The purpose of this assignment is to conduct various assessments and analyze the results on a family with a typically or atypically developing child to assist you in learning best practices

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Matt Case Study

Due to medical complications associated with her blood pressure, it became necessary to induce labor for Melissa 10 days before she was due to have her second child. When Matt was born, she knew immediately that his blue color was not normal. For what seemed to her to be an extraordinarily long time, the doctors worked with the infant while she had no idea of what was happening. Eventually, they explained that the baby was having difficulty breathing and they needed to call in an ear, nose, and throat specialist. After this examination found no structural cause for the breathing problem, a heart specialist was called in, who quickly confirmed that there was a problem with Matt’s heart. He recommended that the child be sent to the heart center at Premier Medical Center, over 200 miles away, to see if there was any hope for the child. The infant’s departure was treated as a final good-bye for Clay and Melissa, who were told that might be the last time they would see the child alive. In the meantime, Melissa was having problems of her own. Difficulties during the delivery had necessitated a Caesarean section delivery. Further complications required that she have an immediate complete hysterectomy. Clay drove to Premier Medical Center while Matt was transported by plane. Clay arrived shortly after the plane and hoped for the best while his newborn son faced surgery and his wife remained back at the hospital recovering from her own surgery. Clay, a police officer who worked hard and had received several promotions, had the flexibility to take time off from work to be with his new son without undue concern for his job, through which the family had excellent insurance benefits.

Melissa and Clay were fortunate to live close to their own hometown and have extended family members in the area Clay’s parents were caring for Alex, their five- year-old son, during the delivery. They and Melissa’s sister provided the care for him over the next several days while Clay attended to Matt out of town and Melissa recovered from surgery in the local hospital. Melissa’s physician had experienced his own personal trauma a few years previously when his daughter nearly died in a car accident. Because he had felt the pain of a parent whose child was near death, he released Melissa the second day following her surgery to travel. Her father ran her by her house to prepare quickly for the trip to reunite her with her husband and new son. Within five minutes of being home, five different friends and family members had each given her $100. Although the costs associated with the treatment that Matt was and would be receiving had not really been on Melissa’s mind, these financial gestures of support and goodwill emotionally overwhelmed her. She headed off to Premier Medical Center with her father and Alex, knowing that many people were supporting them and hoping for the best for their youngest child. Before their

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crisis ended, the police department alone gave Melissa and Clay $2,500 to help offset the costs of Matt’s medical care.

Matt did survive. His heart problems are serious and will require numerous additional surgeries over the next two years. Genetic testing has revealed that the cause of his heart problems is the absence of a portion of the 22nd

chromosome. Melissa and Clay declined to undergo genetic analysis primarily because of the motives of the physicians. They seemed eager to perform these tests for research-related rather than treatment-oriented reasons. However, their brothers and sisters, who might anticipate becoming parents in the future, and their other child will all likely have genetic screening as needed sometime in the future.

The family eventually returned home. Although there would be multiple additional surgeries needed in the future, they finally had their three-month-old home. They have survived well over another year and have settled into routines. Matt’s medical problems are never far from Melissa’s mind as she goes about the routines of getting Alex off to school, maintaining the household, returning to work as a part-time parent trainer in an early intervention program, and playing with Matt. Although she worries about his developmental progress, she is far more concerned about his ability to survive the major surgeries that she knows the child is still facing. However, she realizes that as an 18-month-old Matt is lagging in his language development as well as his motor skills. She has decided to contact the early intervention service coordinator and update the developmental assessment of Matt and consider the possibility of placing him in some type of group-based early intervention program.

Findings:

The assessment of Matt’s communication efforts and his speech development were focused on ways to increase his functional communication because the parents were particularly concerned about his ability to be understood by the family. The service coordinator, Ellen Thomas, arranged for a speech/language pathologist to do observations focused on the communicative skills of Matt in his home setting and to give him the Preschool Language Scale-3 (PLS-3). During the observation, Elizabeth Fox, the speech pathologist, used a naturalistic play-based approach to observe Matt’s communicative behaviors. The setting was arranged so that Matt and his mother and brother were playing. Elizabeth sat nearby observing and gradually eased her way into the play. Matt banged objects, attempted to build with blocks, and appeared to enjoy knocking down tower blocks constructed by the others. He got his mother’s attention with sounds and poking at her. During the play, his mother spoke to him frequently and encouraged him to repeat sounds or respond to her questions. He consistently made eye contact with his mother or others who were speaking and repeated sounds in vocal play, but relied primarily on physical manipulation as a means of communication. He was particularly interested in interactive toys that made sounds. When he wanted an interactive toy to be started, he would put his hands on his mother’s arm or hand and pull her hand to the object. She encouraged him to tell her what he wanted. However, if she did not provide the

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outcome he was seeking within a brief period, his frustration became apparent. Melissa indicated that when she has held out for more language before responding to his request, his frustration quickly turns to anger and crying. She prefers to maintain a positive interaction with Matt instead of demanding more language out of him at the cost of upsetting him.

Elizabeth Fox used the observations she had made of Matt to calculate both an auditory comprehension and expressive comprehension score on the PLS-3. Matt received credit for all of the items on both scales at the birth to 5 months level, including auditory skills such as the ability to look at a speaker during play, react to the sound of a cellophane wrapper, and expressive skills such as vocalizing a variety of pleasure and displeasure sounds, vocalizing in response to speech, and laughing. All items on both scales at the 6 to 11 months level were also demonstrated. He can anticipate an event and follow a line of action. He approximates sounds made by others, communicates through gestures, and produces at least four different consonant-like sounds. Matt had 2 of the 12 to 17 months level auditory skills, but none of the expressive skills. He was able to maintain attention for two minutes during play and could identify familiar objects, but was unable to identify pictures from the PLS picture manual.

Ellen Thomas, the service coordinator, chose to use the Hawaii Early Learning Profile (HELP) as a guide to identify Matt’s current developmental functioning. The HELP checklist is organized into sections for cognitive, expressive language, gross motor, fine motor, social-emotional, and self-help. The lists are arranged in sequential order with an age range associated with each item that indicates the approximate age a typically developing child will acquire that skill. Ellen completed the checklist from her own observations of Matt playing at home with family members and a parent interview. It appeared that Matt has demonstrated most of the skills listed below six months of age, so she started at the six-month point for each of the developmental areas. In the cognitive area, he could also perform all items that begin at the six-month level, such as, “looks for family members or pets when named,” “plays 2-3 minutes with single toy,” “retains two of three objects offered,” and “smells different things.” He has most of the items falling in the 7- to 10-month range, but is still missing a few, such as “looks at pictures one minute when named.”

Matt’s developmental skills become inconsistent for items that have developmental ages 8 months and older. However, he does have some skills in this range, such as “throws object,” “knows what ‘no-no’ means,” and “unwraps a toy.” Yet, there were skills that he has demonstrated or are emerging that are identified as between the 12- to 18-month level. For example, he has consistently demonstrated “moves to rhythms,” “places round piece of formboard,” and “understanding pointing.” Emerging skills at this level include “matches objects,” “pats picture,” and “helps turn pages.” His expressive language skills include most of the skills associated with 8-month-olds and younger. Emerging skills are between 7 and 15 months, and include “shouts for attention,” “shows understanding of words by appropriate behavior or gesture,” and “babbles in response to human voice.” He is also missing some skills at this approximate level, such as “says ‘dada’ or ‘mama,’ nonspecifically.” Most items between the

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12- and 18-month level are beyond his current skill development, such as “babbles intricate inflection,” “uses single word sentences,” and “names one or two familiar objects.” He does vocalize or gesture spontaneously to indicate needs and greet with verbal cues, and attempts to sing sounds to music.

In the gross motor area, Matt has accomplished skills through the 6-month level, but has gaps beyond that point. Skills that typically appear starting at 6 months that he does have include “sitting without assistance,” “bears large fraction of weight on legs,” and “bounces.” Pulling to a stand might be considered as an emerging skill because he has recently started attempting to pull to stand. Older skills that do not involve standing, such as “sits without hand support for ten minutes,” “creeps on hands and knees,” and “protective extension of arms to back,” are established.

Fine motor skills are at approximately a 1-year level, according to the HELP checklist. Matt takes objects out of containers, releases objects voluntarily, marks paper with crayon, and bangs two cubes held in his hands. Examples of skills that are emerging include scribbling spontaneously, using both hands at midline, and building 3-cube towers.

The social-emotional skills that Matt currently has mastered are in the approximate range of 9- to 12-month-olds. Melissa indicated that he is currently in a phase of letting only her meet his needs, has been testing her during meals and bedtime routines, and enjoys simple imitative play. He also has a few of the skills at the 12- to 18-month level, such as “gives toy to familiar adult spontaneously and upon request,” “acts impulsively, unable to recognize rules,” and “needs and expects rituals and routines.”

In the area of self-help, Matt has most skills up to the 12-month level. He can feed himself finger foods, sleep through the night, and cooperates for dressing. Skills that typically begin appearing between 12 and 18 months are spotty. Emerging skills at this level include holding and drinking from a cup and showing discomfort with a soiled diaper.