HPsyHD S6 (Done) Flashcards
Outline what is meant by ‘attachment’ in terms of infants
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
Outline Schaffer’s proposed stages of social development within the first 8 months of life
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
Describe Mary Ainsworth’s ‘Strange situation’
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)
What features of a child’s behaviour are of particular interest in the strange situation?
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)
What are the different attachment styles?
Secure
Insecure:
Avoidant
Ambivalent
Disorganised
What child/caregiver behaviours are likely to predict secure attachment?
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
What are the benefits of secure attachment to the child?
Better:
Social competence
Peer relations
Self reliance
Physical and emotional health
What behavioural changes might be seen in a child that is separated from its carer?
Separation anxiety
Aggression
Clingy
Bed wetting
Detatchment
Depression
Slower movement
Less play and sleep
Changes in HR and temp
What are Bowlby’s 3 stages of separation?
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
In what age group are the most overt signs of distrss upon separation seen?
Why might this be?
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)
What might be the implications on health outcomes for a child that has been separated from carer?
Adherence to treatment suffers, may impede recovery
Pain may be worsened by anxiety
Stress may adversely affect health
Outline the critisisms of attachment theory
Too simplistic
Ignores other carers (focus on mother)
Multiple attachments may be formed, this was not initially explored
Quality of substitute care not considered
How might in-patient based care of children minimise the effects of separation from carer?
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
Outline Piaget’s theory of cognitie development
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
Outline the cognitive developments and limitations that typify a child during the sensorimotor stage of development
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
Outline the cognitive developments and limitations that typify a child during the preoperational stage of development
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)
Outline the cognitive developments that typify a child during the concrete operational stage of development
Developments:
Thinking logically
Acheive conservation of mass, volume, number
Classification of object by multiple features
Egocentrism is overcome, can see things from others perspective
Outline the cognitive developments that typify a child during the formal operational stage of development
Developments:
Abstract logic
Hypothetic-deductive reasoning
What are the critisisms of Piaget’s theory of child development?
Focus on what the child cannot do, rather than what they can achieve
Overlooks the effect of the child’s culture and social situation
Outline Vygotsky’s theory of social development
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
What are the implications for practie of the theories of child development?
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)
Give 3 examples of good clinical practices that enhance our ability to communicate and teach children
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
How might you approach the beginning of a consultation with a child and carer(s)?
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
What are the key points on dealing with parents in a consultation?
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
What key factor determines how you interact with a child?
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
When assessing how to interact with a child, what do you consider?
Language level (easiest indicator, watch for when english is second language)
Non-verbal cues (body language)
How does having a child with special needs affect your assessment and interactions with the child?
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)
When dealing with sensory impaired children, what might you need to keep in mind?
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
What are some of the issues that arise during care of adolescents?
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)
When communicating with a child, what are some basic things you can do to improve co-operation?
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
What are some of the ways you can manage a child’s emotional state in a consultation?
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)
What are some things to avoid in all consultations with children?
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
