4PSYC004W – Developmental Psychology
Assessment 2 – Case study: Zac 9 years old.
Zac is a nine-year-old male who was referred for behavioural intervention treatment of ADHD. Zac lives with his parents and his sixteen-year-old sister and thirteen-year-old brother. At the first appointment, Zac’s parents reported that he exhibits restlessness and hyperactivity. He also was described as easily distracted, having difficulties listening and following instructions and had difficulties playing quietly. His parents said that he was always “jumpy.”
Background information
For much of Zac’s early life he was in the care of a local childminder. Zac’s mother returned to work when he was 4 months old, both parents having low-paid full-time work. The childminder was unregistered and cared for several other young children. For the first few years of his life, Zac was quiet and undemanding, so spent much of his time in a baby chair in front of the television, while the childminder attended to the needs of the more demanding children.
When Zac was two, he spoke fewer words than children of a similar age and his pronunciation was very difficult for non-family members to understand. His parents brought him to the GP and on closer questioning he had <10 words of speech.
Review of his Personal Child Health Record (red book) showed consistent growth along centile lines, and other developmental milestones were attained. In the consultation room he made reasonably good eye contact and was able to identify his nose and ears when asked. A referral to audiology was made and a hearing testing was performed. He had hearing thresholds of >40 dB (mild-to-moderate hearing loss).
He was actively observed for 3 months and then referred to an ear, nose, and throat consultant. With evidence of persistent conductive hearing loss, he was offered hearing aids or grommets, in keeping with National Institute for Health and Care Excellence guidelines.
His parents elected for grommet insertion. On follow-up at 2 years, 6 months, his vocabulary had expanded to >100 words, and audiogram showed thresholds <20 dB in the normal range.
Since starting school, Zac’s energy and attempts to socialise with his peers increased. He is currently in year four of his local primary school. When he was seven, he was diagnosed with ADHD. According to his teacher, Zac showed no involvement in class assignments; he regularly disturbed class activities and behaved aggressively. This behaviour seemed to be getting more disruptive over time.
The school asked the parents to see their GP and she referred Zac to a specialist who diagnosed ADHD and prescribed Ritalin. The drug apparently caused Zac to lose weight. At that point, his parents searched for an alternative for Ritalin and discovered a behavioural intervention program in which Zac’s parents were asked about his screen time habits.
The parents reported that he had in his bedroom a PlayStation and a computer which he also used to play video games and watch TV. Along using these devices, Zac also multi-screened with his smartphone, occasionally using it for playing video games. Not very often, he also used virtual reality glasses. His parents reported that screens ‘quiet’ down Zac.
Zac was not interested in participating in any after-school activities. Thus, most of his after-school time was devoted to digital media use, which was estimated to be seven hours in weekday and more on weekends. Once, he played video games with his brother from 9 a.m. until 6 a.m. Zac’s weekday’s bedtime was usually around 11 p.m., and he was reportedly viewing screen close to bedtime.
Based on: Lissak, G., (2018) Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study, Environmental Research, Volume 164, Pages 149-157.
What do you think are the most important issues for the Behavioural Intervention team to be aware of? (500 words)
What other information, not included in the description above, would be helpful to know? (100)
What explanation would you suggest for Zac’s apparent change of behaviour when starting school? (300 words)
Apart from his hearing loss, what might account for the delay in Zac’s language development? (300 words)
Would either Piaget or Vygotsky’s theory be able to provide insight into Zac’s cognitive development? (300 words)
What possible support could the behavioural team put in place to address some of the issues raised in the case study? (500 words)