Developmentalism

Principles:

• physiological development drives psycho-social development

• time is a major determinant of personality development

• “stages of development” exist; stages cannot be skipped, missed, or avoided

Developmental Tasks of Infancy

• Motor Skills

• Emotive Skills

• Cognitive Skills

• Social Skills

• Integrative skills

I. Stages of Motor Development

1 month Lifts head while lying on stomach

2 months Lifts chest while lying on stomach

3 months Rolls over

4 months Sits up with support

6-7 months Sits up alone

8 months Crawls, stands up with help

11 months Stands alone

12 months Walks alone

17 months Walks up steps

II. Stages of Emotional Development

• Attachment related to genetically based behaviours (crying, sucking, smiling, clinging and following)

• Attachment is active and reciprocal

• Separation anxiety caused by absence of the attachment figure

Attachment

• Parents who respond to cries promptly

• Appropriate responsiveness of parent more important than time of physical closeness

• Categorization of infants:

Secure Insecure

Ambivalent-resistant Avoidant

III. Stages of Cognitive Development

• Piaget

• Sensorimotor

• Pre-operational

• Concrete operational

• Formal Operational

Sensorimotor Stage

• 0-2 years of age

• Use of senses and motor abilities to understand and respond to the world

• Object permanence

• Cause-effect reasoning

• The development of memory

Pre-operational Stage

• 2-6 years of age

• Ability to hold mental representations

• Pretending, play are possible

• Ego-centric world-view (“I” vs “you”)

• Ability to think symbolically

• “The Explosion of Words”

• Consequential thinking

Concrete Operations

• 7-11 years of age

• Progressive ego-decentering

• Ability to classify, categorize, draw generalizations, stereotype

• Ability to consequentialize and seriate (put things in order)

• Able to use inductive and deductive logic

Formal Operations

• 12+ years of age

• Able to form and test mental hypothesis

• Able to deal with abstractions

• Able to understand (though not deal with) ambiguity

IV. Stages of Social Development

• Belenky’s “Women’s Way of Knowing”

• Culture Shock Model

• Perry’s Development of College-Aged Students

Erikson’s Stages of Human Development

Stage Age Crisis

1 0-1 Trust vs.Mistrust

2 1-2 Autonomy vs.Doubt

3 2-6 Initiative vs.Guilt

4 6-12 Industry vs.Inferiority

Erikson’s Stages of Human Development

Age Stage Crisis

5 13-20 Identity vs.Role Confusion

6 20-35 Intimacy vs.Isolation

7 35-55 Generativity vs.Stagnation

8 55+ Integrity vs.Despair

Stage 1: Infancy (0-1)

• Crisis: Trust vs. Mistrust

• Description: In early life, infants must rely entirely upon adults to meet basic physiological needs

• Positive Outcome: If needs are met consistently and responsively, secure attachment will form

Stage 2: Toddler (1-2)

• Crisis: Autonomy vs. Doubt

Independence vs. Shame

• Description: Toddlers learn to walk, talk, use toilets, etc. which represents self-control

• Positive Outcome: Confidence to cope with situations that require initiative, choices, control and independence

Stage 3: Early Childhood (2-6)

• Crisis: Initiative vs. Guilt

• Description: Children discover their own power, and must learn to control impulses and childish fantasies

• Positive Outcome: Children learn, with consistent discipline to accept without shame that certain things are not allowed

Stage 4: School Years (6-12)

• Crisis: Industry/Competence vs. Inferiority

• Description: Transition from world of home to world of peers and others

• Positive Outcome: Pleasure in intellectual stimulation, being productive and succeeding in competition

Stage 5: Adolescence (13-20)

• Crisis: Identify vs. Role Confusion

• Description: With the onset of puberty, children struggle to determine their owh characters, independent of family

• Positive Outcomes: Grounded acceptance and sense of self, and one’s own strengths and limitations

Stage 6: Early Adulthood (20-35)

• Crisis: Intimacy vs. Isolation

• Description: Adults learn to share feelings with others and develop intense, mutual inter-dependent relationships with others

• Positive Outcomes: The ability to relate and share emotions and thoughts with others and to learn and grow from this

Stage 7: Middle Adulthood (35-55)

• Crisis: Generativity vs. Stagnation

• Description: At the peak of their working lives, adults need to contribute meaningfully to society

• Positive Outcomes: Artefacts, creativity, insight, accomplishment, success

Stage 8: Late Adulthood (55+)

• Crisis: Integrity vs. Despair

• Description: Towards the end of life, adults must come to terms with their lives and accept all their dreams did not come true

• Positive Outcome: Death with dignity

Developmental Explanation for Emotional Responses

Rage: (anger due to frustrated desire)

Guilt: (self-recrimination due to lack of control)

Self-conciousness:

(fear of negative evaluation by others)

Embarrassment:

(experiencing negative evaluation by others)

Shame: (enduring state of embarrassment)

Social Anxiety: (avoidant/withdrawal behaviours)

Behaviours that emerge as a result of emotional responses

• Denial (distorting reality)

• Downward social comparison

• Self-handicapping

• Self-focus/narcissism

• Rule-boundedness

• Borderline

Summary of Developmental Perspective

• Stages of development cannot be skipped

• Personality formation is based on successful, age-appropriate negotiation of fundamental crises

• Is there a fixed time in which personality or traits may be formed?

Application to Pharmacy Practice

• People cannot understand issues which are developmentally beyond them

• Need to meet patient at his/her developmental level, not yours

• Observed behaviour is not the end-point; reason for emergence of behaviour is important