DEVELOPMENTAL Frames of Reference

1. DEVELOPMENTAL Frames of Reference THEORISTS: Jung, Freud, Erikson, Levinson, Kohlberg and Wilcox and Gilligan, Piaget, Laslett and Mosey.

3. BASIC ASSUMPTIONS Development is considered an age and stage process which is sequential. Influences of culture, socialization and morality play an integral part. Each theorist defines stages differently

4. Basic Assumptions, cont. Mosey�s Adaptive Skills model is useful for interpreting these theories in the context of occupational behavior (Cole, Appendix C) Sensory Integration Skill Cognitive Skill Dyadic Interaction Skill Group Interaction Skill Self-Identity Skill Sexual (Role)-Identity Skill.

5. ANNE MOSEY: RECAPITULATION OF ONTOGENESIS A Developmental Frame of Reference Ontogenesis = normal development of an organism Adaptive Skills � �learned patterns of behavior (essential) for successful participation in ...occupational performance.�

6. SIX ADAPTIVE SKILLS& Subskills 1. Sensory Integration Skill: ability to receive, select, combine, and coordinate vestibular, proprioceptive, and tactile information for functional use. Based on Ayres Ages Birth to 3

7. Mosey, Cont. 2. Cognitive Skill: ability to perceive, represent, and organize sensory information for the purpose of thinking and problem-solving Based on Piaget Ages: Birth to 13 years

8. Mosey, cont. 3. Dyadic Interaction Skill: ability to participate in a variety of dyadic relationships Association relationships (3-5 yrs.) Authority relationships (6-7 yrs.) Chum relationships (10-14 yrs.) Peer-Authority relationships (15-17 yrs.) See authority figures realistically Intimate relationships (18-25 yrs.) Nurturing relationships (19-30 yrs.)

9. Mosey, cont. 4. Group Interaction Skill: The ability to engage in a variety of primary groups (Appendix B) Parallel group (18 mo.-2 yrs.) Project group (2-4 yrs.) Egocentric-cooperative group (5-7 yrs.) Cooperative group (9-12 yrs.) Mature group (15-18 yrs.)

10. Mosey, cont. 5. Self-identity Skill: ability to perceive the self as a relatively autonomous, holistic, and acceptable person who has permanence and continuity over time (influenced by Erikson) Self as worthy person (9-12 months) Assets & limitations (11-15 yrs.) Self directed (20-25 yrs.) Productive member of social group (30-35 yrs.) Autonomous identity (35-50 yrs.) Aging of oneself, understand mortality (45-60 yrs.)

11. Mosey, cont. Sexual Identity Skill: ability to perceive one�s sexual nature as good and to participate in a relatively long-term sexual relationship that is oriented to the mutual satisfaction of sexual needs Parallels psychosexual stages Based on ego psychology

12. Mosey�s Adaptive Skills, cont. Represents attempt to integrate many developmental theories as they relate to occupation and adaptation in daily life (OT) Provides guidelines for evaluating, structuring, and sequencing skills in a variety of areas.

13. Mosey, Current Research Mary Donohue�s Group Profile Means for validating Mosey�s group interaction skill sequence 1. Parallel Level Group: Three year olds playing separately next to each other in a sand box Adults standing in rows next to each other doing movement to music in a Movement Group

14. Donohue, Group Profile, cont. 2. Project/Associative Level Group Four year olds playing telephone for two minutes Five year olds building blocks together to make a fort � 5 minute interaction Adults engaged in a �Pass the ball� game identifying names of members � 15 minute interactive exercise

15. Donohue�s Group Profile, cont. 3. Egocentric Cooperative Level Group (Basic Coop.) Seven year olds role playing in costumes with mutually designed guidelines for role interaction Adults in an ADL group washing, cutting, mixing, serving, and eating fruit in a salad

16. Donohue�s Group Profile, cont. 4. Cooperative Level Group (supportive cooperative) Sixteen year olds discussing feelings about musical lyrics while making decorations for a parade float Seniors discussing feelings about peers� illnesses, memories of the past, and process of dying

17. Donohue�s Group Profile, cont. 5. Mature Level Group Twenty year old college students take turns coaching each other in a computer science course Forty year old parents of children with learning disabilities coach each other on methods of intervention for their children in a parents� support group

18. FUNCTION Achieving the appropriate developmental tasks for the current age/stage of the individual. Each theorist defines normal function at each stage somewhat differently.

19. Function�Dysfunction, cont. Dysfunction occurs when the client�s growth & development fall below that expected for his/her age. Illness may cause regression to an earlier developmental stage.

20. CHANGE An individual�s need for mastery motivates skill learning. What an individual seeks to master at a given age is determined by an internal biological clock.

21. ASSESSMENT Tests of adaptive skills for each sequential stage of development Evaluation of age-specific skills in comparison with normal development is most helpful, when using specific theories of development.

22. OT Intervention The occupational therapist arranges a growth-facilitating environment for the stimulation of age-appropriate behavior and skill learning. Mastery of skills and success experiences are important treatment concepts. Focus of activities depends on specific theorist.

23. The End Next time: Levinson, review of other theorists, Developmental case assignment

24. Review of Developmental Theories Freud: Psychosexual stages Jung: Spiritual development Erikson: Psychosocial Development Kohlberg & Wilcox: Moral reasoning Piaget: Intellectual Development Levinson: Life Transitions Laslett: Third Age Theory

25. Carl Jung: Spiritual development Childhood: birth to puberty Blissful ignorance, inherited predispositions Youth: puberty to 35 yrs. Conscience and doubting Taking on responsibility Midlife: 35 yrs. to old age �afternoon of life� Change in direction, individuation & integration Old Age: infirmity & death Afterlife & collective unconscious

26. Erikson:8 Psychosocial stages Trust vs. Mistrust (0-2 yrs.) Autonomy vs. Shame & doubt (2-4 yrs.) Initiative vs. Guilt (5-7 yrs.) Industry vs. Inferiority (8-12 yrs.) Identity vs. Role confusion (13-22 yrs.) Intimacy vs. Isolation (23-35 yrs.) Generativity vs. Stagnation (36-50 yrs.) Integrity vs. Despair (50 yrs.-death)

27. Kohlberg & Wilcox: Moral Pre-conventional: 2-4 yrs. Stage 1: egocentric, no empathy Stage 2: reciprocity, make deals Conventional: 6+ yrs. Decisions based on pleasing others Stage 3: authority is fair, good people get best treatment Stage 4: Law & order orientation Rules necessary to maintain social structure Only one system is �right�

28. Kohlberg & Wilcox, cont. Post-conventional: 11-12 yrs. Fairness is free-standing logic Stage 5: Individual rights & human dignity can override rules Empathy influences decisions Right & wrong separate from rules Stage 6: Ideal stage, rarely encountered in reality Unconditional value of rights of humanity Empathized with all participants in moral dilemma Creatively resolves polarities and contradictions

29. Carol Gilligan, A Different Voice (Female vs. Male) Points out that prior theorists based their stages on male development Challenges the �age & stage� nature of adult development Professor at Harvard Studied women from childhood through maturity Considers factors of culture, time, occasion, and gender Views main difference as Men � focus on career, autonomy Women � focus on relationships

30. Daniel Levinson�s Life�s Adult Transitions Study done at Yale University Interviewed men at midlife (35-45 yrs.) Gail Sheehy�s �Passages� Identified 3 major �crises� of adulthood, early, middle, and late life transitions During transitions, developmental tasks and conflict resolution must occur

31. Developmental tasks Primarily the tasks of each transition period are to: Re-evaluate the existing life structure, Explore the possibilities of change and Make choices that will restructure life in the next era.

32. Levinson, cont. Era's are in between stages of stability described as young, middle and late adulthood. Life structure includes: Place of residence Career or job Family & social groups Roles & routines Interests & leisure pursuits

33. Levinson, Young Adult Transition (17-22 yrs.) Separation from home of origin Establishing separate identity Establishing independence Physical Financial Emotional Tasks: A young adult must Form a dream Find a mate and start a family Choose and prepare for a career Enter into a mentor relationship

34. Levinson, Midlife Transition (40-45 yrs.) A person at midlife must reappraise the past and resolve four polarities: Young/old Destruction/creation Masculine/Feminine Attachment/Separateness According to Levinson, each polarity or conflict is resolved by exploring the opposite side from that which predominated prior to midlife.

35. Levinson, Late Life Transition (Ages 60-65 yrs.) A person approaching late life must come to terms with certain realities: Physical decline Loss of the productive role Coming to terms with death

36. Peter Laslett: Third Age Theory Describes 4 �Ages� in lifespan development Based on current population studies: People living longer 85+ yrs. People maintaining health longer Published in 1991 in England �A Fresh Map of Life� Not well known in USA

37. Laslett, cont. 1. First Age: dependency, socialization, education 2. Second Age: maturity, independence, familial & social responsibility 3. Third Age: self fulfillment, �Crown of Life� comes after release from pressures of workaday world. 4. Fourth Age: dependence, physical decline, preparation for death

38. Laslett�s Third Age Begins at retirement (no specific age range) Ends when person becomes dependent on others for important life tasks Takes into account the possibility of 25-30 years of wellness & self fulfillment Seeks to change society�s view of older adulthood from (�) to (+).

39. Laslett�s Fourth Age Johnson & Barer (1992) found that 50% of those over 85 years could be considered disengaged. Signs of disengagement were: 1) A redefinition of social boundaries, 2) A change in time orientation, and 3) A decrease in emotional intensity. A voluntary narrowing of one�s social circle has been recognized as Socio emotional Selectivity Theory (SST) (Carstensen,1992).

40. Selection, Optimization & Compensation (Baltes, 2002) Three components of adaptation Selective optimization � focus efforts on tasks of immediate priority � explains maintenance of high goal involvement into later adulthood. Compensation � investing goal-relevant means to counteract losses Takes gains & losses jointly into account Based on Berlin Aging Study Life management strategies apply to all ages � good research evidence

41. Disengagement Theory Originally introduced by Cumming and Henry (1961) Involves an older adult�s inevitable mutual withdrawal from major life roles and responsibilities. Results in decreasing interaction between the aging person and others in the social systems to which he or she belongs. Criticized for alignment with medical model which equates aging with physical decline. More consistent with Laslett�s Fourth Age.

42. Continuity Theory (Atchley, 1989) Suggests that as adults age, they make adaptive choices which tend to preserve existing internal and external structures and Strive to maintain their self identity and existing perceptions of self and the world. One occupational therapy application of continuity theory is Velde and Fidler�s Lifestyle Performance Model (2002).

43. Activity Theory of Aging Activity theory (Havighurst, 1961) has contradicted disengagement theory almost from on the beginning. Proposes that greater continued engagement in activities leads to greater life satisfaction in the later years. Occupational therapists have embraced this theory, as have most senior social programs over the last half-century. Current research shows this to be true of �younger� retirees More consistent with Laslett�s Third Age.

44. OT Interventions Based on Developmental Theories Activities from this model include: future goal setting, evaluation of the past, reminiscence, values exploration, and self awareness activities. Group treatment is useful when helping people with life tasks during transitions

45. The End Developmental Case Assignment Compare two theories of older adulthood Levinson�s Late Life Transition Laslett�s Third Age Interview an older adult (60+ yrs.)