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Casebook: Developmentally Appropriate Practice in Early Childhood Programs Serving Children from Birth Through Age 8

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About the book.

• Make connections to the fourth edition of Developmentally Appropriate Practice in Early Childhood Programs 
• Think critically about the influence of context on educator, child, and family actions 
• Discuss the effectiveness of the teaching practices and how they might be improved 
• Support your responses with evidence from the DAP position statement and book 
• Explore next steps beyond the case details 
• Apply the learning to your own situation 

Table of Contents

• Editors, Contributors, and Reviewers
• Introduction and Book Overview | Jennifer J. Chen and Dana Battaglia
• 1.1 Missed Opportunities: Relationship Building in Inclusive Classrooms | Julia Torquati
• 1.2 “My Name Is Not a Shame” | Kevin McGowan
• 1.3 Fostering Developmentally Appropriate Practice Through Virtual Family Connections | Lea Ann Christenson
• 1.4 Counting Collections in Community | Amy Schmidtke
• 1.5 The Joy Jar: Celebrating Kindness | Leah Schoenberg Muccio
• 1.6 Prioritizing Listening to and Learning from Families | Amy Schmidtke 
• 2.1 Julio’s Village: Early Childhood Education Supports for Teen Parents | Donna Kirkwood
• 2.2 Healthy Boundaries: Listening to Children and Learning from Families | Jovanna Archuleta
• 2.3 Roadmap of Family Engagement to Kindergarten: An Ecological Systems Approach | Marcela Andrés
• 2.4 Taking Trust for Granted? The Importance of Communication and Outreach in Family Partnerships | Suzanna Ewert
• 2.5 Book Reading: Learning About Migration and Our Family Stories | Sarah Rendón García 
• 3.1 Pairing Standardized Scale with Observation | Megan Schumaker-Murphy
• 3.2 The Power of Observing Jordan | Marsha Shigeyo Hawley and Barbara Abel
• 3.3 “But What Is My Child Learning?” | Janet Thompson and Jennifer Gonzalez
• 3.4 Drawing and Dialogue: Using Authentic Assessment to Understand Children’s Sense of Self and Observe Early Literacy Skills | Brandon L. Gilbert
• 3.5 The ABCs of Kindergarten Registration: Assessment, Background, and Collaboration Between Home and School | Bridget Amory
• 3.6 Creating Opportunities for Individualized Assessment Activities for Biliteracy Development | Esther Garza
• 3.7 Observing Second-Graders’ Vocabulary Development | Marie Ann Donovan
• 3.8 Writing Isn’t the Only Way! Multiple Means of Expressing Learning | Lee Ann Jungiv 
• 4.1 Engaging with Families to Individualize Teaching | Marie L. Masterson 
• 4.2 Tumbling Towers with Toddlers: Intention and Decision Making Over Blocks | Ron Grady  
• 4.3 What My Heart Holds: Exploring Identity with Preschool Learners | Cierra Kaler-Jones 
• 4.4 “I See a Really Big Gecko!” When Background Knowledge and Teaching Materials Don’t Match | Germaine Kaleilehua Tauati and Colleen E. Whittingham 
• 4.5 Using a Humanizing and Restorative Approach for Young Children to Develop Responsibility and Self-Regulation | Saili S. Kulkarni, Sunyoung Kim, and Nicola Holdman 
• 4.6 Joyful, Developmentally Appropriate Learning Environments for African American Youth | Lauren C. Mims, Addison Duane, LaKenya Johnson, and Erika Bocknek 
• 5.1 Using the Environment and Materials as Curriculum for Promoting Infants’ and Toddlers’ Exploration of Basic Cause-and-Effect Principles | Guadalupe Rivas 
• 5.2 Social Play Connections Among a Small Group of Preschoolers | Leah Catching 
• 5.3 Can Preschoolers Code? A Sneak Peek into a Developmentally Appropriate Coding Lesson | Olabisi Adesuyi-Fasuyi 
• 5.4 Everyday Gifts: Children Show Us the Path—We Observe and Scaffold | Martha Melgoza 
• 5.5 Learning to Conquer the Slide Through Persistence and Engaging in Social Interaction | Sueli Nunes 
• 5.6 “Sabes que todos los caracoles pueden tener bebés? Do You Know that All Snails Can Have Babies?” Supporting Children’s Emerging Interests in a Dual Language Preschool Classroom | Isauro M. Escamilla 
• 5.7 “Can We Read this One?” A Conversation About Book Selection in Kindergarten | Larissa Hsia-Wong  
• 6.1 Take a Chance on Coaching: It’s Worth It! | Lauren Bond 
• 6.2 It Started with a Friendship Parade | Angela Vargas 
• 6.3 The World Outside of the Classroom: Letting Your Voice Be Heard | Meghann Hickey 
• 7.1 Communication as a Two-Way Street? Creating Opportunities for Engagement During Meaningful Language Routines | Kameron C. Cardenv 
• 7.2 Eli Goes to Preschool: Inclusion for a Child with Autism Spectrum Disorder | Abby Hodges
• 7.3 Preschool Classroom Supports and Embedded Interventions with Coteaching | Racheal Kuperus and Desarae Orgo
• 7.4 Addressing Challenging Behavior Using the Pyramid Model | Ellie Bold
• 7.5 Dual Language or Disability? How Teachers Can Be the First to Help | Alyssa Brillante
• 7.6 Adapting and Modifying Instruction Using Reader’s Theater | Michelle Gonzalez
• 7.7 Supporting Children with Learning Disabilities in Mathematics: The Importance of Observation, Content Knowledge, and Context | Renee B. Whelan 
• 8.1 Facilitating a Child’s Transition from Home to Group Care Through the Use of Cultural Caring Routines | Josephine Ahmadein
• 8.2 Engaging Dual Language Learners in Conversation to Support Translanguaging During a Small Group Activity | Valeria Erdosi and Jennifer J. Chen
• 8.3 Incorporating Children’s Cultures and Languages in Learning Activities | Eleni Zgourou
• 8.4 Adapting Teaching Materials for Dual Language Learners to Reflect Their Home Languages and Cultures in a Math Lesson | Karen Nemeth
• 8.5 Studying Celestial Bodies: Science and Cultural Stories | Zeynep Isik-Ercan
• 8.6 Respecting Diverse Cultures and Languages by Sharing and Learning About Cultural Poems, Songs, and Stories From Others | Janis Strasser

Book Details

Faculty resources.

To access tips and resources for teaching the cases, please complete this brief form.  You’ll be able to download the items after you complete the form. 

Teacher Inquiry Group Resources

To access reflection questions to deepen your learning, please click here.

More DAP Resources

To read the position statement, access related resources, and stay up-to-the-minute on all things DAP, visit  NAEYC.org/resources/developmentally-appropriate-practice .

Pamela Brillante,  EdD, is professor in the Department of Special Education, Professional Counseling and Disability Studies, at William Paterson University. She has worked as an early childhood special educator, administrator, and New Jersey state specialist in early childhood special education. She is the author of the NAEYC book The Essentials: Supporting Young Children with Disabilities in the Classroom. Dr. Brillante continues to work with schools to develop high-quality inclusive early childhood programs. 

Jennifer J. Chen, EdD, is professor of early childhood and family studies at Kean University. She earned her doctorate from Harvard University. She has authored or coauthored more than 60 publications in early childhood education. Dr. Chen has received several awards, including the 2020 NAECTE Foundation Established Career Award for Research on ECTE, the 2021 Kean Presidential Excellence Award for Distinguished Scholarship, and the 2022 NJAECTE’s Distinguished Scholarship in ECTE/ECE Award. 

Stephany Cuevas, EdD, is assistant professor of education in the Attallah College of Educational Studies at Chapman University. Dr. Cuevas is an interdisciplinary education scholar whose research focuses on family engagement, Latinx families, and the postsecondary trajectories of first-generation students. She is the author of Apoyo Sacrifical, Sacrificial Support: How Undocumented Parents Get Their Children to College (Teachers College Press). 

Christyn Dundorf, PhD, has more than 30 years of experience in the early learning field as a teacher, administrator, and adult educator. She serves as codirector of Teaching Preschool Partners, a nonprofit organization working to grow playful learning and inquiry practices in school-based pre-K programs and infuse those practices up into the early grades.

Emily Brown Hoffman, PhD, is assistant professor in early childhood education at National Louis University in Chicago. She received her PhD from the University of Illinois at Chicago in Curriculum & Instruction, Literacy, Language, & Culture. Her focuses include emergent literacy, leadership, play and creativity, and school, family, and community partnerships. 

Daniel R. Meier, PhD, is professor of elementary education at San Francisco State University. His publications include Critical Issues in Infant-Toddler Language Development: Connecting Theory to Practice (editor), Supporting Literacies for Children of Color: A Strength-Based Approach to Preschool Literacy (author), and Learning Stories and Teacher Inquiry Groups: Reimagining Teaching and Assessment in Early Childhood Education (coauthor). 

Gayle Mindes, EdD, is professor emerita, DePaul University. She is the author of Assessing Young Children , fifth edition (with Lee Ann Jung), and Social Studies for Young Children: Preschool and Primary Curriculum Anchor, third edition (with Mark Newman). Dr. Mindes is also the editor of Teaching Young Children with Challenging Behaviors: Practical Strategies for Early Childhood Educators and Contemporary Challenges in Teaching Young Children: Meeting the Needs of All Students . 

Lisa R. Roy, EdD, is executive director for the Colorado Department of Early Childhood. Dr. Roy has supported families with young children for over 30 years, serving as the director of program development for the Buffett Early Childhood Institute, as the executive director of early childhood education for Denver Public Schools, and in various nonprofit and government roles.

Early Childhood Education: How to do a Child Case Study-Best Practice

• Creating an Annotated Bibliography
• Lesson Plans and Rubrics
• Children's literature
• Podcasts and Videos
• Cherie's Recommended Library
• Great Educational Articles
• Great Activities for Children
• Professionalism in the Field and in a College Classroom
• Professional Associations
• Pennsylvania Certification
• Manor's Early Childhood Faculty
• Manor Lesson Plan Format
• Manor APA Formatting, Reference, and Citation Policy for Education Classes
• Conducting a Literature Review for a Manor education class
• Manor College's Guide to Using EBSCO Effectively
• How to do a Child Case Study-Best Practice
• ED105: From Teacher Interview to Final Project
• Pennsylvania Initiatives

Description of Assignment

During your time at Manor, you will need to conduct a child case study. To do well, you will need to plan ahead and keep a schedule for observing the child. A case study at Manor typically includes the following components: 

• Three observations of the child: one qualitative, one quantitative, and one of your choice. 
• Three artifact collections and review: one qualitative, one quantitative, and one of your choice. 
• A Narrative

Within this tab, we will discuss how to complete all portions of the case study.  A copy of the rubric for the assignment is attached. 

• Case Study Rubric (Online)
• Case Study Rubric (Hybrid/F2F)

Qualitative and Quantitative Observation Tips

Remember your observation notes should provide the following detailed information about the child:

• child’s age,
• physical appearance,
• the setting, and
• any other important background information.

You should observe the child a minimum of 5 hours. Make sure you DO NOT use the child's real name in your observations. Always use a pseudo name for course assignments. 

You will use your observations to help write your narrative. When submitting your observations for the course please make sure they are typed so that they are legible for your instructor. This will help them provide feedback to you. 

Qualitative Observations

A qualitative observation is one in which you simply write down what you see using the anecdotal note format listed below. 

Quantitative Observations

A quantitative observation is one in which you will use some type of checklist to assess a child's skills. This can be a checklist that you create and/or one that you find on the web. A great choice of a checklist would be an Ounce Assessment and/or work sampling assessment depending on the age of the child. Below you will find some resources on finding checklists for this portion of the case study. If you are interested in using Ounce or Work Sampling, please see your program director for a copy. 

Remaining Objective 

For both qualitative and quantitative observations, you will only write down what your see and hear. Do not interpret your observation notes. Remain objective versus being subjective.

An example of an objective statement would be the following: "Johnny stacked three blocks vertically on top of a classroom table." or "When prompted by his teacher Johnny wrote his name but omitted the two N's in his name." 

An example of a subjective statement would be the following: "Johnny is happy because he was able to play with the block." or "Johnny omitted the two N's in his name on purpose." 

• Anecdotal Notes Form Form to use to record your observations.
• Guidelines for Writing Your Observations
• Tips for Writing Objective Observations
• Objective vs. Subjective

Qualitative and Quantitative Artifact Collection and Review Tips

For this section, you will collect artifacts from and/or on the child during the time you observe the child. Here is a list of the different types of artifacts you might collect: 

Potential Qualitative Artifacts 

• Photos of a child completing a task, during free play, and/or outdoors. 
• Samples of Artwork 
• Samples of writing 
• Products of child-led activities 

Potential Quantitative Artifacts 

• Checklist 
• Rating Scales
• Product Teacher-led activities 

Examples of Components of the Case Study

Here you will find a number of examples of components of the Case Study. Please use them as a guide as best practice for completing your Case Study assignment. 

• Qualitatitive Example 1
• Qualitatitive Example 2
• Quantitative Photo 1
• Qualitatitive Photo 1
• Quantitative Observation Example 1
• Artifact Photo 1
• Artifact Photo 2
• Artifact Photo 3
• Artifact Photo 4
• Artifact Sample Write-Up
• Case Study Narrative Example Although we do not expect you to have this many pages for your case study, pay close attention to how this case study is organized and written. The is an example of best practice.

Narrative Tips

The Narrative portion of your case study assignment should be written in APA style, double-spaced, and follow the format below:

• Introduction : Background information about the child (if any is known), setting, age, physical appearance, and other relevant details. There should be an overall feel for what this child and his/her family is like. Remember that the child’s neighborhood, school, community, etc all play a role in development, so make sure you accurately and fully describe this setting! --- 1 page
• Observations of Development :   The main body of your observations coupled with course material supporting whether or not the observed behavior was typical of the child’s age or not. Report behaviors and statements from both the child observation and from the parent/guardian interview— 1.5  pages
• Comment on Development: This is the portion of the paper where your professional analysis of your observations are shared. Based on your evidence, what can you generally state regarding the cognitive, social and emotional, and physical development of this child? Include both information from your observations and from your interview— 1.5 pages
• Conclusion: What are the relative strengths and weaknesses of the family, the child? What could this child benefit from? Make any final remarks regarding the child’s overall development in this section.— 1page
• Your Case Study Narrative should be a minimum of 5 pages.

Make sure to NOT to use the child’s real name in the Narrative Report. You should make reference to course material, information from your textbook, and class supplemental materials throughout the paper . 

Same rules apply in terms of writing in objective language and only using subjective minimally. REMEMBER to CHECK your grammar, spelling, and APA formatting before submitting to your instructor. It is imperative that you review the rubric of this assignment as well before completing it. 

Biggest Mistakes Students Make on this Assignment

Here is a list of the biggest mistakes that students make on this assignment: 

• Failing to start early . The case study assignment is one that you will submit in parts throughout the semester. It is important that you begin your observations on the case study before the first assignment is due. Waiting to the last minute will lead to a poor grade on this assignment, which historically has been the case for students who have completed this assignment. 
• Failing to utilize the rubrics. The rubrics provide students with guidelines on what components are necessary for the assignment. Often students will lose points because they simply read the descriptions of the assignment but did not pay attention to rubric portions of the assignment. 
• Failing to use APA formatting and proper grammar and spelling. It is imperative that you use spell check and/or other grammar checking software to ensure that your narrative is written well. Remember it must be in APA formatting so make sure that you review the tutorials available for you on our Lib Guide that will assess you in this area. 
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1 Chapter 1: Introduction to Child Development

Chapter objectives.

After this chapter, you should be able to:

• Describe the principles that underlie development.
• Differentiate periods of human development.
• Evaluate issues in development.
• Distinguish the different methods of research.
• Explain what a theory is.
• Compare and contrast different theories of child development.

Introduction

Welcome to Child Growth and Development. This text is a presentation of how and why children grow, develop, and learn.

We will look at how we change physically over time from conception through adolescence. We examine cognitive change, or how our ability to think and remember changes over the first 20 years or so of life. And we will look at how our emotions, psychological state, and social relationships change throughout childhood and adolescence. 1

Principles of Development

There are several underlying principles of development to keep in mind:

• Development is lifelong and change is apparent across the lifespan (although this text ends with adolescence). And early experiences affect later development.
• Development is multidirectional. We show gains in some areas of development, while showing loss in other areas.
• Development is multidimensional. We change across three general domains/dimensions; physical, cognitive, and social and emotional.
• The physical domain includes changes in height and weight, changes in gross and fine motor skills, sensory capabilities, the nervous system, as well as the propensity for disease and illness.
• The cognitive domain encompasses the changes in intelligence, wisdom, perception, problem-solving, memory, and language.
• The social and emotional domain (also referred to as psychosocial) focuses on changes in emotion, self-perception, and interpersonal relationships with families, peers, and friends.

All three domains influence each other. It is also important to note that a change in one domain may cascade and prompt changes in the other domains.

• Development is characterized by plasticity, which is our ability to change and that many of our characteristics are malleable. Early experiences are important, but children are remarkably resilient (able to overcome adversity).
• Development is multicontextual. 2 We are influenced by both nature (genetics) and nurture (the environment) – when and where we live and our actions, beliefs, and values are a response to circumstances surrounding us.  The key here is to understand that behaviors, motivations, emotions, and choices are all part of a bigger picture. 3

Now let’s look at a framework for examining development.

Periods of Development

Think about what periods of development that you think a course on Child Development would address. How many stages are on your list? Perhaps you have three: infancy, childhood, and teenagers. Developmentalists (those that study development) break this part of the life span into these five stages as follows:

• Prenatal Development (conception through birth)
• Infancy and Toddlerhood (birth through two years)
• Early Childhood (3 to 5 years)
• Middle Childhood (6 to 11 years)
• Adolescence (12 years to adulthood)

This list reflects unique aspects of the various stages of childhood and adolescence that will be explored in this book. So while both an 8 month old and an 8 year old are considered children, they have very different motor abilities, social relationships, and cognitive skills. Their nutritional needs are different and their primary psychological concerns are also distinctive.

Prenatal Development

Conception occurs and development begins. All of the major structures of the body are forming and the health of the mother is of primary concern. Understanding nutrition, teratogens (or environmental factors that can lead to birth defects), and labor and delivery are primary concerns.

Figure 1.1 – A tiny embryo depicting some development of arms and legs, as well as facial features that are starting to show. 4

Infancy and Toddlerhood

The two years of life are ones of dramatic growth and change. A newborn, with a keen sense of hearing but very poor vision is transformed into a walking, talking toddler within a relatively short period of time. Caregivers are also transformed from someone who manages feeding and sleep schedules to a constantly moving guide and safety inspector for a mobile, energetic child.

Figure 1.2 – A swaddled newborn. 5

Early Childhood

Early childhood is also referred to as the preschool years and consists of the years which follow toddlerhood and precede formal schooling. As a three to five-year-old, the child is busy learning language, is gaining a sense of self and greater independence, and is beginning to learn the workings of the physical world. This knowledge does not come quickly, however, and preschoolers may initially have interesting conceptions of size, time, space and distance such as fearing that they may go down the drain if they sit at the front of the bathtub or by demonstrating how long something will take by holding out their two index fingers several inches apart. A toddler’s fierce determination to do something may give way to a four-year-old’s sense of guilt for action that brings the disapproval of others.

Figure 1.3 – Two young children playing in the Singapore Botanic Gardens 6

Middle Childhood

The ages of six through eleven comprise middle childhood and much of what children experience at this age is connected to their involvement in the early grades of school. Now the world becomes one of learning and testing new academic skills and by assessing one’s abilities and accomplishments by making comparisons between self and others. Schools compare students and make these comparisons public through team sports, test scores, and other forms of recognition. Growth rates slow down and children are able to refine their motor skills at this point in life. And children begin to learn about social relationships beyond the family through interaction with friends and fellow students.

Figure 1.4 – Two children running down the street in Carenage, Trinidad and Tobago 7

Adolescence

Adolescence is a period of dramatic physical change marked by an overall physical growth spurt and sexual maturation, known as puberty. It is also a time of cognitive change as the adolescent begins to think of new possibilities and to consider abstract concepts such as love, fear, and freedom. Ironically, adolescents have a sense of invincibility that puts them at greater risk of dying from accidents or contracting sexually transmitted infections that can have lifelong consequences. 8

Figure 1.5 – Two smiling teenage women. 9

There are some aspects of development that have been hotly debated. Let’s explore these.

Issues in Development

Nature and nurture.

Why are people the way they are? Are features such as height, weight, personality, being diabetic, etc. the result of heredity or environmental factors-or both? For decades, scholars have carried on the “nature/nurture” debate. For any particular feature, those on the side of Nature would argue that heredity plays the most important role in bringing about that feature. Those on the side of Nurture would argue that one’s environment is most significant in shaping the way we are. This debate continues in all aspects of human development, and most scholars agree that there is a constant interplay between the two forces. It is difficult to isolate the root of any single behavior as a result solely of nature or nurture.

Continuity versus Discontinuity

Is human development best characterized as a slow, gradual process, or is it best viewed as one of more abrupt change? The answer to that question often depends on which developmental theorist you ask and what topic is being studied. The theories of Freud, Erikson, Piaget, and Kohlberg are called stage theories. Stage theories or discontinuous development assume that developmental change often occurs in distinct stages that are qualitatively different from each other, and in a set, universal sequence. At each stage of development, children and adults have different qualities and characteristics. Thus, stage theorists assume development is more discontinuous. Others, such as the behaviorists, Vygotsky, and information processing theorists, assume development is a more slow and gradual process known as continuous development. For instance, they would see the adult as not possessing new skills, but more advanced skills that were already present in some form in the child. Brain development and environmental experiences contribute to the acquisition of more developed skills.

Figure 1.6 – The graph to the left shows three stages in the continuous growth of a tree. The graph to the right shows four distinct stages of development in the life cycle of a ladybug. 10

Active versus Passive

How much do you play a role in your own developmental path? Are you at the whim of your genetic inheritance or the environment that surrounds you? Some theorists see humans as playing a much more active role in their own development. Piaget, for instance believed that children actively explore their world and construct new ways of thinking to explain the things they experience. In contrast, many behaviorists view humans as being more passive in the developmental process. 11

How do we know so much about how we grow, develop, and learn? Let’s look at how that data is gathered through research

Research Methods

An important part of learning any science is having a basic knowledge of the techniques used in gathering information. The hallmark of scientific investigation is that of following a set of procedures designed to keep questioning or skepticism alive while describing, explaining, or testing any phenomenon. Some people are hesitant to trust academicians or researchers because they always seem to change their story. That, however, is exactly what science is all about; it involves continuously renewing our understanding of the subjects in question and an ongoing investigation of how and why events occur. Science is a vehicle for going on a never-ending journey. In the area of development, we have seen changes in recommendations for nutrition, in explanations of psychological states as people age, and in parenting advice. So think of learning about human development as a lifelong endeavor.

Take a moment to write down two things that you know about childhood. Now, how do you know? Chances are you know these things based on your own history (experiential reality) or based on what others have told you or cultural ideas (agreement reality) (Seccombe and Warner, 2004). There are several problems with personal inquiry. Read the following sentence aloud:

Paris in the

Are you sure that is what it said? Read it again:

If you read it differently the second time (adding the second “the”) you just experienced one of the problems with personal inquiry; that is, the tendency to see what we believe. Our assumptions very often guide our perceptions, consequently, when we believe something, we tend to see it even if it is not there. This problem may just be a result of cognitive ‘blinders’ or it may be part of a more conscious attempt to support our own views. Confirmation bias is the tendency to look for evidence that we are right and in so doing, we ignore contradictory evidence. Popper suggests that the distinction between that which is scientific and that which is unscientific is that science is falsifiable; scientific inquiry involves attempts to reject or refute a theory or set of assumptions (Thornton, 2005). Theory that cannot be falsified is not scientific. And much of what we do in personal inquiry involves drawing conclusions based on what we have personally experienced or validating our own experience by discussing what we think is true with others who share the same views.

Science offers a more systematic way to make comparisons guard against bias.

Scientific Methods

One method of scientific investigation involves the following steps:

• Determining a research question
• Reviewing previous studies addressing the topic in question (known as a literature review)
• Determining a method of gathering information
• Conducting the study
• Interpreting results
• Drawing conclusions; stating limitations of the study and suggestions for future research
• Making your findings available to others (both to share information and to have your work scrutinized by others)

Your findings can then be used by others as they explore the area of interest and through this process a literature or knowledge base is established. This model of scientific investigation presents research as a linear process guided by a specific research question. And it typically involves quantifying or using statistics to understand and report what has been studied. Many academic journals publish reports on studies conducted in this manner.

Another model of research referred to as qualitative research may involve steps such as these:

• Begin with a broad area of interest
• Gain entrance into a group to be researched
• Gather field notes about the setting, the people, the structure, the activities or other areas of interest
• Ask open ended, broad “grand tour” types of questions when interviewing subjects
• Modify research questions as study continues
• Note patterns or consistencies
• Explore new areas deemed important by the people being observed
• Report findings

In this type of research, theoretical ideas are “grounded” in the experiences of the participants. The researcher is the student and the people in the setting are the teachers as they inform the researcher of their world (Glazer & Strauss, 1967). Researchers are to be aware of their own biases and assumptions, acknowledge them and bracket them in efforts to keep them from limiting accuracy in reporting. Sometimes qualitative studies are used initially to explore a topic and more quantitative studies are used to test or explain what was first described.

Let’s look more closely at some techniques, or research methods, used to describe, explain, or evaluate. Each of these designs has strengths and weaknesses and is sometimes used in combination with other designs within a single study.

Observational Studies

Observational studies involve watching and recording the actions of participants. This may take place in the natural setting, such as observing children at play at a park, or behind a one-way glass while children are at play in a laboratory playroom. The researcher may follow a checklist and record the frequency and duration of events (perhaps how many conflicts occur among 2-year-olds) or may observe and record as much as possible about an event (such as observing children in a classroom and capturing the details about the room design and what the children and teachers are doing and saying). In general, observational studies have the strength of allowing the researcher to see how people behave rather than relying on self-report. What people do and what they say they do are often very different. A major weakness of observational studies is that they do not allow the researcher to explain causal relationships. Yet, observational studies are useful and widely used when studying children. Children tend to change their behavior when they know they are being watched (known as the Hawthorne effect) and may not survey well.

Experiments

Experiments are designed to test hypotheses (or specific statements about the relationship between variables) in a controlled setting in efforts to explain how certain factors or events produce outcomes. A variable is anything that changes in value. Concepts are operationalized or transformed into variables in research, which means that the researcher must specify exactly what is going to be measured in the study.

Three conditions must be met in order to establish cause and effect. Experimental designs are useful in meeting these conditions.

The independent and dependent variables must be related. In other words, when one is altered, the other changes in response. (The independent variable is something altered or introduced by the researcher. The dependent variable is the outcome or the factor affected by the introduction of the independent variable. For example, if we are looking at the impact of exercise on stress levels, the independent variable would be exercise; the dependent variable would be stress.)

The cause must come before the effect. Experiments involve measuring subjects on the dependent variable before exposing them to the independent variable (establishing a baseline). So we would measure the subjects’ level of stress before introducing exercise and then again after the exercise to see if there has been a change in stress levels. (Observational and survey research does not always allow us to look at the timing of these events, which makes understanding causality problematic with these designs.)

The cause must be isolated. The researcher must ensure that no outside, perhaps unknown variables are actually causing the effect we see. The experimental design helps make this possible. In an experiment, we would make sure that our subjects’ diets were held constant throughout the exercise program. Otherwise, diet might really be creating the change in stress level rather than exercise.

A basic experimental design involves beginning with a sample (or subset of a population) and randomly assigning subjects to one of two groups: the experimental group or the control group. The experimental group is the group that is going to be exposed to an independent variable or condition the researcher is introducing as a potential cause of an event. The control group is going to be used for comparison and is going to have the same experience as the experimental group but will not be exposed to the independent variable. After exposing the experimental group to the independent variable, the two groups are measured again to see if a change has occurred. If so, we are in a better position to suggest that the independent variable caused the change in the dependent variable.

The major advantage of the experimental design is that of helping to establish cause and effect relationships. A disadvantage of this design is the difficulty of translating much of what happens in a laboratory setting into real life.

Case Studies

Case studies involve exploring a single case or situation in great detail. Information may be gathered with the use of observation, interviews, testing, or other methods to uncover as much as possible about a person or situation. Case studies are helpful when investigating unusual situations such as brain trauma or children reared in isolation. And they are often used by clinicians who conduct case studies as part of their normal practice when gathering information about a client or patient coming in for treatment. Case studies can be used to explore areas about which little is known and can provide rich detail about situations or conditions. However, the findings from case studies cannot be generalized or applied to larger populations; this is because cases are not randomly selected and no control group is used for comparison.

Figure 1.7 – Illustrated poster from a classroom describing a case study. 12

Surveys are familiar to most people because they are so widely used. Surveys enhance accessibility to subjects because they can be conducted in person, over the phone, through the mail, or online. A survey involves asking a standard set of questions to a group of subjects. In a highly structured survey, subjects are forced to choose from a response set such as “strongly disagree, disagree, undecided, agree, strongly agree”; or “0, 1-5, 6-10, etc.” This is known as Likert Scale . Surveys are commonly used by sociologists, marketing researchers, political scientists, therapists, and others to gather information on many independent and dependent variables in a relatively short period of time. Surveys typically yield surface information on a wide variety of factors, but may not allow for in-depth understanding of human behavior.

Of course, surveys can be designed in a number of ways. They may include forced choice questions and semi-structured questions in which the researcher allows the respondent to describe or give details about certain events. One of the most difficult aspects of designing a good survey is wording questions in an unbiased way and asking the right questions so that respondents can give a clear response rather than choosing “undecided” each time. Knowing that 30% of respondents are undecided is of little use! So a lot of time and effort should be placed on the construction of survey items. One of the benefits of having forced choice items is that each response is coded so that the results can be quickly entered and analyzed using statistical software. Analysis takes much longer when respondents give lengthy responses that must be analyzed in a different way. Surveys are useful in examining stated values, attitudes, opinions, and reporting on practices. However, they are based on self-report or what people say they do rather than on observation and this can limit accuracy.

Developmental Designs

Developmental designs are techniques used in developmental research (and other areas as well). These techniques try to examine how age, cohort, gender, and social class impact development.

Longitudinal Research

Longitudinal research involves beginning with a group of people who may be of the same age and background, and measuring them repeatedly over a long period of time. One of the benefits of this type of research is that people can be followed through time and be compared with them when they were younger.

Figure 1.8 – A longitudinal research design. 13

A problem with this type of research is that it is very expensive and subjects may drop out over time. The Perry Preschool Project which began in 1962 is an example of a longitudinal study that continues to provide data on children’s development.

Cross-sectional Research

Cross-sectional research involves beginning with a sample that represents a cross-section of the population. Respondents who vary in age, gender, ethnicity, and social class might be asked to complete a survey about television program preferences or attitudes toward the use of the Internet. The attitudes of males and females could then be compared, as could attitudes based on age. In cross-sectional research, respondents are measured only once.

Figure 1.9 – A cross-sectional research design. 14

This method is much less expensive than longitudinal research but does not allow the researcher to distinguish between the impact of age and the cohort effect. Different attitudes about the use of technology, for example, might not be altered by a person’s biological age as much as their life experiences as members of a cohort.

Sequential Research

Sequential research involves combining aspects of the previous two techniques; beginning with a cross-sectional sample and measuring them through time.

Figure 1.10 – A sequential research design. 15

This is the perfect model for looking at age, gender, social class, and ethnicity. But the drawbacks of high costs and attrition are here as well. 16

Table 1 .1 – Advantages and Disadvantages of Different Research Designs 17

Consent and Ethics in Research

Research should, as much as possible, be based on participants’ freely volunteered informed consent. For minors, this also requires consent from their legal guardians. This implies a responsibility to explain fully and meaningfully to both the child and their guardians what the research is about and how it will be disseminated. Participants and their legal guardians should be aware of the research purpose and procedures, their right to refuse to participate; the extent to which confidentiality will be maintained; the potential uses to which the data might be put; the foreseeable risks and expected benefits; and that participants have the right to discontinue at any time.

But consent alone does not absolve the responsibility of researchers to anticipate and guard against potential harmful consequences for participants. 18 It is critical that researchers protect all rights of the participants including confidentiality.

Child development is a fascinating field of study – but care must be taken to ensure that researchers use appropriate methods to examine infant and child behavior, use the correct experimental design to answer their questions, and be aware of the special challenges that are part-and-parcel of developmental research. Hopefully, this information helped you develop an understanding of these various issues and to be ready to think more critically about research questions that interest you. There are so many interesting questions that remain to be examined by future generations of developmental scientists – maybe you will make one of the next big discoveries! 19

Another really important framework to use when trying to understand children’s development are theories of development. Let’s explore what theories are and introduce you to some major theories in child development.

Developmental Theories

What is a theory.

Students sometimes feel intimidated by theory; even the phrase, “Now we are going to look at some theories…” is met with blank stares and other indications that the audience is now lost. But theories are valuable tools for understanding human behavior; in fact they are proposed explanations for the “how” and “whys” of development. Have you ever wondered, “Why is my 3 year old so inquisitive?” or “Why are some fifth graders rejected by their classmates?” Theories can help explain these and other occurrences. Developmental theories offer explanations about how we develop, why we change over time and the kinds of influences that impact development.

A theory guides and helps us interpret research findings as well. It provides the researcher with a blueprint or model to be used to help piece together various studies. Think of theories as guidelines much like directions that come with an appliance or other object that requires assembly. The instructions can help one piece together smaller parts more easily than if trial and error are used.

Theories can be developed using induction in which a number of single cases are observed and after patterns or similarities are noted, the theorist develops ideas based on these examples. Established theories are then tested through research; however, not all theories are equally suited to scientific investigation.  Some theories are difficult to test but are still useful in stimulating debate or providing concepts that have practical application. Keep in mind that theories are not facts; they are guidelines for investigation and practice, and they gain credibility through research that fails to disprove them. 20

Let’s take a look at some key theories in Child Development.

Sigmund Freud’s Psychosexual Theory

We begin with the often controversial figure, Sigmund Freud (1856-1939). Freud has been a very influential figure in the area of development; his view of development and psychopathology dominated the field of psychiatry until the growth of behaviorism in the 1950s. His assumptions that personality forms during the first few years of life and that the ways in which parents or other caregivers interact with children have a long-lasting impact on children’s emotional states have guided parents, educators, clinicians, and policy-makers for many years. We have only recently begun to recognize that early childhood experiences do not always result in certain personality traits or emotional states. There is a growing body of literature addressing resilience in children who come from harsh backgrounds and yet develop without damaging emotional scars (O’Grady and Metz, 1987). Freud has stimulated an enormous amount of research and generated many ideas. Agreeing with Freud’s theory in its entirety is hardly necessary for appreciating the contribution he has made to the field of development.

Figure 1.11 – Sigmund Freud. 21

Freud’s theory of self suggests that there are three parts of the self.

The id is the part of the self that is inborn. It responds to biological urges without pause and is guided by the principle of pleasure: if it feels good, it is the thing to do. A newborn is all id. The newborn cries when hungry, defecates when the urge strikes.

The ego develops through interaction with others and is guided by logic or the reality principle. It has the ability to delay gratification. It knows that urges have to be managed. It mediates between the id and superego using logic and reality to calm the other parts of the self.

The superego represents society’s demands for its members. It is guided by a sense of guilt. Values, morals, and the conscience are all part of the superego.

The personality is thought to develop in response to the child’s ability to learn to manage biological urges. Parenting is important here. If the parent is either overly punitive or lax, the child may not progress to the next stage. Here is a brief introduction to Freud’s stages.

Table 1. 2 – Sigmund Freud’s Psychosexual Theory

Strengths and Weaknesses of Freud’s Theory

Freud’s theory has been heavily criticized for several reasons. One is that it is very difficult to test scientifically. How can parenting in infancy be traced to personality in adulthood? Are there other variables that might better explain development? The theory is also considered to be sexist in suggesting that women who do not accept an inferior position in society are somehow psychologically flawed. Freud focuses on the darker side of human nature and suggests that much of what determines our actions is unknown to us. So why do we study Freud? As mentioned above, despite the criticisms, Freud’s assumptions about the importance of early childhood experiences in shaping our psychological selves have found their way into child development, education, and parenting practices. Freud’s theory has heuristic value in providing a framework from which to elaborate and modify subsequent theories of development. Many later theories, particularly behaviorism and humanism, were challenges to Freud’s views. 22

Erik Erikson’s Psychosocial Theory

Now, let’s turn to a less controversial theorist, Erik Erikson. Erikson (1902-1994) suggested that our relationships and society’s expectations motivate much of our behavior in his theory of psychosocial development. Erikson was a student of Freud’s but emphasized the importance of the ego, or conscious thought, in determining our actions. In other words, he believed that we are not driven by unconscious urges. We know what motivates us and we consciously think about how to achieve our goals. He is considered the father of developmental psychology because his model gives us a guideline for the entire life span and suggests certain primary psychological and social concerns throughout life.

Figure 1.12 – Erik Erikson. 23

Erikson expanded on his Freud’s by emphasizing the importance of culture in parenting practices and motivations and adding three stages of adult development (Erikson, 1950; 1968). He believed that we are aware of what motivates us throughout life and the ego has greater importance in guiding our actions than does the id. We make conscious choices in life and these choices focus on meeting certain social and cultural needs rather than purely biological ones. Humans are motivated, for instance, by the need to feel that the world is a trustworthy place, that we are capable individuals, that we can make a contribution to society, and that we have lived a meaningful life. These are all psychosocial problems.

Erikson divided the lifespan into eight stages. In each stage, we have a major psychosocial task to accomplish or crisis to overcome.  Erikson believed that our personality continues to take shape throughout our lifespan as we face these challenges in living. Here is a brief overview of the eight stages:

Table 1. 3 – Erik Erikson’s Psychosocial Theory

These eight stages form a foundation for discussions on emotional and social development during the life span. Keep in mind, however, that these stages or crises can occur more than once. For instance, a person may struggle with a lack of trust beyond infancy under certain circumstances. Erikson’s theory has been criticized for focusing so heavily on stages and assuming that the completion of one stage is prerequisite for the next crisis of development. His theory also focuses on the social expectations that are found in certain cultures, but not in all. For instance, the idea that adolescence is a time of searching for identity might translate well in the middle-class culture of the United States, but not as well in cultures where the transition into adulthood coincides with puberty through rites of passage and where adult roles offer fewer choices. 24

Behaviorism

While Freud and Erikson looked at what was going on in the mind, behaviorism rejected any reference to mind and viewed overt and observable behavior as the proper subject matter of psychology. Through the scientific study of behavior, it was hoped that laws of learning could be derived that would promote the prediction and control of behavior. 25

Ivan Pavlov

Ivan Pavlov (1880-1937) was a Russian physiologist interested in studying digestion. As he recorded the amount of salivation his laboratory dogs produced as they ate, he noticed that they actually began to salivate before the food arrived as the researcher walked down the hall and toward the cage. “This,” he thought, “is not natural!” One would expect a dog to automatically salivate when food hit their palate, but BEFORE the food comes? Of course, what had happened was . . . you tell me. That’s right! The dogs knew that the food was coming because they had learned to associate the footsteps with the food. The key word here is “learned”. A learned response is called a “conditioned” response.

Figure 1.13 – Ivan Pavlov. 26

Pavlov began to experiment with this concept of classical conditioning . He began to ring a bell, for instance, prior to introducing the food. Sure enough, after making this connection several times, the dogs could be made to salivate to the sound of a bell. Once the bell had become an event to which the dogs had learned to salivate, it was called a conditioned stimulus . The act of salivating to a bell was a response that had also been learned, now termed in Pavlov’s jargon, a conditioned response. Notice that the response, salivation, is the same whether it is conditioned or unconditioned (unlearned or natural). What changed is the stimulus to which the dog salivates. One is natural (unconditioned) and one is learned (conditioned).

Let’s think about how classical conditioning is used on us. One of the most widespread applications of classical conditioning principles was brought to us by the psychologist, John B. Watson.

John B. Watson

John B. Watson (1878-1958) believed that most of our fears and other emotional responses are classically conditioned. He had gained a good deal of popularity in the 1920s with his expert advice on parenting offered to the public.

Figure 1.14 – John B. Watson. 27

He tried to demonstrate the power of classical conditioning with his famous experiment with an 18 month old boy named “Little Albert”. Watson sat Albert down and introduced a variety of seemingly scary objects to him: a burning piece of newspaper, a white rat, etc. But Albert remained curious and reached for all of these things. Watson knew that one of our only inborn fears is the fear of loud noises so he proceeded to make a loud noise each time he introduced one of Albert’s favorites, a white rat. After hearing the loud noise several times paired with the rat, Albert soon came to fear the rat and began to cry when it was introduced. Watson filmed this experiment for posterity and used it to demonstrate that he could help parents achieve any outcomes they desired, if they would only follow his advice. Watson wrote columns in newspapers and in magazines and gained a lot of popularity among parents eager to apply science to household order.

Operant conditioning, on the other hand, looks at the way the consequences of a behavior increase or decrease the likelihood of a behavior occurring again. So let’s look at this a bit more.

B.F. Skinner and Operant Conditioning

B. F. Skinner (1904-1990), who brought us the principles of operant conditioning, suggested that reinforcement is a more effective means of encouraging a behavior than is criticism or punishment. By focusing on strengthening desirable behavior, we have a greater impact than if we emphasize what is undesirable. Reinforcement is anything that an organism desires and is motivated to obtain.

Figure 1.15 – B. F. Skinner. 28

A reinforcer is something that encourages or promotes a behavior. Some things are natural rewards. They are considered intrinsic or primary because their value is easily understood. Think of what kinds of things babies or animals such as puppies find rewarding.

Extrinsic or secondary reinforcers are things that have a value not immediately understood. Their value is indirect. They can be traded in for what is ultimately desired.

The use of positive reinforcement involves adding something to a situation in order to encourage a behavior. For example, if I give a child a cookie for cleaning a room, the addition of the cookie makes cleaning more likely in the future. Think of ways in which you positively reinforce others.

Negative reinforcement occurs when taking something unpleasant away from a situation encourages behavior. For example, I have an alarm clock that makes a very unpleasant, loud sound when it goes off in the morning. As a result, I get up and turn it off. By removing the noise, I am reinforced for getting up. How do you negatively reinforce others?

Punishment is an effort to stop a behavior. It means to follow an action with something unpleasant or painful. Punishment is often less effective than reinforcement for several reasons. It doesn’t indicate the desired behavior, it may result in suppressing rather than stopping a behavior, (in other words, the person may not do what is being punished when you’re around, but may do it often when you leave), and a focus on punishment can result in not noticing when the person does well.

Not all behaviors are learned through association or reinforcement. Many of the things we do are learned by watching others. This is addressed in social learning theory.

Social Learning Theory

Albert Bandura (1925-) is a leading contributor to social learning theory. He calls our attention to the ways in which many of our actions are not learned through conditioning; rather, they are learned by watching others (1977). Young children frequently learn behaviors through imitation

Figure 1.16 – Albert Bandura. 29

Sometimes, particularly when we do not know what else to do, we learn by modeling or copying the behavior of others. A kindergartner on his or her first day of school might eagerly look at how others are acting and try to act the same way to fit in more quickly. Adolescents struggling with their identity rely heavily on their peers to act as role-models. Sometimes we do things because we’ve seen it pay off for someone else. They were operantly conditioned, but we engage in the behavior because we hope it will pay off for us as well. This is referred to as vicarious reinforcement (Bandura, Ross and Ross, 1963).

Bandura (1986) suggests that there is interplay between the environment and the individual. We are not just the product of our surroundings, rather we influence our surroundings. Parents not only influence their child’s environment, perhaps intentionally through the use of reinforcement, etc., but children influence parents as well. Parents may respond differently with their first child than with their fourth. Perhaps they try to be the perfect parents with their firstborn, but by the time their last child comes along they have very different expectations both of themselves and their child. Our environment creates us and we create our environment. 30

Theories also explore cognitive development and how mental processes change over time.

Jean Piaget’s Theory of Cognitive Development

Jean Piaget (1896-1980) is one of the most influential cognitive theorists. Piaget was inspired to explore children’s ability to think and reason by watching his own children’s development. He was one of the first to recognize and map out the ways in which children’s thought differs from that of adults. His interest in this area began when he was asked to test the IQ of children and began to notice that there was a pattern in their wrong answers. He believed that children’s intellectual skills change over time through maturation. Children of differing ages interpret the world differently.

Figure 1.17 – Jean Piaget. 32

Piaget believed our desire to understand the world comes from a need for cognitive equilibrium . This is an agreement or balance between what we sense in the outside world and what we know in our minds. If we experience something that we cannot understand, we try to restore the balance by either changing our thoughts or by altering the experience to fit into what we do understand. Perhaps you meet someone who is very different from anyone you know. How do you make sense of this person? You might use them to establish a new category of people in your mind or you might think about how they are similar to someone else.

A schema or schemes are categories of knowledge. They are like mental boxes of concepts. A child has to learn many concepts. They may have a scheme for “under” and “soft” or “running” and “sour”. All of these are schema. Our efforts to understand the world around us lead us to develop new schema and to modify old ones.

One way to make sense of new experiences is to focus on how they are similar to what we already know. This is assimilation . So the person we meet who is very different may be understood as being “sort of like my brother” or “his voice sounds a lot like yours.” Or a new food may be assimilated when we determine that it tastes like chicken!

Another way to make sense of the world is to change our mind. We can make a cognitive accommodation to this new experience by adding new schema. This food is unlike anything I’ve tasted before. I now have a new category of foods that are bitter-sweet in flavor, for instance. This is  accommodation . Do you accommodate or assimilate more frequently? Children accommodate more frequently as they build new schema. Adults tend to look for similarity in their experience and assimilate. They may be less inclined to think “outside the box.”

Piaget suggested different ways of understanding that are associated with maturation. He divided this into four stages:

Table 1.4 – Jean Piaget’s Theory of Cognitive Development

Criticisms of Piaget’s Theory

Piaget has been criticized for overemphasizing the role that physical maturation plays in cognitive development and in underestimating the role that culture and interaction (or experience) plays in cognitive development. Looking across cultures reveals considerable variation in what children are able to do at various ages. Piaget may have underestimated what children are capable of given the right circumstances. 33

Lev Vygotsky’s Sociocultural Theory

Lev Vygotsky (1896-1934) was a Russian psychologist who wrote in the early 1900s but whose work was discovered in the United States in the 1960s but became more widely known in the 1980s. Vygotsky differed with Piaget in that he believed that a person not only has a set of abilities, but also a set of potential abilities that can be realized if given the proper guidance from others. His sociocultural theory emphasizes the importance of culture and interaction in the development of cognitive abilities. He believed that through guided participation known as scaffolding, with a teacher or capable peer, a child can learn cognitive skills within a certain range known as the zone of proximal development . 34 His belief was that development occurred first through children’s immediate social interactions, and then moved to the individual level as they began to internalize their learning. 35

Figure 1.18- Lev Vygotsky. 36

Have you ever taught a child to perform a task? Maybe it was brushing their teeth or preparing food. Chances are you spoke to them and described what you were doing while you demonstrated the skill and let them work along with you all through the process. You gave them assistance when they seemed to need it, but once they knew what to do-you stood back and let them go. This is scaffolding and can be seen demonstrated throughout the world. This approach to teaching has also been adopted by educators. Rather than assessing students on what they are doing, they should be understood in terms of what they are capable of doing with the proper guidance. You can see how Vygotsky would be very popular with modern day educators. 37

Comparing Piaget and Vygotsky

Vygotsky concentrated more on the child’s immediate social and cultural environment and his or her interactions with adults and peers. While Piaget saw the child as actively discovering the world through individual interactions with it, Vygotsky saw the child as more of an apprentice, learning through a social environment of others who had more experience and were sensitive to the child’s needs and abilities. 38

Like Vygotsky’s, Bronfenbrenner looked at the social influences on learning and development.

Urie Bronfenbrenner’s Ecological Systems Model

Urie Bronfenbrenner (1917-2005) offers us one of the most comprehensive theories of human development. Bronfenbrenner studied Freud, Erikson, Piaget, and learning theorists and believed that all of those theories could be enhanced by adding the dimension of context. What is being taught and how society interprets situations depends on who is involved in the life of a child and on when and where a child lives.

Figure 1.19 – Urie Bronfenbrenner. 39

Bronfenbrenner’s ecological systems model explains the direct and indirect influences on an individual’s development.

Table 1.5 – Urie Bronfenbrenner’s Ecological Systems Model

For example, in order to understand a student in math, we can’t simply look at that individual and what challenges they face directly with the subject. We have to look at the interactions that occur between teacher and child. Perhaps the teacher needs to make modifications as well. The teacher may be responding to regulations made by the school, such as new expectations for students in math or constraints on time that interfere with the teacher’s ability to instruct. These new demands may be a response to national efforts to promote math and science deemed important by political leaders in response to relations with other countries at a particular time in history.

Figure 1.20 – Bronfenbrenner’s ecological systems theory. 40

Bronfenbrenner’s ecological systems model challenges us to go beyond the individual if we want to understand human development and promote improvements. 41

In this chapter we looked at:

underlying principles of development

the five periods of development

three issues in development

Various methods of research

important theories that help us understand development

Next, we are going to be examining where we all started with conception, heredity, and prenatal development.

Child Growth and Development Copyright © by Jean Zaar is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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• Case report
• Open access
• Published: 11 September 2017

A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy

• Magdalena Romanowicz   ORCID: orcid.org/0000-0002-4916-0625 1 ,
• Alastair J. McKean 1 &
• Jennifer Vande Voort 1  

BMC Psychiatry volume  17 , Article number:  330 ( 2017 ) Cite this article

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Long-term effects of neglect in early life are still widely unknown. Diversity of outcomes can be explained by differences in genetic risk, epigenetics, prenatal factors, exposure to stress and/or substances, and parent-child interactions. Very common sub-threshold presentations of children with history of early trauma are challenging not only to diagnose but also in treatment.

Case presentation

A Caucasian 4-year-old, adopted at 8 months, male patient with early history of neglect presented to pediatrician with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. He was subsequently seen by two different child psychiatrists. Pharmacotherapy treatment attempted included guanfacine, fluoxetine and amphetamine salts as well as quetiapine, aripiprazole and thioridazine without much improvement. Risperidone initiated by primary care seemed to help with his symptoms of dyscontrol initially but later the dose had to be escalated to 6 mg total for the same result. After an episode of significant aggression, the patient was admitted to inpatient child psychiatric unit for stabilization and taper of the medicine.

Conclusions

The case illustrates difficulties in management of children with early history of neglect. A particular danger in this patient population is polypharmacy, which is often used to manage transdiagnostic symptoms that significantly impacts functioning with long term consequences.

Peer Review reports

There is a paucity of studies that address long-term effects of deprivation, trauma and neglect in early life, with what little data is available coming from institutionalized children [ 1 ]. Rutter [ 2 ], who studied formerly-institutionalized Romanian children adopted into UK families, found that this group exhibited prominent attachment disturbances, attention-deficit/hyperactivity disorder (ADHD), quasi-autistic features and cognitive delays. Interestingly, no other increases in psychopathology were noted [ 2 ].

Even more challenging to properly diagnose and treat are so called sub-threshold presentations of children with histories of early trauma [ 3 ]. Pincus, McQueen, & Elinson [ 4 ] described a group of children who presented with a combination of co-morbid symptoms of various diagnoses such as conduct disorder, ADHD, post-traumatic stress disorder (PTSD), depression and anxiety. As per Shankman et al. [ 5 ], these patients may escalate to fulfill the criteria for these disorders. The lack of proper diagnosis imposes significant challenges in terms of management [ 3 ].

J is a 4-year-old adopted Caucasian male who at the age of 2 years and 4 months was brought by his adoptive mother to primary care with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. J was given diagnoses of reactive attachment disorder (RAD) and ADHD. No medications were recommended at that time and a referral was made for behavioral therapy.

She subsequently took him to two different child psychiatrists who diagnosed disruptive mood dysregulation disorder (DMDD), PTSD, anxiety and a mood disorder. To help with mood and inattention symptoms, guanfacine, fluoxetine, methylphenidate and amphetamine salts were all prescribed without significant improvement. Later quetiapine, aripiprazole and thioridazine were tried consecutively without behavioral improvement (please see Table  1 for details).

No significant drug/substance interactions were noted (Table 1 ). There were no concerns regarding adherence and serum drug concentrations were not ordered. On review of patient’s history of medication trials guanfacine and methylphenidate seemed to have no effect on J’s hyperactive and impulsive behavior as well as his lack of focus. Amphetamine salts that were initiated during hospitalization were stopped by the patient’s mother due to significant increase in aggressive behaviors and irritability. Aripiprazole was tried for a brief period of time and seemed to have no effect. Quetiapine was initially helpful at 150 mg (50 mg three times a day), unfortunately its effects wore off quickly and increase in dose to 300 mg (100 mg three times a day) did not seem to make a difference. Fluoxetine that was tried for anxiety did not seem to improve the behaviors and was stopped after less than a month on mother’s request.

J’s condition continued to deteriorate and his primary care provider started risperidone. While initially helpful, escalating doses were required until he was on 6 mg daily. In spite of this treatment, J attempted to stab a girl at preschool with scissors necessitating emergent evaluation, whereupon he was admitted to inpatient care for safety and observation. Risperidone was discontinued and J was referred to outpatient psychiatry for continuing medical monitoring and therapy.

Little is known about J’s early history. There is suspicion that his mother was neglectful with feeding and frequently left him crying, unattended or with strangers. He was taken away from his mother’s care at 7 months due to neglect and placed with his aunt. After 1 month, his aunt declined to collect him from daycare, deciding she was unable to manage him. The owner of the daycare called Child Services and offered to care for J, eventually becoming his present adoptive parent.

J was a very needy baby who would wake screaming and was hard to console. More recently he wakes in the mornings anxious and agitated. He is often indiscriminate and inappropriate interpersonally, unable to play with other children. When in significant distress he regresses, and behaves as a cat, meowing and scratching the floor. Though J bonded with his adoptive mother well and was able to express affection towards her, his affection is frequently indiscriminate and he rarely shows any signs of separation anxiety.

At the age of 2 years and 8 months there was a suspicion for speech delay and J was evaluated by a speech pathologist who concluded that J was exhibiting speech and language skills that were solidly in the average range for age, with developmental speech errors that should be monitored over time. They did not think that issues with communication contributed significantly to his behavioral difficulties. Assessment of intellectual functioning was performed at the age of 2 years and 5 months by a special education teacher. Based on Bailey Infant and Toddler Development Scale, fine and gross motor, cognitive and social communication were all within normal range.

J’s adoptive mother and in-home therapist expressed significant concerns in regards to his appetite. She reports that J’s biological father would come and visit him infrequently, but always with food and sweets. J often eats to the point of throwing up and there have been occasions where he has eaten his own vomit and dog feces. Mother noticed there is an association between his mood and eating behaviors. J’s episodes of insatiable and indiscriminate hunger frequently co-occur with increased energy, diminished need for sleep, and increased speech. This typically lasts a few days to a week and is followed by a period of reduced appetite, low energy, hypersomnia, tearfulness, sadness, rocking behavior and slurred speech. Those episodes last for one to 3 days. Additionally, there are times when his symptomatology seems to be more manageable with fewer outbursts and less difficulty regarding food behaviors.

J’s family history is poorly understood, with his biological mother having a personality disorder and ADHD, and a biological father with substance abuse. Both maternally and paternally there is concern for bipolar disorder.

J has a clear history of disrupted attachment. He is somewhat indiscriminate in his relationship to strangers and struggles with impulsivity, aggression, sleep and feeding issues. In addition to early life neglect and possible trauma, J has a strong family history of psychiatric illness. His mood, anxiety and sleep issues might suggest underlying PTSD. His prominent hyperactivity could be due to trauma or related to ADHD. With his history of neglect, indiscrimination towards strangers, mood liability, attention difficulties, and heightened emotional state, the possibility of Disinhibited Social Engagement Disorder (DSED) is likely. J’s prominent mood lability, irritability and family history of bipolar disorder, are concerning for what future mood diagnosis this portends.

As evidenced above, J presents as a diagnostic conundrum suffering from a combination of transdiagnostic symptoms that broadly impact his functioning. Unfortunately, although various diagnoses such as ADHD, PTSD, Depression, DMDD or DSED may be entertained, the patient does not fall neatly into any of the categories.

This is a case report that describes a diagnostic conundrum in a young boy with prominent early life deprivation who presented with multidimensional symptoms managed with polypharmacy.

A sub-threshold presentation in this patient partially explains difficulties with diagnosis. There is no doubt that negative effects of early childhood deprivation had significant impact on developmental outcomes in this patient, but the mechanisms that could explain the associations are still widely unknown. Significant family history of mental illness also predisposes him to early challenges. The clinical picture is further complicated by the potential dynamic factors that could explain some of the patient’s behaviors. Careful examination of J’s early life history would suggest such a pattern of being able to engage with his biological caregivers, being given food, being tended to; followed by periods of neglect where he would withdraw, regress and engage in rocking as a self-soothing behavior. His adoptive mother observed that visitations with his biological father were accompanied by being given a lot of food. It is also possible that when he was under the care of his biological mother, he was either attended to with access to food or neglected, left hungry and screaming for hours.

The current healthcare model, being centered on obtaining accurate diagnosis, poses difficulties for treatment in these patients. Given the complicated transdiagnostic symptomatology, clear guidelines surrounding treatment are unavailable. To date, there have been no psychopharmacological intervention trials for attachment issues. In patients with disordered attachment, pharmacologic treatment is typically focused on co-morbid disorders, even with sub-threshold presentations, with the goal of symptom reduction [ 6 ]. A study by dosReis [ 7 ] found that psychotropic usage in community foster care patients ranged from 14% to 30%, going to 67% in therapeutic foster care and as high as 77% in group homes. Another study by Breland-Noble [ 8 ] showed that many children receive more than one psychotropic medication, with 22% using two medications from the same class.

It is important to note that our patient received four different neuroleptic medications (quetiapine, aripiprazole, risperidone and thioridazine) for disruptive behaviors and impulsivity at a very young age. Olfson et al. [ 9 ] noted that between 1999 and 2007 there has been a significant increase in the use of neuroleptics for very young children who present with difficult behaviors. A preliminary study by Ercan et al. [ 10 ] showed promising results with the use of risperidone in preschool children with behavioral dyscontrol. Review by Memarzia et al. [ 11 ] suggested that risperidone decreased behavioral problems and improved cognitive-motor functions in preschoolers. The study also raised concerns in regards to side effects from neuroleptic medications in such a vulnerable patient population. Younger children seemed to be much more susceptible to side effects in comparison to older children and adults with weight gain being the most common. Weight gain associated with risperidone was most pronounced in pre-adolescents (Safer) [ 12 ]. Quetiapine and aripiprazole were also associated with higher rates of weight gain (Correll et al.) [ 13 ].

Pharmacokinetics of medications is difficult to assess in very young children with ongoing development of the liver and the kidneys. It has been observed that psychotropic medications in children have shorter half-lives (Kearns et al.) [ 14 ], which would require use of higher doses for body weight in comparison to adults for same plasma level. Unfortunately, that in turn significantly increases the likelihood and severity of potential side effects.

There is also a question on effects of early exposure to antipsychotics on neurodevelopment. In particular in the first 3 years of life there are many changes in developing brains, such as increase in synaptic density, pruning and increase in neuronal myelination to list just a few [ 11 ]. Unfortunately at this point in time there is a significant paucity of data that would allow drawing any conclusions.

Our case report presents a preschool patient with history of adoption, early life abuse and neglect who exhibited significant behavioral challenges and was treated with various psychotropic medications with limited results. It is important to emphasize that subthreshold presentation and poor diagnostic clarity leads to dangerous and excessive medication regimens that, as evidenced above is fairly common in this patient population.

Neglect and/or abuse experienced early in life is a risk factor for mental health problems even after adoption. Differences in genetic risk, epigenetics, prenatal factors (e.g., malnutrition or poor nutrition), exposure to stress and/or substances, and parent-child interactions may explain the diversity of outcomes among these individuals, both in terms of mood and behavioral patterns [ 15 , 16 , 17 ]. Considering that these children often present with significant functional impairment and a wide variety of symptoms, further studies are needed regarding diagnosis and treatment.

Abbreviations

Attention-Deficit/Hyperactivity Disorder

Disruptive Mood Dysregulation Disorder

Disinhibited Social Engagement Disorder

Post-Traumatic Stress Disorder

Reactive Attachment disorder

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Romanowicz, M., McKean, A.J. & Vande Voort, J. A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy. BMC Psychiatry 17 , 330 (2017). https://doi.org/10.1186/s12888-017-1492-y

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Introduction

In this family and child developmental case study, I have chosen a family close to my residence. As required by the syllabus, I have been able to stay with the family and enquire deeply into Jessica’s development. Prior to the stay, I had read a few articles and books on developmental milestones. Mary Sheridan’s book “From birth to five years” and an article on the Child Development Programme by the Centre for Child and Adolescent Services Research Centre provided me all the necessary information to make suitable inquiries with the family. I was already armed with a set of questions to be asked when I reached for the stay.

The Family structure

Jessica Ray is an infant of one year and nine months of age. She has an elder brother, Ryan, of age four years and six months. They have their mother Cathy and father, Peter, with them at home. The maternal grandparents, John and Louise are also living with them. They are a close-knit extended family with plenty of bonding with each other and the children. Peter and Cathy have full-time jobs. Peter is aged 31 and is a software engineer in the Wachovia Bank. Cathy is 30 and a staff nurse in the Hayes Hospital in town.

Ryan, the elder child, is 3 years and 6 months of age. He is attending a day-care center close to his house. Louise takes him to and from it. Jessica is just 1 year and nine months.

The older Rays are essentially farmers who had moderate holdings. Now the two brothers work there. The McKennas are also middle-class and held Government jobs. Both have accepted voluntary retirement and are living with Peter and Cathy to help them.

Louise has Non-Insulin-dependent diabetes mellitus which is well controlled and she enjoys fairly good health as she conforms strictly to her diet and exercises apart from her medicines. John is absolutely healthy, jovial, and keeps the atmosphere bonhomie. The grandchildren are really fond of him.

Both John and Louise understand that their grandchildren need their attention and guidance badly as Cathy and Peter are busy. Louise is the carer and child rearer. John is a disciplinarian and maintenance person. He makes sure that groceries and baby food are always sufficient. Peter is the decision-maker and plays the role of the primary breadwinner. Cathy is the person who looks after the health of the children and family members. She always is on the dot where her children’s immunizations are due. Both Cathy and Peter are ardent workers and responsible parents.

Relationship with family members

William and Marie, the paternal grandparents, live just around the corner and visit this family frequently. The grandchildren are lucky to have two sets of doting grandparents. Cathy’s sister Anne’s family lives twenty miles from them. Her two girls are extremely fond of the children here and insist on seeing them almost every weekend if they had their way. Peter’s unmarried brothers live together in the countryside where they have a fruit orchard. Their visits are few and far between but they are there when an occasion arises.

Relationship with others

The family is religious and attends Church on Sundays no matter what happens. They have good relationships with the neighbors and there is a community hall where they meet for various purposes, charitable and otherwise. Elaine and her child come over once in a while. Louise, Cathy, and Jessica return these visits. Father Richard visits them occasionally. Religion may not be the only matter discussed on these visits.

The parents and grandparents (McKennas) have interactions at the mother-baby clinic where the children are taken for immunizations and the ‘Littlebabes’ day-care center which Ryan goes to.

Cathy’s pregnancy with Jessica

Cathy had an uneventful pregnancy. She availed of the regular antenatal services provided by the hospital where she works. Antenatal care in Australia is frequently reviewed and the evidence-based approach to develop guidelines has been promoted (Hunt and Lumley, 2002). Cathy made visits every four weeks till she reached the 28 th week, every two weeks till she reached 36 weeks and every week till her delivery at the 42 nd week. This is the regime followed in her hospital and reflects the standard protocol.

(Hunt and Lumley, 2002). The World Health Organisation after a systematic review has pointed out that reduced schedules of visits are ‘not associated with worse outcomes for mothers or babies’ (Carroli, 2001)

She was checked for gestational diabetes at her first visit, at 24 weeks, 26 weeks, and at 28 weeks. Gestational diabetes usually presents between the 26 th and 28 th weeks of gestation (Hunt and Lumley, 2002). Cathy had the glucose challenge and tolerance tests, the HbA 1c , and the random blood sugar tests. She was normal for all.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) however does not recommend routine screening for diabetes (Hunt and Lumley, 2002). Screening for and managing gestational diabetes has not been demonstrated to have improved the outcomes of mothers and babies (Walkinshaw, 2001; Wen et al, 2000). Also, labeling them as high risk and managing them with diet, exercise and insulin may have adverse effects (Enkin, 2000; Wen et al, 2000 😉

Screening for syphilis and HIV was done routinely at her first visit. Her hospital does routine HIV screening for antenatal whereas many in Australia do not (Hunt and Lumley, 2002). RANZCOG has included syphilis screening as routine but recommends HIV screening after appropriate counseling.

Cathy was earlier found to be positive for Hepatitis B surface antigen. However, she tested negative for the Hepatitis C test done at her first visit. The risk of transmission vertically is 6% if a woman is HCV RNA positive. There are no interventions to prevent or reduce the mother-to-baby transmission (Hunt and Lumley, 2002).

The inquiry was made about smoking but Cathy did not smoke. Many hospitals advise quitting smoking however only very few actually give written advice (Hunt and Lumley, 2002). No national guidelines are provided for smoking.

Cathy was strict about her diet and kept close to it with Louise’s help. She had a well-balanced and healthy diet with complex carbohydrates and protein. In the first trimester, she reduced the nausea of morning sickness by frequent small meals rich in B group vitamins and low in spice and fat (Morning Sickness, Baby Center). Her mother Louise advised her to sniff a cut lemon when feeling nauseous (Morning Sickness, Baby Center)

She took 400 micrograms of folic acid from before her pregnancy all through the first trimester in order to ensure that her child does not get any neural defects or spina bifida. (10 steps to a healthy pregnancy, Babycentre). Cathy had calcium supplements too. Louise made sure that Cathy would have fish frequently in her meals but ensured that it would be of the smaller variety and preferably canned (so that it contains lesser mercury). Fish helps the birth weight of the child to be normal and also helps in the development of the baby’s brain and nerves in the 3 rd trimester (10 steps to a healthy pregnancy, Babycentre).

Cathy avoided iron supplements as she was not anemic. Her exercise program included mild exercise and pelvic floor exercises to help her carry the baby and to handle distress in labor (10 steps to a healthy pregnancy, Babycentre). Cathy gained about 12 kgs during her pregnancy (10 steps to healthy pregnancy, Babycentre). She went through labor fairly fast and had a normal delivery.

Jessica as a newborn

Jessica was born in normal labor after 42 weeks of gestation and she was assessed as AGA (10-90 th percentile). She weighed 4.0 kgs and her APGAR score was 8 at one minute and nine at 5minutes. Her length was 52.5cms.and head circumference 37 cms. ‘A lively, kicking child bawling out loudly’ was how her gynaecologist described the newborn Jessica.

From the table above, we may assume that Jessica had a very normal life till now. Her results for the 3 parameters coincide with the normal charts of the three (Revised Growth Charts, 2005). She maintains the 90 th percentile for all three parameters.

Head circumference is thought to correlate with brain volume (Mannerkoski, 2008). Increased head circumference is associated with autism and Asperger. Developmental problems and lower cognitive ability are seen in a child with 2 lesser or more than the normal head circumference. Normal head circumference is related to high IQ more than a height difference (Mannerkoski, 2008).

The length-for-age percentiles Jessica’s changes from birth to 21 months.

The weight for age percentiles Jessica’s changes from birth to 21 months.

The head circumference-for-age percentiles Jessica’s changes from birth to 21 months.

Jessica’s Immunisations

Jessica’s immunisations have all been taken at timely intervals. As Cathy was positive for Hepatitis B surface Antigen, Jessica received her HepB and 0.5 ml.of Hepatitis B immunoglobulin about five hours after her birth (Recommended Immunization Schedules, US). She has had the 3 doses of Rota, the 3 doses of DTaP and its 1 st booster , the 3 doses and 1 st booster of Hib (Hemophilus influenza type B), Inactivated Poliovirus (3 doses), Pneumococcal conjugate vaccine (3 doses), MMR, Varicella vaccine and the Meningococcal vaccine. Her parents have been vigilant in this respect. Her schedule was as follows.

Jessica’s Immunization schedule (National Immunisation Schedule, Immunise Australia Programme).

Her next immunization would be at the age of 4 when she would receive the boosters for DTPa, Inactivated Poliovirus and MMR.

Jessica as she was

Cathy has a record of the developmental milestones of Jessica. Jessica recognized her mother early and thoroughly enjoyed breastfeeding. Cathy did not introduce a pacifier to her. She believed that breast feeding led to effective mother-infant bonding and that human milk is the best nutrition for all infants (Joanna Briggs Institute, 2005). Pacifiers are known to cause Sudden Infant Death Syndrome and studies have associated the two. Gastro-intestinal infection and dental caries are also associated but effective research has still to connect them with the pacifier (Joanna Briggs Institute, 2005). The use of the pacifier is considered a barrier to effective breast feeding. Jessica was lucky in that Cathy breastfed her till she was one.

At six weeks she started smiling at her mummy. By then she held up her head too. Cathy fed her at regular intervals and in between Jessica was a contented baby. Her cooing and other sounds thrilled the elders galore. Louise always used to sing her favourite lullabies for Jessica. The soft music of which John is crazy about also used to evoke some interest in Jessica. She never used to wake up at night after her 10 o’clock feed. She sat with support at 6 months of age (Sheridan, 2007).

By then she was also focusing her eyes. At this time she would search for the toys and stretch out to grasp them, very close to her palm (Sheridan, 2007). This indicated the development of fine movements. The sound of her family approaching her resulted in her chuckling and

sometimes squealing aloud. She used both hands to play. Playing with even unfamiliar and new visitors was not a problem to her (Sheridan, 2007).

Her first tooth appeared at 7 months of age. Louise recalls how Jessica used to put something in her mouth frequently to chew. Her family had to go on watching to see that she did not put anything into her mouth (Sheridan, 2007). Solid foods were introduced at the eighth month. Her behaviour developed a shyness to strangers.

At nine months she was crawling. Toys would be handled with both hands and transferred to and fro. She was also using the pincer grasp for holding the strings which were attached to some toys, an improvement in fine movements (Sheridan, 2007). Sometimes she threw the toys afar and then went crawling to look for them. Slowly she pulled herself to standing position (Sheridan, 2007). She had started dressing and needed help only at times. Granny and Jessica used to play peek-a-boo frequently. Louise remembers that she used to hide her face from strangers (Sheridan, 2007).

She started walking at age 1. In fact she took her first step on her first birthday (Childhood Development, CASRC). The family had come together to celebrate it. She was on all fours and moving towards her mummy when her daddy held out a toy. She held onto her mummy’s chair and rose up. On reaching out for the toy, she inadvertently took a step forward and clutched her toy, simultaneously dropping down to sit. Peter gave a whoop of joy. He had missed capturing that first step on video. Her milestones of development were well within normal limits. This gives her a chance to do well in her education (Mannerkoski, 2008). Her dolls were frequently carried and used to be cast off afar when she got angry.

Jessica as she is now

Jessica is 1 year and nine months now. Her locomotor milestones are within the normal range. She walks fairly well still with a broad base but her legs are closer now than before. Her arms are no longer held extended to balance her walk (Sheridan, 2007). The first 5 years of infant life are packed with extraordinary physical growth and increasing complexity of function. Jessica is no different. She walks and fairly well now at this age (Childhood Development, CASRC).

Both Ryan and Jessica love climbing the stairs and then coming down. Stair climbing is considered a major milestone in the motor development literature (Berger, 2007). Jessica wants help but she still enjoys it (Sheridan, 2007). Louise remembers when she crawled upstairs the first time and gleefully called her from the fourth step (Berger, 2007). Ryan jumps from the third stair now. It is difficult to keep him still. John has attached baby gates at the bottom of the stairs to prevent Jessica and Ryan from climbing without the elders’ supervision (Childhood Development, CASRC). Stair climbing illustrates how multiple factors contribute to the acquisition of milestones (Berger, 2007).

Jessica, I notice, is a contented child but has begun showing independence in selecting the color of the cereal which she wants to consume for a meal which she has sometimes. She usually joins the family at the table for all their 3 meals. Her special penchant for ‘cheeky chikin fly’ is a point of humor for the family. Louise makes a preparation of it so that Jessica can chew it easily and swallow. A bread-spread using butter and yoghurt is another favorite of hers (Childhood Development, CASRC).

Jessica loves her pink toothbrush and so brushing her tiny teeth is a pleasure to her for the time being and she does it in the morning and before sleeping. Louise helps out. The child got compliments from the dentist at her last visit. Cathy has given her a pretty spoon ‘specially made’ (that is what she has told her) for her to consume her food. She is learning to handle it (Sheridan, 2007). Her fingers hold it a little distance from the broader scooped end.

Nevertheless she is able to spoon her bowl contents into her mouth, of course spilling some of it. In the corner of her play room, there is a bucket which holds her toys which range from plastic spoons to picture postcards. Louise has taught her how to drop things in her bucket but she does not always bother (Childhood Development, CASRC). A favorite hobby of hers is to ‘draw’ with the crayons that her cousin left for her.

She makes criss-cross marks on the drawing paper and the wall when her granny is not looking. Ryan meanwhile manages to make pictures of cats and dogs and houses more successfully. Jessica likes to arrange her playthings one on top of each other (Sheridan, 2007). I joined in her game and I could understand that she was well in the path of development. She could arrange six layers of cubes before they get toppled. Her gleeful laughter when the whole stack tumbles down is indicative of her healthy disposition. Ryan sometimes helps her build towers and they have great fun watching the tower topple (Childhood Development, CASRC).

Jessica wears her squeaky shoes when she is taken ‘for a walk’ in the lawn outside for some exercise. Pink is the color of her dress and it needs to have frills. Both grandparents are receptive to the idea that talking frequently and teaching Jessica and Ryan as and when they communicate. Jessica keeps pointing at things or articles which catch her attention (Sheridan, 2007). One of them names it and says some more or tells a nonsense tale attached to it.

Jessica looks at herself in the mirror and points to her body parts and John would be ready to help her name them (Childhood Development, CASRC). Her vocabulary has reached around 30 words by her granny’s assessment (Sheridan, 2007). She has recently started waving good bye to her parents every morning after climbing on the sofa outside on the verandah and wishing them ‘ave a nice day’ (Sheridan, 2007).. It thrills them a lot.

Every day after breakfast, she has a bath. Now her granny is having a problem soaping her as she wants to do it herself and she wheels some toys into her bath too(Sheridan, 2007). She soaps her toy doggie and ‘bathes’ him. Dressing has become a tedious affair with Jessica selecting her own dress, a pink one with frills almost daily. On top of that she keeps changing her selection at least twice (Childhood Development, CASRC).

Louise has to be patient and slowly ‘wean’ her away. Then she slowly turns the pages of her picture book which Cathy got for her. She does not allow Louise to do it. She compares the colors of her dress or Louise’s with the colors in her book and keeps shrieking in delight (Childhood Development, CASRC).. Another favourite pastime is tending to her ‘Barbie’ doll which she has named Lucy.

She feeds her with a spoon, combs her hair, changes her clothes and what not. The other day she dipped her in the bucket of water saying she is ‘smelly’. This is symbolic play (Goldson, 2007). Play is a significant means of learning. It is a very complex process which involves the practice and rehearsal of roles, skills, and relationships. It is a way to integrate the child’s life experiences. There is emotional development, cognitive development and social/motor development. Play has a developmental progression. If last year, peek-a-boo was her favourite game, this year she is playing by herself or with her imaginary friends (Goldson, 2007). Next year she would have her pre-school friends. It is all social development.

Jessica has a habit of making monosyllable answers to the parents’ and grandparents’ queries. Sometimes several ‘nos’ make things difficult (Childhood Development, CASRC). Cathy commented to her mother that the word ‘no’ needs to be removed from their family dictionary till Jessica forgets it. Now she asks for ‘sumthin to dink’ and ‘I thirsty or ‘wanna eat’. Cathy’s neighbor Elaine brings her two and a half year old child over occasionally.

Jessica immediately runs close to her granny and sits on her lap till the other child leaves (Childhood Development, CASRC). Maybe she is worried that she may lose the attention of her granny in the presence of others or it is that she is not that social yet. This is definitely normal going by the milestones. Cathy recites nursery rhymes to her just before she sleeps. She loves ‘Mary had a little lamb’. Louise keeps asking her to show the doggie, kitty etc from her picture books and Jessica happily obliges.

She has learnt the left-to-right technique of going through her pictures. Jessica has her tantrums when Louise restricts her running out of the front door or wishing to play under the tap in the bathroom. Jessica has been introduced to her potty training (Childhood Development, CASRC). She likes it because there are some musical sounds coming from her potty. Brain maturation permits infants to sense full rectum or bladder

and also controls the bowel and bladder sphincters (Goldson, 2007). Jessica for one feels proud when she has been able to inform her granny in time for her to use her potty. Louise makes it a point to praise her ‘accomplishment’. Cathy has specifically advised her parents not to be too strict over this (Goldson, 2007). Jessica was to decide when to go. She reminds them about her son who used to make a big issue due to frequent restrictions by the grandparents.

Sleep is a restful period for Jessica. Though it is accepted that 17% of infants have moderate sleep problems, Jessica is not affected. This is probably because Jessica’s parents are both mentally and physically healthy (Fauroux et al, 2008). Jessica lies on her side (prone position) while sleeping. The supine position is associated with delays in motor development and thereby a delay in the motor milestones (Fauroux et al, 2008). There is a hypothesis that says that children who have greater activity during the night in their sleep and increased sleep disturbances tend to show a delay in the onset of locomotor milestones (McKay, 2006). Thankfully Jessica does not fall in this category.

In the recent times, evidence has emerged which says that earlier motor development is associated with better scholastic performance, better educational outcomes in adulthood and better cognitive functions (Murray et al, 2006). Murray’s study found that “infant motor development was an independent predictor of adult cognition” in some aspects like adolescent behavioural problems.

Jessica’s Colic

Jessica has colic occasionally. She would cry incessantly holding onto her abdomen. It has been estimated that 40% of male and female infants suffer from colic (Joanna Briggs Institute, 2008). Food allergies, gastrointestinal causes, behavioural symptoms, change in bowel or urine excretion patterns, dietary patterns should be taken into consideration. Jessica has only very few colic episodes after Louise reduced cow’s milk from her diet and tried a soy-based formula and then a fibre-enriched formula both of which failed to provide relief to Jessica.

Then at the advice of the paediatrician, Jessica has been started on the hypoallergenic formula (Joanna Briggs Institute, 2008).. Special attention is taken to give sufficient fresh fruit and juices to Jessica so that she does not have constipation. When her symptoms are severe enough she is taken to Cathy’s hospital where the paediatrician advises some antispasmodic injection for relief. However such visits are few and far between now that Jessica is growing up and her diet is well adjusted.

Analysis of Jessica’s development

Jessica is healthy child conforming to the changes of weight, length and head circumference to the 90 th percentile of each parameter in the Revised Growth Charts of Victoria. Her mother had a normal pregnancy which terminated in a normal delivery.

Jessica had no congenital or other abnormalities. She had a fairly normal neonatal and infant period. Her milestones of development were all within normal limits. She has been immunized to most childhood illnesses as indicated in the immunization schedule of Australia. Her mental, locomotor and social developments are appropriate. Her IQ is normal and she is expected to do well in her education. Her warmth reflects the strong interactions among the family members and with the rest of the world.

Reflections

I visited the Ray family on the 25 th of August, 2008 and spent about two days in their home. They welcomed me warmly into the family and permitted me to stay in their guest room. I was surprised that they allowed me to move fairly freely with them and also to join in looking after Jessica. Jessica too took to me and invited me to play with her. I had no difficulties. All my qualms about family nursing practice flew away at their response. I was lucky to get a good start. This has confirmed my option to choose family nursing. I am aware that this may not be the situation in all families. However my mind is made up.

Having never directly faced the clients before, I was a little apprehensive of things. However, I was lucky to get a warm family. The questions that I had prepared came in handy and I could extract plenty of information for my case study. I was able to do the genogram and ecomap of the family and include the maximum information that I gathered. The Calgary Family Assessment Model guided me in putting on paper what I had learned.

I have attempted to include many facets of Jessica’s developmental milestones but I had to limit my findings to stay within the length of paper allowed. I realized that assessing the family as a whole is essential in assessing a child. My confidence has been lifted with this assignment. I have also been able to look for good references. With sufficient preparation, I should be able to face clients and really be efficient in getting the maximum information for study. Interacting with the family has changed my outlook and I expect to go through my study with flying colours.

Berger, Sarah E., (2007), “How and when infants learn to climb”, Infant Behaviour and Development, Vol. 30, Pgs 36-49., ScienceDirect, Elsevier.

Carroli, G.; Villar, J.; Piaggio et al, (2001), “WHO Systematic Reviews of randomized controlled trials of routine antenatal care”, Lancet, Vol 357, Pgs. 1565 – 1570.

Child Development Programme, Child and Adolescent services Research center. Web.

CASRC Enkin, M. et al, (2000), “A guide to effective care in pregnancy and childhood”, 3 rd Ed., Oxford: Oxford University Press, 2000.

Fauroux, Brigitte et al, (2008), “What’s new in paediatric sleep in 2007), Paediatric Respiratory News , Vol 9, Pgs. 139-143, Elsevier.

Goldson, Edward and Reynolds, Ann; (2007), “Normal Development’ in Chapter 2, Current Paediatric diagnosis and treatment, 18th ed, The McGraw Hill Companies.

Hunt, Jennifer M. and Lumley, Judith; (2002), “Are recommendations about routine Antenatal care in Australia consistent and evidence- based”, Medical Journal of Australia (MJA ), Vol 176, Pgs 255-259.

Joanna Briggs Institute, (2005), Early childhood pacifier use in relation to Breastfeeding, SIDS, Infection and Dental malocclusion, Best Practice , Vol 9, Issue 3, page 1-6.

Joanna Briggs Institute, (2008), The effectiveness of interventions for infant colic”, Best Practice, Vol 12, Issue 6, Pgs. 1-4.

Kaakinen et al, (2005), “Family Nursing Assessment and Intervention”, Chapter 8 of Family Health Care Nursing: Theory, Practice and Research by Shirley M.H.Hanson, Joanna Rowe Kaakinen and Vivian Gedaly Duff, 3 rd Ed., F.A.Davis Company.

Mannerkoski, M. et al, (2008), Childhood Growth and Development associated with the need for full time special education at school age , European Journal of Paediatric Neurology.

McKay, Sandra M., (2006), “Longitudinal assessment of leg motor activity and sleep patterns in infants with and without Down’s syndrome”, Infant Behaviour and Development Vol 29, Pgs 153-168.

“Morning Sickness’, Babycentre, Australia Medical Advisory Board, BabyCentre LLC. Web.

Murray, G.K. et al, (2006), Infant motor development and adult cognitive functions, Schizophrenia Research, Vol 81, Pgs 65-74, ScienceDirect, Elsevier.

National Immunisation Schedule, Immunise Australia Programme , Recommended Immunisation Schedules for 0-6 years, Advisory Committee on Immunisation Practices, Department of Health and Human Services, Centre for Disease Control and Prevention, 2008.

Revised CDC Growth Charts, (2005), Department of Education and Early Childhood Development, Government of Australia, Victoria. Web.

Sheridan, Mary D. et al; (2007). From birth to five years : children’s developmental progress, Hawthorn: Australian Council for Educational Research.

“10 steps to healthy pregnancy”, Babycentre, Australia Medical Advisory Board, BabyCentre LLC. Web.

Wen, S.W. et al, (2000), Impact of prenatal glucose on the diagnosis of gestational diabetes and on pregnancy outcomes”, American Journal of Epidemiology, Vol 152, Pgs 1009-1014.

Walkinshaw, S., (2001), “Dietary regulation for gestational diabetes”, (Cochrane Review), In: The Cochrane Library, Issue 2, 2001, Oxford: Update software.

Wright, L.M. and Leahy, M.; (2005), “Calgary Family Assessment Model” in Nurses and Families: A Guide to family Assessment and Intervention, 4 th Ed., Philadelphia, F.A.Davis.

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IvyPanda. (2021, September 30). Family and Child Development Milestones. https://ivypanda.com/essays/family-and-child-development-case-study/

"Family and Child Development Milestones." IvyPanda , 30 Sept. 2021, ivypanda.com/essays/family-and-child-development-case-study/.

IvyPanda . (2021) 'Family and Child Development Milestones'. 30 September.

IvyPanda . 2021. "Family and Child Development Milestones." September 30, 2021. https://ivypanda.com/essays/family-and-child-development-case-study/.

1. IvyPanda . "Family and Child Development Milestones." September 30, 2021. https://ivypanda.com/essays/family-and-child-development-case-study/.

Bibliography

IvyPanda . "Family and Child Development Milestones." September 30, 2021. https://ivypanda.com/essays/family-and-child-development-case-study/.

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Home > ETD > Doctoral > 5823

Doctoral Dissertations and Projects

Examining the needs of administrators, teachers, and professional staff in an elementary school moving to become a trauma-sensitive school: a single instrumental case study.

Samantha Nicole George , Liberty University Follow

School of Education

Doctor of Philosophy in Education (PhD)

Lucinda Spaulding

Adverse Childhood Experiences (ACE), challenging behavior, elementary school, trauma-informed care, trauma-informed program, trauma-informed strategies, trauma-sensitive schools

Disciplines

Recommended citation.

George, Samantha Nicole, "Examining the Needs of Administrators, Teachers, and Professional Staff in an Elementary School Moving to Become a Trauma-Sensitive School: A Single Instrumental Case Study" (2024). Doctoral Dissertations and Projects . 5823. https://digitalcommons.liberty.edu/doctoral/5823

This single instrumental case study discovered the needs of a Central Virginia elementary school as it moved toward becoming a trauma-sensitive school. The theory informing this study was Bronfenbrenner’s (1979) ecological systems theory, as it provided a framework to explore the instrumental role of administrators, teachers, and professional staff in the complex system of relationships that support child development in the microsystem of the school. Participants were recruited from one elementary school in Central Virginia after obtaining IRB approval from Liberty University. Data collection entailed surveys, interviews, and focus groups to describe the needs of administrators, teachers, and professional staff in becoming a trauma-sensitive school. The data was then analyzed within the case to develop the following naturalistic generalizations of needing training and in-person support from professionals with skills specific to childhood trauma. Findings included administrators, teachers, and professional staff needing training and support from professionals qualified in childhood trauma.

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How to cite ChatGPT

Use discount code STYLEBLOG15 for 15% off APA Style print products with free shipping in the United States.

We, the APA Style team, are not robots. We can all pass a CAPTCHA test , and we know our roles in a Turing test . And, like so many nonrobot human beings this year, we’ve spent a fair amount of time reading, learning, and thinking about issues related to large language models, artificial intelligence (AI), AI-generated text, and specifically ChatGPT . We’ve also been gathering opinions and feedback about the use and citation of ChatGPT. Thank you to everyone who has contributed and shared ideas, opinions, research, and feedback.

In this post, I discuss situations where students and researchers use ChatGPT to create text and to facilitate their research, not to write the full text of their paper or manuscript. We know instructors have differing opinions about how or even whether students should use ChatGPT, and we’ll be continuing to collect feedback about instructor and student questions. As always, defer to instructor guidelines when writing student papers. For more about guidelines and policies about student and author use of ChatGPT, see the last section of this post.

Quoting or reproducing the text created by ChatGPT in your paper

If you’ve used ChatGPT or other AI tools in your research, describe how you used the tool in your Method section or in a comparable section of your paper. For literature reviews or other types of essays or response or reaction papers, you might describe how you used the tool in your introduction. In your text, provide the prompt you used and then any portion of the relevant text that was generated in response.

Unfortunately, the results of a ChatGPT “chat” are not retrievable by other readers, and although nonretrievable data or quotations in APA Style papers are usually cited as personal communications , with ChatGPT-generated text there is no person communicating. Quoting ChatGPT’s text from a chat session is therefore more like sharing an algorithm’s output; thus, credit the author of the algorithm with a reference list entry and the corresponding in-text citation.

When prompted with “Is the left brain right brain divide real or a metaphor?” the ChatGPT-generated text indicated that although the two brain hemispheres are somewhat specialized, “the notation that people can be characterized as ‘left-brained’ or ‘right-brained’ is considered to be an oversimplification and a popular myth” (OpenAI, 2023).

OpenAI. (2023). ChatGPT (Mar 14 version) [Large language model]. https://chat.openai.com/chat

You may also put the full text of long responses from ChatGPT in an appendix of your paper or in online supplemental materials, so readers have access to the exact text that was generated. It is particularly important to document the exact text created because ChatGPT will generate a unique response in each chat session, even if given the same prompt. If you create appendices or supplemental materials, remember that each should be called out at least once in the body of your APA Style paper.

When given a follow-up prompt of “What is a more accurate representation?” the ChatGPT-generated text indicated that “different brain regions work together to support various cognitive processes” and “the functional specialization of different regions can change in response to experience and environmental factors” (OpenAI, 2023; see Appendix A for the full transcript).

Creating a reference to ChatGPT or other AI models and software

The in-text citations and references above are adapted from the reference template for software in Section 10.10 of the Publication Manual (American Psychological Association, 2020, Chapter 10). Although here we focus on ChatGPT, because these guidelines are based on the software template, they can be adapted to note the use of other large language models (e.g., Bard), algorithms, and similar software.

The reference and in-text citations for ChatGPT are formatted as follows:

• Parenthetical citation: (OpenAI, 2023)
• Narrative citation: OpenAI (2023)

Let’s break that reference down and look at the four elements (author, date, title, and source):

Author: The author of the model is OpenAI.

Date: The date is the year of the version you used. Following the template in Section 10.10, you need to include only the year, not the exact date. The version number provides the specific date information a reader might need.

Title: The name of the model is “ChatGPT,” so that serves as the title and is italicized in your reference, as shown in the template. Although OpenAI labels unique iterations (i.e., ChatGPT-3, ChatGPT-4), they are using “ChatGPT” as the general name of the model, with updates identified with version numbers.

The version number is included after the title in parentheses. The format for the version number in ChatGPT references includes the date because that is how OpenAI is labeling the versions. Different large language models or software might use different version numbering; use the version number in the format the author or publisher provides, which may be a numbering system (e.g., Version 2.0) or other methods.

Bracketed text is used in references for additional descriptions when they are needed to help a reader understand what’s being cited. References for a number of common sources, such as journal articles and books, do not include bracketed descriptions, but things outside of the typical peer-reviewed system often do. In the case of a reference for ChatGPT, provide the descriptor “Large language model” in square brackets. OpenAI describes ChatGPT-4 as a “large multimodal model,” so that description may be provided instead if you are using ChatGPT-4. Later versions and software or models from other companies may need different descriptions, based on how the publishers describe the model. The goal of the bracketed text is to briefly describe the kind of model to your reader.

Source: When the publisher name and the author name are the same, do not repeat the publisher name in the source element of the reference, and move directly to the URL. This is the case for ChatGPT. The URL for ChatGPT is https://chat.openai.com/chat . For other models or products for which you may create a reference, use the URL that links as directly as possible to the source (i.e., the page where you can access the model, not the publisher’s homepage).

Other questions about citing ChatGPT

You may have noticed the confidence with which ChatGPT described the ideas of brain lateralization and how the brain operates, without citing any sources. I asked for a list of sources to support those claims and ChatGPT provided five references—four of which I was able to find online. The fifth does not seem to be a real article; the digital object identifier given for that reference belongs to a different article, and I was not able to find any article with the authors, date, title, and source details that ChatGPT provided. Authors using ChatGPT or similar AI tools for research should consider making this scrutiny of the primary sources a standard process. If the sources are real, accurate, and relevant, it may be better to read those original sources to learn from that research and paraphrase or quote from those articles, as applicable, than to use the model’s interpretation of them.

We’ve also received a number of other questions about ChatGPT. Should students be allowed to use it? What guidelines should instructors create for students using AI? Does using AI-generated text constitute plagiarism? Should authors who use ChatGPT credit ChatGPT or OpenAI in their byline? What are the copyright implications ?

On these questions, researchers, editors, instructors, and others are actively debating and creating parameters and guidelines. Many of you have sent us feedback, and we encourage you to continue to do so in the comments below. We will also study the policies and procedures being established by instructors, publishers, and academic institutions, with a goal of creating guidelines that reflect the many real-world applications of AI-generated text.

For questions about manuscript byline credit, plagiarism, and related ChatGPT and AI topics, the APA Style team is seeking the recommendations of APA Journals editors. APA Style guidelines based on those recommendations will be posted on this blog and on the APA Style site later this year.

Update: APA Journals has published policies on the use of generative AI in scholarly materials .

We, the APA Style team humans, appreciate your patience as we navigate these unique challenges and new ways of thinking about how authors, researchers, and students learn, write, and work with new technologies.

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000

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