Developmental stages: psychosocial implications

Considerable emphasis has been placed on the social worker's special competence in the area of psychosocial diagnosis of the handicapped patient. Part of that diagnosis concerns the effect of specific phases of the life cycle on the patient and his or her situation.

A handicapped child in a household and community poses special problems such as schooling, peer relationships, and family reactions. On a physical level, depending on the nature of the problem, the child will not be able to go through the normal developmental tasks of children such as talking, walking, and eating. If diagnosis and treatment involve frequent trips to institutions (clinics) or agencies, such trips may be frightening; the child may feel deprived and see the process as a further indication of difference from siblings. The nature and varieties of discipline become problematic when a parent is feeling guilty or overprotective of the child. Some handicapped children respond to their condition by excessive aggression and determination. Within the proper context, this may be appropriate for the coping task, yet it can have unpleasant consequences in interpersonal or peer relationships. Much work has been done about the personality of handicapped people in relation to their adaptation to the problem. Frequently, other children in the school or community will taunt or ridicule a handicapped child. Unless there is parental agreement about handling the child throughout the growing years, there is constant friction and conflict, particularly if the parents are giving major attention to the child.

Adolescence is in and of itself a highly problematic life stage. The emergence of sexuality and sexual feelings cre¬ates enormous anxiety in the nonhandicapped child. When there is loss of body part or body function, the teenager may withdraw and become depressed, especially since peer approval is critical at this time. The various forms of acting out by the handicapped youngster can be self-destructive and cause regression to earlier stages of dependency. The role and place of authority becomes highlighted at this age, and testing out can be expected to take place, as when the teenager pushes his parents to see if they really love him.

Disabilities occurring in the young adult stage may be extremely traumatic, since this is a time of early marriage, child rearing, and beginning financial struggles. Accidents occurring at this stage are severely disruptive to the young person or couple. The various role functions (whether male or female) will be thrown into disarray if the disability results in a serious change in life-style and functioning. Partners must take on new and different roles to accommodate the other's handicap. The impact on young children of a parent's sudden disability can have serious effects on the child's developing personality.

Children born with genetic defects or missing limbs are understandably shocking to the young couple. Parents react in a variety of ways: some mothers shudder with repugnance and are unable to nurture a deformed child. Depending on the extent of the deformity, some parents will decide not to take a child home but have it placed in an institution. All of these decisions give rise to tremendous amounts of guilt, particularly if the condition is experienced as genetically transmitted from one spouse or other. This often leads to conflict between the couple and decisions to separate or divorce. The physician and social worker must quickly move into such situations to help sort out the complicated feelings of both parents and to help them move toward a solution. Some parents, on the other hand, exert enormous dedication to the handicapped child, to the extent of personal sacrifice. This may lead to neglect of other siblings in the home or the spouse. At another level, parents may deny the responsibility for the child or deny the child's special needs.

In middle and old age, there are special considerations concerning the onset of disability or disabling disease process. Again, marital status and children's reactions come into focus. Children may resent having to care for a disabled parent when they are trying to make their own family and .marriage adjustments. The elderly pose particular problems Because of their fragility and the questionable prognosis. This is usually compounded by other complaints such as failing eyesight and arthritis, which make independent living highly problematic.

The social worker has a special role to play in all these life situations by providing counseling or making available educational groups for patients of comparable age or with comparable diagnoses. 5 Supportive or self-help groups can be very enabling to the handicapped at all stages of their lives.