1) Discuss prenatal issues and how they may be related to Jesse’s developmental progress up to his current functioning.
Developmental History Formulation Using the attached developmental interview consider developmental issues regarding (a) the child’s current functioning and (b) implications for future social emotional functioning. Answer each of the following as comprehensively as possible, given your understanding of course material presented thus far.
1) Discuss prenatal issues and how they may be related to Jesse’s developmental progress up to his current functioning. Be sure to address environmental influences and generate hypotheses about how Sally’s overall functioning during her pregnancy may have led to some of Jesse’s difficulties.
2) Consider Jesse’s birth weight. Discuss causes as well as short-term and long-
term consequences that Jesse has experienced or is at-risk for experiencing due to his weight.
3) Discuss Jesse’s temperament (what type) and the implications of having this
temperament with regard to long-term adjustment. Be sure to consider Jesse’s age and Sally’s parenting techniques when formulating your answer.
4) Given what you know about Sally’s care giving style and Jesse’s home
environment, discuss the following: (a) what phase of attachment he is most likely to be in (Shaffer & Emerson), (b) what type of attachment he most likely experiences, (c) how he is most likely to behave in the Strange Situations procedure and (d) the implications this has for adjustment in the pre-school years and adolescence.
5) Given Jesse’s history, what interventions, if any, do you feel are needed at this
time? What specific issues would you be targeting if you were to propose an intervention plan?
Child’s Name Jesse Nickname Date of Birth 12/01/91 Date of Evaluation 02/29/93 Social Security # AGE: 15 months Parent’s Name Sally Person Completing this form Mother and Grandmother interviewed together Who referred you for evaluation?
Why are you seeking help for your child? Grandmother concerned about development What type of services do you believe are necessary for your child? Not sure
Circumstances and factors regarding this problem.
Do both parents agree about the nature and cause of the problem?
Sally wants Jesse to stop crying so much, grandmother is concerned About Sally’s lack of warmth and apparent dislike in caring for him
What do you enjoy most about your child? He is not enjoyable to be around; would rather be out with friends What do you find most difficult about raising your child? Cries all the time, irritable Doesn’t like new people or situations What do you see your child doing when he/she grows up? Don’t know Who is in charge of discipline in the home? Mother and grandmother Do all caregivers agree on discipline? No, grandmother disagrees with Sally leaving him in his room so much; grandmother gets upset because when Jesse cries, Sally usually gets angry and puts him in his bed. Describe discipline techniques
What has proven most effective with this child? How does the child respond to discipline? Previous Psychological Evaluations Date of most recent evaluation Psychologist Reason for evaluation Results
Family History Mother’s name Sally Stepmother? No Yes Mother’s birthdate 12/13/75 Highest grade completed 8th Occupation Employer Home phone Work phone Social Security Father’s name Unknown Stepfather? No Yes Father’s birthdate Highest grade completed Occupation Employer Home phone Work phone Social Security # Family address Does your child have other parent(s)/stepparent(s)? No _ Yes If yes, please provide the following information. Name Relationship to your child Home phone Address Name Relationship to your child Home phone Address Parent’s marital status Are there any significant family or marital conflicts? If yes, please describe. Conflict between Sally and grandmother regarding Jesse’s care Has your child experienced any parental separations, divorces or death? If yes, please explain. If parents are separated or divorced, how often does the other parent see this child? Child is: Natural Adopted Foster Siblings: Please name all brothers and sisters, their ages. gender, and whether or not they are in
the home. Other’s living in the home. Child’s grandmother (Mary) and her 2 children (Sally’s siblings) ages 8, 12, and 18 Languages spoken in the home. English Past or current health problems of mother. Past or current health problems of father. Does the family participate in an organized religion? Please indicate relatives, if anv, who have been diagnosed with anv of the following: Developmental problems Neurological Disorder Seizures Behavioral problems mom Drug/Alcohol abuse Learning problems mom Speech/Language problems Psychiatric problems Hyperactivity Emotional problems mom Chronic illness Genetic disorders Mental Retardation Hearing/Vision problems Cancer Cystic fibrosis Diabetes Kidney disease Hypertension Multiple sclerosis Migraine headaches Stroke Physical handicap Alzheimer’s disease Tuberculosis Huntington’s chorea Hemophilia Sickle-cell anemia Parkinson’s disease Tourette’s syndrome Tay-Sach’s disease Heart disease Birth defect Cerebral palsy Nervousness Head injury Pregnancy and Birth History
Was pregnancy planned? No Was prenatal care received? After 6 months Previous miscarriages? No
Age of mother at delivery 16 Age of father
Indicate if any of the following occurred during the pregnancy: Difficulty in conception Excessive swelling Measles/German Measles Flu Vaginal Bleeding Emotional problems High Blood Pressure Excessive vomiting Toxemia Abnormal weight gain 19 lbs Anemia Hypertension Other (specify) Maternal injury (describe) none Hospitalization during pregnancy? (describe) No X-rays during pregnancy? (when?, why?) No Medications during pregnancy (type) No Alcohol or drug use during pregnancy? (frequency, type) mom smoked throughout and drank heavily on a couple of weekends Delivery was: Vaginal x Cesarean (emergency or planned) Birth was: Natural __ x Local anesthesia General anesthesia Was child born in a hospital? If no, where? yes Length of pregnancy in weeks 38 Birthweight 4 ¾ lbs Length 17 inches Length of labor in hours 28 Apgar scores? 6 at five min. Any complications? Child’s condition at birth small but relatively healthy Mother’s condition at birth fine Were forceps used for delivery? No Was this a “feet first” delivery? No Was labor induced? No Did the baby experience any breathing problems right after birth? (describe) no How old was the baby at discharge from the hospital? 39 weeks Did the baby have any medical problems after discharge? (describe) apnea
Any medical problems in the first 6 months? Baby was on monitor because of apnea Did the baby ever need surgery or anesthesia? No Early Development Was early development significantly different from the child’s siblings? Did the baby have problems with feeding? Irregular eating, mom never knew if he was hungry or not Was the baby normally active? Very active, fussy How did the baby act when held? Arched back, not cuddly, did not like it Did the baby gain weight and grow normally? Gained weight, but still small for age Was-the child breast or bottle fed? When weaned? Bottle, currently still takes a bottle Motor Development Was the child slow to learn skills like riding a bicycle, skipping, or throwing a ball? What hand does the child prefer to use? Has the child been forced to change writing hand? Which hand does the parents/siblings use? Was physical therapy ever necessary? Was occupational therapy ever necessary? Please indicate the age at which your child performed the following tasks: Turn over 4 months Sit independently 7 months Crawl 9 months Pull self to standing position don’t remember Stand alone 11 months Walk alone not yet Feed self with spoon Dress self Did the baby have abnormal gait? (ex., walked on toes?) Toilet trained during the day (when) Toilet trained at night (when) Number of times per week “accidents” occur Any medical reasons for “accidents?” Problems encountered during training? Did the child drool past the age of 2 or have trouble swallowing, when fed? Language Development
Did the child’s language development differ from siblings or peers? Did the baby babble as much as other children? Did the child use gestures to communicate? Please indicate the age at which your child performed the following tasks: Said first word no words yet Put 2-3 words together Pointed to what was wanted Spoke in complete sentences Recited the alphabet Counted to 10 Was speech or language therapy ever necessary (when, why?) Is the child able to hold a conversation or tell a story? Does the child parrot what others say or repeat TV commercials? Is the child’s speech clear and understandable? Does the child frequently use gibberish or baby words? Does the child understand the meaning of “no?” Is the child able to follow short directions? Is the child able to follow complex directions? Does the child have difficulty understanding what is said? Did the parents ever think the child might have a hearing problem? Did the child have earaches or infections? (describe) Did the child require ear tubes? Does the child talk too much or too little? Does the child’s voice sound like other’s? Does the child stutter? Medical history Date of most recent vision screening & results
Date of most recent hearing screening & results Name of child’s physician Dr. Herman Please list illnesses/injuries/hospitalizations/surgeries: Date Incident Has the child ever had problems with sleep (describe) Never been a good sleeper; sleeps 2-3 hours, then wakes up and may go back for any amount of time; unpredictable; mom lets him cry at night if he wakes up Does the child have a history of any of the following?: Febrile seizures Epilepsy Lead poisoning Ingestion of a toxin Asthma Allergies Concussion/contusion Loss of consciousness Headaches Vomiting/nausea Ear infections x Eating difficulties Tics/twitching Repetitive movements Impulsivity Temper tantrums Nail biting Clumsiness Head banging Self-injurious behavior Meningitis Frequent high fevers Diabetes Over/under weight under at birth Anti-social behavior Hydrocephalus Endocrine disorder Developmental delay Psychiatric disorder Encephalitis What medication is the child currently taking? (Please indicate type and reason). None What previous medications were the child prescribed? None, antibiotics for ear infection Has the child ever had a head injury? (describe) no Has the child had all vaccinations? Yes Has the child ever had an EEG or MRI? no If yes, please indicate provider, date, reason and results: Please describe any behavioral or emotional problems that you believe your child has
Is there knowledge or suspicion of drug or alcohol use by this child? (describe)
Is there knowledge or suspicion that this child was ever the victim of physical abuse (describe) _ Is there knowledge or suspicion that this child was ever a victim of sexual abuse (describe) Does the child manifest any physical problems that were not discussed? Educational History Did the child attend day care? (describe) does not attend-at home with mother during the day, Grandmother works full time Did the child attend nursery or preschool? (describe) At what age did the child begin elementary school? Please list all schools that the child has attended: ____________________________________________________________________________________________ ____________________________________________________________________________________________ Current school and address Grade Teacher’s name(s) Did the child ever skip or repeat a grade? Have teacher(s) reported problems in any of the following areas? Reading Attention/Concentration Spelling Hyperactivity Arithmetic Behavior Writing Social Adjustment What subject does the child enjoy most? What subject does the child dislike most? Has the child ever been evaluated in the school system? (if so, please provide a copy of results) Has the child ever been placed in a special classroom? Does the child fight at school or have very few friends? Has the child received special tutoring outside of school? Did the child have trouble with a particular grade? (describe) If the child has difficulty with a particular subject, does tutoring help?
Does the teacher report problems that are not noted at home? Does the child like school? How does the child get along with teachers? Social Behavior and Play Does the child get along well with other children? Does the child prefer older or younger peers? Does the child get along with adults?
Does the child make and keep friends? Does the child understand social cues (ex., when someone is angry?) Is the child shy? Around familiar individuals? Does the child enjoy toys? What kind? Does the child prefer to play with others or alone? Does the child use imagination in play? Does the child initiate play with peers? Does the child participate in organized sports? (describe) Does the child understand rules? Do other parent’s complain about the child’s behavior? (describe) Does the child become overly excited during play? How many hours per week does the child enjoy watching TV? What is his/her favorite show? What activities does the child enjoy? Does the child have problems with peer pressure? Does the child frequently fight with peers? Are there any significant conflicts between the child and other family members? Has the child’s social skills or relationships recently changed? Does the child become overly anxious or upset when separated from parents? Please describe the child’s personality
Has your child ever received any psychological counseling? With whom? When? ____________________________________________________________________________________________ Have there been any incident in your child’s life that you believed caused noticeable changes in his/her behavior? ________________________________________________________________________________ Please describe any additional information that would be helpful in understanding your child. __________________ _____________________________________________________________________________________________