For this assignment, I observed my client Herman Greenberg ( name changed to guarantee confidentiality ) , for whom I am presently supplying Service Coordination. Herman, a 2.5-year-old male child, is fighting to get the better of his developmental hold, a status ensuing from premature birth. He is presently having home-based therapies to help him in making age-appropriate mileposts. Herman resides with his natural parents and four older siblings in a close-knit, middle-class vicinity. I observed Herman within his natural household context. His female parent was present throughout, and his male parent, siblings, and healer were present at assorted intervals. Herman was diffident and reserved, and did non admit my presence for most of my visit.


Mrs. Greenberg ushered me into the kitchenette, where she was feeding Herman. I instantly noticed his dabbled high chair and Herman ‘s dirty custodies. Mrs. Greenberg urgently tried to feed her boy, but he would non eat the sandwich she offered. Mrs. Greenberg so switched to dry cereal, which Herman placed one by one into his oral cavity. He chewed each piece separately before get downing. I besides noticed that his fingers were joined together as they manipulated the cereal. After about two proceedingss, he slammed down his custodies and refused to eat anything else. Mrs. Greenberg proceeded to alter Herman ‘s dirty vesture. Herman did non take part and thresh about as his female parent tried to acquire his dirty vesture off, and a new outfit on. Finally, he was ready for the Occupational Therapist, Kathy Newman, who had merely arrived.

I observed the therapy session, which Kathy conducted with Herman. It appeared as if he truly wanted to collaborate, nevertheless, due to his terrible Sensory Integration Disorder, he had trouble take parting in the tactile activities in which Kathy tried to prosecute him. I noticed Herman ‘s organic structure stiffen, as he was visibly upset at the drama dough Kathy placed into his custodies. Kathy noticed, excessively, and started the Wilbarger Deep Pressure and Proprioceptive Technique ( DPPT ) , along with musculus compactions, to diminish the overpowering experiences for Herman. Herman used minimum words throughout the session.

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After the therapy session, Mrs. Greenberg put Herman down for his day-to-day sleep. I remained with him in his darkened room, watching as Herman lay in his cot with his eyes broad unfastened, sucking on a bottle of expression. When he was through with most of the bottle, he arched his dorsum and tried to fall asleep. Suddenly, he made a unusual noise and gulped for air. I rapidly rushed over and picked him up. As Herman ‘s external respiration forms became normal once more, Mrs. Greenberg came in to see what the disturbance was approximately. She was defeated to see that yet once more, Herman failed to kip through his afternoon sleep. She explained to me that Herman suffered from sleep apnea, and the remotion of pharyngeal tonsils and tonsils did non decide this issue.

Herman ‘s older sisters came place from school shortly thenceforth, and rushed over to surround him with clinchs and busss. Herman tensed and resisted his sisters ‘ show of fondness. He scrambled off to acquire his conciliator and nappy, and conceal inside a dark cupboard, presumptively to avoid the exhilaration. He stayed there for a piece and I realized that his female parent and siblings did non trouble oneself him. My conjecture is that this is a common happening, and Herman ‘s intolerance to resound and people causes him to seek out a quiet topographic point for himself to quiet down. After a piece, he did come out on his ain, but showed displeasure at seeing the tabular array set for dinner. Mrs. Greenberg coaxed him into his high chair, where he eventually agreed to savor a little piece of dry poulet scallop. As Herman noticed his female parent turn off, he giggled as he rapidly grabbed his poulet and flung it on the floor. He so wiggled his manner out of his place. By so, Mrs. Greenberg saw what was traveling on, and tried to coerce one more piece of poulet into his oral cavity, but Herman gagged and ptyalize it out. He wandered out of the kitchen, and I followed him down to the cellar. Herman had trouble jumping his pess, taking the stairss one at a clip and invariably keeping on to the railing. He looked up at me, admiting my presence for the first clip that twenty-four hours. He pointed towards a cupboard, gesticulating for me to open it. I complied and opened the door to happen Herman ‘s plaything stacked neatly on the shelves. Without vacillation, Herman chose a pail of blocks and started to stack them one on top of the other. However, he was unable to organize his motions and maintain on knocking over the ‘tower ‘ . After several efforts, he left this activity and went to acquire his toy truck. As Herman pushed his auto forward and backward, I waited to hear some kind of verbal communicating. However, none was forthcoming, and I realized that Herman did non even possess private address. I tried to open a conversation by indicating at the truck and inquiring where it was traveling. Herman looked at me and after a few seconds, he turned back to his plaything. I prompted him once more, inquiring him if the truck can do sounds. This broke the ice. Herman smiled at me and, while steering the truck, made some siren sounds and said “ Beep, bleep ” . He kept on looking up at me, and I smiled back, promoting him to utilize more words. Herman kept on stating the same sounds repeatedly, each clip doing certain that I noticed. After a piece, he went to the cupboard once more, and this clip, he came back with a simple eight-piece mystifier with a boundary line. Herman concentrated on each piece individually, seeking to suit them in suitably. It took him several attempts to acquire his first piece in, and he looked at me for assessment. As I smiled encouragingly and complimented him, he turned back to his mystifier. By the clip Herman got his 2nd piece in, it was acquiring tardily and his female parent came to bathe him. Herman put up a large dither, declining to travel into the H2O. Finally, he allowed himself to be put into the bath, conciliator in his oral cavity. When Mrs. Greenberg wrapped him in a towel, he snuggled in tightly. Dressing Herman in pyjama was another major ordeal. At last, he was in bed, calmly sucking on his expression bottle. He looked at me with broad eyes as I waved good bargain to him and offer him good dark.

Interpreting the Observation:

The first thing I noticed about Herman ‘s behaviour was his deficiency of address. He did non utilize words to pass on throughout most of the twenty-four hours, with the exclusion of some sounds elicited during drama. I believe that the usage of private address, which is hearable address non intended or directed at others ( Vygotsky, 1934/1986 ) , was non utilized by Herman and resulted in a failure to internalise the accomplishments of address. The deficiency of private idea and address in a kid ‘s development can do it impossible for him to get by in many state of affairss, as he can non command and direct or modulate his behaviour. ( commendation )

( By detecting Herman engaged in daily activities, it was evident that he is enduring from Sensory Processing Disorder. A survey by Ahn, Miller, Milberger and McIntosh in 2004 revealed that at least one in every 20 kids is ( ARE ) affected by this upset. These kids are negatively affected in there developmental abilities, including behavioural, emotional, motor, and cognitive spheres ( Kandel et al. ; Shepherd, 1994 ) . Herman ‘s intolerance for tactile, sound, and even people can be linked to what A. Jean Ayres ( 1920-1988 ) dubbed as a ‘traffic jam ‘ that thwarts parts of the encephalon to have information to treat centripetal integrating. ) ( we did n’t larn about SPD, so could I include it? The online coach @ Touro ( Benjamin Miller commented, “ I would include it because you are bring outing or larning new things in the procedure of composing. This is common in research documents and it means you ‘re taking the authorship to where you want to take it. It ‘s a good mark! ” Do you hold with him? )

The nature of Herman ‘s relationship with his household is most interesting to observe. Apparently, he becomes overwhelmed when excessively many people are around, even though they are his close household members. This may be linked to the fact that he did non see initial maternal fond regard, due to being incubated. Bowlby concluded that maternal separation/deprivation in the kid ‘s early life caused lasting emotional harm. Harmonizing to Bowlby, this status involves a deficiency of emotional development, characterised by a deficiency of concern for others, deficiency of guilt and inability to organize meaningful and permanent relationships. ( `Bowlby, 1946 ) ( I did non yet complete this thought- I want to compose more about research done in this country. I besides have to include commendations here and add my ain reading of these remarks which I found at some sites. ) In Herman ‘s instance, his female parent was unable to set up physical contact with him until at least one month of age. This has caused Herman to be wary and leery of people, as could be observed by his interaction with his siblings. Herman ‘s deficiency of concern for others was evident in his refusal to follow with his female parent ‘s demands. Herman besides objected to his sibling ‘s show of devotedness, which could be ascribed to his inability to organize meaningful relationships.

As can be seen from this observation, Herman is delayed in his motor accomplishments, both all right and gross. I noticed this when he was eating, during his therapy session, and when walking stepss. Herman had trouble with all of these activities, due to being born prematurely. Other accomplishments, including cognitive,