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Dee Matchett Case Study of Adolescent Female 1

Spring 2014

Case Study of Adolescent Female

Dee Matchett Issues in Human Development Education 566 April 10, 2014

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Spring 2014 Introduction

The subject of this case study is a 12 year old adolescent female in the sixth grade that will soon turn 13 years old. For privacys sake she will be referred to by a false name. This study will look at the developmental problems the subject has overcome through speech therapy and also the impact of developmental issues that are currently being treated with vision therapy. It will consider the following questions: Could there be any connection between the mothers health prenatally that may have influenced development? Could some of the subjects behavioral issues have arisen as a result of speech and vision problems? How has parenting style and family dynamics influenced development?

Any comments concerning these questions must be considered speculative and a nonprofessional analysis. Recommendations for positively influencing development will be given, but should only be considered as a personal reflection based upon information obtained from this course in human development.

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Table of Contents
Spring 2014 Developmental History ..............................................................................................4 Prenatal Period ......................................................................................................4 Labor, Delivery, and Postpartum .............................................................................7 Infancy and Toddlerhood .......................................................................................7 Early Childhood .....................................................................................................9 Middle and Late Childhood ................................................................................... 10 Current Adolescent Development .......................................................................... 15 PHYSICAL/MOTOR DEVELOPMENT .................................................................... 15 Interview with Sylvia ........................................................................................ 15 Visual Processing Evaluation ............................................................................. 19 SOCIAL/EMOTIONAL DEVELOPMENT ................................................................. 21 Keirsey Temperment Profile .............................................................................. 21 Career Interest Survey...................................................................................... 21 MORAL/FAITH DEVELOPMENT .......................................................................... 22 American Heritage Girls .................................................................................... 22 Kohlberg Dilemma Interview ............................................................................. 23 Conclusion .............................................................................................................. 25 References ............................................................................................................. 26 Appendices ............................................................................................................. 28 A. B. C. D. E. F. G. Speech Therapy Diagnosis........................................................................... 29 Vision Therapy Diagnosis ............................................................................ 32 School Sample Work ................................................................................... 37 Career Interest Test .................................................................................... 47 Keirsky Personality Profile............................................................................ 53 Kohlberg Dilemmas ..................................................................................... 58 Parent Comments ....................................................................................... 60

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Developmental History
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Prenatal Period

Interview with mother 02/05/2014 1:00 pm

The mother became pregnant in July, 2010 and it was an unplanned pregnancy. According to the mother, she was still in the honeymoon phase of mothering her first child and had not yet planned a second child. However, the unexpected pregnancy was met with delight and the parents were elated with the prospect of an addition to the family. Spermicide was the birth control being use at the time, although the mother says she may have miscalculated ovulation and been unprotected at the time of conception. The active ingredient in vaginal spermicides is either nonoxynol-9 or octoxynol-9. There is some speculation that these spermicides can alter the DNA of sperm and therefore affect fetal development. However, research has not identified any statistically significant risk that would identify these substances as teratogenic (Mills, Harley, Reed, & Berendes, 1982). No recent studies could be found to confirm previous studies. There have been no studies on either the speech or visual development of infants exposed to vaginal spermicides. There is therefore, no research that would connect child development issues with the use of a spermicide. The mother weighed 240 pounds at the time of conception and stood 57 tall. There was a weight gain of 14 pounds. Although the mother was more than 70 pounds overweight during pregnancy, none of the issues associated with obesity presented. Blood pressure remained normal and there was no sign of gestational diabetes or excessive edema.

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National Vital Statistics Reports, Vol. 61, No. 1, August 28, 2012
Figure 1

Prenatal care began at six weeks with a certified nurse midwife at a freestanding birth center. This places the mother in the less than 2% of American women who choose out of hospital birth settings (see Figure 1). The

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mother experienced debilitating nausea and vomiting during the first trimester with weight loss and extreme fatigue. Medication for nausea was not helpful. Nausea and vomiting associated with the increased hormone levels of pregnancy subsided in the second trimester. Prenatal examinations indicated normal growth of the infant. Ultrasound diagnostic at five months revealed a female fetus within normal growth parameters. However, the mother began to experience new symptoms that were not recognized as gall bladder dysfunction until late in the second trimester. These symptoms were controlled by diet as the mother entered the 3rd trimester. In utero, this baby was much different than her older sister who was calm and quiet and even now is the more subdued child. The mother describes this second childs activity in the womb as, A party for one! She was extremely active with violent jerking. She remains a very active and lively child. The mother also describes the pregnancy as a hard one for me due to nausea and vomiting in the 1sr trimester and dealing with gall bladder disease thereafter; especially in the 2nd trimester before measures to control the symptoms were taken. Prenatal stress of this nature can

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lead to adrenal fatigue due to increased cortisol levels and have an effect on fetal neurodevelopment, both short and long term: Spring 2014 Prospective studies have shown that maternal stress and anxiety during pregnancy are related to infant outcomes such as:

temperamental problems and increased fussiness problems with attention, attention regulation, and emotional reactivity
(DiPietro, 2004) Prenatal maternal stress (PNMS) is substantially linked to high activity levels in the offspring and other ADHD symptoms (Van den Bergh & Marcoen, 2004, p.2). The Douglas Mental Health Institute reports that the effect of PNMS upon infants is greatest in the first two trimesters. Exposure to cortisol and glucocorticoids from the adrenal glands via the placenta during these critical periods of pregnancy will influence which developing structures are affected and therefore determine the physical, cognitive or behavioral outcome (Zeindler, 2013). The author of this article also stresses that, relatively small increases in maternal cortisol are equivalent to relatively large increases in fetal cortisol (Zeindler, 2013). In a 1998 study, PNMS was also associated with lower language abilities in 2 year olds. This effect was found only in toddlers who had been exposed to higher than normal levels of corticoids during the 1st or 2nd trimester of prenatal development (King & Laplante, 2005, p.9). As the study continued to follow the development of these children, PNMS was also associated with more behavioral difficulties and attention problems in kindergarten.

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Labor, Delivery, and Postpartum

Mother interview, 02/05/2014 8:00 pm

Spring 2014 Labor and delivery proceeded normally. Mother and father arrived at the birthing center at 11:30 p.m. with labor advancing rapidly. Contractions were 2.5 minutes apart and strong. The mother labored in a birthing pool and felt the warm water helped her relax and make labor more comfortable. Sylvia was born around 1:00 a.m., weighing 9 pounds and 10 ounces, length 21 inches, APGAR score = 9. This above average weight, length and high APGAR score would indicate that Sylvia did not suffer any short term effects from PNMS that are associated with fetal distress and low birth weight (Laplante et al., 2004, p.1). Infants with APGAR scores from 9-10 are low risk for ADHD (Santrock, 2013, p.95). The mother reports immediate bonding with her newborn, who was alert and nursed vigorously, She was controlling from the start. It was instantly clear who was the boss. It was as if she was declaring, You belong to ME! The postpartum period was marked by maternal depression the first month, for which medication was prescribed. The mother describes this time period as challenging, since Sylvia was not a sound sleeper at first, but began sleeping through the night at 8-10 weeks. Initially, Sylvia grew well and thrived, but weight and length slowed.

Infancy and Toddlerhood

Interview with mother 02-06-2014, 3:00 p.m.

At her five month pediatric checkup, baby Sylvia had not gained weight in six weeks. She was diagnosed with failure to thrive, probably the result of insufficient milk supply resulting

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from mastitis. This led to terminating breastfeeding and beginning to bottle feed. Weight and growth pattern returned to normal. Spring 2014 After this, the mother reports that Sylvia was a happy baby, reaching developmental milestones within appropriate parameters: sitting at 6 months, crawling at 9 months, standing at 10 months and walking at 12 months. However, the mother began to be concerned about language development. At a year old, Sylvia had not spoken a single word, not even ma or da. Her pediatrician dismissed her concerns and assured the mother that this was normal for a 2nd child. According to the textbook for human development used for this course and referenced for this case study, Sylvias lack of speech was still within normal parameters for her age (Santrock, 2013, p.164). From 12-18 months, Sylvias physical and cognitive development continued to proceed normally. She was very physically active, began building towers with blocks, enjoyed sorting activities, throwing balls and waving bye bye. By 16 months, she was running and playing hide and seek. However, there was still no distinguishable speech, although she was babbling some. The Figure 2 - Variation in Language Developmental Milestones

pediatrician was still unconcerned at 18 months. However, according to the graph in figure 2, Sylvia was now beginning to move outside the normal parameters for her age.

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From 18-24 months, physical and cognitive development still proceeded normally. She enjoyed coloring and recognized color names, although she could not say them. A favorite Spring 2014 activity for Sylvia was story time when her mother would read books to her. She began making the s sound. Everything was called s. She would point to an object and make her s sound, regardless of the name of the object. Refer to Figure 2 and notice that at this point Sylvia had fallen well behind the norm for first words spoken and should have been experiencing a vocabulary growth spurt. From 2-3 years, the mother recalls being frustrated to the point of tears because she could not understand her child. There were a few recognizable words now and her older sister understood most things and acted as an interpreter. At 3 years 7 months old, the mother disregarded pediatric opinion and consulted a speech therapist. A speech and language evaluation was done that indicated delays in auditory comprehension and expressive communication. (See Appendix A). Speech deficits were noted for initial, medial and final position and with all blended sounds. The summary states, ...presents with moderate-severe deficits in articulation making it difficult for her to communicate. A speech therapist was assigned for home visitation twice a week.

Early Childhood

Interview with mother 02-06-2014, 3:00 p.m.

The mother recalls a significant emotional experience for Sylvia when she played back an audio recording so that Sylvia could to hear her own voice. Sylvia was shocked by what she heard. She became quiet and awestruck that she could not understand her own speech. After this experience, she was highly motivated her to work for the therapist. She became determined to

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learn correct speech and would practice phonemes over and over again. It took 2 years, but Sylvia accomplished her goal. Spring 2014 I met the family during this time period and remember having to ask Sylvia to repeat herself and often still not understanding her. I am happy to say that Sylvia now communicates clearly. It is a credit to Sylvias commitment and to her mothers persistent efforts to communicate with her daughter and her decision to listen to her own mothering instincts that Sylvia no longer struggles to communicate effectively. Without intervention, 50% of children with specific language impairment (SLI) experience persistent speech problems that can interfere with academic achievement (Benjamas Prathanee, Thinkhamrop, & Dechongkit, 2007, p.1787). Since the mothers cortisol levels were not tested during pregnancy, conclusive evidence does not exist to link Sylvias speech problems with PNMS. However, in light of the study cited earlier (King & Laplante, 2005), it is plausible that PNMS interfered with language development. Delayed speech also resulted in delayed reading. The speech therapist recommended that Sylvia not be taught to read until the speech deficit had been overcome.

Middle and Late Childhood

mother via Skype on 03-31-2014, 3:42 p.m.

Even though the mother followed the speech therapists recommendation and did not attempt to teach her daughter to read until speech therapy goals were completed, she reports that learning to read was a difficult and slow process. This was unlike her older sister who learned to read at age 4 and was reading chapter books by first grade. The mother used a phonetic reading approach. Reading lessons were stressful for both mother and child and the mother found it

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necessary for them to take periodic breaks. These stress relief periods also slowed the progression of learning. It didnt really click with her until she was 9. She is now reading Spring 2014 well and on grade level. However, her eyes become tired and watery with prolonged reading and she must take a break. She sometimes develops headaches from reading. Math has been an easier subject for Sylvia and she does well. (Examples of Sylvias schoolwork from 5th and 6th grade are in Appendix B). Penmanship has been a particular issue with sloppy letters of inconsistent size. Instruction has required much repetitive demonstration on letter formation and how to hold a writing instrument correctly. Sylvia wants to hook her wrist and hold her pencil upright rather than at a 45 angle. This indicates a need to improve fine motor skills for better pencil grip (Selfin, 2003, p. 27;Feder & Majnemer, 2007, p. 313). There has been improvement since beginning cursive writing this year, although without lined paper the improvement is not as apparent. (See Appendix B and E.) Wrist exercises for children found at this website may be helpful for Sylvia. http://www.ot-mom-learning-activities.com/wristexercises-for-kids.html The Center for Development at Pediatric Occupational, Physical Behavior, Nutrition, Speech and Language Therapies of Cookeville in Tennessee says that for delayed handwriting ability: The number one way to help handwriting is to find out what the underlying problem is: usually a visual perceptual problem (how the brain processes visual information), fine motor delays (poor weight bearing history, lack or delay of creeping and crawling, weak joints or muscles), and/or other developmental delays.

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(Center for the Development of Pediatric Therapies, n.d.)

Recommendations for improving handwriting skills can be found at their website: http://www.developmental-delay.com/page.cfm/178 Spring 2014 I am sure the mother would appreciate a recommendation for reduction of doodling, since Sylvia has always doodled on anything and everything, including her skin, the walls, furniture and desktops. She is showing more control in this area, but still has to be reminded to keep her school papers doodle free. There might be a bright side to the doodling issue. Recent research into the effects of doodling on brain activity seem to indicated that doodling enhances recall and increases concentration (Andrade, 2010). Participants were given shapes to shade while listening to a boring taped conversation. They recalled information from the conversation almost 30 % better than the control group. However, the findings are preliminary and require more refined testing. It remains to be discovered whether the benefits of the shading task extend to naturalistic doodling (Andrade, 2010). Perhaps a scratch pad for doodling would keep school papers legible and neat, while also keeping Sylvias brain focused, especially during listening tasks. Behavioral problems became pronounced during this stage of development. Instructions had to be constantly repeated, but this did not insure compliance. Sylvia was frequently off task, whether the task was school work or her chores. She was so easily distracted that the mother felt the better part of her day was spent monitoring Sylvia in an attempt to keep her on schedule. Her short attention span was apparent. She seemed unconcerned about her undesirable behaviors or the quality of her school work or obedience to parents. She seemed to live in her own world unaware of the havoc her behaviors were having on others. According to Banduras Social

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Cognitive Theory, self-assessment is a necessary component of self-regulation. People cannot influence their own motivation and actions very well, if they do not pay adequate attention to Spring 2014 their own performances(Bandura, 1991, p. 250). When asked about Sylvias ability to self-regulate during this time period, the mother replied, None. She would blurt out at inappropriate times and interrupt others. There was no forethought or restraint in her blunt expressions. This led to friction with parents and her sibling. Lack of forethought seemed to be the rule, not the exception. A new electronic keyboard had been purchased and the sisters had begun piano lessons. Sylvia set down to practice and placed her drink on one edge of the keyboard. She knew this was hazardous and that water could harm the keyboard. The inevitable happened and a brand new keyboard was ruined. Negative outcomes as a result of thoughtless behavior happened frequently. During middle to late childhood self-regulation usually increases and the period is marked by a childs efforts to control their behavior. The increased capacity for self-regulation is linked to developmental advances in the brains prefrontal cortex" (Santrock, 2013, p. 321). This may indicate some delay in the development of gray matter in the prefrontal cortex at this age. A lack of moral self-monitoring was also apparent. She cheated playing games, but would deny it when confronted. She liked to eat toothpaste, but would lie about doing so, even when the evidence was all over her face. Lying continued to be an issue until around age 8 when Sylvia began to make an effort to self-monitor. By age 9 she had become honest and lying is no longer an issue. The development of moral personality is closely tied to self-control. To achieve this self-control, children must learn to delay gratification (Santrock, 2013, p. 250).

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Sylvia also displayed repetitive behaviors. The father found these repetitive behaviors and the lack of self -regulation particularly annoying, which led to father/daughter conflict. The Spring 2014 combination of short attention span, inability to focus and poor self-control caused the mother to suspect ADHD, but she chose not to have testing done. She based this decision upon the fact that she did not want medication prescribed and felt her best approach to the situation was to learn how to parent a child of this nature. Her parenting style is authoritative, with the father leaning toward the authoritarian style in which he was raised. During this stage of development, family counseling was sought, which helped some with understanding family dynamics. It also helped the father work more towards authoritative rather than authoritarian parenting and provided strategies for coping with Sylvias behavior. It is recommended that the parents review those strategies to see if any of them would be helpful in the current adolescent stage of development. Depending on the personality of the teenager, the response of adolescents to authoritarian parenting is either to rebel or become excessively dependent upon parents and have difficulty establishing the confidence needed to make adult decisions. In contrast, adolescents reared by authoritative parents tend to become socially competent, responsible, and autonomous (Kopko, 2007). In light of these findings, it is highly recommended that the father continue to pursue the development of authoritative parenting skills.

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Current Adolescent Development


Spring 2014 PHYSICAL/MOTOR DEVELOPMENT Interview with Sylvia Ethnicity: Caucasian Heritage: Birthdate: Maternal: Swedish & German April 26, 2001 Paternal: Cherokee Indian

03-20-2014, 1:05 pm

Height: 56 (4 inches above average) Weight: 135 (10 pound above average, but this fits with above average height and still places her in normal range for BMI) BMI: 21.8 (normal range) Eye color: Mixed green, blue and hazel. Maternal: blue Paternal: green and hazel Hair color: light brown like aunt Maternal: blonde Paternal: blonde as youth, turned brown Skin tone: between Mom and Dad. Maternal: very fair Paternal: medium

Body Build: Large bones and long legs. Ive got my Moms leg and my Dads bones. Favorite Food: Hersheys cream pie! Favorite Sports: Baseball. Its the only one I understand.

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Extracurricular Activities: American Heritage Girls; Voice Lessons Favorite Recreational Activities: Swimming; rock climbing; roller blading, roller skating Spring 2014 Sylvia is quite agile and has developed good gross motor skills. Following questions answered by mother: Puberty: 10 years old, beginning of pubic hair and mammary gland development Menarche: 01-2014 LANGUAGE/COGNITIVE DEVELOPMENT You are about to have your 13th birthday. How do you feel about becoming a teenager? Exciting, because I get to have a party. What are your strengths? Singing, musical things~ playing piano and guitar. Younger kids flock to me. Note: She relates well to children socially and feels that forming these relationships is one of her strengths. I always talk to whomever, even strangers, but Im not supposed to. Note: She is comfortable with other social settings also. What are your weaknesses? Im bad at hmm I dont know what Im bad at. I dont really think about that a lot.

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I need to stop talking to strangers I dont know. (rephrasing question) What about yourself do you need to improve? I could use more patience. Spring 2014 What is your favorite school subject? Handwriting. Im good at penmanship. Note: Her mother disagrees, although she does say Sylvia is improving. She has Sylvia redo schoolwork that has sloppy penmanship. This along with the difficulty assessing weakness supports the statement from textbook, Self-esteem reflects perceptions that do not always match reality (Santrock, 2013, p. 319). What is your least favorite subject? Math. Its horrible. Do you like school? Yes Why? Because I get to learn new things

What kind of books do you like to read? Dystopian What is that? They are world gone wrong books. People are trying to escape or be rescued or find a cure or something like that. Right now Im reading The Scorch Trial. Whos the author? James Dashner Why do you like these books? They keep you in suspense. Do you every write stories? I try, but I usually fail at that. My sisters better at that. Think back to the earliest thing you can remember and describe that memory to me:

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Walking into a party and getting to run around and play with a bunch of toys and crawling through a mazeand there was a post office area I played in. Spring 2014 Was it like a discovery museum? Maybe thats what it was. I dont know. Kind of hard to remember. But there were tunnels to crawl through and stuff. Other than that the thing I remember is my 6th birthday. Mom tried to make these peanut butter cupcakes and they were gross. I ate vanilla ice cream instead. When you were a little girl you were given speech therapy. Tell me about that experience: You repeat words back and try to correct the sound by shaping your mouth. Did you like it? I think I liked itdont remember well. I remember she would let me play with bubbles. I liked that part. Note: Her mother says she was very committed to correcting her speech problems and worked hard to overcome them. Now you are in vision therapy. Tell me about that: Do you think it is helpful? You do eye exercises; activities to help your eyes like looking for certain letters in a paragraph. Im doing pretty good.

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Visual Processing Evaluation Spring 2014 Sylvia was complaining of headaches when reading and her eyes burning, her Because parents thought she might need glasses and took her to an optometrist for an examination. The optometrist happened to be a Behavioral Optometrist who specializes in the treatment of vision information processing problems. Sylvia had 20/20 vision in her right eye and 20/-20 in her left eye. Although glasses were recommended for correction of slightly far sighted vision, the doctor scheduled a neuro-processing evaluation to determine the cause of headaches and ocular irritation. The evaluation showed: Moderate delays in visual motor integration Severe delays in visual perception skills Mild delays in sentence copy ability Severe delays in left-right visual recognition Mild delays in oculomotor development Mild delays in primitive reflex testing

(See Appendix C) These deficiencies can cause delays in spelling, math concepts and reading and other age appropriate functioning. A program of 30-35 therapy sessions once a week was recommended and at home exercises of 15-20 minutes per day, 5 days per week. Sylvias earlier speech problems collaborated with the optometrists findings, who informed the parents that children with speech disorders often have visual disorders as well. The American Academy of Pediatrics

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associates an early history of speech delay and difficulty with language development as a possible indication of dyslexia (Handler & Fierson, 2011). Because children with Spring 2014 accommodative visual dysfunction of this nature are inattentive and fall behind academically, they are sometimes misdiagnosed with ADHD (Damari, Liu, & Smith, 2000). The parents feel that they have finally found the root cause of Sylvias behavioral and cognitive issues and are hopeful that vision therapy will bring much improvement. It is therefore recommended that vision therapy be continued. The mother feels Sylvia is capable of working on grade level now, but is behind because of delays. The visual problems make completing school work a slow process. Breaks are needed because of eye strain. Although her attention span has improved, she still requires parental monitoring to stay on task. The mother has developed a system that is working well for this without causing frustration. Tasks are presented in small increments, which keep Sylvia from feeling overwhelmed with schoolwork and makes monitoring her progress easier. Sylvia will turn age13 in April and is still in the 6th grade. That will place her at 19 years of age before high school graduation and depending upon the outcome of vision therapy and its impact on academic progress, perhaps longer. Her speech problem contributed to slow academic progress in early childhood and her visual processing issues continue to contribute to delay. The mother does not view this as a hindrance. It is therefore recommended that the mother continue following her instincts and not expect her daughter to make up the time lapse that developmental delay has caused. It may actually be to Sylvias benefit, since graduating later than most adolescents will allow more time for the prefrontal cortex to develop so that executive

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functioning is at a higher level. Research indicates that gray matter in the prefrontal cortex is still developing well into the 20s (Lebel & Beaulieu, 2011). The mother put it this way, I would Spring 2014 like to see her be more self-governed before graduation. I graduated at 17 and it was way too early. I wasnt ready for adult responsibility. The mother is glad that home schooling has allowed for this flexibility without creating any negative stigma or criticism from peers. Sylvia feels good about herself and her abilities, as can be seen from the interview with her in the previous section. It is good that she is traversing through her developmental problems in a healthy constructive way and feeling satisfied with her progress. SOCIAL/EMOTIONAL DEVELOPMENT Keirsey Temperment Profile The Keirsey Temperment Profile reflected Sylvias outgoing personality well. (See Appendix D. ) The results indicate that she is an Artisan/Promoter; a bold temperament that excels in the arts, enjoys people and is very persuasive with people, even with strangers. They are goal oriented and often take pathways out of the ordinary to achieve their purpose. This personality type has served Sylvia well in her efforts to overcome developmental delays. Career Interest Survey The Career Interest Survey that was administered also reflects Sylvias temperament. (See Appendix E.) Sylvia enjoys gardening and growing flowers, and outdoor activities like hiking and camping. Her highest career interest was Agriculture, Food and Natural Resources. Her score was a tie for the next categories : the Arts, Audio/Visual

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S Technology and Communication (which corresponds with Sylvias Artistic/Promoter temperament); Education and Training; Law, Public Safety, Corrections and Security. The last category was a reflection of her compassionate nature that desires to help people in need. Sylvia Spring 2014 reports that when she was younger she wanted to be a midwife and help pregnant women. Now she is more focused on a specific goal. She aspires to go to college and complete a double major in Art and Voice. Sylvia has a unique voice quality that is very appealing and I can visualize her as a recording artist or as a music educator, since she loves children and they respond so well to her. MORAL/FAITH DEVELOPMENT American Heritage Girls Sylvias participation in American Heritage Girls has contributed to both her social/emotional development and her moral/faith development. She has completed 60 service hours, either through providing companionship to nursing home residents or through providing voluntary child care. This type of service learning reduces the self-centeredness that generally characterizes adolescence and creates a desire to serve the community. Other benefits have been shown to exist as well: Improvements in adolescent development related to service learning include higher grades in school, increased goal setting, higher self-esteem, a greater sense of being able to make a difference for others, and an increased willingness to serve as volunteers in the future. (Santrock, 2013, p. 381)

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Sylvia has also earned 11 badges in a variety of areas. Among these are badges in Cake Decorating, Textile Arts, Archery, Family Helper, Creative Crafts, Scrapbooking, Dance, Spring 2014 Internet Adventure, and Kid Care. Another notable accomplishment was the Lets Talk badge that covered activities for developing communication skills. Another badge, called Daughter of the King, has contributed to Sylvias Moral/Faith Development. This badge included learning about how to have a healthy body, mind, and spirit with an emphasis on inner as well as outer beauty. Kohlberg Dilemma Interview

One of the Kohlberg Dilemmas was also administered to assess moral development. (See Appendix F.) Sylvia seems to operate with conventional reasoning at a stage 3 understanding of interpersonal conformity. This is based on her answers to the following questions: Should Louise, the older sister, tell their mother that Judy lied about the money or should she keep quiet? She should tell. Thats my opinion, but Judy has to make her own choice, I cant decide for her. Why? Because its right to let the mother know she lied, so the mother can help her learn not to lie.

Is the fact that Judy earned the money herself important in this situation? No, if her parents said no, then it is wrong to go.

Why or why not? Parents are in authority, you live under their roof. In general, what should be the authority of a mother over her daughter? The daughter should obey the mothers decisions.

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Why? As long as you are under 18 and live in their house thats how it is. What do you think is the most important thing a mother should be concerned about in her relationship to her daughter? Honesty. Talking about things. Protecting her from bad

Spring 2014 things. Why is that the most important thing? Because until the daughter is old enough to make their own decisions she should keep her safe and protected ~ like I dont always know how to make the best decision.

Sylvia does not support her answers with preconventional reasoning. She is beyond the stage of moral development that obeys the rules out of fear of punishment. Her reasoning for obedience encompasses the long term welfare of others. She has adopted her parents moral standards with an understanding that they want what is best for her. This is level 2 stage 3 reasoning that makes moral judgments based on values of trust, caring and loyalty. This developmental stage is appropriate for Sylvias age.

Before age 9, most children use level 1, preconventional reasoning based on external rewards and punishments, when they consider moral choices. By early adolescence, their moral reasoning is increasingly based on the application of standards set by others. Most adolescents reason at stage 3s age. (Santrock, 2013, p. 325)

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Conclusion
Spring 2014 Recommendations that might be helpful to the parents are located throughout this case study. Despite the behaviors and developmental issues which have made Sylvia a challenge to parent, she is a delightful child; creative, loving, and sociable with a strong family attachment. This is a tribute to the nurturing family environment in which she has been privileged to develop. It is my personal opinion that the parents have handled the challenges of raising a child with developmental delays quite well and have given Sylvia excellent opportunities for developing academic achievement and healthy social skills.

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References
Spring 2014 Andrade, J. (2010). What Does Doodling do? Applied Cognitive Psychology, 24(1), 100 106. doi:10.1002/acp Bandura, A. (1991). Social Cognitive Theory of Self-Regulation. Organizational Behavior and Human Decision Processes, 50, 248287. Center for the Development of Pediatric Therapies. (n.d.). Handwriting Recommendations. Retrieved from http://www.developmentaldelay.com/page.cfm/178 Damari, D. A., Liu, J., & Smith, K. B. (2000). Visual Disorders Misdiagnosed as ADHD. Journal of Behavioral Optometry, 11(4), 8791. DiPietro, J. A. (2004). The effects of maternal stress and anxiety during pregnancy The effects of maternal stress and anxiety during pregnancy (mot07).pdf. Current Directions in Psychological Science, 13(2), 7174. Retrieved from http://www.psychiatry.emory.edu/PROGRAMS/GADrug/Feature Articles/Mothers/The effects of maternal stress and anxiety during pregnancy (mot07).pdf Feder, K. P., & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine and Child Neurology, 49(4), 312317. doi:10.1111/j.1469-8749.2007.00312.x Handler, S. M., & Fierson, W. M. (2011). Learning disabilities, dyslexia, and vision. Pediatrics, 127(3), e81856. doi:10.1542/peds.2010-3670 King, S., & Laplante, D. P. (2005). The effects of prenatal maternal stress on childrens cognitive development: Project Ice Storm. Stress (Amsterdam, Netherlands), 8(1), 3545. doi:10.1080/10253890500108391 Kopko, K. (2007). Parenting Styles and Adolescents. Cornell Univesity Cooperative Extension (pp. 18). Ithaca. Retrieved from http://www.human.cornell.edu/pam/outreach/parenting/research/upload/Parenting -20Styles-20and-20Adolescents.pdf

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Laplante, D. P., Barr, R. G., Brunet, A., Galbaud du Fort, G., Meaney, M. L., Saucier, J.F., King, S. (2004). Stress during pregnancy affects general intellectual and Spring 2014 language functioning in human toddlers. Pediatric Research, 56(3), 40010. doi:10.1203/01.PDR.0000136281.34035.44 Lebel, C., & Beaulieu, C. (2011). Longitudinal development of human brain wiring continues from childhood into adulthood. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 31(30), 1093747. doi:10.1523/JNEUROSCI.5302-10.2011 Mills, J. L., Harley, E. E., Reed, G. F., & Berendes, H. W. (1982). Are spermicides teratogenic? JAMA: The Journal of the American Medical Association, 248(17), 21482151. doi:10.1001/jama.248.17.2148 Prathanee, B., Thinkhamrop, B., & Dechongkit, S. (2007). Factors associated with specific language impairment and later language development during early life: a literature review. Clinical Pediatrics, 46(1), 2229. doi:10.1177/0009922806297153 Santrock, J. W. (2013). Life-Span Development (p. 644). Debuque, Iowa: McGraw Hill Companies, Inc. Selfin, A.-S. (2003). Pencil Grip (p. 140). Painosalama Oy, Finland: BO AKADEMI UNIVERSITY PRESS. Retrieved from http://www.doria.fi/bitstream/handle/10024/4108/TMP.objres.23.pdf?sequence=2 Van den Bergh, B. R. H., & Marcoen, A. (2004). High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-yearolds. Child Development, 75(4), 108597. doi:10.1111/j.1467-8624.2004.00727.x Zeindler, C. (2013). Prenatal maternal stress, Zeindler. Douglas Mental Health University Institute. Retrieved from http://www.douglas.qc.ca/info/prenatal-stress

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Appendices

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A. Speech Therapy Diagnosis

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Appendix B

Spring 2014 Therapy Diagnosis B. Vision

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Appendix C

Spring 2014 Sample Work C. School

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Appendix D

D. Career Interest Test


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Appendix E

Spring 2014 Personality Profile E. Keirsky

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Custom Keirsey Temperament Report for: Sylvia


Your Keirsey Temperament Sorter Results indicates that your personality type is that of the Artisan/Promoter (ESTP).

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Artisans are the temperament with a natural ability to excel in any of the arts, not only the fine arts such as painting and sculpting, or the performing arts such as music, theater, and dance, but also the athletic, military, political, mechanical, and industrial arts, as well as the "art of the deal" in business. Artisans are most at home in the real world of solid objects that can be made and manipulated, and of real-life events that can be experienced in the here and now. Artisans have exceptionally keen senses, and love working with their hands. They seem right at home with tools, instruments, and vehicles of all kinds, and their actions are usually aimed at getting them where they want to go, and as quickly as possible. Thus Artisans will strike off boldly down roads that others might consider risky or impossible, doing whatever it takes, rules or no rules, to accomplish their goals. This devil-may-care attitude also gives the Artisans a winning way with people, and they are often irresistibly charming with family, friends, and co-workers. Artisans want to be where the action is; they seek out adventure and show a constant hunger for pleasure and stimulation. They believe that variety is the spice of life, and that doing things that aren't fun or exciting is a waste of time. Artisans are impulsive, adaptable, competitive, and believe the next throw of the dice will be the lucky one. They can also be generous to a fault, always ready to share with their friends from the bounty of life. Above all, Artisans need to be free to do what they wish, when they wish. They resist being tied or bound or confined or obligated; they would rather not wait, or save, or store, or live for tomorrow. In the Artisan view, today must be enjoyed, for tomorrow may never come. There are many Artisans, perhaps 30 to 35 percent of the population, which is good, because they create much of the beauty, grace, fun, and excitement the rest of us enjoy in life. Of all the Artisans, Promoters (ESTP) are the most persuasive and winning, able to put forward a venture, or a scheme, and then to talk perfect strangers into going along with it, to get everyone on board. In a sense, Promoters are able to handle people with much the same skill as other Artisans operate a variety of tools - machines, vehicles, weapons, musical instruments, and the like. People almost seem like musical instruments in the hands of a Promoter; the Promoter picks them up gracefully and makes them play their tune, and they do so willingly.

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F. Kohlberg Dilemmas
Spring 2014 Kohlberg Dilemma II

Judy was a twelve-year-old girl. Her mother promised her that she could go to a special rock concert coming to their town if she saved up from baby-sitting and lunch money to buy a ticket to the concert. She managed to save up the fifteen dollars the ticket cost plus another five dollars. But then her mother changed her mind and told Judy that she had to spend the money on new clothes for school. Judy was disappointed and decided to go to the concert anyway. She bought a ticket and told her mother that she had only been able to save five dollars. That Saturday she went to the performance and told her mother that she was spending the day with a friend. A week passed without her mother finding out. Judy then told her older sister, Louise, that she had gone to the performance and had lied to her mother about it. Louise wonders whether to tell their mother what Judy did. 1. Should Louise, the older sister, tell their mother that Judy lied about the money or should she keep quiet? She should tell. Thats my opinion, but Judy has to make her own choice, I cant decide for her. Why? Because its right to let the mother know she lied, so the mother can help her learn not to lie. 2. In wondering whether to tell, Louise thinks of the fact that Judy is her sister. Should that make a difference in Louise's decision? No 2a. Why or why not? Well in a way yes, because she wants the best for her sister and she has become responsible since she knows now what her sister has done 2. Does telling have anything to do with being a good daughter? Yes, it makes her a good daughter 3a. Why or why not? because shes telling truth and helping her mom with parenting. 3. Is the fact that Judy earned the money herself important in this situation? No, if her parents said no, then it is wrong to go 4a. Why or why not? Parents are in authority, you live under their roof.

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5.SThe mother promised Judy she could go to the concert if she earned the money. Is the fact that the mother promised the most important thing in the situation? No 5a. Why or why not? Because humans have the right to change their mind, she may have decided it wasnt the best decision and buying clothes was better way to spend the money. Ive had to spend my money on clothes before. Whats important can change. Spring 2014 Why in general should a promise be kept? Because its their word, but the mother can make a decision in that way. 7. Is it important to keep a promise to someone you don't know well and probably won't see again? Yes 7a. Why or why not? Because that still right and could cause issue you dont know that could happen. 8. What do you think is the most important thing a mother should be concerned about in her relationship to her daughter? Honesty, talking about things, protecting her from bad things. 8a. Why is that the most important thing? Because until the daughter is old enough to make their own decisions she should keep her safe and protected..like I dont always know how to make the best decision. 9. In general, what should be the authority of a mother over her daughter? The daughter should obey the mothers decisions. 9a. Why? As long as you are under 18 and live in their house thats how it is. 10. What do you think is the most important thing a daughter should be concerned about in her relationship to her mother? That she let her mother know what is going on. Is the mother being honest with her? Being obedient and honoring what she says. 10a. Why is that the most important thing? because I know she wants the best for me. 11. In thinking back over the dilemma, what would you say is the most responsible thing for Louise to do in this situation? Tell her mother. 11a. Why? Its whats best for her sister. My sister did that for me when I lied to my Mom and it helped a lot.

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Appendix G

G. Parent Comments
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