Stage One: Conception to 24 months

N.A.S is a 23 month old male who weighs approximately 28.5 pounds which, according to the text, would put him above the 50th percentile. He was born at 38 weeks via cesarean section and weighed in at just under 8 pounds. According to the mother, N.A.S was placed in the care of the Neonatal Intensive Care Unit for the first few hours due to concerns about his pallor at birth. He was subsequently released to the care of his parents and registered within normal parameters for child development until a recent visit to the doctor for an ear infection. At that time N.A.S.’s medical provider voiced concerns about possible speech delay and referred him for a hearing screening. Subsequently, N.A.S. has been diagnosed with partial hearing loss, possibly due to fluid in the inner ear. He lives with his father (who is currently deployed), his mother and a 15 year old sister. The observation took place in a naturalistic setting (the home) and lasted about 45 minutes.
Upon arrival, the sister answered the door at which time he ran into the entry way stopping upon seeing me. I would later be told by the mother that the door was decorated with bells which N.A.S. would respond to. I said “Hello” to him, received no initial response, but was greeted with a wave and a mispronounced “Hello” after turning my attention back to the sister. He was hiding behind his sister’s leg and observing me from this position but quickly warmed up to me after being greeted by his mother a moment later, even walking up to me and grabbing my hand. While seated at the dining room table asking the mother questions, N.A.S. walked over to the chair next to where I was seated and said “Up-ah”. He then pulled the chair out, climbed it and attempted to grab a cookie from a plate in the center of table. N.A.S was exhibiting Stage 6 of Piaget’s Sensorimotor Intelligence. Sometime during the conversation with the mother, her phone rang, at which time N.A.S. grabbed the phone from the coffee table in the living room and proceeded to connect the call and answer with another mispronounced “Hello”. The mother stated that N.A.S. occasionally answered her phone, and stated that he had even initiated video calls with his father. According to the information-processing theory, this would indicate that N.A.S’s computer-like brain has observed his family performing this, or similar activities, processed the scenario, remember it and successfully applied it to the current phone call.
I asked the mother to leave the living room, where N.A.S was playing with some toys. He displayed separation anxiety as his mother left through the front door, crying momentarily, but resumed playing after less than one minute. He then ran to the door as his mother re-entered the room, laughing and hugging her. This would indicate that he has secure attachment, according to the Strange Situation findings, and may be consistent with the text’s statements about intensified separation anxiety by age 2.
I observed that N.A.S. had a very limited vocabulary, communicating mainly by gestures and screaming, with the majority of his spoken words being mispronounced or familiar only to his family. For example, at one point in the interview N.A.S. began to say “Ku” repeatedly. His mother informed me that he was asking for milk. According to the text, children at his age usual have anywhere from a 100 to 550 word vocabulary, which N.A.S. did not exhibit and which indicates a significant delay in speech development. He did reach for a book after his mother asked “Where’s your book?” which may indicate that his vocabulary is greater than he is able to express. I was informed by his mother that he did not currently know sign language, but that they had pending appointments with both an ear, nose and throat specialist and a speech pathologist and would follow whatever guidance they recommended.
I think that although N.A.S. displays significant cognitive development and appropriate psychosocial tendencies, but left unattended, his current impairment could drastically hinder future development. I found it interesting to see firsthand a child that had reached certain developmental milestones described in the book, while lagging behind in others and would be interested to see how any interventions might change the current scenario.