Human Development and Child and Adolescent Mental Health

LIFESPAN DEVELOPMENTAL FRAMEWORK

Erikson's psychosocial stages describe eight developmental conflicts across the lifespan, each requiring resolution for healthy development: Trust vs. Mistrust (infancy), Autonomy vs. Shame/Doubt (toddlerhood), Initiative vs. Guilt (preschool), Industry vs. Inferiority (school age), Identity vs. Role Confusion (adolescence), Intimacy vs. Isolation (young adult), Generativity vs. Stagnation (middle adult), Integrity vs. Despair (older adult). Resolution creates specific virtues (e.g., trust → hope; identity → fidelity).

INFANCY: ATTACHMENT THEORY

John Bowlby proposed that infants have an evolutionarily determined need to maintain proximity to a primary attachment figure for protection. The Strange Situation (Ainsworth) classified attachment styles: Secure attachment — infant explores freely, is distressed by separation, readily comforted by caregiver's return; associated with sensitive, responsive parenting. Insecure-Anxious/Ambivalent — clingy, difficult to soothe on reunion. Insecure-Avoidant — ignores caregiver at reunion. Disorganised — no coherent strategy; associated with frightening/abusive caregiving and predicts adverse outcomes. Long-term consequences: secure attachment predicts emotional regulation, social competence, resilience, and healthier adult relationships; disorganised attachment predicts increased risk of psychiatric disorders and difficulties with interpersonal trust.

CHILDHOOD: COGNITIVE DEVELOPMENT AND NEURODEVELOPMENTAL DISORDERS

Piaget's stages of cognitive development: Sensorimotor (0–2 years) — object permanence; Preoperational (2–7 years) — symbolic thinking, egocentrism, lacks conservation; Concrete Operational (7–11 years) — logical reasoning about concrete objects; Formal Operational (12+ years) — abstract reasoning.

ADHD: Attention Deficit Hyperactivity Disorder — prevalence approximately 5% of children globally, more common in males 3:1. Subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Neurobiology: dopamine and noradrenaline dysregulation in prefrontal cortical circuits governing executive function and attention. Methylphenidate (Ritalin) — first-line stimulant; blocks dopamine and noradrenaline reuptake transporters; effective in 70–80%; adverse effects include reduced appetite, sleep disturbance, and modest growth suppression. Atomoxetine — non-stimulant SNRI; suitable when stimulants are contraindicated (e.g., tic disorders, substance misuse risk). Behavioural interventions (parent training, classroom accommodations) are essential adjuncts.

Autism Spectrum Disorder (ASD): DSM-5 defines two core domains — (1) persistent deficits in social communication and interaction (social reciprocity, nonverbal communication, developing/maintaining relationships); (2) restricted, repetitive behaviours, interests, or activities (stereotyped movements, insistence on sameness, highly restricted interests, hyper/hyporeactivity to sensory input). Onset in early development (though may not fully manifest until social demands increase). No single pharmacological treatment for core symptoms; intensive behavioural interventions (Applied Behaviour Analysis), speech therapy, and educational support are central.

Conduct Disorder vs. Oppositional Defiant Disorder (ODD): ODD involves recurrent anger/irritability, argumentativeness, and defiance toward authority. Conduct Disorder involves more severe violations of others' rights or social norms (aggression, destruction of property, deceitfulness, rule violations). Conduct disorder is a significant risk factor for antisocial personality disorder in adulthood.

ADOLESCENCE

Erikson's Identity vs. Role Confusion stage: adolescents explore different roles and must integrate a coherent sense of self. Brain development: the prefrontal cortex (executive function, impulse control, long-term planning) is the last brain region to fully myelinate, completing in the mid-20s. This relative prefrontal immaturity combined with a more mature limbic reward system explains heightened risk-taking, novelty-seeking, peer susceptibility, and susceptibility to addiction during adolescence.

Eating Disorders: Anorexia Nervosa (AN) — refusal to maintain minimally normal body weight (BMI <17.5 kg/m2 in adults; weight below expected in adolescents), intense fear of weight gain, and distorted body image. In females before menopause: amenorrhoea. Restricting and binge-eating/purging subtypes. Medical complications: bradycardia, hypotension, QTc prolongation, hypothermia, lanugo hair, peripheral oedema, electrolyte disturbances (hypokalaemia, hyponatraemia, hypophosphataemia), osteoporosis, and refeeding syndrome (precipitous hypophosphataemia on re-nutrition, causing cardiac arrhythmias). Bulimia Nervosa (BN) — recurrent binge-eating followed by compensatory behaviours (vomiting, laxatives, exercise); typically normal weight; Russell's sign (dorsal hand abrasions from induced vomiting); parotid hypertrophy; dental erosion; electrolyte disturbances from purging. CBT-BN is the most effective treatment for BN; SSRIs also reduce binge-purge frequency.

Substance Use Disorders — DSM-5 integrates abuse and dependence into a single spectrum; features include craving, loss of control, tolerance, withdrawal, and functional impairment.

MID-LIFE AND LATER ADULTHOOD

Grief and Bereavement: Kübler-Ross's stages (Denial, Anger, Bargaining, Depression, Acceptance) are not linear or universal but provide a descriptive framework. Complicated grief (prolonged grief disorder, ICD-11) is characterised by persistent yearning and functional impairment ≥6 months post-loss.

Late-life depression: often presents atypically with cognitive complaints, somatic symptoms, and hypochondriasis rather than explicit sadness. Pseudodementia: depression that mimics dementia; key distinguishing features — abrupt onset, patient complains actively of memory loss (vs. anosognosia in true dementia), orientation preserved, improves with antidepressant treatment.

Delirium: acute confusional state characterised by fluctuating inattention, disorientation, altered consciousness, and often perceptual disturbances (hallucinations). Causes: PINCH ME (Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment/immobility). Management: treat the underlying cause; non-pharmacological approaches first (orientation, familiar environment, normalise sleep-wake cycle); haloperidol for severe agitation.

MATERNAL MENTAL HEALTH

Perinatal depression: affects approximately 1 in 7 women during pregnancy or the first year postpartum. The Edinburgh Postnatal Depression Scale (EPDS) is the validated screening tool; score ≥13 warrants further assessment. Treatment: psychosocial support, CBT, and SSRIs (sertraline preferred — minimal transfer into breast milk).

Postpartum psychosis: rare (approximately 1 in 1000 births) but a psychiatric emergency; onset usually within the first 2 weeks postpartum with rapid onset of psychosis, severe mood disturbance (mania, depression, or mixed), confusion, and disorganised behaviour. Immediate psychiatric admission is required due to risks to mother and infant. Lithium is the most effective prophylaxis in women with bipolar disorder or prior postpartum psychosis.