Week 2 response 1

Case Scenario 3: Mrs. Obi comes to the clinic today with her 2-year-old son Max. She is concerned because although Max says a few recognizable sounds such as “ba” for bottle he mostly gestures and points to what he wants when he tries to communicate his needs. In addition, she is requesting information about starting toilet training.

• What type of screening tool(s) should the APRN use to assess Max’s language and social delay and why?

• The screening tool used is the ASQ-3, it suites Mrs. Obi 2 year old son to help evaluate communication, personal-social, problem-solving, gross motor, and fine moto domains for children of ages 1-66 months. The reason ASQ-3 is the proper tool for Max’s evaluation is due to its combines practical feasibility with adequate psychometric properties for detecting developmental delays across multiple domains, including the communication and personal-social concerns present in this case. ASQ- 3 will evaluate five developmental domains like communication, gross motor, fine motor, problem-solving and personal-social-skills.

• What potential risk factors (e.g., prenatal, pregnancy, neonatal) could place Max at risk for language/social delay?

• There are multiple prenatal, perinatal, and neonatal factors that increase the risk for speech and language delays. One of the most important risk factors include prematurity, birth complications that may require intensive care support during the neonatal period, or if there is any family history of speech and language disorders. It is also important to understand that the bilingual status and later birth order are not associations with increased risk of speech and language delays. There are children that learn multiple languages and may perform lower on standardized tests but typically due to normal developmental patters.

• What type of anticipatory guidance should the APRN provide to support Max’s communication and language development?

• Educating Mrs. Obi on the frequency of parent-child verbal interaction to help promote language. Mrs. Obi should encourage to speak to Max often using simplified sentences with clear pronunciation, engage in daily reading activities, and incorporating play that can help build Max’s vocabulary and comprehensive skills. Reducing screen time can help Max focus on social interactions, there are studies showing that excessive screen time has been associated with developmental delays. It is important to remember that during the first six months of life, language development is at its most critical.

• How should toilet training readiness be assessed? • Max’s readiness would need to demonstrate signs like the ability of walking, put on

and remove clothes, follow parental instructions, the use of expressive language,

demonstrating awareness of a full bladder or rectum, and demonstrating dissatisfaction with soiled diaper. Children between 18-30 months begin to show success through physiological, cognitive, and emotion.

• What anticipatory guidance should be provided regarding toilet training? • Max can be oriented to approach these successes by focusing on the physiological

maturity, and ability to understand and respond to feedback. Mrs. Obi can help by setting realistic expectations, given Max’s current language delay, coordinating with speech-language pathology may be an option to help optimize toilet training success. Max should be reassured that all health children eventually toilet train and the process should be customized to Max’s individual developmental trajectory.

References:

Feltner, C., Wallace, I. F., Nowell, S. W., Orr, C. J., Raffa, B., Middleton, J. C., Vaughan, J., Baker, C., Chou, R., & Kahwati, L. (2024). Screening for Speech and Language Delay and Disorders in Children 5 Years or Younger: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, 331(4), 335–351. https://doi.org/10.1001/jama.2023.24647

Johnson, S. B., Kuehn, M., Lambert, J. O., Spin, J. P., Klein, L. M., Howard, B., Sturner, R., & Perrin, E. M. (2024). Developmental Milestone Attainment in US Children Before and During the COVID-19 Pandemic. JAMA pediatrics, 178(6), 586–594. https://doi.org/10.1001/jamapediatrics.2024.0683

Maaks, D.L. G., Starr, N., & Gaylord, N. (2019). Burns' Pediatric Primary Care (7th ed.). Elsevier - Evolve. https://online.vitalsource.com/books/9780323581967Links to an external site.

Siegel, M., McGuire, K., Veenstra-VanderWeele, J., Stratigos, K., King, B., American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI), Bellonci, C., Hayek, M., Keable, H., Rockhill, C., Bukstein, O. G., & Walter, H. J. (2020). Practice Parameter for the Assessment and Treatment of Psychiatric Disorders in Children and Adolescents With Intellectual Disability (Intellectual Developmental Disorder). Journal of the American Academy of Child and Adolescent Psychiatry, 59(4), 468– 496. https://doi.org/10.1016/j.jaac.2019.11.018