23 Mar 2015
For this assignment I aim to focus on the importance of lifespan development theory when appreciating the effects of hearing impairment on an individual. I aim to concentrate on the lifespan development of a child in its infancy stage (0-2 years).
Human development or also known as the developmental psychology is the study of systematic emotional changes, psychological changes and social changes that occur throughout an individual's life span. The study analyses the individual's physical development, cognitive development which involves learning, interaction and problem solving and emotional and intellectual development. By evaluating human development it is effortless to understand the changing or arrangement of beliefs, worry, desires and skills that occur at different periods of the life cycle (Mussen et al., 1974).
Hearing is now clearly identified as being crucial to early communication, speech and language development and active learning. Children with hearing impairment may therefore lag behind in communication skills, intellectual achievement and social performance. Therefore as a healthcare professional it is valuable to appreciate the different stages of lifespan development when trying to understand the individual's awareness and behaviour. The earlier the hearing impairment is recognized and treated the smaller the severity of the impact on the development of the child (ASHA, 2012).
In order to respect patient confidentiality I will use the name Ellie for my case scenario. Ellie is a 1 and a half year old girl who attended the appointment for a hearing test with her mum and her four siblings. Ellie is part of a big family of seven and Ellie's mother is a very heavy smoker and smoked all through her pregnancy with Ellie. Her mother reports that Ellie is quite an aggressive girl and doesn't attempt to socialise with her siblings and other children her age. In addition, she reports that Ellie doesn't pay attention to her when given requests or instructions. Ellie passed her new-born hearing screening, however after great encouragement from us Audiologist VRA (visual reinforcement audiometry) and tympanometry was performed revealing that Ellie has a moderate flat conductive hearing loss. Due to concerns of Ellie's lack of speech and language development and behaviour problems, valuable information about grommets or a hearing aid was supplied to the mother. However, Ellie's mother was in disagreement about any of these options. Therefore Ellie was given a follow up appointment to see how she is getting on.
I have chosen this case I will be able to truly see how hearing impairment affects the physical, social and cognitive development of an infant.
In order to assess an infant's condition immediately after birth it has now become essential to perform a quick test such as an APGAR test devised by Virginia Apgar in 1953 (MedlinePlus, 2009). This assessment is taken place instantly on the new-born to detect how well the heart is beating, their colour, respiratory rate, general response to stimulation and their muscle tone. The new-borns are then given an Apgar score which is rated out of 10, with a score above 7 meaning the new-born is in no danger, and a score of 4-6 meaning the new-born has some difficulty breathing and may have possible long term risks. However with an Apgar score of less than 3 the new-born is said to be in a critical condition and requires immediate special support or treatment (Bee and Boyd, 2007). From the gathered history taken from Ellie's mother, Ellie underwent a normal birth with no significant abnormalities occurring therefore Ellie must have been given an Apgar score of above seven.
According to Arnold Gesell children develop at different rates, however their patterns of development are all constant (Mussen et al.,1974). The development of an infant can be analysed in three different ways- their physical development, social and cognitive development. Physical development is at its greatest between the ages of 0-2 years and is essential for children providing them with the abilities to seek the world around them. For the first year of a child's life the main apparent physical development is the immense growth changes that occur to the body. By the age of one the body length would have increased over a third of the original length (20 inches) and the weight would have gained approximately triple the original weight (7.5pounds). These physical developmental changes proceeds from the head downwards (Cephalocaudal) to the trunk outwards (Proximodistal) (Fitxgerald et al.,1977). Therefore by having these normative values we can tell if a child's physical development is lacking. Ellie was born as a low birth weight baby possibly as a result of the mother smoking throughout the pregnancy. Low birth weight babies like Ellie generally progress slower through the developmental stages but generally catch up in the first two years (Vasta et al., 1999). However Ellie is now one and a half and has no apparent physical developmental abnormalities.
The bones of an infant are much softer than adult's bones as a result of higher water content. These bones then harden through the developmental stages of an individual up to adolescence in a process called ossification. A new-born baby's skull has the ability to compress without damage during birth as it is separated by spaces named fontanels. By Ellie's age the fontanels would have been replete with bone developing into a singular combined skull bone (Bee and Boyd, 2004). In the first few years of an infant's life there is an accelerated growth in the human brain with the greatest development occurring in the midbrain. The cerebral cortex and the cerebrum enclose the midbrain and control the construction of language, consciousness, problem solving, thinking and learning. Thus an infant's life commences with a set of beneficial natural responses called reflexes. A reflex is an involuntary movement in response to any stimuli. According to the psychologist Jean Piaget the beginning of an infant's life is all to do with movement and so most of the infants actions are reflexive (Davenport, 1994). Most of these reflexes may be adaptive reflexes or also known as survival reflexes in which assists the infant to swallow, breath, grasp or suck involuntary. Whilst the primitive reflexes are not essential for their survival, it only gives a good suggestion of the status of the infant's neurological system. Examples may be of the Babisnki reflex (as the sole of an infant's foot is stroked the big toe enhances with the other toes spreading outwards) ; and the Moro reflex (startle reflex - extending arms and legs after loud noises). With Ellie's case these reflexes have disappeared which is normal for her age and demonstrates that there is no damage to her nervous system (Mussen et al., 1974).
Infants are born with surprisingly good set of perceptual skills and so are fully equipped to follow objects that are 12 inches away, distinguish pitch and level of sound and recognize parent's faces from others. By one month old the infants posture and large movements should be fully developed. The infant's arms would be more active than the legs, the infant will turn head away as you rub its ear, their head will descent loosely unless supported however the neck muscles will start to develop at this stage (Sheridan, 1975). During the VRA testing it is apparent that Ellie's small and large motor skills such as handling of small objects, hand-eye coordination, grasping, sitting upright and walking seem to be fully developed. However her language development was lacking which may be due to her hearing loss. Ellie's mother raised a slight concern on Ellie's ability to talk. During the appointment Ellie's speech was very difficult to understand and her sentence structures were as to be expected from a child with a hearing loss. Infant's with a hearing loss often cannot hear speech sounds and therefore misinterpret and misuse their vocabulary. Developmental problems such as speech and language may also contribute to a reduced academic achievement and social isolation from the children which can be remarkably distressing for the parents (ASHA, 2012).
Erik Erikson was the first psychologist to develop the 'psychosocial model of personality', which is the foremost known model of development and personality. He believed that development is constant throughout one's life. Erikson's model expresses how a child's social experiences influence an individual's value of self and their personality (Mcleod, 2008). Like Erik, John Bowlby (1907-1990) was another theorist concerned with child development which created the attachment theory. Bowlby suggested that an infant's personality is influenced by their childhood relationships. According to Bowlby: 'children come into the world biologically pre-programmed to form attachments with others, because this will help them to survive' (Cited from Mcleod, 2007). Children who fail to form this real attachment by around 6 months of age tend to be less sociable, less emotionally mature and more aggressive. Therefore for a positive and healthy development of a child like Ellie it is essential for a strong attachment between the infant and the primary caregiver (usually the mother). However Ellie's positive behaviour and social skills seemed to be lacking. A child similar to Ellie with a significant hearing loss may often feel isolated as they cannot communicate therefore it is vital at this stage for the mother to understand this and meet their child's needs (Shaffer, 1993). From informally assessing Ellie behaviour and her mother it is clear that this initial bonding may be absent between the two.
Vygotsky the theorist believed that a child's development associates mostly to mental development, being language, interpretation processes and thought (Cattan and Tilford, 2006). However Jean Piaget (1896-1980) concluded that a child's cognitive development is formed from a distinct series of stages. He believed that a child's cognitive development skills take place due to advancement of the brain and the child's abilities to interact with their surroundings. Piaget characterizes the development of children into four set stages with each stage symbolizing the child's appreciation of the reality and its surroundings at that stage. The first two years of an infant's development is regarded to as the sensorimotor stage. During this stage the child learns and experiences the world around them through their senses and movement. The child accomplishes an activity and by repeating this activity they are able to advance on their new knowledge and awareness (Bee and Boyd, 2004). Piaget termed the cognitive structures as schemes (set of activity, anticipations and memories that allow the child to understand their surroundings). Therefore for Ellie to keep up with her cognitive development she must have good coordination between her sensory (hearing) and motor actions (movement). Ellie's cognitive development might be underdeveloped as she receives less sensory information due to her hearing loss and therefore has less motor actions. The effect of a hearing loss on the cognitive development of a child like Ellie is rather intricate due to the different ways cultures, families and human kind respond to children whom attempts or fails to talk and communicate due to their hearing loss (Mayberry, 2002).
There are also learning theories involved in cognitive development. Ivan Pavlov devised the classically conditioned model, which is described as a learning process that takes place when an unfamiliar stimulus is presented into the system. As the new-born is repeatedly conditioned to the same stimuli (brush cheek before feeding), this stimuli will become a conditioned stimuli in the course of time. Operant conditioning is also classed as a learning process as the new-born learns and interacts through the use of reinforcement - such as a toy, smile, attention or food (Bee and Boyd, 2007). During the VRA testing, Ellie was conditioned to move her eyes in the direction of the sound source and rewarded visually by a lighted up toy ('BATOD', 2012). After great encouragement Ellie performed a positive VRA test and therefore show no signs of abnormal learning process.
Starting at the age of 1 and increasing until the age of 5, repetitive and exploratory play is very common in children. At around Ellie's age it is expected of children to be able to push and pull large toys, carry a toy, grasp crayon, enjoy coloured books and perform VRA testing. However in Ellie's case and for any child with a hearing loss these normal behaviours might be deficient or absent as hearing and speech are the vital implements to learning process, play and development of social skills (Sheridan, 1975). Hearing is essential to a child's development, 'yet children with hearing problems continue to be an under identified and undeserved population' (Cited from 'ASHA', 2012). Not only does a child's hearing loss affect the child's development it also affects the parents/primary caregivers involved inflicting feelings of anxiety on their new responsibilities for their child. Therefore it is essential to provide the parents or the primary caregivers the vital information and advice on their child's hearing loss for the child's positive development. Ellie's mum needed great encouragement on this in order to improve Ellie's self-esteem and help her to positively develop ('ASHA', 2012).
Hearing impairment has a great effect on the child's social life, cognitive and learning development. Ellie has proven to have normal physical development; however her cognitive and social development and speech and language capabilities are evidently hindered by her hearing impairment. It is therefore essential to supply the family of the child with any valuable information that will benefit the child's development and stress the importance of early intervention. The earlier the hearing impairment is recognized and intervened the greater the developmental outcome.
Without knowing the normative of a child's developmental process it is hard to analyse the exact cause of the child's behaviour. Ellie's hearing loss has evidently delayed her revealing and acceptant communication skills (speech and language) leading to her social seclusion and low self-esteem. Her aggressive behaviour and her lack of interest in others can be explained by her lack of auditory input and therefore lack of her ability to effectively communicate. It is important for Ellie's mum to appreciate the challenges that Ellie is faced before managing them properly herself. However it is also crucial to support the entire family through Ellie's developmental progress and early family concentrated intervention is advised to advance Ellie's language and cognitive development ('ASHA', 2012).
An additional appointment was made for Ellie to see if they have changed their mind regarding to trying a hearing aid, however Ellie will continue to receive advice and care from us Audiologist, a specialised paediatrician and speech and language therapist throughout. From this case study I am able to fully appreciate the effect that a hearing impairment has on the developmental process of a child. However I am also very aware for the future of the importance to support the entire family when attempting to provide the best care for a child similar to Ellie.
Why is ellie aggressive and don't socialise..can categorize them into being naughty straight away. Important that ellie gets enough attention she needs to help her develop, but important that this doesn't overurule the development of other kids. Vital to give all info need to parents and stress on the importance of early implementation - better outcome.
http://www.asha.org/About/news/Press-Releases/2011/Do-You-Understand-The-Effects-Of-Hearing-Loss-On-Your-Child-s-Development.htm - conclusion?
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