MB ChB and BDS Lecture series
MEDICAL PSYCHOLOGY COURSE
Sesssion 6
Human Development across the life span
By Prof SW Acuda.
1
Objectives
By the end of this session you should be
able to understand human development
from infancy, through adolescence,
adulthood and old age.
2
Topics to be covered
Attachment and theories of
attachment
Cognitive and moral development
Adolescence
Adulthood
Old age
Bereavement
3
Early experience attachment
Studies of attachment and
loss(separation)
Underlies the importance of early
experience
Specifically, the importance of
mother-child relationship
Impact of its disruption in adult life
4
Early experience attachment John
Bowlby (1907 – 1990)
English Psychiatrist did most original
studies
Studied development of children raised
in institutions
Introduced the concept of maternal
deprivation
Maternal deprivation had negative
impact on later adult life 5
Early experience
attachment (cont.)
Emphasis on role of the mother in
child development
Ignored role of the father’s role
Development also involves networks
outside the family
Importance of neighbours, school,
teachers, class mates etc.
6
Development and attachment
What is attachment?
“an intense emotional relationship that is specific
to two people that endures over time and in
which prolonged separation from the partner is
accompanied by stress and sorrow” (Kagan et al
1978)
Attachment occurs at any time in life
The first attachment in life is with the
mother
Regarded as the prototype (model) for all
future relationships 7
Phases of development
(Shaffer 1996)
Pre-attachment phase - Birth to
3 months
Babies develop attraction to
other humans in preference to
the environment
Indicated by nestling, gurgling
and smiling
8
Phases of development
(Shaffer 1996) (cont.)
The indiscriminate phase – at 3
months
Begins to discriminate between
familiar and unfamiliar people
Allows strangers to handle them
9
Phases of development (Shaffer
1996) (cont.)
Discriminate phase – 7 to 8 months
Development of specific attachments
Actively trying to stay close to certain people
(mother)
Distressed when separated (separation
anxiety)
Knows difference between mother and others.
Avoids closeness to others
Fear of stranger’s response 10
Phases of development (Shaffer
1996) (cont.)
Multiple attachment phase – 9 months
onwards
Adds additional ties with other close people
Father, grand parents, siblings etc.
The strongest attachment remains with
mother
11
Theories of attachment
process
The “Cupboard Love Theory”
Attachment to the mother
Mother satisfies its instinctual needs
Feeding satisfies the basic need for
food,
12
Theories of attachment
process (cont.)
Also security and sexual needs
Unhealthy attachments occur when
babies are deprived of food and oral
pleasure
Stresses the importance of breast
feeding and mother figure
Food acts as a reinforcement (a
reward) 13
Harlow’s experiment (Harlow 1959)
Separated new born monkeys from their
mothers
Raised them in cages containing baby
blankets (comfort)
The baby monkeys became intensively
attached to the blankets
Became highly distressed when blanket
was removed
The blanket served as a surrogate mother
14
Harrow’s experiment- (cont.)
As adults they failed to develop normally
They became extremely aggressive as adults
Rarely interacted with others
Made inappropriate sexual advances
Difficult to breed
Conclusion: “Rhesus monkeys develop normally
only if they interacted with others during
the first six months of life”
15
The Ethological Approach
Ethologists study animal behaviour in
their natural environments
Lorenz (1935) an Ethologist
Some non- humans form strong bonds
with the first moving object they see
Usually, but not always, the mother
He called this imprinting
16
The Ethological Approach(cont.)
Imprinting occurs without the feeding
Occurs at a specific releasing stimulus
Occurs only during a critical time in
which the event must happen
Once imprinting occurs, it is irreversible
If missed, the animal does not acquire
that behaviour
Gosling experiment
17
The Ethological Approach(cont.)
Bowlby concluded that babies are
genetically programmed to behaviours
towards their mothers to ensure
survival
There seems to be a critical period
during which attachment occurs
The child is attached to the mother
but the mother is bonded to the child.
18
The Ethological Approach(cont.)
Specific behaviours used by infants to
control their mothers
Suckling – not only for food, but also
for pleasure
Cuddling- babies adjust their postures
to mould contours of mother’s body
19
The Ethological Approach(cont.)
Looking- when parents don’t make eye
contact babies become distressed.
Smiling – seems to be innate (born
with) behaviour, not learnt
Crying – only when hungry or in
distress
Can effectively be ended by picking up
and cuddling
20
The Ethological Approach(cont.)
The role of the father
According to Bowlby, fathers had no
direct emotional significance to the
infant
Fathers role was indirectly through
economic support
21
Activity 1.
Discuss with people next to you.
▪ Bowlby’s theory of attachment to
mothers only
▪ That the father has no significant
role
What are your cultural practices in
early upbringing of children?
22
Critics of Bowlby’s Theory
Infants and babies display a range of
attachments to other people apart from
the mother
Children are able to form multiple
attachments
His studies were based on children raised
in institutions
23
Critics of Bowlby’s Theory
(cont.)
Maternal deprivation does not always
lead to irreversible damage
Protection and survival increased the
chances of successful reproduction
Cultural variations in child upbringing
24
Separation Anxiety
The fear that separation will occur again
Increased aggressive behaviour
Greater demand on the mother
Clinging behaviour- unable to let mother
out of sight
Emotional detachment –becomes self
sufficient
Psychosomatic reactions- non- specific
physical complaints
25
Separation Anxiety (cont.)
Recent studies on consequences of
separations due to
▪ Divorce
▪ Day Care
▪ Adaptions
▪ Working mothers
▪ Maternity and Paternity Leaves
26
Cognitive Development
The study of a child as a thinker
How a child’s thinking develops?
Jean Piaget’s (1896 – 1980) Theory of
child development
Still the most influential and
comprehensive theory
Theory of how the child comes to
understand the world
27
Cognitive Development (cont.)
He was a Psychologist who specialised
on Intelligence testing
Studies were based on observation of
his own children
Proposed a concept of mental
structures he called “schemas” which
form the building blocks of
understandings
28
Cognitive Development (cont.)
The child is born with certain reflexes –
suckling, crying
Cognitive development occurs through
interaction of the inborn capacities and the
environment.
29
Cognitive Development (cont.)
As the child interacts with the world
around them, they develop mental
structures (Schemas)
Schemas are the building blocks of
cognitive development
Just as in a building, it not possible to build
a second floor before the first one
Schemas may be behavioural, symbolic or
operational
30
Cognitive Development (cont.)
Schemas are developed through
▪ Assimilation and accommodation
▪ Assimilation- in cooperation of new
information on existing ones
▪ Accommodation – modifying or alteration
of information to fit into existing ones
Together these constitutes adaptation
Underpins cognitive development
31
Cognitive Development (cont.)
Cognitive development progresses through
stages
Each stage is representing a stage in the
development of intelligence
All children pass through the stages in the
same sequence
This was universal in all cultures
32
Cognitive Development Piaget’s Stages
of cognitive development
0 – 2 years: Sensorimotor stage
▪ Infants use sensory information gained
through the mouth and hands to learn
about objects around them
2 – 7 years
▪ Preoperational stage
▪ Children influenced by how things look.
Children learn to use imagination and
language. They become self- aware
33
Cognitive Development Piaget’s Stages
of cognitive development (cont.)
7 – 11
▪ Concrete operational stage
▪ Child able to use logical reasoning. Can view
things through others perspective. Still has
difficulties dealing with abstract concept
11 years and above
▪ Formal operation stage
▪ Child capable of engaging in abstract thoughts.
▪ Able to manipulate ideas and follow arguments
34
Cognitive Development Piaget’s Stages
of cognitive development (cont.)
The theory has been criticised
Remains influential in the understanding of
a child’s level of understanding
35
Moral development
Becomes important as the child grows
Associated with independence
Ability to tell right from wrong, good
from bad, moral immoral
36
Moral development: Kohlberg’s
stages of moral development (1996)
Preconvention morality
▪ Consequences used to distinguish right
from wrong
▪ Aim to achieve rewards and avoid
punishment
▪ Obedience to authority
37
Moral development: Kohlberg’s
stages of moral development (1996)
Conventional Morality
▪ Need to be seen as a nice person
▪ Behaviour judged to be a good person
▪ Based on societal and cultural norms the child
lives in
Post conventional morality
▪ Emphasises the importance of obeying agreed
laws and social rules
▪ Adaption of ethical principles and conscience
38
Adolescence
Period between childhood and adult life
Key/crucial time for development
Adolescence was overlooked by the major
theories of development- Freud and
Piaget)
Onset is at puberty
Age varies across cultures
Difficulties determining the exact age
39
Adolescence (cont.)
Some cultures have initiation ceremonies
to mark the beginning
Individuals mature differently at their
own pace
It is time of enormous physiological
changes
Changes in behaviour, expectations,
relationship with parents and peers
40
Adolescence (cont.)
A period of transition between childhood
and adult
Consists of multiple transitions and shifts.
Education and training,
Employment and unemployment
Living circumstances
41
Normative and Non-Normative
shifts (Hendy and Kloep 1999
Normative maturation shifts
▪ Growth spurt, Menarche, Voice breaking
▪ Nocturnal emissions (wet dreams)
▪ Changes, maturation in sexual organs
▪ Beginning of sexual attractions/arousals
42
Normative and Non-Normative
shifts (Hendy and Kloep 1999) (cont.)
Normative maturation shifts (cont.)
▪ Gender role, Increasing autonomy,
romantic relationships
▪ Changes from primary to secondary
schools
▪ Leaving school, starting work
▪ Acquisition of legal rights- Driving
license, buying alcohol
43
Normative and Non-Normative
shifts (Hendy and Kloep 1999) (cont.)
Non- normative shifts
▪ Parental divorce/separations
▪ Family bereavement
▪ Illness
▪ Natural disasters, civil wars,
displacements
▪ Risk taking behaviours
44
Young People
Young people and mental health
(WHO 2018, WFMH 2018)
The age group 15 to 24 years
Can be very exciting time but also
associated with constant stress.
Rapid changes in the body
Critical stages of brain development
45
Young People (Cont.)
School issues – day to boarding
Leaving home
Starting University
First jobs/new jobs
Forming relationships/getting
married
Assuming responsibilities
46
Young people and mental health
(WHO 2018, WFMH 2018)
47
Availability and use of online
technologies (internet)
Has many
benefits but also
additional stress
Much time spent
on internet
Access to
unlimited
information
48
Availability and use of online
technologies (internet) cont.
Cyber-
crimes/cyber
bullying
Violent video
games
49
Growing up in today’s World –
Can be stressful
Pressure to succeed/examinations
50
Growing up in today’s World –
Can be stressful (cont.)
Trauma -Domestic
violence
Sexual violence,
abuse abuse
Hash parenting
51
Growing up in today’s World –
Can be stressful (cont.)
Bullying
52
Growing up in today’s World – Can be
stressful (cont.)
• Consequences of bullying
53
Growing up in today’s World –
Can be stressful (cont.)
Humanitarian crisis, conflicts, wars,
natural disasters
Association with stress
54
Activity 2
Discuss with the person next to
you the stresses you have
experienced so far
Share your experiences with the
class
Has any one you know experienced
cyber bullying/crime?
55
Consequences of stress
If not recognized early can result in
mental illness.
Poor mental health in adolescence has
negative impact on education and the
future.
75% percent of mental illnesses begin
between age 14 and 24 years.
Most go undetected and untreated
56
Consequences of stress (cont.)
Emotional disorders- Depression, anxiety,
irritability, withdrawal/isolation is the
commonest
Suicide is second most common cause of death
among 15 to 29 year olds
Eating disorders – Anorexia Nervosa and
Bulimia
57
Consequences of stress (cont.)
Gender Issues –LGBTI (Lesbians, Gay,
Bisexual, Transsexual, Intersexual etc.)
Suffer from persecution,
discrimination, imprisonment, death
penalty
Suicide thoughts, attempts.
58
Activity 3
Have you experienced or come
across persons with gender
identity issues?
What is your cultural attitudes
toward these persons?
59
Maladaptive reactions to stress
Behavioural disorders and conduct
disorders
Antisocial behaviours
Harmful use of
alcohol/drugs/unsafe/unprotected sex
Repeated self- harm
Testing limits and boundaries
Perpetration of violence
60
Adulthood
The longest phase of life
From late teens to 60 or 65
years
Go through psych- biosocial
transitions (Levinson 1986)
Also called critical life events
61
Critical life events
Normative-age graded influences
Menopause, social changes, marriage
Normative-history guided influences
Historical events that affect
generations at same time
Wars, epidemics, recession
Non-normative influences
Divorce, unemployment, illness
62
Midlife crisis
Is there a “mid-life crisis”?
Age 40 – 45
About 25% of both men and women
experience some mid-life crisis (Wethington
2000)
Awareness of aging and concern about time
left to live
In Africa life expectancy was in mid fifties
Review and re-evaluation of lives
63
Midlife crisis (cont.)
What have I achieved?
Could I have done better
Many people make radical changes in their
lives at this time
Depression and sexual problems occur at
this time
But “the experience of a major mid-life
identity crisis does not appear to affect the
majority of mid-life adults” Kroger 20070
64
Marriage
A normal expectation in life
An important transition
Lasting commitment to another person
Financial responsibilities
Family responsibilities
65
Marriage (cont.)
Co-habiting relationships
More likely to divorce when they get
married
Less satisfied with marriage
40% percent do not marry at all
66
Benefits of marriage
Mortality is affected by marital status
Married people live longer than the
unmarried
They are happier and healthier
Lower rates of mental illness
Divorcees and widows in their 30s have
high risks of early death
67
Divorce
Increasing in high income countries
Highest during first 5 years of
marriage
A second peak after 15 -20 years of
marriage
50% of marriages in UK currently end
in divorce (Hill 2009)
68
Divorce (cont.)
Divorce associated with significant stress
for both
Loss of major attachment
Loss of emotional support
Consequences of divorce – financial,
accommodation, children etc.
Men experience more stress than women
69
Parenthood
90% of adults become parents
Requires psychological adjustment
Brings couple closer
Increased responsibilities
70
Parenthood (cont.)
Majority of parenthood involve
couples
Others are single or homosexual
couple
More women in high income
countries delaying first child
because of career development
71
The “Empty Nest Vs Crowded
Nest” syndrome
Departure of children from home
Parents react differently
To others it is stressful to others it is a
relief
Increasing number of children opting to
stay at home
Can be a major source of stress.
72
Old Age
Defined as age of retirement (60 or 65) in
high income countries
Lower in low income countries
Life expectancy increasing, currently 56
(Uganda), 80 (UK)
Fastest growing age group in developed
countries
In Uganda the elderly constitutes about
2%, 17% (UK)
73
What is old age?
Chronological age – official birthday
Biological age – the look of the face
and body shape
Subjective age- how one feels
Functional age – Lifestyle, what one
is able to do
74
Major changes/challenges in old age
The elderly is classified as vulnerable
populations
Heath problems- High blood pressure,
Heart and lung diseases, Diabetes etc.
Cognitive changes in old age- impaired
memory including dementia
Impaired sensory functions – vision and
hearing
75
Major changes/challenges in old age
(cont.)
Loss of role in society
Social and economic changes, isolation
Effect of retirement
Many lost children due to HIV/AIDS
Caring for grand children
Bereavement
76
Bereavement-Grief Reaction
Psychological reaction due to death of an
attachment figure
Can occur at any stage in the life span
Becomes more likely with advancing age
In old age involves a spouse
77
Bereavement Grief Reaction
(cont.)
It is a natural human reaction
Found in all creatures
Duration and severity varies
Bereaved couples are at increased risk
of dying compared with age matched
controls.
78
Symptoms/Features
Numbness, disbelief, unreality, denial
Alarm reaction – anxiety,
restlessness, stress, fear.
Feeling of regret, failure, guilt
Yearning, searching for lost one
79
Symptoms/Features (cont.)
Continuing interaction with the
diseased
Feeling of a presence of the diseased
Hearing voice or seeing vision of the
diseased
Anger, sorrow, despair, ruminations.
Difficulty maintain normal social
relationships 80
Physical symptoms
Insomnia
Fatigue, lethargy
Slowed thinking, poor
concentration
Loss of appetite.
Anniversary reactions
81
Atypical grief reaction
Prolonged – over six months
High intensity- symptoms of major
depression
Distorted grief – hostility, over
activity, extreme withdrawal
Can precipitate a major mental illness.
82
Summary:
Discussed theories of attachment and
importance of attachment in shaping later life
behaviour.
Reviewed Jean Piaget’s theory of cognitive
development and its role in enable
understanding a child’s level of understanding.
Discussed adolescence and early adulthood,
adult life and old age and challenges they face
including bereavement.
83
End
Thank you
84
