Peds final Flashcards
Describe changes in puberty?
In Males
7 main chages
o Males: increase in penis and testicle size, appearance of straight pubic hair, minor voice change, 1st ejaculation, appearance of curly pubic hair, onset of max growth in height and weight, growth of hair in armpits, more detectable voice changes, & facial hair
Describe changes in puberty?
In females
7 main changes
o Females: breasts enlarge, appearance of pubic hair, hair under armpits, increase in height, hips widen then shoulders widen, then late in puberty cycle her 1st menarche occurs, no voice change, weight gain
Describe the cognitive development of adolescence
What theory is this part of?
Executive functioning?
What is increased?
cognitive changes include increase in abstract, idealistic, & logical thinking. Adolescents began to think in more egocentric ways, realizing they are unique and invulnerable.
Piaget’s formal operational thought process
Executive functioning – reasoning, decision-making, critical thinking, monitoring own cognitive processes
o generate options; see several perspectives; anticipate consequences
o increased speed/capacity for information processing
o increased breadth/depth of knowledge
o increased ability to apply knowledge
o increased range and use of strategies
Analyze issues of schooling and delinquency?
• Delinquency: Masculine behaviors” are associated with aggressive behavior in certain groups
o Poverty, unemployment, and feelings of alienation feed into antisocial behavior
• Avoid Delinquency: Parental support and monitoring are important deterrents to antisocial behavior
Describe potential risks to adolescents due to high risk behaviors
• Risk factors of early sexual activity: Drug use, delinquency, teen pregnancy, STDs
Describe growth and skeletal changes of puberty
• Physical Changes in Variations in timing of puberty:
• Growth in height and weight:
o Males: 13.5 years, 4”/year
o Females: 11.5 years, 3.5”/year
Females are taller and outweigh males until about age 14
Describe the influence of the pituitary and hypothalamus in the changes associated with puberty: testosterone, estradiol.
Preocious puberty?
Preocupation with body image?
o Testosterone and Estradiol (Estrogen)
• Males: beginning 10-13.5 years, ending 13-17 yrs
• Females: beginning 9-11 years, ending 13-15 yrs
• Precocious puberty: girls before 8, boys before 9
• Preoccupation with body image
o Boys generally more positive than girls
• Early/late maturation impacts both boys and girls
o Typically, later maturation is more positive for girls, early maturation is more positive for boys.
• Motor skill capacity and expertise increases
Describe changes in the amygdala, corpus callosum and prefrontal cortex as they are related to adolescents’ ability to process information
- Corpus callosum: thickens in adolescence to process information more effectively
- Prefrontal cortex: “judgment” region continues to develop intense emotions, but full maturity occurs between ages 18-25
- Amygdala matures before the prefrontal cortex – emotional stability
How does testosterone, estradiol facilitate puberty
• puberty is facilitated by hormones:
o testosterone: associated with genital maturation, increase in height, and change in voice
o estradiol: form of estrogen for breasts, uterine, and skeletal development
Describe changes in the amygdala, corpus callosum and prefrontal cortex as they are related to adolescents’ ability to process information.
- Corpus callosum: thickens in adolescence to process information more effectively
- Prefrontal cortex: “judgment” region continues to develop intense emotions, but full maturity occurs between ages 18-25
- Amygdala matures before the prefrontal cortex – emotional stability
Identify psychological responses to physical changes
• Social Developmental Neuroscience: connections between development, brain, and socioemotional processes
o early activation of strong ‘turbo-charged’ feelings with a relatively un-skilled set of ‘driving skills’ or cognitive abilities to modulate strong emotions and motivations”
What are the issues associated with adolescent sexuality?
4 issues
- Early sexual experiences in adolescence leads to substance abuse, delinquency, and school-related problems.
- Risk factors such as socioeconomic status, poverty, family/parenting and peer factors,
- Having older siblings that are sexually active places adolescent girls at risk for pregnancy
- Attention problems & aggression lead to increased chances of having early initiation of sexual activity
What are the major causes of death in adolescents?
- Accidents-mainly motor vehicle accidents
- Homicides: especially African American males 3x more likely to be killed by guns than natural causes
- suicides
Describe Piaget formal operational thought: abstract, idealistic, logical?
Adolescent egocentrism?
Imaginary audience?
Personal fable?
• Piaget: Formal operational thought
o More abstract
o Idealistic –possibilities
o Logical and problem solving; hypothetical and deductive reasoning
• Adolescent egocentrism (heightened self-consciousness), belief that others are as interested in them as they are in themselves
• Imaginary audience: involves feeling one is center of everyone’s attention and sensing one is on stage
• Personal fable: adolescent’s sense of personal uniqueness and invincibility
Define how this level of thought influences academics
n/a
Define secondary school issues: transition issues, top-dog phenomenon
Transition issues 4 characteristics
Positive influences?
- Transition issues: increased responsibility, independence in association, decreased dependence on parents, more impersonal experience. Big transition between MS and HS, Most effective schools: Lower student/counselor ratio, High involvement of parents and community, Team teaching configuration, Focus on student health and fitness, High expectations and support
- Positive influences:
- Extracurricular activities: diverse activities including sports, academic clubs, band, drama, and math clubs
- Service learning opportunities: form of education that promotes social responsibility and service to community
- Top-dog phenomenon: circumstance of moving from the top position in elementary (oldest, most powerful) to the lowest middle school (youngest, least powerful)
Identify goals and controversies for secondary school
3 goals
3 controversies
- Goals: “personalizing instruction, show interest in students’ lives, creating a supportive caring social environment”
- Controversies: low expectations, alienation, & low achievement
Identify the reasons for the high dropout rates in some populations:
5 reasons
- School-related: Not liking school, being suspended, or expelled
- Family-related: parents are not involved in their child’s life
- Economic: economically supporting family
- Peer-related: friends dropped out
- Personal reasons: pregnancy or marriage
Identify solutions to keep students in school
- Early detection of school-related difficulties
- Programs focused on reading, tutoring, counseling, and mentoring
- Engaging children in positive ways to be involved in school activities
What constitutes effective schools for young adolescents
7
- Developing smaller “communities” to decrease the impersonal nature of MS
- Lowering student: teacher ratio
- Developing curricula to increase literacy, knowledge of sciences, sense of health, ethics, & citizenship
- Involving parents & community leaders in schools
- Team-teach in flexible curriculum blocks
- Boost students’ health & fitness with more in-school programs
- Help students who need public health care
What reduces adolescent drug use
name 5 reasons
• Early educational achievement, positive relationships with parents, parental monitoring, having friends within their school’s social network, & fewer friends who abuse substances
What propels teens to use drugs?
name 3 reasons
• Having a friend who abuses the substance, weak academic orientation, & low parental support
Delinquency- what social emotional factors contribute to delinquency
earlier development of puberty poor family relationships, abuse, early sexual activity
Teen pregnancy –What are the risks to the mother?- 3 risk What are the risks to the infant? 3 risk
What facilitates teen pregnancy? What are some successful tactics to reduce teen pregnancy
• What are the risks to the mother?
o Drop out of school, lower achievement scores, & behavioral problems
• What are the risks to the infant?
o Low birth rates, neurological problems, & childhood illness
• What facilitates teen pregnancy?
o The United States doesn’t have a strong view on “childbearing being an adult activity” compared to other countries
o Do not send clear messages about sexual behavior: the media glamorizes it and adults do not have clear messages about sexual behavior. Other countries promote safe sex expect it to only occur within long term relationships while the US adults do not have a high expectation on the adolescents here who have sporadic relationships and partners.
o The US is not as accepting as other countries with the idea of teens having sex just “adults” so they do not have as readily available multiple family planning services that are easily accessible without red tape
Suicide – What factors contribute to this issue?
- Suicide is a side effect of Prozac and some of the other anti-depressants
- Risk factors include poor familial experiences and poor peer relations including peer victimization
- Alcohol is an increasing part of the risk factor for both sexes
- Males show less prevalence with African American and non-Latino whites
- Stress has been reported as an increasing risk factor for Latino populations.
Eating disorders - What are anorexia & bulimia? Who is at risk for these disorders
- Anorexia: pursuit of thinness through starvation
* Bulimia: individual consistently follows a binge-then-purge eating pattern
Who is at risk for these disorders
• Adolescents or emerging adults from Non-Latino White families, well-educated, middle to upper class
• Factors:
o Body image: most are dissatisfied with the image
o Parenting: observing parents with healthy eating habits and exercise increased adolescents’ healthy habits
o Sexual activity: sexually active or pubertal transition girls are more likely to diet or engage in eating disorders
o Role models and media: girls who are motivated to look like same-sex figures in media are more likely to be concerned about their weight
Describe the goal to balance autonomy and attachment?
- Adolescents push for autonomy
- The parent must balance the relinquish of control with necessary guidance
- Although there are frequent disagreements, parents are important attachment and support figures
- GOAL: allow adolescents to gain ability to make mature decisions on their own with their parents guidance along the way
Describe parent/adolescent conflict: causes/resolutions?
• Moderate problems, everyday negotiations, & minor disputes create a positive developmental function of helping the adolescent transition from childhood dependency to adult independence
• Keep conflict from escalating by keeping:
o Open communication
o Active listener
o Respect adolescent’s developing status
o Communicate expectations for achievement & conduct standards
Peer pressure- crowds, cliques. What is the purpose of each? How does it influence adolescent behavior?
- Peer pressure: young adolescents conform more to peer standards than children do. This can cause an individual who is unsure about their social identity, have a low self-esteem, or those who have high social anxiety will most likely conform
- Crowds: larger than cliques & less personal; self-esteem can increase probability to becoming a member & due to membership self-esteem increases;
- Cliques: a small group that ranges from 2 to 12 individuals, averaging 5 to 6 individuals, and one that can form because adolescents can engage in similar activities. Develop an in-group identity, share ideas, & build a friendship
How does dating contribute to social-emotional development?
3 positives
5 negatives
- Dating can create higher levels of social acceptance, friendship competence, & romantic competence
- Negatively affect development: higher levels of substance abuse, delinquency, & sexual behavior, adolescent pregnancy, problems at home & school
Does our culture have rites of passage? What are these rites of passage?
- Rite of passage: ceremony or ritual that marks an individual’s transition of status from one thing to the next
- The US as a whole does not, but religious and social groups in the US do
What are these rights of passage
• Debutante balls, bat mitzvah, graduations, pinning ceremonies
Ethnicity and diversity - How do these issues affect the developing adolescent
• Ethnicity: characteristic based on cultural heritage, nationality, race, religion, & Language
• Diversity: quality of being different
• Double Disadvantages:
1. Prejudice, discrimination, and bias because of their ethnic minority status
2. Stressful effects of poverty
Define assimilation and pluralism
assimilation:• Assimilation: Piagetian concept involving incorporation of new information into existing schemes
• Pluralism:refers to a society, system of government, or organization that has different groups that keep their identities while existing with other groups or a more dominant group.
Explain Erickson’s stage of identity vs. identity confusion
• Erickson states that adolescents are faced with deciding who they are, what they are all about, & where they are going in life. There’s a gap between childhood security and adult autonomy where society leaves adolescents relatively free of their culture’s identity files, experiment with different roles, & personalities. Adolescents discard unwanted roles. Those who successfully cope with conflicting identities emerge with a new sense of self, identity. Those who do not resolve their identity crisis are suffering from Identity Confusion. This confusion can cause withdrawing from peers and family or they immerse themselves in their world of peers and get lost in the crowd
Explain Marcia’s four stages of identity status
4 stages
what is a crisis what is a commitment?
- Identity Diffusion: status of individuals who have not yet experienced a crisis (explored alternatives) or made any commitments
- Identity Foreclosure: status of individuals who have made a commitment but have not yet experienced a crisis
- Identity Moratorium: individuals who are in the midst of a crisis but whose commitments are absent or vaguely defined
- Identity Achievement: individuals who have undergone a crisis and have made a commitment
- Crisis: period of identity development where the individual is exploring alternative (Exploration)
- Commitment: personal investment in identity
Who developed SI Theory and what disciplines are incorporated into SI Theory
-A .Jean ayres this discipline involves neuroscience and psychology
Major tenets of SI theory
Integrated sensation is “nourishment for the
brain.”
• Adaptive responses are required to successfully
meet challenges essential for growth and
development.
• The inner drive of the human being invites the
experience of life.
• Active participation promotes organization.
• Artful vigilance
Target population for intervention
Individuals with sensory dysfunction and sensory processing disorder other mental illnesses
Definition/description of sensory integration
“Sensory integration is the neurological process that organizes sensations from one’s own body and from the environment, and makes it possible to use the body effectively within the environment. Sensory integration is information processing.”
Main subtypes of Sensory Processing Disorder
-sensory modulation disorder
sensory over responsive
sensory under responsive
sensory craving
- sensory-based motor disorder
- dyspraxia
- postural disorder
sensory discrimination disorder
Review the 10 characteristics of occupational therapy intervention using an SI approach
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What are the issues associated with adolescent sexuality?
4 issues
• Early sexual experiences in adolescence leads to substance abuse, delinquency, and school-related problems.
• Risk factors such as socioeconomic status, poverty, family/parenting and peer factors,
• Having older siblings that are sexually active places adolescent girls at risk for pregnancy
• Attention problems & aggression lead to increased chances of having early initiation of sexual activity
-developing a sexual identity
-sexual risk taking
-Timing and trends in adolescent sexual behavior
Who developed SI Theory and what disciplines are incorporated into SI Theory
-A .Jean ayres this discipline involves neuroscience and psychology, biology, and education,
The brains ability to process sensory information and motor capabilities
Occupational therapy with a sensory integration approach
Major tenets of SI theory
Integrated sensation is “nourishment for the
brain.”
• The inner drive of the human being invites the
experience of life.
• Active participation promotes organization.
• Artful vigilance
-learning is dependent on the ability to take in and process sensation
-Individuals who have a decreased ability to process sensation also may have difficulty producing appropriate actions
-Enhanced sensation, as part of meaningful activity
Main subtypes of Sensory Processing Disorder
-sensory modulation disorder Problem turning sensory messages into regulated behaviors sensory over responsive extremely sensitive sensory under responsive unaware of sensation sensory craving always need more input
-sensory-based motor disorder weak with poor endurance/ clumsy and awkward -dyspraxia poor motor planning -postural disorder poor core stability poor endurance/ lazy or clumsy
sensory discrimination disorder: Poor interpretation of sensory information Visual auditory tactile smell
Review the 10 characteristics of occupational therapy intervention using an SI approach
provide sensory opportunities provide just-right challenges collaborate on activity choice guide self-organization support optimal arousal create play context maximize childs success ensure physical safety arrange room to engage child foster therapuetic alliance
What is the purpose of IDEA how has it affected how children are educated
Purpose of IDEA (Individuals with Disabilities Education Act) and how it has affected how children with disabilities are educated
• Stipulated that students with disabilities be educated in their neighborhood schools with same age peers unless the nature and severity of the disability requires another arrangement. This is called Least Restrictive Environment (LRE).
• Purpose was to increase the amount of schools educating only children with disabilities. Most children with disabilities were excluded from the education system and many lived in institutions where they were accommodated, not assessed, educated, and rehabilitated.
• Guaranteed a free, appropriate public education for each child with a disability aged 3-21 in every state across the country.
Role of occupational therapy in the educational model
• To help in transportation and such developmental, corrective, and other supportive services that are required to assist a child with a disability to benefit from special education
practitioners collaborate with early childhood and school teams to promote the physical, communication, cognitive, adaptive, and social-emotional domains of infants and toddlers. As a related service under Part B of IDEA and a pupil service under Elementary and Secondary Education Act (also known as No Child Left Behind), occupational therapy practitioners support children and youth by promoting participation in home, school, and community life.
How OT services are delivered in schools
• Evaluating therapist makes a recommendation to the IEP team whether OT services are required for the child to access and progress in his/her educational program
• Decision to add OT services is left to child’s IEP team not OT
• Goals promote participation in and access to the child’s educational program.
• Goals must be measureable and educationally relevant
• Goals are written to reflect what the child will do, not what service is provided. THERE ARE NO OT GOALS. All members of the IEP team are responsible for all of the goals; however, there are goals that OT support will focus on more than the others
• Collaborate with teachers, paraprofessionals and parents
There may be recommendations regarding classroom or assignment modifications or adaptations provided to the teachers,
Reflexes Denver II
to help health providers detect potential developmental problems in in young children
The test gives a comparison of the child’s performance to the performance of other children of the same age
Consists of 125 items which are arranged in 4 sections:
o
Beery VMI- Beery-Buktenica Developmental Test of Visual Motor Integration:
Children’s ability to copy geometric forms correlated to academic achievement
Purpose: To assess the ability to coordinate visual perception and finger-hand movements
Ages 3 to adult
Developmental sequence of 27 geometric forms that are to be copied with pencil and paper.
Supplemental tests were developed to tease out relative strengths and weaknesses in visual perception or motor control skills
Sequence and script must be followed for validity of results: VMI, Visual Perception, Motor tests
VMI is not timed, but there are time limits to the Visual Perception (3 min.) and Motor Control(5 min.) tests
Motor-Free Visual Perception Test (MVPT)
Purpose to assess overall visual perceptual ability.
Perceptual skills targeted are spatial relationships, visual discrimination, figure-ground, visual closure, and visual memory. .
A series of pictures are presented; child must choose the correct answer from 4 choices.
No motor responses required; child can point to the correct answer or say the letter that corresponds to the answer.
TVPS- Test of Visual Perceptual Skills
Tests visual perceptual abilities in 7 areas:
o Visual Discrimination
o Visual Memory
o Spatial Relationships
o Form Constancy
o Sequential Memory
o Visual Figure-Ground
o Visual Closure
Requires limited motor skills to respond
Targeted population: ages 4 – 18yrs, 11months
16 plates in each of the 7 categories, plus 2 examples
Can usually be completed in 30 minutes
Peabody development motor scales
An early childhood motor development designed to assess motor skills of children from birth through 5 years of age.
PDMS-2 Test can be used by Medical, Allied health, Educators, and others interested in examining the motor abilities of young children
PDMS comprises of six components (Subtests)
o Reflexes- Birth – 11 months
o Stationary- All ages
o Locomotion- All ages
o Object manipulation- 12 months and older
o Grasping –All ages
o Visual motor integration – All ages
Piaget’s cognitive levels
• Piaget’s Cognitive Development Theory
Children construct their understanding of the world and go through 4 stages
1. Sensorimotor stage
o Lasts from birth – 2 years old
o Infants construct understanding of the world by coordinating sensory with physical/motor actions
2. Preoperational
o Age 2-7 years old
o Kids represent the world with images and drawings
3. Concrete Operational
o Age 7-11 years old
o Can reason logically with concrete example
o Ex. Child will know 5 nickels is the same thing as 1 quarter
4. Formal Operational
o Age 11-15 years old
o Abstract and logical thinking
Erickson’s levels
• Erikson’s Psychosocial Theory
Believed human behavior is social and stem from a desire to affiliate with other people
8 stages of development
1. Trust vs. Mistrust
• Experienced in 1st year of life. In gaining trust in caregivers infants discover their own personality and learn if the world is a pleasant place to live
2. Autonomy vs. Shame and Doubt
• 1-3 yrs old. If kids are punished too much they began to develop and sense of shame and doubt
3.Intiative vs. Guilt
• Preschool age
• Assuming responsibility for their bodies, behavior, toys etc. If child is irresponsible they may feel guilty
4. Industry vs. Inferiority
• Elementary school. Child directs their energy toward mastering knowledge. If child does bad, they may feel incompetent and unproductive
5. Identity vs. Identity confusion
• Adolescent years. Finding out who they are
6.Intimacy vs Isolation
• Early adulthood. If intimacy is not found with another person the teen will feel isolated
7. Generativity vs. Stagnation
• Middle adulthood. Helping the younger generation develop and lead useful lives. The feeling of not helping is stagnation
8. Integrity vs. Despair
• Late adulthood. Person reflects back on life and feels wither positive of negative about it
screening
gathering information to determine whether an evaluation is necessary
evaluation
the process of obtaining and interpreting data necessary for intervention
