The Case of Anna
You are one of a team who are involved in assessing developmental issues of young children.
An adoptive family has approached you and your team for advice on understanding their daughter and information on intervention to assist in her development and for the interest of family functioning.
Anna is 8 years and one month old at the time in which she arrives at your office.
Anna’s history:
She was born to married, Caucasian parents when her mother was 28 years of age and her birth father was 35 years old. This was the third live born infant for Anna’s birth mother. Her pregnancy was complicated by extensive alcohol use. The birth father reported that he would generally buy one case of beer daily and that when it was available he and his wife would each drink about half of this amount in the evening. This level of drinking persisted through the first half of the pregnancy. During the second half of Anna’s gestation, Anna’s birth father drank more while her mother drank less, although she still probably ingested about a six-pack daily until delivery. Anna’s mother also used marijuana about once a month and smoked half a pack of cigarettes each day. The pregnancy was further complicated by physical abuse of the mother by her husband, although this abuse never led to a medical assessment during the pregnancy. Both biological parents reported that their own fathers, but not their mothers, had been heavy drinkers. Neither biological parent reported significant academic problems, nor both had finished high school.
Anna was born at term, and her delivery was described as typical. At birth, she weighed 5 lbs. 6 ounces and was 18 inches long. She was always described as small. While in foster care, Anna received a nutritional evaluation and a thyroid screen. Anna grew steadily but more slowly than typically developing children. One previous foster parent repeatedly asked her physician to hospitalize the infant because she ardently believed that her inability to “fatten the baby up” meant that the baby was ill. Anna had an inguinal hernia that was repaired when she was 9 months old. She had chronic problems with otitis media until she reached age 3, though she never had a documented hearing loss. Despite these problems, she had been in good health overall.
After Anna was born, she lived with her parents for about 6 months, and then she was removed from parental custody after the biological mother was beaten several times by her husband. In addition investigators found that the child was living in an unclean apartment without food or appropriate clothing. Six month-old Anna was placed in foster care and moved periodically over the next two and a half years while social service agencies determined that neither parent could control their drinking and regain custody. Anna was then made available for adoption and was retained by her last foster family (mother, father, and a brother 3 years older than Anna) when she was about 3 years of age. The adoption was legalized when Anna was almost 5 years old.
At the time of meeting Anna, her adoptive parents reported that she had shown behavior problems since 30 months of age. Sometimes Anna was very negative and aggressive, especially with family members, while at other times she was cooperative and pleasant. Upon entering preschool, she was so aggressive with her peers that she was unsuccessful in two preschool programs. Her parents said that these behavior problems continued but had grown less frequent and violent since Anna started kindergarten. Anna consistently displays a state of anxiousness.
At age 7 and midway through first grade, Anna was made a “focus of concern” by her school district because of poor academic progress and increasingly problematic behavior. As part of her school assessment she was evaluated using a standardized test of intelligence, the Wechsler Intelligence Scale for Children. On that test, her verbal IQ scored was a standard 68, below expectation, and her performance IQ was a standard 90, within normal limits. Additional individual tests were given in the following areas: reading, math, written language, knowledge, communication, daily living skills, and socialization. Academic subjects were within in the normal range. Adaptive behavior composite was 52. The sub domain scores were in communication, daily living skills, and socialization. The school was to provide resource support but no educational plan was developed to address her cognitive and academic difficulties.
The adoptive parents were confused and exhausted. They wished to understand how Anna’s multiple diagnoses related to each other and how to maximize the effectiveness of her academic and mental health interventions.
Caregiver Interview
Questions were asked of the caregiver’s in the following areas: planning, behavior regulation, abstract thinking and judgment, information processing and verbal memory, spatial skills and memory, social skills and adaptive behavior, sensorimotor integration, and both oral-motor and motor control skills.
The parents commented that they sometimes understood the antecedents of her angry outbursts (but often did not) and that Anna was basically loving and caring. Nevertheless, Anna had never enjoyed being held or hugged for more than a brief period time. Furthermore, her parents said that she had always been very sensitive to loud noise and to rough or scratchy clothing.
Anna’s parents noted that their daughter had difficulty organizing spaces; for example, she tended to crowd the letters of her name into one corner of a page and she could not put her toys away in their proper places. Her parents also agreed that their daughter had tremendous difficulty following directions. They reported that she generally failed to remember an instruction if more than few minutes elapsed between the times the instruction was given and when she was expected to carry it out. Anna also could not successfully follow more than a one-step instruction. She could repeat instructions if she practices saying them many times (e.g., Questions: “Anna, what do we do before we eat?”; Answer: “We wash our hands”). Yet Anna usually forgot the rule without a direct reminder at the time the instruction was to be implemented. In fact, she did not understand lengths of time (e.g., the difference between an events taking place in a few minutes or one that was a few days away).
In the domain of social skills, Anna’s parents described her as isolated with no friends. She seemed to enjoy the company of other children but often tried to direct all activities. This behavior usually led to marginalization by her peer group. When rejected, Anna sometimes played alone, but she usually responded to peer rejection or noncompliance with anger or physical aggression. Anna played well with younger children (ages 3 or 4 years) and was kind to animals.
In physical terms, Anna had trouble going to bed and often awoke in the night, but then she generally tired during the latter part of the day. Her mother commented ruefully that Anna could climb, in-line skate, and do other age appropriate outdoor activities but did them in a frighteningly reckless and somewhat clumsy way. In general, Anna was described as having problems with self-regulation. Her parents had learned to send their daughter to her room when she was out of control. In time out, Anna quickly calmed down and seemingly forgot the entire event within minutes. Such outbursts could occur daily or even several times per day.
Midterm
In a written format identify the following:
Identify the developmental concept as to its ideal role and as to how it applies to Anna.
Secondly, how would you advise a person regarding the application of these developmental concepts? (What can be done to compensate or correct the situation?)
You may write in a legal format or a medical format. The introduction should be a synopsis of the presenting case followed by the analysis then conclusion of recommendations. If you should have ever seen your medical charts they are written in this format.
APA format and include supportive citations. Do not plagiarize the textbook or any other sources you choose to use.
Gestation and Prenatal Development (Environmental Influences)
Temperament
Attachment
Parenting Styles
Piaget-Cognitive
Erikson-Social Emotional
Language-Comprehension-Chomsky/Skinner
Self Regulating Behaviors
Vygotsky-ZPD (Critical/Sensitive Learning Periods)
Choose three additional areas from chapters 1-9 and apply.
Keep in mind that you will be examining Anna within four stages of development.
Conception/Gestation
Infancy
Toddler
Early Childhood
In addition remember that all of these concepts and issues are either found in one or more of the four domains of child development: physical, emotional, social, and mental/cognitive.
Students should examine the basis of the twelve concepts and then they should examine these concepts within the Anna profile. After you have examined the concepts and Anna you should conclude with recommendations as to how to aid this family and Anna.
Conclusion should be your recommendations to the family as to what issues can be addressed and what can be aided or compensated.
