The stages [edit] Hope: Trust vs.

Mistrust (Infants, 0 to 1 year)

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Psychosocial Crisis: Trust vs. Mistrust Virtue: Hope

The first stage of Erik Erikson's centers around the infant's basic needs being met by the parents. The infant depends on the parents, especially the mother, for food, sustenance, and comfort. The child's relative understanding of world and society come from the parents and their interaction with the child. If the parents expose the child to warmth, regularity, and dependable affection, the infant's view of the world will be one of trust. Should the parents fail to provide a secure environment and to meet the child's basic need a sense of mistrust will result. According to Erik Erikson, the major developmental task in infancy is to learn whether or not other people, especially primary caregivers, regularly satisfy basic needs. If caregivers are consistent sources of food, comfort, and affection, an infant learns trust- that others are dependable and reliable. If they are neglectful, or perhaps even abusive, the infant instead learns mistrust- that the world is in an undependable, unpredictable, and possibly dangerous place. [edit] Will: Autonomy vs. Shame & Doubt (Toddlers, 2 to 3 years)
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Psychosocial Crisis: Autonomy vs. Shame & Doubt Main Question: "Can I do things myself or must I always rely on others?" Virtue: Will

As the child gains control over eliminative functions and motor abilities, they begin to explore their surroundings. The parents still provide a strong base of security from which the child can venture out to assert their will. The parents' patience and encouragement helps foster autonomy in the child. Highly restrictive parents, however, are more likely to instill the child with a sense of doubt and reluctance to attempt new challenges. As they gain increased muscular coordination and mobility, toddlers become capable of satisfying some of their own needs. They begin to feed themselves, wash and dress themselves, and use the bathroom. If caregivers encourage self-sufficient behavior, toddlers develop a sense of autonomy- a sense of being able to handle many problems on their own. But if caregivers demand too much too soon, refuse to let children perform tasks of which they are capable, or ridicule early attempts at self-sufficiency, children may instead develop shame and doubt about their ability to handle problems. [edit] Purpose: Initiative vs. Guilt (Preschool, 4 to 6 years)
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Psychosocial Crisis: Initiative vs. Guilt Main Question: "Am I good or am I bad?" Virtue: Purpose Related Elements in Society: ideal prototypes/roles

Initiative adds to autonomy the quality of undertaking, planning and attacking a task for the sake of being active and on the move. The child is learning to master the world around him, learning basic skills and principles of physics. Things fall down, not up. Round things roll. He learns how to zip and tie, count and speak with ease. At this stage, the child wants to begin and complete his own actions for a purpose. Guilt is a confusing new emotion. He may feel guilty over things that logically should not cause guilt. He may feel guilt when his initiative does not produce desired results. The development of courage and independence are what set preschoolers, ages three to six years of age, apart from other age groups. Young children in this category face the challenge of initiative versus guilt. As described in Bee and Boyd (2004), the child during this stage faces the complexities of planning and developing a sense of judgment. During this stage, the child learns to take initiative and prepare for leadership and goal achievement roles. Activities sought out by a child in this stage may include risk-taking behaviors, such as crossing a street alone or riding a bike without a helmet; both these examples involve self-limits. Within instances requiring initiative, the child may also develop negative behaviors. These behaviors are a result of the child developing a sense of frustration for not being able to achieve a goal as planned and may engage in behaviors that seem aggressive, ruthless, and overly assertive to parents. Aggressive behaviors, such as throwing objects, hitting, or yelling, are examples of observable behaviors during this stage. Preschoolers are increasingly able to accomplish tasks on their own, and with this growing independence comes many choices about activities to be pursued. Sometimes children take on projects they can readily accomplish, but at other times they undertake projects that are beyond their capabilities or that interfere with other people's plans and activities. If parents and preschool teachers encourage and support children's efforts, while also helping them make realistic and appropriate choices, children develop initiative- independence in planning and undertaking activities. But if, instead, adults discourage the pursuit of independent activities or dismiss them as silly and bothersome, children develop guilt about their needs and desires. [edit] Competence: Industry vs. Inferiority (Childhood, 7 to 12 years)
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Psychosocial Crisis: Industry vs. Inferiority Main Question: "Am I successful or worthless?" Virtue: Competence Related Elements in Society: division of labour

The aim to bring a productive situation to completion gradually supersedes the whims and wishes of play. The fundamentals of technology are developed. To lose the hope of such "industrious" association may pull the child back to the more isolated, less conscious familial rivalry of the oedipal time. "Children at this age are becoming more aware of themselves as individuals." They work hard at "being responsible, being good and doing it right." They are now more reasonable to share and cooperate. Allen and Marotz (2003) also list some perceptual cognitive developmental traits

specific for this age group: Children understand the concepts of space and time, in more logical, practical ways, beginning to grasp, gain better understanding of cause and effect and understand calendar time. At this stage, children are eager to learn and accomplish more complex skills: reading, writing, telling time. They also get to form moral values, recognize cultural and individual differences and are able to manage most of their personal needs and grooming with minimal assistance (Allen and Marotz, 2003). At this stage, children might express their independence by being disobedient, using back talk and being rebellious. Erikson viewed the elementary school years as critical for the development of self-confidence. Ideally, elementary school provides many opportunities for children to achieve the recognition of teachers, parents and peers by producing things- drawing pictures, solving addition problems, writing sentences, and so on. If children are encouraged to make and do things and are then praised for their accomplishments, they begin to demonstrate industry by being diligent, persevering at tasks until completed, and putting work before pleasure. If children are instead ridiculed or punished for their efforts or if they find they are incapable of meeting their teachers' and parents' expectations, they develop feelings of inferiority about their capabilities. [edit] Fidelity: Identity vs. Role Confusion (Adolescents, 13 to 19 years)
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Psychosocial Crisis: Identity vs. Role Confusion Main Question: "Who am I and where am I going?" Ego quality: Fidelity Related Elements in Society: ideology

The adolescent is newly concerned with how they appear to others. Superego identity is the accrued confidence that the outer sameness and continuity prepared in the future are matched by the sameness and continuity of one's meaning for oneself, as evidenced in the promise of a career. The ability to settle on a school or occupational identity is pleasant. In later stages of Adolescence, the child develops a sense of sexual identity. As they make the transition from childhood to adulthood, adolescents ponder the roles they will play in the adult world. Initially, they are apt to experience some role confusion- mixed ideas and feelings about the specific ways in which they will fit into society- and may experiment with a variety of behaviors and activities (e.g. tinkering with cars, baby-sitting for neighbors, affiliating with certain political or religious groups). Eventually, Erikson proposed, most adolescents achieve a sense of identity regarding who they are and where their lives are headed. Erikson is credited with coining the term "Identity Crisis"[1] Each stage that came before and that follows has its own 'crisis', but even more so now, for this marks the transition from childhood to adulthood. This passage is necessary because "Throughout infancy and childhood, a person forms many identifications. But the need for identity in youth is not met by these."[2] This turning point in human development seems to be the reconciliation between 'the person one has come to be' and 'the person society expects one to become'. This emerging sense of self will be established by 'forging' past experiences with anticipations of the future. In relation to the eight life stages as a whole, the fifth stage corresponds to the crossroads:

What is unique about the stage of Identity is that it is a special sort of synthesis of earlier stages and a special sort of anticipation of later ones. Youth has a certain unique quality in a person's life; it is a bridge between childhood and adulthood. Youth is a time of radical changethe great body changes accompanying puberty, the ability of the mind to search one's own intentions and the intentions of others, the suddenly sharpened awareness of the roles society has offered for later life.[3] Adolescents "are confronted by the need to re-establish [boundaries] for themselves and to do this in the face of an often potentially hostile world."[4] This is often challenging since commitments are being asked for before particular identity roles have formed. At this point, one is in a state of 'identity confusion', but society normally makes allowances for youth to "find themselves," and this state is called 'the moratorium': The problem of adolescence is one of role confusiona reluctance to commit which may haunt a person into his mature years. Given the right conditionsand Erikson believes these are essentially having enough space and time, a psychological moratorium, when a person can freely experiment and explorewhat may emerge is a firm sense of identity, an emotional and deep awareness of who he or she is.[5] As in other stages, bio-psycho-social forces are at work. No matter how one has been raised, ones personal ideologies are now chosen for oneself. Oftentimes, this leads to conflict with adults over religious and political orientations. Another area where teenagers are deciding for themselves is their career choice, and oftentimes parents want to have a decisive say in that role. If society is too insistent, the teenager will acquiesce to external wishes, effectively forcing him or her to foreclose on experimentation and, therefore, true self-discovery. Once someone settles on a worldview and vocation, will he or she be able to integrate this aspect of self-definition into a diverse society? According to Erikson, when an adolescent has balanced both perspectives of What have I got? and What am I going to do with it? he or she has established their identity:[6] Dependent on this stage is the ego quality of fidelitythe ability to sustain loyalties freely pledged in spite of the inevitable contradictions and confusions of value systems.[7] Given that the next stage (Intimacy) is often characterized by marriage, many are tempted to cap off the fifth stage at 20 years of age. However, these age ranges are actually quite fluid, especially for the achievement of identity, since it may take many years to become grounded, to identify the object of one's fidelity, to feel that one has "come of age." In the biographies Young Man Luther and Gandhi's Truth, Erikson determined that their crises ended at ages 25 and 30, respectively: Erikson does note that the time of Identity crisis for persons of genius is frequently prolonged. He further notes that in our industrial society, identity formation tends to be long, because it takes us so long to gain the skills needed for adulthoods tasks in our technological world. So we do not have an exact time span in which to find ourselves. It doesn't happen automatically at eighteen or at twenty-one. A very approximate rule of thumb for our society would put the end somewhere in one's twenties. [8]

[edit] Love: Intimacy vs. Isolation (Young Adults, 20 to 34 years)

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Main Question: "Am I loved and wanted?" or "Shall I share my life with someone or live alone?" Virtue: Love Related Elements in Society: patterns of cooperation (often marriage)

Main article: Young adult (psychology) Body and ego must be masters of organ modes and of the other nuclear conflicts in order to face the fear of ego loss in situations that call for self-abandonment. Avoiding these experiences leads to openness and self-absorption The Intimacy vs. Isolation conflict is emphasized around the ages of 20 to 34. At the start of this stage, identity vs. role confusion is coming to an end, and it still lingers at the foundation of the stage (Erikson, 1950). Young adults are still eager to blend their identities with friends. They want to fit in. Erikson believes we are sometimes isolated due to intimacy. We are afraid of rejections such as being turned down or our partners breaking up with us. We are familiar with pain, and to some of us, rejection is painful; our egos cannot bear the pain. Erikson also argues that "Intimacy has a counterpart: Distantiation: the readiness to isolate and if necessary, to destroy those forces and people whose essence seems dangerous to our own, and whose territory seems to encroach on the extent of one's intimate relations" (1950).[9][10] Once people have established their identities, they are ready to make long-term commitments to others. They become capable of forming intimate, reciprocal relationships (e.g. through close friendships or marriage) and willingly make the sacrifices and compromises that such relationships require. If people cannot form these intimate relationships--(perhaps because of their own needs)--a sense of isolation may result. [edit] Care: Generativity vs. Stagnation (Middle Adulthood, 35 to 65 years)
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Psychosocial Crisis: Generativity vs. Stagnation Main Question: "Will I produce something of real value?" Virtue: Care Related Elements in Society: parenting, educating, or other productive social involvement

Generativity is the concern of establishing and guiding the next generation. Socially-valued work and disciplines are expressions of generativity. Simply having or wanting children does not in and of itself achieve generativity. During middle age the primary developmental task is one of contributing to society and helping to guide future generations. When a person makes a contribution during this period, perhaps by raising a family or working toward the betterment of society, a sense of generativity- a sense of productivity and accomplishment- results. In contrast, a person who is self-centered and unable or unwilling to help society move forward develops a feeling of stagnation- a dissatisfaction with the relative lack of productivity.

[edit] Central tasks of Middle Adulthood

y y y y y y y y y y y y y

Express love through more than sexual contacts. Maintain healthy life patterns. Develop a sense of unity with mate. Help growing and grown children to be responsible adults. Relinquish central role in lives of grown children. Accept children's mates and friends. Create a comfortable home. Be proud of accomplishments of self and mate/spouse. Reverse roles with aging parents. Achieve mature, civic and social responsibility. Adjust to physical changes of middle age. Use leisure time creatively. Love for others

[edit] Wisdom: Ego Integrity vs. Despair (Seniors, 65 years onwards)

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Psychosocial Crisis: Ego Integrity vs. Despair Main Question: "Have I lived a full life?" Virtue: Wisdom

As we grow older and become senior citizens we tend to slow down our productivity and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life. If we see our life as unproductive, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness. The final developmental task is retrospection: people look back on their lives and accomplishments. They develop feelings of contentment and integrity if they believe that they have led a happy, productive life. They may instead develop a sense of despair if they look back on a life of disappointments and unachieved goals. [edit] Evolution from Freudian theory Erikson was a student of Sigmund Freud, whose psychoanalytic theory contributed to the basic outline of the eight stages, at least those concerned with childhood. Namely, the first through fourth of Erikson's life stages correspond to Freud's oral, anal, phallic, and latency phases, respectively. Also, the fifth stage of adolescence is said to parallel the genital stage in psychoanalytic theory: Although the first three phases are linked to those of the Freudian theory, it can be seen that they are conceived along very different lines. The emphasis is not so much on sexual modes and their consequences as on the ego qualities which emerge from each stages. There is an attempt also to link the sequence of individual development to the broader context of society.[11]

Erikson saw a dynamic at work throughout life, one that did not stop at adolesence. He also viewed the life stages as a cycle: the end of one generation was the beginning of the next. Seen in its social context, the life stages were linear for an individual but circular for societal development:[12] In Freud's view, development is largely complete by adolescence. In contrast, one of Freud's students, Erik Erikson (1902-1994) believed that development continues throughout life. Erikson took the foundation laid by Freud and extended it through adulthood and into late life.[13] [edit] Value of the theory One value of this theory is that it illuminated why individuals who had been thwarted in the healthy resolution of early phases (such as in learning healthy levels of trust and autonomy in toddlerhood) had such difficulty with the crises that came in adulthood. More importantly, it did so in a way that provided answers for practical application. It raised new potential for therapists and their patients to identify key issues and skills that required addressing. But at the same time, it yielded a guide or yardstick that could be used to assess teaching and child rearing practices in terms of their ability to nurture and facilitate healthy emotional and cognitive development. "Every adult, whether he is a follower or a leader, a member of a mass or of an elite, was once a child. He was once small. A sense of smallness forms a substratum in his mind, ineradicably. His triumphs will be measured against this smallness, his defeats will substantiate it. The questions as to who is bigger and who can do or not do this or that, and to whomthese questions fill the adult's inner life far beyond the necessities and the desirabilities which he understands and for which he plans." - Erik H. Erikson (19021994), U.S. psychoanalyst. Childhood and Society, ch. 11 (1950). [edit] Critique Most empirical research into Erikson has stemmed around his views on adolescence and attempts to establish identity. His theoretical approach was studied and supported, particularly regarding adolescence, by James E. Marcia.[14] Marcia's work has distinguished different forms of identity, and there is some empirical evidence that those people who form the most coherent self-concept in adolescence are those who are most able to make intimate attachments in early adulthood. This supports Eriksonian theory, in that it suggests that those best equipped to resolve the crisis of early adulthood are those who have most successfully resolved the crisis of adolescence. On the other hand, Erikson's theory may be questioned as to whether his stages must be regarded as sequential, and only occurring within the age ranges he suggests. There is debate as to whether people only search for identity during the adolescent years or if one stage needs to happen before other stages can be completed. However, Erikson states that each of these processes occur throughout the lifetime in one form or another, and he emphasizes these "phases" only because it is at these times that the conflicts become most prominent. [15] [edit] See also

The Developmental Stages of Erik Erikson By Arlene F. Harder, MA, MFT "It is human to have a long childhood; it is civilized to have an even longer childhood. Long childhood makes a technical and mental virtuoso out of man, but it also leaves a life-long residue of emotional immaturity in him." Erik Homburger Erikson (1902-1994) Our personality traits come in opposites. We think of ourselves as optimistic or pessimistic, independent or dependent, emotional or unemotional, adventurous or cautious, leader or follower, aggressive or passive. Many of these are inborn temperament traits, but other characteristics, such as feeling either competent or inferior, appear to be learned, based on the challenges and support we receive in growing up. The man who did a great deal to explore this concept is Erik Erikson. Although he was influenced by Freud, he believed that the ego exists from birth and that behavior is not totally defensive. Based in part on his study of Sioux Indians on a reservation, Erikson became aware of the massive influence of culture on behavior and placed more emphasis on the external world, such as depression and wars. He felt the course of development is determined by the interaction of the body (genetic biological programming), mind (psychological), and cultural (ethos) influences. He organized life into eight stages that extend from birth to death (many developmental theories only cover childhood). Since adulthood covers a span of many years, Erikson divided the stages of adulthood into the experiences of young adults, middle aged adults and older adults. While the actual ages may vary considerably from one stage to another, the ages seem to be appropriate for the majority of people. Erikson's basic philosophy might be said to rest on two major themes: (1) the world gets bigger as we go along and (2) failure is cumulative. While the first point is fairly obvious, we might take exception to the last. True, in many cases an individual who has to deal with horrendous circumstances as a child may be unable to negotiate later stages as easily as someone who didn't have as many challenges early on. For example, we know that orphans who weren't held or stroked as infants have an extremely hard time connecting with others when they become adults and have even died from lack of human contact. However, there's always the chance that somewhere along the way the strength of the human spirit can be ignited and deficits overcome. Therefore, to give you an idea of another developmental concept, be sure to see Stages of Growth for Children and Adults, based on Pamela Levine's work. She saw development as a spiraling cycle rather than as stages through which we pass, never to visit again. As you read through the following eight stages with their sets of opposites, notice which strengths you identify with most and those you need to work on some more.

1. Infancy: Birth to 18 Months Ego Development Outcome: Trust vs. Mistrust Basic strength: Drive and Hope Erikson also referred to infancy as the Oral Sensory Stage (as anyone might who watches a baby put everything in her mouth) where the major emphasis is on the mother's positive and loving care for the child, with a big emphasis on visual contact and touch. If we pass successfully through this period of life, we will learn to trust that life is basically okay and have basic confidence in the future. If we fail to experience trust and are constantly frustrated because our needs are not met, we may end up with a deep-seated feeling of worthlessness and a mistrust of the world in general. Incidentally, many studies of suicides and suicide attempts point to the importance of the early years in developing the basic belief that the world is trustworthy and that every individual has a right to be here. Not surprisingly, the most significant relationship is with the maternal parent, or whoever is our most significant and constant caregiver. 2. Early Childhood: 18 Months to 3 Years Ego Development Outcome: Autonomy vs. Shame Basic Strengths: Self-control, Courage, and Will During this stage we learn to master skills for ourselves. Not only do we learn to walk, talk and feed ourselves, we are learning finer motor development as well as the much appreciated toilet training. Here we have the opportunity to build self-esteem and autonomy as we gain more control over our bodies and acquire new skills, learning right from wrong. And one of our skills during the "Terrible Two's" is our ability to use the powerful word "NO!" It may be pain for parents, but it develops important skills of the will. It is also during this stage, however, that we can be very vulnerable. If we're shamed in the process of toilet training or in learning other important skills, we may feel great shame and doubt of our capabilities and suffer low self-esteem as a result. The most significant relationships are with parents. 3. Play Age: 3 to 5 Years Ego Development Outcome: Initiative vs. Guilt Basic Strength: Purpose

During this period we experience a desire to copy the adults around us and take initiative in creating play situations. We make up stories with Barbie's and Ken's, toy phones and miniature cars, playing out roles in a trial universe, experimenting with the blueprint for what we believe it means to be an adult. We also begin to use that wonderful word for exploring the world "WHY?" While Erikson was influenced by Freud, he downplays biological sexuality in favor of the psychosocial features of conflict between child and parents. Nevertheless, he said that at this stage we usually become involved in the classic "Oedipal struggle" and resolve this struggle through "social role identification." If we're frustrated over natural desires and goals, we may easily experience guilt. The most significant relationship is with the basic family. 4. School Age: 6 to 12 Years Ego Development Outcome: Industry vs. Inferiority Basic Strengths: Method and Competence During this stage, often called the Latency, we are capable of learning, creating and accomplishing numerous new skills and knowledge, thus developing a sense of industry. This is also a very social stage of development and if we experience unresolved feelings of inadequacy and inferiority among our peers, we can have serious problems in terms of competence and selfesteem. As the world expands a bit, our most significant relationship is with the school and neighborhood. Parents are no longer the complete authorities they once were, although they are still important. 5. Adolescence: 12 to 18 Years Ego Development Outcome: Identity vs. Role Confusion Basic Strengths: Devotion and Fidelity Up to this stage, according to Erikson, development mostly depends upon what is done to us. From here on out, development depends primarily upon what we do. And while adolescence is a stage at which we are neither a child nor an adult, life is definitely getting more complex as we attempt to find our own identity, struggle with social interactions, and grapple with moral issues. Our task is to discover who we are as individuals separate from our family of origin and as members of a wider society. Unfortunately for those around us, in this process many of us go into a period of withdrawing from responsibilities, which Erikson called a "moratorium." And if we are unsuccessful in navigating this stage, we will experience role confusion and upheaval.

A significant task for us is to establish a philosophy of life and in this process we tend to think in terms of ideals, which are conflict free, rather than reality, which is not. The problem is that we don't have much experience and find it easy to substitute ideals for experience. However, we can also develop strong devotion to friends and causes. It is no surprise that our most significant relationships are with peer groups. 6. Young adulthood: 18 to 35 Ego Development Outcome: Intimacy and Solidarity vs. Isolation Basic Strengths: Affiliation and Love In the initial stage of being an adult we seek one or more companions and love. As we try to find mutually satisfying relationships, primarily through marriage and friends, we generally also begin to start a family, though this age has been pushed back for many couples who today don't start their families until their late thirties. If negotiating this stage is successful, we can experience intimacy on a deep level. If we're not successful, isolation and distance from others may occur. And when we don't find it easy to create satisfying relationships, our world can begin to shrink as, in defense, we can feel superior to others. Our significant relationships are with marital partners and friends. 7. Middle Adulthood: 35 to 55 or 65 Ego Development Outcome: Generativity vs. Self absorption or Stagnation Basic Strengths: Production and Care Now work is most crucial. Erikson observed that middle-age is when we tend to be occupied with creative and meaningful work and with issues surrounding our family. Also, middle adulthood is when we can expect to "be in charge," the role we've longer envied. The significant task is to perpetuate culture and transmit values of the culture through the family (taming the kids) and working to establish a stable environment. Strength comes through care of others and production of something that contributes to the betterment of society, which Erikson calls generativity, so when we're in this stage we often fear inactivity and meaninglessness. As our children leave home, or our relationships or goals change, we may be faced with major life changesthe mid-life crisisand struggle with finding new meanings and purposes. If we don't get through this stage successfully, we can become self-absorbed and stagnate. Significant relationships are within the workplace, the community and the family.

8. Late Adulthood: 55 or 65 to Death Ego Development Outcome: Integrity vs. Despair Basic Strengths: Wisdom Erikson felt that much of life is preparing for the middle adulthood stage and the last stage is recovering from it. Perhaps that is because as older adults we can often look back on our lives with happiness and are content, feeling fulfilled with a deep sense that life has meaning and we've made a contribution to life, a feeling Erikson calls integrity. Our strengt h comes from a wisdom that the world is very large and we now have a detached concern for the whole of life, accepting death as the completion of life. On the other hand, some adults may reach this stage and despair at their experiences and perceived failures. They may fear death as they struggle to find a purpose to their lives, wondering "Was the trip worth it?" Alternatively, they may feel they have all the answers (not unlike going back to adolescence) and end with a strong dogmatism that only their view has been correct. The significant relationship is with all of mankind"my-kind." Copyright 2002, Revised 2009, Arlene F. Harder, MA, MFT ARE WE GIVEN A SECOND CHANCE TO LEARN? While the first premise of Erik Erikson's developmental stages, i.e., the world gets bigger and more complex as we go along, is fairly obvious, but we might take exception to the last, i.e., failure is cumulative. It is true that in many cases an individual who has to deal with horrendous circumstances as a child may be unable to negotiate later stages as easily as someone who didn't have many challenges early on.

For example, we know that orphans who weren't held or stroked as infants have an extremely hard time connecting with others when they become adults and have even died from lack of human contact. However, there's always the chance that somewhere along the way the strength of the human spirit can be ignited and deficits overcome. Therefore, I like the concept of development as a spiraling cycle rather than as stages through which we pass, never to visit again. You can see how this concept of developmental stages works in Words of Encouragement for Everyone . . . Especially Parents Who Want to Know How to Encourage Their Children, a fourminute presentation of how affirmations appropriate to each period of growth is the best way to navigate developmental cycles. Also see Integrating All of Life's Lessons developed for the Childhood Affirmations website. And be sure to listen to an excerpt from a CD titled Words of Encouragement Everyone Needs [Note: If you don't have a

Flash player, click here for a FREE download.] As you examine the legacy given to you by your parents and grandparents, you may discover strengths you underestimated. You may also realize you didn't hear important affirmations you would benefit from today. But it's never too late to learn what you may have missed. Incidentally, several people have been credited with organizing the stages of growth in this way. I first learned about this cycle of stages from material written by Pam Levine and expanded by Sheryn Scott, Ph.D. Later I discovered these concepts further elaborated by Jane Illsley Clarke and Connie Dawson in Growing Up Again: Parenting Ourselves,

DISCHARGE PLAN Medication

Present to the significant other all take home medications. Give emphasis to the brand and generic name, therapeutic and side effects as well as its daily dose and proper route. This will lessen the anxiety and will encourage the proper compliance of the drug Educate the significant other to avoid taking medications that are not prescribed by the physician. Motivate the patient and the family as well, to seek for physicians medical advices if there are unusualities felt before continuing taking the medicines. Over the counter drugs may interfere with the effectiveness of the prescribed drugs. It can also harm the patient if the drug is contraindicated Inform the family to seek medical help immediately if adverse reactions or allergies occur. To prevent further complications and enables the physician to directly intervene untoward reactions to the drug Exercise Instruct the client not to engage in very strenuous activities. To avoid injury and to restore energy and promotes comfort and healing Treatment Encourage the patient to participate diligently in the treatment modalities advised to him by the physician. To hasten the improvement of her health status Encourage the patient to verbalize honest information to the physician and other health care provider. To aid accurate detection of a disease and early medical intervention Tell the family that they should take part on the treatment of the patient. To strengthen the support system of the client Inform the patient and her family not self-medicate, especially when unusualities occur. Certain drugs are contraindicated to his case. Hygiene Instruct the patient to take a bath regularly. To prevent the risk of infection and promote comfort Instruct the parents to close the container when they collect water. Clean water is conducive for formation of eggs.

Instruct parents to clean the surroundings and spray insecticides. To prevent occurrence. Out-patient orders Instruct to take the medications as ordered.

Compliance would help in the recovery of the disease Follow up check up after 1 week. To check patients recovery. Diet Encourage to eat a well balanced diet. To avoid too much intake or less intake of one or more substance Instruct to increase intake of carbohydrates and increase protein intake To have enough energy with carbohydrates.

Generic name: Paracetamol (Acetaminophen) Brand name: Date ordered: July Ordered dose: 250mg/5ml, 5ml q4 Classification: Central Nervous System Antipyretic Suggested dose: Tempra 30, 2009 p.r.n for fever Narcotic Analgesic;

hrs, Agent;

For mild to moderate pain, fever o Children ages 6-8 yrs old: 320 mg P.O. q 4-6 hrs, p.r.n Therapeutic actions: Thought to produce analgesia by blocking pain impulses of prostaglandin in the CNS or of other receptors to stimulation. The drug may action in the hypothalamic heat-regulating center. Indications: substances that sensitize pain relieve fever through central

Fever Temporary relief of mild to moderate Generally as substitute for aspirin when the later is no tolerated or is contraindicated. Contraindications and cautions: Hypersensitivity Long Children Malnutrition Thrombocytopenia Arthritic or rheumatoid conditions affecting children < 12 term < 3 to alcohol years old acetaminophen use unless (may directed or cause by a

reduction pain

phenacin hepatotoxicity) physician

years

old

Safety during pregnancy (category B) or lactation is not established. Adverse effects: Hematologic: Hepatic: Metabolic: hypoglycemia hemolytic anemia, leukopenia, pancytopenia, neutropenia jaundice

Narrative Pathophysiology of Dengue Hemorrhagic Fever The dengue viruses, the cause of dengue illness, are members of the Flaviviridae family. Four genetically related but distinct serotypes, designated DENV-1, DENV-2, DENV-3, DENV4, are circulating worldwide. The main vector for dengue virus transmission is the Aedes aegypti species of mosquitos. Dengue viruses, similar to other flaviviruses, have a positive singlestranded RNA genome packaged inside a core protein, which is surrounded by an icosahedral scaffold and covered by a lipid envelope. The genome of the dengue virus contains 11-kb plussensed RNA encoding 3 structural proteins and 7 non-structural proteins. Viral protein and RNA synthesis occur predominantly in the cytoplasm of host cells. Replication is slow and begins within 15 hours after infection. Low amounts of dengue virus are released into the supernatant fluid. Dengue virus replication does not significantly affect the metabolic function of the host cell as exemplified by normal levels of protein synthesis by the infected cells. Dengue fever, caused by an infection with dengue virus, is not a new disease, but recently because of its serious emerging health treats, coupled with possible dire consequences including death, it has aroused considerable medical and public health concerns worldwide.

Today, dengue is considered one of the most important arthropod-borne viral diseases in humans in terms of morbidity and mortality. Globally, it is estimated that approximate 50-100 million new dengue virus infections occur annually. Among these, there are 200,000 to 500,000 cases of potential life-threatening dengue hemorrhagic fever (DHF)/ dengue shock syndrome (DSS), characterized by thrombocytopenia and increased vascular permeability. Risk factors of DHF are the following: Age (DHF/ DSS is more predominantly in children <15years of age), Heredity (infants in mother having an antibodies to dengue serotype, immunity to one dengue virus serotype may enhance response to the secondary infection), Sex (common in females than males), Race (common in Caucasian, dengue virus generally cause a benign syndrome, DF. And severe syndrome DHF/DSS in Southeast Asia). Dengue infection starts in a bite of virus-carrying mosquito (aedes aegypti). The mosquito injects fluid into the host skin then the virus can freely enter in the bloodstream. In the bloodstream, the virus will infect cells (mononuclear phagocyte lineage) and will replicate in sufficient amount. And will initiate an immune response. Normally all humans have their own innate immune system which is inborn in nature. This immune system is a universal and ancient form of host defense against infection. The innate immune system has been shown to consist of several components broadly ranging from skin barriers to cellular effector mechanisms and genome-encoded molecules, which act in concert to provide the host with an initial barrier against foreign organism. The innate immune system thus includes natural antibody and factors involved in the maintenance of the homeostasis. Key features of innate immunity are that it is not antigen specific, and can respond immediately or within a few hours after encountering a novel intruder and thereby to prevent or reduce infection. The innate immune response to dengue infection, I is basically a subject that is too a large extent underexplored. There are two important components of the innate immune system, the natural IgM antibody and platelets, are likely to play a critical role in the period of dengue virus infection. Natural IgM Antibody:

Humoral immunity is mainly mediated by B cells, which is produce different classes of antibodies, both natural and pathogen induced. Natural IgM antibodies are produced mainly by CD5+ B cells (B1 cells) and are component of innate immunity. These nonspecific circulating natural antibodies can bind to pathogens, providing early host protection. Natural antibodies may facilitate antigen uptake, processing, and presentation by B lymphocytes via complement and Fc receptors. Interestingly, it has been suggested that B cells are the principal circulating mononuclear cells infected by dengue virus. Although in humans about 30% of the circulating antibodies are pentameric IgM molecules, a small amount of hexameric IgM, IgG, and IgA natural antibodies circulate as well. The physiologic roles of the natural IgM antibodies are not known.

The multimeric structures makes IgM a strong complement activator; a single-bound IgM pentamer can trigger the classical pathway of complement activation and can lyse a red blood cell, while approximately a thousand IgG molecules are required to accomplish the same. Furthermore the hexamer IgM, even though it circulates in smaller amounts, is 15 -20 times more efficient in activating complement system. Unfortunately a deep role of circulating IgMimmune complex in DHF/DSS is unknown. Platelets One of the clinical manifestations in dengue diseases is thrombocytopenia, otherwise known as low platelet count. This arises from both decreased production and increase destruction of platelets. During dengue virus infection, platelets may provide a wonderful shield for the virus from exposure and binding to neutralizing preexisting antibody. Interestingly, there are few reports that dengue virus may associate with platelets, directly or indirectly through antibody. Now we can envision that the virus-platelets- antibody complexes may enhanced phagocytosis or be engulfed by macrophages or monocytes. This can lead to vasculopathy (plasma leakage), thrombocytopenia (<100) and coagulopathy (prolonged PT/ APTT). It is also possible that platelets can serve as the reservoir for dengue virus replication; however this issue is a subject of further investigation. Hyper-thermal Factors Dengue fever is one of the hallmarks of dengue virus infection. Fever is the normal physiologic response of the body to mediators that are generated during the acute phase of dengue virus infection. In fact, fever is a condition induced by the host to subdue and contain the adverse effects of the infection, making it unfavorable for the infecting agent, and is designed to promote body health. Heat inducible factors from host cells are expressed and released into the circulation. Most prominent among this heat inducible factors are the cytokines the trigger fever (fever inducers) such as TNF-alpha, IL-1, and IL-6. On the other hand, activation of memory T-cell response during re-exposure to second infection stimulates the release of a massive amount of proinflammatory cytokines, which induces vascular cell activation and is likely cause of the capillary leak syndrome. This response also can enhance virus-antibody complex leading to cytolysis. Treatment can be supportive, administration of anti-pyretic (avoid NSAID and aspirin), ORS in case of N/V. Normal saline is indicated but over hydration can lead to pulmonary edema. Blood, platelets is indicated in significant hemorrhage. There is no need of IV immunoglobulins and steroids. If the patient is not cured immediately, fluid shift due to prolonged plasma leakage can lead to increased hematocrit leading to hypovolemia the later, tissue acidosis.

Tissue acidosis, thrombocytopenia and coagulopathy may lead to disseminated intravascular coagulation (DIC) which can lead to severe hemorrhage. The patient will experience an intractable shock leading to multi-organ failure then death.

Industry vs. Inferiority (competence) - is the central task of our patient. Mr. Dave is comparing self worth to others (such as in a classroom environment). He can recognize major disparities in personal abilities relative to other children. He also feels a sense of shame if his parents unthinkingly share his failures with others. Children who cannot master their school work may consider themselves a failure and feelings of inferiority may arise. HAVIGURST Robert Havighursts developmental Physiological theory Robert Havighurst believed that learning is basic to life and that people continue to learn throughout life. He described growth and development as occurring during stages, each associated with 6-20 tasks to be learned. Developmental task which arises at a certain period in the life of an individual, successful achievement of which leads to his happiness and success with later tasks, while failure leads to unhappiness in the individual. Havighurst identified Six Major Stages in human life covering birth to old age. Infancy & early childhood (Birth till 6 years old) Middle childhood (6-12 years old) Adolescence (13-18 years old) Early Adulthood (19-30 years old) Middle Age (30-60years old) Later maturity (60 years old and over