Saturday, April 13, 2013

Home visit case study example

The child, which we shall call Sally, 6½ months old, was observed in her parents home in a suburban neighborhood of a major city.  While I was studying Sally, she stayed in the family room of the house.  The carpets of the approximately 11’ by 14’ room were a light gray.  A television was in the northwest corner, and there was a sofa along the east wall with a loveseat on the south wall.  I sat on the loveseat for the duration of the observation; the father sat on the sofa.  Other furniture included two end tables at either side of the loveseat, a white coffee table in the middle of the room, and a desk placed end to end with the sofa.  A large bay window took up most of the north wall, and rose bushes were visible through the open blinds.  Toys were randomly scattered throughout the room, but mostly concentrated toward the northeast corner, close to the desk.  The parents had recently invested in a ‘baby gym,’ a colorful pad with an arch in which toys hung from, and it had been positioned between the coffee table and the sofa.
Overall, this room felt slightly congested to me.  There seemed to be a few too many items for such a small room.  I think the noise from the television added to a general busy feeling.  Lighting was adequate, most of which filtered through the rose bushes and the tops of the windows.  I don’t remember feeling too hot or cold, so I would say the temperature was pleasant.  Sally seemed comfortable in the room; she did not appear to be distracted by her mother and brother, who were occasionally in and out, and she never once followed them.  I would guess that Sally felt pretty safe and at home in her surroundings, so undisturbed by what I perceived to be an active setting that she fell asleep at the end of the observation.

    II.     Physical Development and Motor Skills
Sally stuck her tongue out.  She used her left hand to touch and grasp her tongue for about 10 seconds.
Grasping is part of early infant development.
I observed her rolling around on the ground.  She would roll to her left or right until she reached a major piece of furniture.  She did a full roll (stomach to side to back to side to stomach) three times.
According to the norms for her age, her gross motor skills are normal. The only mobilization of her whole body to move to a different place was by rolling.
Of the five toys she grasped in her hands, all except one, the ‘baby gym,’ was placed into her mouth before manipulating it in any other way.  She used her fingers to touch each of the toys, and spent at least 20 seconds but not more than 1½  minutes doing this.
Grasping and sucking on stimuli are part of infant development, both physically and cognitively.
Another time, Sally’s mother stood over her, holding both of her hands.  Sally sat up, then was pulled onto her feet.  She did not support all of her own weight, and her legs were shaky.
According the table 5.2 on page 152 of Berger, this is normal for a child her age.  I did not observe her participating in any gross motor skills that were ahead of the norm.  It seems that she her physical development is normal.

I saw her place her first two fingers in her mouth and suck on them a number of times, and each time she was staring at something.
Stage One of Sensorimotor Intelligence
When she put a toy in her mouth, she would open her mouth wide and use both hands to bring the toy to her mouth, making a biting motion, but not taking any bites.  All of the toys did not fit inside her mouth.  When the toys were at her mouth, she looked down in the direction of the toy, not staring, but her eyes were moving.
It looked very much like she was exploring the toys with her senses.  The way that she used her mouth to suck her fingers was different than the way she put her toys in her mouth (Stage 2 of Sensorimotor).
On one occasion, Sally’s father held her under the arms, toward him, their faces approximately 24 inches apart.  Sally stared straight in the direction of his face.  Her father manipulated the muscles in his face, expressing different emotions.  He created faces of joy, surprise, and interest, holding each for a few seconds.  When his expression changed, Sally’s expression changed shortly afterward, or she would laugh or say “oooooo.”
This closely resembles what Piaget called Stage Three of Sensorimotor Intelligence, in which the child responds to people and objects.
From the data I collected, I speculate that Sally has moved through the first two stages of Piaget’s Sensorimotor Intelligence phase, and is currently in Stage Three, right where she should be.  Sally demonstrated all of the reflexes of Stage One: sucking, grasping, staring (especially at faces) and listening.
Language Development / Communication
I observed Sally laughing and saying “oooooo,” a vowel sound, when her father showed a number of facial emotions.
The vocalization of vowel sounds is normal for a child her age.  I did not witness any babbling, or the repetition of syllables, an indicator of the next stage in language development.
Sally was sitting up on the floor, legs forward with a toy in her left hand.  She moved the toy from her mouth to the floor, still grasping it, and her eyes widened and let out a quick cry or yelp.  Next, there was a face of disgust, then a groan (“euuuhhhh”) came just before she spit up.
I attribute the outcry and groan to communication of uneasy feelings in the stomach preceding the spit up.  She also displayed facial expressions of joy, surprise, and interest, all forms of reflexive communication.

When I first sat down in the room where the observation took place, Sally raised her head and eyes from the floor toward my face.  She focused in this way for between 5 and 10 seconds, face blank, then looked back down at the toy in her hands.
Stranger wariness, a fear of unknown people, likely did not occur, at least not outwardly.
Soon after, while being supported facing her father, Sally was held at arms length, then brought nose to nose with him, then pulled back to arms length.  He repeated it four times.  Each time, while being pulled away, she exhibited a laugh.  Her eyes were wide, mouth open in a subtle smile, with cheek muscles raised.
I would classify this as joy.
Sally showed two other distinct expressions that were exhibited more than three times each.  In the first, her eyes were open wide, eyebrows raised and pushed in somewhat, her mouth closed, and lips pursed. In the other, her eyes were wide, eyebrows raised straight up, and her mouth open in circular shape.
I would classify these as the nonverbal emotions of interest and surprise, respectively.

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