Erik Erikson s 8 Stages of Psychosocial Development

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1 Erik Erikson s 8 Stages of Psychosocial Development Each stage presents a task which Erikson believes must be completed for a positive outcome. The resolution of one task lays the foundation for growth in the next stage. AGES Birth to 12 to 18 months 18 months to 3 BASIC CONFLICT Trust vs. Mistrust Autonomy vs. Shame/Doubt IMPORTANT EVENT Feeding Toilet training EFFECT OF HOSPITALIZATION Infants with a physical disability may undergo a series of painful surgery and other treatments. An infant is completely vulnerable to pain, and cannot distinguish from internal or external pain. Many infants born with disabilities of bone growth may be immobilized in casts or same other restraints A toddler separated from family through repeated and prolonged hospitalization is often in strange surroundings. They may feel abandoned and regress to infantile actions. Hospitalization and treatments may physically restrict the active toddler, and they lose any sense of control over their own actions SUMMARY The infant must form a first loving, trusting relationship with the caregiver, or develop a sense of mistrust The child s energies are directed toward the development of physical skills, including walking, grasping, and rectal sphincter control. The child learns control but may develop shame and doubt if not handled well

2 3 to 6 Initiative vs. Guilt Independence Conflict between parents and the child may begin in this stage, when the preschooler wants to be able to make their own choices. The child continues to become more assertive and to take more initiative, but may be too forceful, leading to feelings of guilt Preschool age children have a primitive sense of cause and effect. They may have a sense that their disability, and the related medical treatments, are punishment. This punishment may be for real or imaged crimes. Parents may feed into this idea, consciously or unconsciously, by restraining activity with admonitions of "Be careful or you'll hurt yourself" or with threats of "Be good or you'll go back to the hospital" (Kleinherg, 1982). Medical treatments, hospitalization may he seen as Punishment. X-ray machines, operating rooms, etc. may be seen as monsters. The child's imagination builds these monsters into a frightening fantasy which parents must approach with gentleness and love. School age children develop an understanding of their own mortality. They begin to understand that they may never be a 'normal' adult and may come to fear the possibility of death. Because of this fear of both death and possible 'mutilation' the child may become overly dependent on parents, avoid risks involved in taking part in daily life, become overly fearful of medical treatment, unmanageable in school, home or hospital. 6 to 12 Industry vs. Inferiority School The child must deal with demands to learn new skills or risk a sense of inferiority, failure and incompetence Such children may retreat into themselves dwelling on the fear of physical pain and mutilation. They may react with denial, rebellion, immaturity, overdependence (Kleinherg, 1982) depression, anxiety, helplessness or mature acceptance. Many factors influence the rejection or acceptance of a disability and the alert teacher or counsellor will identify and acknowledge these indicators.

3 12 to 18 Identity vs. Role Confusion Peer relationships The stress and complications of daily living increase as an individual moves into the adolescent stage. The task of adolescence is to find and establish an identity. They must also strive for emotional, if not physical independence, from parents and family. The teenager must achieve a sense of identity in occupation, sex roles, politics and religion The adolescent is involved in forming their identity deciding who they are and focusing planning what their future may be. The added stress of a disability enters many dimensions of the adolescent personality; disability has effects on self image, on how an individual relates to the world and on future plans for career, education, and marriage. The adolescent are often full of times of great self doubt; the adolescent's body changes quickly, they are very self conscious. Every change or event brings with it a new trauma -- acne, unruly hair, appearance is very important as is the approval of peers. To be different is a problem -- belonging to a group is important.

4 Piaget s Developmental Stages Stage Age Effect of Hospitalization Examples of Characteristics Observed Sensorimotor 0 to 4 Explanations of medical procedures should involve playing out what will happen (using cloth dolls, play medical kits or actual materials); use of all senses! Preoperational 2 to 7 Will display magical thinking. Watch for misconceptions about procedures. Use simple words and play; prepare child for procedures honestly and practice coping strategies Concrete operations 7 to 11 Child is able to understand why they are in the hospital with clear explanations. Give lots of opportunity for questions! Child may want to know EXACTLY what is going to happen, when, where and why! Explores things that can be seen, felt, touched; develops motors skills Thinks in terms of self; oriented to the present; intuitive rather than logical Begins to understand numbers, space, and classification, and to apply logical operations to concrete problems; thinking is bound to the concrete Formal operations 11 to 15 Child may be very focused on selfconcept (afraid of altered appearance, scars, etc.) and can understand long term effects/future Able to think abstractly, hypothesize, generalize, reason and form different standpoints, and develop ideals

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