HOW TO HELP EXCEPTIONAL NEEDS CHILDREN (THE EXAMPLE CASE STUDY OF MICHAEL)

My current client is 5 years old and his name is Michael. He suffers from hearing loss along with a speech disorder which he is receiving current therapy for. Although, his speech disorder is being addressed, he still has an issue with premature social skills. His parents have also asked me to design an intervention plan which will offer positive growth within this area of development.

According to (Kaplan’s Unit 1 Key Concepts), “children who are physically disabled often need intervention plans. These plans specifically suggest a schedule of developmental markers and required services. Intervention plans are used as a tool to measure how successful particular interventions are and provide valuable feedback for the child and parent” (p. 1). In order to devise a successful intervention plan for Michael, I will first need to determine why his lack of social development may exist. Once this is identified, I will then need to decide what specific techniques may work best in order to help Michael further develop these skills. Therefore, I will build this intervention plan by also addressing these five questions:

1. Why is Michael unable to make friends?
2. How might his disabilities be interfering with social development?
3. How can I assist him with a plan that addresses both immediate and long term goals?
4. How can his parents assist him with this issue?
5. How can his future kindergarten teacher assist him with this issue?

Why is Michael unable to make friends?

Michael’s parents have disclosed that he is an only child who doesn’t play with neighborhood children. He has been exposed to occasional play dates but is unable to effectively communicate with the other children during these times, so his parents rarely set them up now. They have also not enrolled him in school due to this issue. After considering these factors, my initial hypothesis is that Michael may be too isolated and therefore he lacks the level of social interaction that is needed to successfully develop this skill in a healthy manner.

How might his disabilities be interfering with social development?

Michael may also find it difficult to make friends or interact socially due to lack of proper communication. Since, he is hearing impaired and suffers with a speech disorder, it will be very difficult for him, to understand or comprehend his peers. He may also experience a certain level of ridicule and/or rejection by other children due to these factors.

How can I assist him with a plan that addresses both immediate and long term goals?

Early Intervention is the first key factor in order to properly diagnose and assess a child’s existing physical, cognitive and language skills. This can also make a huge difference when it comes to the child’s future overall level of physical and psychological development. Therefore, based on my diagnostic results, I will begin assisting Michael by enrolling him in a regular weekly play therapy group with other children who have exceptional needs. This is because I’m confident that this will build his short and long term level of social skills by offering four major advantages. These are as follows:

1. He will get to interact with other children who have hearing loss and/or speech disorder.
2. The learning environment is specifically designed to aide and assist hearing impaired children.
3. Child Development Specialists will have the opportunity to teach Michael communication techniques, like sign language and lip reading.
4. I will also ensure that bi-weekly reports are provided to both the parents and future teacher. 

How can his parents assist him with this issue?

Since, his parents want to offer the best possible opportunity to develop adequate social skills he will need a way to properly communicate. Therefore, I will highly recommend that they take Michael to a hearing specialist so he can acquire hearing aids. This is because these tools may amplify any hearing that he currently still has while also offering a new and exciting experience! 

Along with this, I will also recommend that both parents enroll in a sign language class because it may give all family members an easier way to communicate. One other valuable strategy that I will implement is to recommend that his parents become involved with Michael’s future Kindergarten Teacher before he begins school. This is because previous research has shown that exceptional needs children seem to improve when they experience a thriving social structure of positive support and growth.

How can his future kindergarten teacher assist him with this issue?

According to (Hunt, Marshall, 2005), [in the past, the diverse educational needs of children with physical disabilities and health impairments often kept them away from public education. Today’s teachers need to know, however, that in most cases, these children can be part of the regular class with accommodations and support] (p. 449). There are also strategies which can be used in order to offer these children normal educational opportunities and development in reading, writing, and thinking skills. Specific strategies may also include federal requirements which must be followed when assisting children with exceptional physical and/or psychological needs. Some of these strategies include:

1. Educational Planning - It is a teacher’s responsibility and federal requirement to ensure that yearly assessments of these children are conducted. This ensures that the children will receive the individual services which are needed. This not only includes children who have current disabilities upon initial enrollment, but also those who show signs of disabilities at a later stage.

2. Accessing Instruction - In 1990, the federal government enacted the Americans with Disabilities Act. This ensures that all of these children have access to public facilities (bathroom) and buildings (school). This act also requires proper placement of equipment and/or furniture within the classroom setting. Not only does this act ensure proper access, but it also requires teachers to provide physical support to children who have exceptional needs. This can include offering help with breathing equipment, feeding and physical movement of the child. This process is also known as physical handling and health maintenance.

3. Integrating Technology - This involves continuous evaluation and/or assessment of a child in order to offer the most appropriate medical and/or educational service/s. These educational services are also most commonly known as assistive technology or special education classes.

Conclusion

My 5 year old client named Michael suffers from hearing loss along with a speech disorder which he is receiving current therapy for. Although, he still has an issue with premature social skills and his parents have requested that I design an intervention plan which will offer positive growth within this area of his development. Therefore, this plan will be accomplished by concentration within five specific areas. These include questioning and addressing why Michael is currently unable to make friends, how his disabilities are interfering with social development, what I can do that addresses long and short term goals for improvement, how his parents can help and what services his future kindergarten teacher can provide. I am also confident that if we work together as a collaborative team to accomplish the goals which are set forth in this plan, than Michaels’s level of social maturity and/or skill should begin to increase at a dramatic level.

References:

Hunt, N., & Marshall, K. (2005). Exceptional children and youth (4th ed.). Belmont, CA:

Wadsworth.

Kaplan University (2011). Unit 1. Key Concepts. Retrieved on March 3 2011 via the Kaplan Online Campus at http://content-asc.kaplan.edu.edgesuite.net/

ADDRESSING APPLIED BEHAVIORAL ANALYSIS (EXAMPLE CASE STUDIES OF BOBBY, JACKIE & EMMA)

     Human behavior is something that an Applied Behavioral Analysis (ABA) Specialist or other professional may want to change because certain aspects are considered undesirable within normal society. Changing undesirable behaviors through ABA is also used in several situations that can include individual or group settings. Some examples of where this may apply are within a single home environment, school system, public agency, prison, or rehabilitation center. Therefore, my goal for this paper will be to review 3 individual case studies, by examining different components that are associated with of ABA. These are also as follows: 

• Case 1 involves Bobby and I will discuss Target Behavior, Operant Conditioning, Positive Reinforcement, and Schedules of Reinforcement.
• Case 2 involves Jackie and I will discuss Behavioral Theory and Selected Modification Program.
• Case 3 involves Emma and I will discuss Principles of Operant Conditioning, Application of that Theory, and Extinction.

The reason that different areas of applied behavior analysis will be addressed is also because behavior modification processes and/or techniques are usually determined, based on each individual case.

Case 1: Bobby

     Bobby Kelly’s bedroom is always unorganized and extremely messy. His father would like to create a process which encourages Bobby, to clean his room on a regular basis. In the next two sections, I will identify the target behavior and recommend a modification program which may initiate his father’s desired behavior.

Identify the Target Behavior

According to (Cooper, Heron, Heward, 2007), “a good definition of a target behavior provides an accurate, complete, and concise description of the behavior to be changed (and therefore measured)” (p. 67). After reviewing the above case, the target behavior is that Bobby’s bedroom is always unorganized and extremely messy. This behavior is causing his father emotional stress, so he would like to modify or improve this situation as soon as possible. Therefore, I will design a modification plan using operant conditioning. This process may then offer the positive desired behavior (cleans room frequently) that his father wants.

Definition of Operant Conditioning

According to (Cooper, Heron, Heward, 2007), “operant conditioning refers to the process and selective effects of consequences on behavior” (p. 33). This method works to increase desired behavior by implementing stimulus changes which may initiate a positive and/or desired response. One example is if Bobby started to clean his room because he just got a new game and needed floor space.

Definition of Positive Reinforcement

Most of the time, applied behavioral analysts will use continuous reinforcement during the first stages of behavior modification. Positive reinforcement occurs when a desired response occurs shortly after a specific stimulus is introduced. There can also be certain issues involved when selecting appropriate and effective reinforcements. Two of these might include the motivational level of each participant and ensuring age appropriate reinforcers. One example of an inappropriate reinforcement would be giving a baby rattle to a teenager like Bobby as reward.

Two Possible Schedules of Reinforcement

According to (Cooper, Heron, Heward, 2007), “a schedule of reinforcement is a rule that describes a contingency of reinforcement, those environmental arrangements that determine conditions by which behaviors will produce reinforcement” (p. 305). Two possible schedules of reinforcement along with the case implementation, advantages, and disadvantages are as follows:

1. Fixed Schedule - When using this reinforcement technique, the time requirement will always remain constant and/or the same. This schedule of reinforcement process could be implemented as a way to acquire the desired behavior for the above case (cleans room frequently). I would implement this process by telling Bobby that he will get $5.00 for each night his room is cleaned by 7:00 pm. Two advantages of this process are that it can produce faster rates of desired response and maximize the delivery rate of the selected reinforcement. Two possible disadvantages are that if ratio requirements become too large then the rate of response may decrease and this can also produce postreinforcement pause.

2. Variable Schedule - This requires a varying and undisclosed number of responses before the participant will receive a desired reinforcement. This process could also be implemented as a way to acquire the desired behavior for the above case (cleans room

regularly). I would implement this process by telling Bobby that if he cleaned his room on a regular basis, then “on occasion he would get $20.00 to go to the mall. Two advantages of this process are that it can produce a steady rate of response and does not produce postreinforcement pause. One disadvantage is that it’s rarely implemented with any type of planned or systematic approach.

Case 2: Jackie

     Jackie acquired a fear of dogs after being bit at 3 years of age. The injury also required several stitches. It has been twenty years since this incident but Jackie still remembers every detail of the event. The trauma associated with this incident has caused severe psychological distress to the point that she cannot be around or even see a dog. If this does occur, she suddenly experiences heart palpitations and nausea. Since the initial incident she has spent her life simply avoiding dogs but will soon marry a breeder. Jackie has come to seek assistance for this fear before her marriage takes place in 6 months.

Selected Behavioral Theory

ABA professionals normally use certain principles when attempting to modify socially significant behavior that is causing extreme distress within the client’s life. There are also several theories which may be used in order to determine behavior and what modification program may work best to alter these. One specific theory that could explain why Jackie has carried this lifelong fear of dogs is due to negative reinforcement. Negative reinforcement can be defined as a termination or removal of a certain stimulus which may lead to a specific response. This can occur if one wishes to change what he or she may personally or socially view as undesirable behavior. In this case, Jackie views dogs as the stimulus that will cause a painful undesired response (biting injury).

Selected Behavior Modification Program

According to (Cooper, Heron, Heward), “applied behavioral analysts use continuous reinforcement during the initial stages of learning and for strengthening behavior” (p. 323). One particular modification process which I would use to help Jackie is called classical conditioning.

The principles of this theory are often used to treat people who suffer from fears and/or phobias. I would perform this process by advising Jackie to meet a dog while offering it a steak bone. I would also train the dog to lick Jackie after the steak bone was received. I would then repeat this process at least 3 times a week until the dog became familiar and/or friendly with Jackie. Over time, the dog would teach Jackie that they are not all going to cause her a severe bite injury.

Case 3: Emma

     A 4 year old named Emma refuses to clean her room even if offered a reward or receiving time out. When it is time to clean up, Emma simply shows anger and throws a temper tantrum. These outbursts include screaming, yelling and throwing toys. On several occasions, her parents have picked her up during these outbursts and choose to clean the room themselves.

Identified Principles of Operant Conditioning

The underlying principles of operant conditioning that may be causing Emma's behavior are that her parents pick up her when she is throwing a tantrum and they clean the room themselves. This has taught Emma that if she exhibits this behavior then she will be rewarded with love and won’t have to clean her room because the parents will do it.

Application of Operant Conditioning Theory 

 I could also apply the operant conditioning theory to create a behavior modification program which may change Emma's undesirable behavior. This would involve a process which replaces the parent’s actions of picking her up and cleaning the room by themselves. One example could be to tell her that it is okay and they will pick her up when the room is clean. They could also praise her during every step of the cleaning process while she completes this task on her own. 

Extinction

According to (Cooper, Heron, Heward), “a procedure occurs when reinforcement of a previously reinforced behavior is discontinued; as a result, the frequency of that behavior decreases in the future” (p. 457). In applied behavioral analysis, this is known as extinction. Certain procedures for extinction can also be identified in three distinct forms which are linked to behavior and they are maintained by positive reinforcement, negative reinforcement and automatic reinforcement. The concept of extinction could be applied in this case which involves Emma if the parents refuse to pick her up or clean the room.

Conclusion

     After reviewing different procedures which can be used in applied behavioral analysis to address human behavior, it does appear that some of these can be valuable modification techniques. Deciding which procedure to use will also be based on each individual case. Undesirable behaviors which were addressed in the 3 cases that I reviewed were refusal to clean a room on a regular basis, fearing dogs and throwing temper tantrums when asked to clean a room. The behavior modification procedures that I chose to implement for these cases are operant conditioning, and classical conditioning. These chosen procedures would also be used in an effort to improve individual behaviors versus those within a group setting.

Reference:

Cooper, J. O., Heron, T. E., Heward, W. L. (2007). Applied Behavior Analysis (2^nd ed). New Jersey: The Lehigh Press, Inc.

UNDERSTANDING “THE STRANGE SITUATION" (An exploration of mother & infant attachment)

For many years, researchers have conducted experiments to explore different aspects of infant and mother attachment. One specific experiment that addressed this topic was called The Strange Situation and it was first introduced by a developmental psychologist named M.S. Ainsworth. According to (Mcleod. 2008), the purpose for her work was to “observe the variety of attachment forms exhibited between mothers and infants” (p. 32). This is because she wanted to confirm that different variations of attachment do exist and therefore, the levels and forms between all mothers and their children are not equal.
One specific article that also explored this particular experiment in further detail was called “Attachment, exploration, and separation: Illustrated by the behavior of one-year olds in a strange situation” by M.S. Ainsworth and S.M. Bell. According to the reading, this experiment involved several features that were implemented, in an effort to measure different ways in which attachment between infants and their mothers may be formed. Therefore, the overall purpose of this review is to first provide a summary of these specific features. I will then discuss some of the main points that the authors made about the overall experiment and whether or not I agree with their particular views. Finally, I will discuss different techniques that may be used in order to ensure that children develop healthy attachment with their individual caregivers.

FEATURES THAT WERE USED IN THE STRANGE SITUATION

In an attempt to measure varying levels of attachment between infants and their mothers, researchers chose to use a longitudinal naturalistic investigation via behavioral observation.

METHOD

Subjects included 56 white family-reared infants from a middle-class setting, one sub sample consisting of 23 infants who had been longitudinally researched from birth and were 51 weeks old at the time of the study, along with a second subsample that included 33 independent project infants who were 49 weeks of age.

PROCEDURE

An experiment room was designed so the infants would have an opportunity to exhibit exploratory behaviors in a strange environment but not to the level that it would invoke fear or attachment behavior from the very beginning. These behaviors were observed from an adjoining room through a one-way vision window. Two other instruments that were used to measure and/or record these behaviors were a tape recorder and hand written notes. In total there were eight episodes used to initiate these behaviors, with the first one being the least disturbing for the infants. Other than episode 1 with the initial introduction, each lasted 3 minutes in duration. Researchers also tried to ensure that none of these episodes would be more emotionally disturbing than normal experiences that infants may face each day. A brief summary of all eight of these episodes has also been provided below:

Episode 1 – The parent and infant were both introduced to the experimental room by the observer.

Episode 2 – The parent and infant remained alone in the room. During this time, the parent did not interact while the infant explored the room.

Episode 3 – The stranger entered the room and talked to the parent. She then approached the infant, while the parent left the room inconspicuously.

Episode 4 – This was the first separation episode. Therefore, the stranger closely observed the infants behavior during this time.

Episode 5 – The mother and infant reunited. She greeted and comforted the infant for a minute, and then left again.

Episode 6 – This was the second separation episode, during which time, the infant was left alone.

Episode 7 – This was a continuation of the second separation. The stranger also entered the room and closely observed the infants behavior. 

Episode 8 – This was the second reunion episode. The mother entered the room to greet and comfort the infant, while the stranger left inconspicuously.

MAIN POINTS THE AUTHORS MADE CONCERNING ATTACHMENT

According to the authors, during these episodes, there were also four aspects of behavior that were observed. These were the level of exploration that the infants engaged in, their reactions to the caregiver’s departure, the level of anxiety when being left with a stranger and how they acted when the caregiver returned. The results indicated that there were several different levels and/or forms of attachment that may occur. For instance, the infant’s did not exhibit attachment while their mothers were present and therefore, chose exploratory behavior of the novel. However, the infant’s did appear to exhibit heightened attachment during their mother’s absence and did not choose exploratory behavior of the novel. One other thing that was observed is that the infant’s exhibited a heightened level of attachment, due to being alarmed when left alone with a stranger. After reviewing all of the data which was acquired, the authors also made several main points about the conclusion of this experiment. Some of these are as follows:

1. Attachment is not simply a coincidence and it is determined based on conditions.

2. Attachment can be heightened if the infant feels threatened by the condition.

3. When heightened attachment occurs it is not compatible with exploratory behavior.

4. Attachment may be reduced but will heighten again when reuniting with the caretaker.

5. Attachment levels may also be based on individual differences between each attached pair.

DO I AGREE OR DISAGREE WITH THESE MAIN POINTS?

When considering the main points that were made by the authors, I agree with their conclusions. This is because most children do seem to show heightened levels of attachment when exposed to a strange situation and/or person. I think that this is because most infants become reliant on their caregivers continuous presence, while also offering them a safe and familiar environment. If this normal routine is altered by a caregiver’s absence, new environment or the presence of a stranger, then they may show signs of insecurity and therefore, have difficulty with exploration. One other thing that could also affect attachment is that all mothers and children are unique when it comes to individual levels of emotion. These differences could be a direct reflection of many factors which may include biology, and varying home and/or social environments. Since this may be the case, there are also several techniques that can be used to help children develop a healthy level of attachment toward their caretakers.

TECHNIQUES THAT MAY HELP CHILDREN DEVELOP HEALTHY ATTACHMENT

One specific technique that can foster healthy attachment is to remember that it is important to comfort a child when he or she wants to explore the world around them. This will also teach the child that it is okay to exhibit exploratory behavior, because the caretaker is there to offer moral support. Although, this is true, the caretaker should also set boundaries and/or limits for the level of support that will be offered. This can help ensure that the child will continue to develop independence through exploratory behavior and not become totally reliant on the caretaker. A second technique that can be implemented to foster healthy attachment is to learn what developmental milestones a growing child should be accomplishing. This information can help a caretaker determine what conditions and/or other experiences might be acceptable for the child. This means, that if a child chooses to exhibit exploratory behavior, then the condition will be age appropriate and less likely to cause heightened attachment due to fear and/or alarm.   

CONCLUSION

As previously discussed, there are several experiments that have been conducted to measure different aspects of attachment between mothers and their children. One specific experiment that was conducted to address this issue was called "The Strange Situation". Some researchers also believed that in order to measure valid measurements, they would need to conduct this experiment within a laboratory setting, versus that of a home environment. One of the main goals of this experiment was to confirm that different levels of attachment do exist and that these can occur based on different conditions. The researchers measured higher levels of attachment in the infants, when their mothers were absent and when left in the care of strangers. The infants also showed little interest in exploring the novel during these moments. 
Therefore, the results support the idea that infants do form varying levels of attachment to their mothers, when exposed to conditions like novelty and alarm. Furthermore, the overall purpose of this review was to provide a summary of this experiment by discussing the features, main points that were made by the authors, and whether or not I agree with their particular views. Finally, I also discussed specific techniques that may be used to ensure that children develop healthy attachment with their individual caregivers.

References:

Ainsworth, M. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year olds in a strange situation. Child Development, 41(1), 49-67. Retrieved on May 4 2012 via the Kaplan Library at

http://web.ebscohost.com.lib.kaplan.edu/ehost/detail?sid=111b4dce-10f2-41cd-9a76-dde59cda38e3%40sessionmgr15&vid=1&hid=12&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=tfh&AN=10398269

McLeod, S. (2008). Simply Psychology: Strange Situation. Retrieved on May 5 2012 via the World Wide Web at http://www.simplypsychology.org/mary-ainsworth.html 

HOW TO CONDUCT A NEUROLOGICAL ASSESSMENT (THE EXAMPLE CASE OF MARY)

A 17-year-old female named Mary has been referred to my office. She attends Latina High School and has always been popular with other kids, while also performing in the top of her class. One day during a social event with friends, they dared her to jump in a pool from a 2^nd story balcony. When she attempted to complete this dare, she lost her footing and ended up hitting her head on the side of the pool. Friends had to jump in and save her because she was unconscious and she was then rushed to a hospital where ICU and PET scans were given. The results indicated that she had obtained bruising and hemorrhaging in the tissues around her frontal lobes. The medical staff suspected that she may also have further injury and placed her on life support in ICU as a precautionary measure.

After approximately 2 hours, she awoke and started moaning incoherently, along with moving around the room in a restless manner, so she was examined by a neurologist. The results indicated that she could respond to strongly presented verbal and tactile stimuli on a normal cognitive level. Later that evening her overall level of responsiveness seemed to improve and by the next morning, she was able to recognize her parents along with express weak verbal communication. Mary then spent a week in the hospital where she was also scheduled for a 2^nd neurological follow-up that would occur one week from the time she was released. While, at home she seemed to recover with little to no obvious problems and was also cleared after returning for her neurological follow-up.

However, when Mary returned to school, she started experiencing issues with concentration, not being able to take notes as fast as she once could and remembering what her teacher said. She also stated that she was unable to complete an English assignment as fast as the other kids and felt extremely worn out by the end of the day. Since all of these issues had occurred, Mary said that she didn’t want to return to school, so her parents asked the hospital to offer further testing and assessment. The hospital then referred the family to my office. Therefore, in order to best assist Mary, I will need to determine which neurological testing and assessment methods may work best to identify any current cognitive deficits that she may be experiencing due to a TBI, followed by any recommendations for rehabilitation and prognosis of expected recovery.

Testing & Assessment

Normally, it’s best to complete a neurological assessment after a head injury because the scores can measure any cognitive and/or behavior deficits that may have occurred due to traumatic brain damage. When this occurs, the severity can range from having no observable injury with no sequelae, a mild TBI which is 20 minutes or less of unconsciousness, and moderate to severe TBI which may include post-concussional amnesia, along with an observable head or brain injury. When the latter occurs, a long-term course of recovery and rehabilitation will be required. Diagnosing and assessing the level of Mary’s possible TBI may also be difficult because it is depends on coup and contrecoup blows, along with unseen damage that can occur from diffuse axonal shearing.

Since, diagnosis and assessment may be difficult, it is important to choose which tools might work the best for each individual patient. There are also many techniques that can be used from the initial point of unconsciousness or coma until well beyond the time that the injury occurred. For example, one specific test that may have been used by the hospital staff to measure Mary’s initial level of unconsciousness is as follows:

Glascow Coma Scale – According to (Lezak, Howieson & Loring. 2004) this “can be used to describe all posttraumatic states of altered consciousness from the mildest confusional state to deep coma” (p. 719). In Mary’s case, she may have been scored based on whether she could do things like open her eyes, use comprehensible speech and obey commands that were given by hospital staff and family members. One major benefit of this technique is that it could have also been repeated during the early post-trauma period, to determine if there was any improvement in function when compared to her initial score. Since, she did awake after two hours in ICU that would have also been a good time to repeat this test and acquire new scores.

When completing a neuropsychological assessment, there are also several other techniques that I could use to measure Mary’s overall level of cognitive functions. Some of these functions may include working memory, attention, concentration, previous and current premorbid intelligence, achievement and cognitive speed. Specific tests that could also be used are as follows:

Trail Making Test A & B – This can be used to assess Mary’s level of scanning and visuomotor tracking, cognitive flexibility and divided attention. When administered to assess working memory and attention, it will be distributed in two separate parts which are identified as A and B. Part A will require Mary to first draw lines that connect consecutively numbered circles on a work sheet and Part B will require her to connect the same number of these circles on a different worksheet, while alternating between the two sequences. Mary will also be advised to connect these circles as fast as she can without lifting her pencil from the worksheet.

PASAT – This can also be used to assess Mary’s level of working memory and attention but overall, this test is very difficult. Therefore, I don’t believe that this is the best method for Mary because she may show invalid deficits with her working memory and attention due to possible lack of comprehension for difficult tasks.

STROOP – This can also be used to assess Mary’s working memory and attention along with performance of response inhibition, response conflict, and/or selective attention. Since, these additional functions can be measured the scores will also identify Mary’s overall level of concentration effectiveness.

Digit Symbol – This test is a symbol substitution task which can also be used to measure Mary’s current level of working memory and attention. I could acquire scores by asking Mary to fill in each blank space with whichever symbol might be paired with the number. Mary would also be advised to complete this process as fast and as accurately as possible. I would then determine her score based on how many squares she filled in correctly.

WRAT-READ – I could use this test in combination with previous school records and No-Child Left Behind Tests to measure Mary’s overall level of achievement. This is because according to (Lezak, Howieson & Loring. 2004), it provides “a better estimate of the lower ranges of the VSIQ” so it is more applicable to individuals who are at a higher risk of TBI” (p. 93).

NAART – Once, initial estimates of Mary’s pre-morbid level of intelligence is obtained by previous school and no child left behind records, I could then acquire comparable data by using The North American Adult Reading Test (NAART) which is also designed to estimate verbal intellectual ability. This is important because since Mary was in the top percentage of her class, the scores may determine whether she has reduced intellect and/or whether she is ready to re-enter school.

However, one major limitation is that it may need to be combined with other methods in order to measure more accurate estimates of verbal intellectual ability and/or premorbid abilities. Since this is the case and Mary is Latino, one alternative method that could be used is known as the American National Reading Test (ANART). This is more suited for ethnical diversity within the US and it also enhances pre-morbid estimates for verbal testing when compared to the NAART.  

WAIS-IV – I could also use the Wechsler Adult Intelligence Scale IV, to measure Mary’s overall level of intelligence. When using this test, I will acquire measurements via four index scores that represent major components, along with two broad scores. These are as follows:

1. Full Scale IQ (FSIQ) – This is a score that will identify Mary’s total performance of VCI, PRI, WMI, and PSI.

2. General Ability Index (GAI) – This is the score of six subtests which are included in the VCI and PRI. There are also 10 subtests within each of the four components and five supplemental subtests that can be measured, if needed. The four components are as follows:

1. Verbal Comprehension Index (VCI)

This includes: Similarities (subtest) - abstract verbal reasoning, Vocabulary (subtest) - learned, comprehension and verbal expression, Information (subtest) - general information that is acquired from culture, and Comprehension (supplemental) - abstract social conventions, rules and expressions. These scores will identify the overall cognitive degree of verbal comprehension that Mary is exhibiting.

2. Perceptual Reasoning Index (PRI)

This includes: Block Design (subtest) - spatial perception, problem solving, and visual abstract processing, Matrix Reasoning (subtest) - spatial/inductive reasoning, nonverbal abstract problem solving, Visual Puzzles (subtest) - spatial reasoning only, Picture Completion (supplemental) -how quickly one perceives visual details, and Figure Weights (supplemental) -analogical/quantitative reasoning. These scores will identify the overall cognitive degree of perceptual reasoning that Mary is exhibiting.

3. Working Memory Index (WMI)

This includes: Digit Span (subtest) - mental control, concentration and attention, Arithmetic (subtest) - concentration when manipulating mathematical problems, and Letter-Number Sequencing (supplemental) - attention, mental control and concentration. These scores will identify the overall cognitive degree of working memory that Mary has.

4. Processing Speed Index (PSI)

This includes: Symbol Search (subtest) - visual perception, visual analysis and scanning speed, Coding (subtest) - visual/motor coordination, motor/mental speed and visual working memory, and Cancellation (supplemental) - visual and perceptual speed. These scores will identify the overall cognitive degree of processing speed that Mary currently has.

Recommendations

Regardless, of which test method/s may be used, I believe that Mary will show some type of cognitive deficit within certain areas due TBI. This is because she is currently experiencing issues with remembering, concentration, not being able to take notes or complete an English assignment as fast as she once could, and fatigue at the end of the day. In general, it can also be difficult to offer rehabilitation for patients that experience cognitive deficits after TBI. However, in some cases, the patient may re-gain some or most of this lost ability when treated with a combination of medication and rehabilitation. Therefore, if assessment scores determine that Mary has reduced functioning with working memory, attention, concentration, previous and current premorbid intelligence, achievement and/or cognitive speed, along with fatigue, I will make the following recommendations: 

Working Memory - I would teach Mary ways to compensate for any existing memory problems and prescribe a medication that is used for Alzheimer’s to try and increase her current level.

Attention - I would recommend a modification to her classroom so there is less distraction when she is trying to learn or hear the teacher and request that her teacher offers friendly reminders. One other thing that I would do is refer Mary for special assistance classes in English. This way, she would have a less distracting environment in the subject that she is struggling in. This may also build an increased level of overall intelligence and achievement because she will get the additional academic services that are medically needed. If these things do not work over time to improve Mary’s level of attention, I would then prescribe medication that can improve attention.

Fatigue - Since, Mary is experiencing an issue with fatigue or low arousal, and cognitive speed, I would advise her to get plenty of sleep at night, increase her level of physical stimulation with light exercise, and prescribe a low dose stimulant medication. This way, it may increase her level of arousal and the rate at which she is currently able to complete assignments.

Prognosis

If it is confirmed that Mary is suffering from cognitive deficits due to TBI, it is difficult to predict what her long-term condition might be. However, since she initially awoke in the hospital after only 2 hours of unconsciousness and was able to verbally speak and follow commands, she may have a much easier time gaining back some or all of the cognitive abilities that have been lost. One other major advantage is that Mary is only 17 years of age. This is because when TBI occurs, it is often easier to heal and recovery when the patient is younger and in excellent health. Therefore, I am confident that Mary will do well, if she follows all recommendations on a regular basis, and has a good support system among family members, health professionals, and school staff.

Summary

A 17-year-old named Mary was referred to my office after suffering from an open head injury while jumping in a pool. Immediately, after the incident, Mary received ICU and PET scans that indicated that she had obtained bruising and hemorrhaging in the tissues around her frontal lobes. Since, this occurred she was also examined by a neurologist while in the hospital. The results indicated that she could respond to strongly presented verbal/tactile stimuli and she seemed to improve greatly during her week-long stay.

After returning home for two weeks, she also seemed to recover fully with little to no obvious problems, until going back to school. This is because after the first day, she told her parents that she couldn’t concentrate, take notes as fast as she once could or remember what her teacher said. She also stated that she was unable to complete an English assignment as fast as the other kids and felt extremely worn out by the end of the day. Since these issues occurred, Mary said that she did not want to return to school, so her parents asked the hospital to have her set up for further testing and assessment. After addressing several tests that may be used to assess Mary’s current level of cognitive deficit and possible TBI, I also discussed specific recommendations for rehabilitation and prognosis of expected recovery.

Reference:

Lezak, M., Howieson, D., & Loring, D. (2004). Neuropsychological Assessment (4^th ed.).

Oxford: Oxford University Press.

ADDRESSING FALSE MEMORIES IN CHILDREN

For many years, addressing the topic of false memories and/or false memory syndrome in adults and children has been extremely important for several reasons. One specific reason is because there may be times when children claim to remember incidents of  certain abuse or other trauma that haven’t actually occurred, simply because they have been led to believe these memories are true. Parents or other caretakers may then press charges against the accused and legal court proceedings will take place. Therefore, according to (Fivush. 2002), “as a growing number of children are brought in to the legal system, there is increasing concern over their ability to provide credible testimony (p. 55). This concern is also crucial during court proceedings that involve child sexual abuse, because it can protect those who are accused by identifying the existence of false memories.

Since, this possible issue must be addressed in a highly professional and legal manner, researchers have also produced extensive information that supports the idea that these memories can be easily created in children and that they are way more dynamic and fluid then people may initially understand. With this possibility in mind, the following work will address how false memories may be formed in children and what this tells researchers about the nature of memory.

HOW ARE FALSE MEMORIES FORMED IN CHILDREN?

According to previous research there are several ways that false memories can be formed in children. One main cognitive reason that these memories may be created is due to decreased memory strength or source confusion. This can also occur if the child is experiencing some type of trauma or cognitive deficit. Although, this can occur a second main reason that a child may recall this type of memory is due to experiencing accidental or unintentional coaching. This can occur when the child may hear things about an event that are untrue, but will choose to believe that the information is factual. 

One example of this is if a young boy over hears his sister talking about details concerning her sexual abuse. He may then process the details of this abuse as real memories that also affected him. Furthermore, a third reason that false memories may occur is due to intentional coaching. This can occur when others try to convince the child that certain memories exist when they are actually invented for some other purpose. According to (Leding. 2012), “within a variety of false memory paradigms, including the misinformation effect, the imagination inflation paradigm, and false confession research, persuasion strategies help create and strengthen false memories” (p. 256). Therefore, the author believed that even though false memories may be created without persuasion strategies, most will occur due to factors like investigators that ask leading questions or interrogators that try to elicit what they want to hear. 

One other article that supported the idea that children may be intentionally coached into reporting false memories is based on how they are questioned in the courtroom. According to (Lyon, Scurich, Choi, Handmaker, & Blank. 2011), “in child sexual abuse cases, the victim’s testimony is essential, because the victim and the perpetrator tend to be the only eyewitnesses to the crime. A potentially important component of an abuse report is the child’s subjective reactions to the abuse. Attorneys may ask suggestive questions or avoid questioning children about their reactions, assuming that children, given their immaturity and reluctance, are incapable of articulation” (p. 448). 

In order to provide evidence that supports this belief, two studies were conducted to compare how children provide evaluative content, which included descriptions of emotion, physical reactions and cognitive recall, in reply to different question-types. These types included “How” questions, “Wh” questions, “Option-Posing” questions and “Suggestive” questions. The results indicated that “How” questions seemed to more productive in acquiring a higher level of factual evaluative content. Since, this occurred the authors also suggested that interviewers and attorneys should always ask “How” questions when they want to elicit evaluative reactions that may be more valid and substantial to the case. Therefore, it is important to ensure that children are questioned about the abuse in a way that it won’t be leading or support persuasion strategies that direct or suggestive questions may initiate. This way, the child may also have an easier time reporting real memories versus those that are created based on what they think the interviewers and attorneys want to hear.  

WHAT DOES THIS TELL RESEARCHERS ABOUT THE NATURE OF MEMORY?

After learning that false memories may occur accidentally or through unintentional and intentional coaching, this can offer researchers further theories about the nature of memory. One major idea that this may create is that some portions of memory can always be distorted and influenced by new information. This influence and/or information can also come from opinions that are shared by external factors, such as authority figures, respected family members, or cultural beliefs and it cannot be avoided.

Since this is the case, this could also provide further evidence which supports something known as the Interference Theory. According to (Anderson. 2010), this theory suggests that “forgetting is caused by other memories interfering with the retention of the target memory” (p. 181). Therefore, when children are unintentionally or intentionally manipulated in to believing and processing memories of sexual abuse, this may also cause extinction of previous memory which proves the new information is false and there was no sexual abuse.

SUMMARY

For many years, researchers have been addressing the topic of false memories which is also known as false memory syndrome. Since, this can occur in both adults and children the need to understand the true cause is extremely important for many reasons. One major reason is because there may be occasions when children claim to remember incidents of sexual abuse that never actually occurred simply because they were led or manipulated by others. Parents or other caretakers will then press charges against the accused and legal court proceedings will follow. When these proceedings occur, there may also be concern about the credibility of the child’s testimony because these memories may have been formed due to coaching of some type. This concern is also warranted because the legal outcome can drastically impact the lives of the child, family members, and the accused. 

Since, the issue of false memories must be addressed in a highly professional and legal manner; researchers have also produced extensive information that may support the idea that these memories can be easily created. This is especially true for children because they are more impressionable toward certain external factors and may be easily influenced. Therefore, certain research studies have provided evidence that the procession of false memories may be way more dynamic and fluid then initially suspected. Since, this might be the case the following work also addressed different ways that false memories might be formed in children. Some ways include accidental formation along with unintentional and intentional coaching via certain persuasion strategies. Furthermore, since false memories may occur through these factors, it also tells researchers that the nature of memory can always be manipulated or distorted by incoming information and during the procession of overall short/long-term memory in children.

References:

Wiley, J. (2002). Children's Testimony: A Handbook of Psychological Research and Forensic Practice. Wiley Series in the Psychology of Crime, Policing, and Law. Retrieved via the Kaplan Library at http://ehis.ebscohost.com.lib.kaplan.edu/ehost/ebookviewer/ebook/nlebk_90301_AN?sid=62e8ffef-b47b-456a-a411-f22391d7dbaf@sessionmgr113&vid=1

Leding, K. J. (2012). False Memories and Persuasion Strategies. American Psychological Association (2012). Retrieved via the Kaplan Library at http://ehis.ebscohost.com.lib.kaplan.edu/ehost/pdfviewer/pdfviewer?sid=3353605f-3026-450a-a68f-252bf0054c1d%40sessionmgr114&vid=2&hid=114

Anderson, R. J. (2010). Cognitive Psychology and Its Implications (7th Edition). Worth Publishers. New York, NY. 

Lyo, D. T., Scurick, N., Choi, K., Handmaker, S., Blank, R (2011). “How Did You Feel?”: Increasing Child Sexual Abuse Witnesses’ Production of Evaluative Information. American Psychological Association (2012). Retrieved via the Kaplan Library at  http://ehis.ebscohost.com.lib.kaplan.edu/ehost/pdfviewer/pdfviewer?sid=f2975da5-d370-4936-b644-b7303b61377a%40sessionmgr115&vid=2&hid=116