding and communication

Visual cues can be useful (E.g. the type of play may indicate ‘mental age’)

Pragmatic to explain concepts to the parents who will be able to communicate this to the child at the right level

You may need to use alternative forms of communication (E.g. Makaton)

Question 28

When dealing with sensory impaired children, what might you need to keep in mind?

Answer 28

Don’t make assumptions based on what carers or history/medical factors might indicate

Make the effort to communicate and understand what it is the patient wants

Question 29

What are some of the issues that arise during care of adolescents?

Answer 29

Increasing independence (Assess Gillick competence)

Increasing risk taking (Compliance and health education, smoking, drinking, drugs, sex)

Increasing self awareness

Increasing conflict with parents and decreased communication (increasing difficulty in accurate assessment)

Whether to see the patient with or without parents (sensitive issues, may not want to disclose)

Question 30

When communicating with a child, what are some basic things you can do to improve co-operation?

Answer 30

Be simple and clear, do not hurry

Act out, imitation with a doll can help the child understand what you want

Give choice, empowering them (E.g. Shall I examine you on mummy’s lap or on the bed?)

Play and adapt yourself to the situation, children engage better when having fun

Distraction, talk about likes and dislikes can help distract the patient from something that might be unpleasant

Question 31

What are some of the ways you can manage a child’s emotional state in a consultation?

Answer 31

Give enthusiastic praise, the emotional jackpot for children

Acknowledge their feelings, congratulate them on their attempts to relay them

Have quick fixes (Stickers, certificates, playing with a special toy)

Question 32

What are some things to avoid in all consultations with children?

Answer 32

Stand over the child or use force

Promise what you cannot deliver, be honest

Express frustration, avoid blame and critisism

Expect the same thing of different ages, communicate on the childs level

Rush. Avoid asking too many questions