Occupation and Mental Health Across Life Span

1. Chapter 4Human Occupation and Mental Health Throughout the Life Span

2. Chapter Objectives • Analyze the motivations for performance of occupation. • Outline changes in performance of occupation from childhood through late life. • Contrast involvement productive activities, activities of daily living and play/leisure activities at different ages. • Define co-occupation, and discuss its role in the development of occupational performance. • Identify important achievements in occupational development at various life stages.

3. Chapter Objectives (Cont’d) • Recognize psychiatric disorders that typically appear in childhood, adolescence, adulthood, and later life. • Describe the effects of mental disorders on performance of occupation at different stages of life.

4. Motivation Toward Occupation • Three levels of motivation toward occupation: • exploration: desire to act or explore purely for pleasure. Primary motivation for infants and children; also a motivation for adults. • competency: desire to influence one’s environment in a meaningful way, seeking feedback and practicing to make improvements. • achievement: desire to attain or surpass a level of excellence in occupation. Standard may be externally or internally determined. Exploration  Competence  Excellence

5. Changes in Occupation over the Life Span • Three main groups of occupations: • activities of daily living (ADLS) (needed for self-maintenance) • productive activities (work, education, care of others) • play/leisure/social activities (Play, leisure, social participation)

6. Changes in Occupation over the Life Span Childhood • Reality and rules that guide actions are learned through play. Early childhood involves no work at all. • As child matures, simple work is introduced (chores).

7. Changes in Occupation over the Life Span Adolescence • Play time exceeds work time. School is a form of work. • Work consists of school and chores. • Adolescents may become focused on competence in one or more tasks (sports, grades, popularity). • The most important development task is to consider future adult occupations.

8. Changes in Occupation (Cont’d) Adulthood • Work time exceeds play time. (Work does not necessarily mean “paid employment.”) • Competence at work satisfies the urge to achieve. • People work to produce something of value to the rest of society. • Important for the self-esteem, sense of identity, and place in the social hierarchy, and reason for being.

9. Changes in Occupation (Cont’d) Later Adulthood • Work time drops off considerably in retirement. • Leisure is the primary occupation. • Loss of work role has both positive and negative consequences. • Self-worth may be dependent on cultivating new interests, and challenges, and social contact.

10. Occupational Development Occupational Development • Functions, typical patterns, and development of occupation during major life stages differ: • child learns about the world through play, which also builds motor and social skills. • teen practices and refines motor and social skills and consolidates them into habits and roles. • adult makes choices about career and life goals, and selectively develops and elaborates skills and habits. • older adult may take up interests had when younger or discover new occupations.

11. The Role of Co-Occupations Throughout the Life Span • Co-occupations are those that involve two or more people and are by nature highly interactive and transactional. • Throughout life, occupation is both solitary and with other people. • Infant depends on parent for everything. • Child interacts with peers and siblings, and pursues solitary occupations such as taking care of pets.

12. The Role of Co-Occupations Throughout the Life Span (Cont’d) • Throughout life, occupation is both solitary and with other people. (Cont’d) • Adolescent co-occupation include school projects, clubs, and social life. Solitary occupation is studying. • Aging adults engages in more co-occupations as performance skills diminish due to age-related factors.

13. The Role of Co-Occupations Throughout the Life Span (Cont’d) ADL and IADL • It is first learned as part of a family life. • In this context independent performance is acquired.

14. Mental Health Factors Throughout the Life Span • Six major life stages: • infancy and early childhood • middle childhood • adolescence • early adulthood • midlife • late adulthood and aging

15. Mental Health Factors Throughout the Life Span (Cont’d) Infancy and Early Childhood • Mental health disorders rarely diagnosed in infancy and preschool years. • If problems are discovered, they are quite severe: • intellectual disability • autism spectrum disorder • ADD/ADHD • oppositional defiant disorder • reactive attachment disorder

16. Mental Health Factors Throughout the Life Span (Cont’d) Infancy and Early Childhood (Cont’d) • OT approaches focus on sensory motor, sensory integrative, or sensory processing techniques. • Structured play experiences build routines and trust. • Very demanding and complex area of practice; OTAs generally require additional training beyond basic skills.

17. Mental Health Factors Throughout the Life Span (Cont’d) Middle Childhood • During school years, children develop concepts of social norms and learn to delay gratification. • Mental health problems are infrequent, but more common than early childhood. They may include: • conduct disorders • oppositional defiant disorder • depression, ADHD, drugs/alcohol • obsessive-compulsive disorder • autism spectrum

18. Mental Health Factors Throughout the Life Span (Cont’d) Middle Childhood (cont’d) • Children with mental health disorders have deficits in executive functions. • OT staff works with other professionals to aid the child. • Sensory integrative, behavior, psychoanalytic, and environmental treatment approaches are used. • Approaches involve helping child define and understand his/her role in society (student, sibling, friend). • Skills such as self-control, stress management, and progressive relaxation can be taught.

19. Mental Health Factors Throughout the Life Span (Cont’d) Adolescence • Teenagers must develop a sense of identity separate from their parents. • Experiences include moodiness, irritability, and sadness. • Some experiment with smoking, alcohol, sex, and drugs. • Gender identity may be a source of confusion.

20. Mental Health Factors Throughout the Life Span (Cont’d) Adolescence (cont’d) • Major psychiatric disorders may appear at this age: • schizophrenia • bipolar disorders • depression • eating disorders

21. Mental Health Factors Throughout the Life Span (Cont’d) Adolescence (cont’d) • OT approaches include: • tech-based approaches (smartphones, tablets, and social media) • self-care lessons, including sex education • vocational training (assembly-line tasks)

22. Mental Health Factors Throughout the Life Span (Cont’d) Early Adulthood • Driven to achieve in the workplace and find a mate. • Internal and external stressors can result in: • adjustment disorders • anxiety disorders, schizophrenia • mood disorders, eating disorders • personality disorders

23. Mental Health Factors Throughout the Life Span (Cont’d) Early Adulthood (cont’d) • OT approaches include: • goal identification such as: • completing education • obtaining and maintaining employment • developing coping skills for life stress • developing and structuring leisure activities

24. Mental Health Factors Throughout the Life Span (Cont’d) Midlife • Realization that not all life goals will be accomplished. • Life goals may be reevaluated; life trajectory is altered. • Erikson’s view of middle adult years is resolving crisis of generativity versus stagnation. • Mental health patients at midlife include: • those with persistent, lifelong mental illness. • those with adjustment disorders (poor coping skills). • those developing neurocognitive disorders (Alzheimer’s disease)

25. Mental Health Factors Throughout the Life Span (Cont’d) Midlife (cont’d) • Each of these subgroups requires a different approach by the OT staff. • For patients with persistent mental illness, focus on: • improving/maintaining daily living skills • providing opportunities for productive work • facilitating independent functioning

26. Mental Health Factors Throughout the Life Span (Cont’d) Midlife (cont’d) • For patients with adjustment disorders, focus on: • identifying and resolving issues that confront them: • death • divorce • unsatisfying career

27. Mental Health Factors Throughout the Life Span (Cont’d) Midlife (cont’d) • For patients with onset of neurocognitive disorders, focus on: • encouraging the patient to seek supervision for daily tasks such as cooking. • support for living in the home for as long as is deemed safe.

28. Mental Health Factors Throughout the Life Span (Cont’d) Midlife (cont’d) • For patients with onset of neurocognitive disorders, focus on: (cont’d) • reality-orientation exercises • memory training • sensory stimulation • physical activities

29. Mental Health Factors Throughout the Life Span (Cont’d) Late Adulthood and Aging • Most important psychosocial task is to appreciate what person contributed to the world and will endure after death. • Life stress increases greatly due to illness, loss of social roles (worker, parent, spouse), and money issues. • Most common mental psychiatric conditions are depression and neurocognitive disorders.

30. Mental Health Factors Throughout the Life Span (Cont’d) Late Adulthood and Aging (Cont’d) • OT staff can support older patients with these approaches: • life-review activities • leisure activities (games, crafts) • social activities • physical activities (modified for physical ability)