child & adolescent 1

7/22/2019 Child & Adolescent 1

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Child is not a mini size measure

adult


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What s the difference between child and

adult ?


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Elementary differences

Child :

have the character of egocentricly, everything

evaluated by the child pursuant to importanceof himself

sexual apparatus hadnt been formed finely;

event that had the sexual character will be

interpreted as something that have the

pregenital character


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< 7 years old : not yet thinking pursuant to

causality; baby cant differentiate himself &

things coming from the outside

dont have the concept concerning time, childsbehaviour especially influenced by instinctual

motivation; if id is more dominant, child

determined by fulfilled immediately of his

satisfaction (fulfilled by demand of instinctualmotivation)


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Differences between Child &

Adolescent Psychiatry and Adult

Psychiatry 1.Child not yet ready :

to express his suffered trouble or problem

to give good & directional information forreferring to his past

2. Child express his emotional difficulty

through his behaviour difficulty ingiving food, sleep, urination/defecation ;behaviour problem, emotional or somaticsymptoms


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3.Childs personality s influenced

by environmental factor; existence of thechange in environment or family will resultin child experienced a larger changes againhimself

4. Child express his feeling & fantasythrough games or by playing

5. If the obtained symptom come from

environment or family, the involved familymember better engaged familytherapy or environmental manipulation


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In facing child with psychiatric disorder wemust pay attention to :

1.Parent-child relationship; role of parents &emotional atmosphere influence informing personality, especially below 5-6 years

old 2.Child step by step performs the forming of

personality to adult personality by elementssince he was born & environmental situation

plays a part in growth & maturation of laterpersonality


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Child Development

Born with intrinsic factor :ability & potency

boundary

the nature experienced changes by

interaction with environmental factor

( representing extrinsic factor)


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Intrinsic factor : hetero constitutional &

represent the matrix for the childsdevelopment in the future

Extrinsic factor : influence the adjustment& development of child


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Extrinsic factors that plays a role

Attitude & attention of the parents

Emotional atmosphere in the family

Norm & ethics in the family

Religious life in the family

Social economy level Parents educational level


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Theories of Personality &

Psychopathology Sigmund Freud

Topographical Model of the Mind

Structural Theory of the Mind Psychosexual Development

Erik Erikson

Psychosocial Development Jean Piaget

Psychocognitive Developmnet


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Jerschildt

Psycho affective Development

Stella Chess

Psychomotor Development

Kohlberg

Moral Development


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Topographical Model of the Mind

Freud divided the mind into 3 regions:

1. The Conscious System

2. The Preconscious System

3. The Unconscious System


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1. The Conscious System

Perceptions coming from the outside world orfrom within the body or mind are brought intoawareness

Consciousness : a subjective phenomenonwhose content can be communicated only by

means language or behaviour

attention cathexis

Conscious Preconscious

hypercathexis


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2.The Preconscious System

Comprises: mental events, processes & contentsthat can be brought into conscious awareness

by the act of focusing attention

Interfaces with unconscious & conscious

regions of the mind To reach conscious awareness: contents of the

unconscious must become linked with words &become preconscious

Serves to maintain the repressive barrier

to censor unacceptable wishes & desires


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3. The Unconscious System

Dynamic

Mental contents & processes are kept fromconscious awareness through the force ofcensorship or repression

Closely related to instinctual drives

Limited to wishes seeking fulfillment

Characterized by primary process thinking,which is principally aimed at facilitating

wish fulfillment & instinctual discharge(pleasure principal)

Consists of id, ego, superego


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Preconscious

Unconscious Conscious

censors are over powered elements

can enter consciousness


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Structural Theory of the Mind

SUPEREGO

CONSCIOUS CONSCIOUS

EGO

UNCONSCIOUS UNCONSCIOUS

Id


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Structural Theory of the Mind

ID SUPEREGO

EGO


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1.Id

reservoir of unorganized instinctual

drives

primary process thinking pleasure principal

(menginginkan sesuatu dan ingin

terlaksana dengan segera tanpa

memperdulikan realita)


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2. Ego

spans all 3 topographical dimensionsof conscious, preconscious &

unconscious

Executive organ of the psyche &controls motility, perception, contact

with reality

Reality principlesecondary process thinking


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3. Superego

Moral conscience: ideals & values internalizedfrom parents

Children internalized parental values &standards at 5-6 years old

Ego ideal : what a personshould do & shouldnt do

Through out the latency period , children

continue to build on early identificationsthrough air contact with admired figures,formation of moral standards, aspirations &ideals


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Stages of Psychosexual

Development Oral stage : birth- 18 months

Anal stage : 18-36 months

Urethral stage

Phallic stage : 3-5 years

Latency stage : 5-6 years-11-13 years

Genital stage : 11-13 years-reaches young

adulthood


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Oral stage :birth:-18 months

Centers on the mouth, lips, tongue Oral sensations : thirst, hunger, pleasurable

tactile stimulations evoked by the nipple orits substitute

Oral triad : eat, sleep, relaxation Oral drives :

Libidinal (oral erotism) >> early part s oforal phase

Aggressive (oral sadism):

biting, chewing, spitting,

crying, destroying


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Objectives

to establish

a trusting dependence on nursing &sustaining objects

comfortable expression & gratification of oral

libidinal needs without excessive conflict or

ambivalence from oral sadistic wishes

Pathological traits : excessive

optimism, narcissism, pessimism,

dependent, envy & jealousy

Character traits: capacities to

give & receive from others without dependence,

envy

rely on others with a sense of self-reliance & self

trust


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Anal Stage: 18-36 months

Maturation of neuromuscular control over sphincter

More voluntary control over retention or expulsion offeces

Toilet training Anal erotism : sexual pleasure in anal functioning:

retaining the precious feces & presenting them as aprecious gift to the parent

Ambivalence Anal sadism : feces : powerful & destructive weapons


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Objective : striving for independence & separationfrom the dependence on & control by the parent

Pathological traits : orderliness,obstinacy, willfulness, stubbornness,frugality, messiness, defiance, rage,sadomasochistic tendency

Character traits: personal autonomy, capacity forindependence & personal initiative without guilt,self-determining without shame or self doubt, lackambivalence ,willing cooperation withoutexcessive willfulness or self diminution or defeat


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Urethral Stage Transitional stage between anal & phallic

stage

Urethral erotism : pleasure in urination &retention

Pathological trait s : competitiveness,ambition, development of penis envy

Character traits : budding gender identity &

subsequent identifications


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Phallic stage : 3-5 years

Primary focus of sexual interests, stimulation &

excitement in genital area

Penis : female evidence of castration Genital masturbation

Oedipal wishes

Objectives: to focus erotic interest in genital area& genital functioning, identification


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Character traits:

foundations for an emerging sense of sexualidentity, sense of curiosity without

embarrassment, initiative without guilt

Regulation of drive impulses & direction to

constructive end

Internal source of regulation is superego; based

on identifications derived primarily from

parental figures


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Latency Stage : 5-6 years-11-13

years Relative quiescence or inactivity of sexual

drive

Primarily homosexual affiliations for boys& girls

Sublimation of libidinal & agressive

energies into learning, play activities,exploring environment


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Objectives:

further integration of oedipal identification consolidation of sex-role identity & sex roles

mastery skills

Character traits Essential basis for a mature adult life of

satisfaction in work & love


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Genital stage : 11-13years-reaches

young adulthood Physiological maturation of systems of

genital functioning & attendant hormonal

systems intensification of drives,particularly libidinal drive

Regression in personality organization;reopens conflicts of previous stages ofpsychosexual development

child & adolescent 1

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