discussion

Case Study 3

Jose is a 36-month-old who presents for a preschool evaluation. His father reports the following development:

· Physical: Walks, runs, and jumps independently, walks upstairs alternating feet, pedals a three-wheeler, scribbles, copies circles and squares, and is able to balance on one foot for 2 to 3 seconds.

· Social: Recognizes three colors; speech is 75% understandable; uses three- to four-word sentences; talks about friends, favorite activities, and family; frequently engages in imitative play; has an imaginary friend; does stutter on occasion when excited or when intent on getting something said. Will typically repeat the first word in a sentence three to four times, but does not repeat syllables or consonants. This happens three to four times a week.

 

Jose, based on his father’s report, met most of his developmental milestones appropriately though, as a clinician, we should always look for potential flags that should be addressed in the early stages before they become serious. In this case study, there are no indications that the child’s growth and weight followed an abnormal pattern. Some of the red flags questions we must consider, with every child we see, are are as follow: How is the toilet training going? Does he try to dress himself? How much do you think your child understand? How does Jose behave around other children? (Burns, et al., 2017). Also, I can ask the child for his name, age and sex and this will allow me to better understand if there is a problem with cognitive development as a three-year-old should know this information.

One possible the red flags I can identify in Jose is language development. This child is 3 years old and speech intelligibility should be at the 90th percentile (Burns, et al., 2017). Referrals should be made to a speech specialist for an evaluation. I do not believe the stutter is a problem for now, but the speech specialist can also check and evaluate that as well. We must also take into consideration the possibility of a bilingual home for Jose. Although there is no mention of Hispanic heritage in the case study, I’m inclined to think so because of the child’s name. If he is in a bilingual home, the 75 % would be normal for this child because studies have found a gap between expressive and receptive skills in the less used language (Ribot, Hoff, & Burridge, 2018). Questions to ask would include: `How many languages are spoken in the household?’ `What is the main language spoken to the child?’ `What is the child’s main language at home?’

Based on what Jose’s father reported,  this child’s physical development is within the normal range, as he has achieved the milestones for his age group such as being able to run, walk, and jump without help, able to climb stairs alternating feet, able to pedal a three-wheeler and able to balance in one foot for 2 to 3 seconds. Another indication of normal development is his ability to copy circles and squares suggesting that his fine motor coordination development is also in the expected range for his age.

Socially and emotionally, this child must be able to copy adults and friends, show affections for friends without prompting, take turns at games, show concern for a crying friend, and separate mom and dad easily. In the cognitive sphere he should be able to work with toys with buttons, moving parts and levers. Also, he should be able to turn pages in a book one at the time and to build towers of 6 or more blocks (Centers For Disease Control And Prevention, 2019). Questions should be asked of the child’s parent to clarify if he has accomplished the mentioned milestones appropriately.

There are multiple screening tools for evaluation of speech and language. In this case I would prefer to use the `Clinical evaluation of language Fundamentals-Preschool’ because this test can be used with children 3 to 6 years of age and can assess the receptive and expressive language. This is a practical test that can efficiently identify and diagnose language issues. It can also be used for performance and follow-up evaluations of language deficits in children 3 to 6 years of age (University of Cambridge, 2019). The authors also mentioned that this test must be applied by “speech and language therapists, educational psychologists, special needs educators and diagnosticians who have been trained and are experienced in the administration and interpretation of standardized tests”. This test identifies strengths and weakness in areas such as sentence and word structure, expressive vocabulary and problems following directions and phonological awareness as well as other areas of language appropriate for this child age (University of Cambridge, 2019).

In today’s well visit, this child does not need to receive any vaccination. At this point he should have already received 3 doses of HepB (birth, 1-2 month and 12-15 month); 3 doses of rotavirus (RV) and DTaP at 2, 4, 6 month of age and another dose of DTaP at age (15-18) months of age. Haemophilus Influenza type b at ages 2, 4, 6 and 12-15 months of age. Pneumococcal (PCV13) at ages 2, 4, 6, 12-15 months of age. Polio vaccination should have been administered at ages 2, 4 and repeat at ages 12-15 months. Also, every year he should have been vaccinated for influenza. Between ages 12-15-month MMR and Varicella should have been given and between 15-18 months of age Hep A vaccine (Centers for Disease Control And Prevention, 2019). This child next appointment would be schedule for a year from today and then more vaccinations will be given such as DTaP, IPV, MMR, and varicella between ages 4-6 years old (Centers for Disease Control And Prevention, 2019).

 

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017). Pediatric Primary Care Sixth Edition. St. Louis: Elsevier.

Centers For Disease Control And Prevention. (2019, February 8). Learn the Signs. Act Early. Retrieved from Centers For Disease Control And Prevention: https://www.cdc.gov/ncbddd/actearly/milestones/milestones-3yr.html

Centers for Disease Control And Prevention. (2019). Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger. Retrieved from Centers for Disease Control And Prevention: https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

Ribot, K. M., Hoff, E., & Burridge, A. (2018, May 1). Language Use Contributes to Expressive Language Growth: Evidence From Bilingual Children. Child Development, 89, 929-940.

University of Cambridge. (2019). Clinical Evaluation of Language Fundamentals (CELF-IV and CELF Preschool-II). Retrieved from The Psychometrics Centre: https://www.psychometrics.cam.ac.uk/services/psychometric-tests/celf