2-Year-Old Case Study Two-Year-Old Child Case Study

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(Broderick & Blewitt).

Aside from the major issue, at least for the parents, of Jason's reserved social demeanor; there have been several other indicators of acting our behavior that he has presented. On several occasions Jason has complained of stomachaches and headaches prior to having to go to day care or even to any other playtimes where he knows his parents will not be attending. Also, if he has felt threatened by other children in outside settings he will also develop these symptoms in order to be sent home. Then, conversely, after he has been at day care he often does not want to return home and occasionally has a minor tantrum or crying fit. In instances such as these, with seemingly confusing and contradictory symptoms, one must remember that children often do not express anxieties in any direct fashion but often present with symptoms or strange ideologies that can be perplexing and juxtaposed. Lacking the ability to directly articulate their problems, the acting out of hypocondriacal illnesses are often the result (Iconis), and the child is sledom even unaware of his or her own participation in this behavior.

In an adult this would also be considered signs of depression, and in this case one would have to agree that the assessment is warranted. In their article, Cognitive Behavioral Studies, the authors review several studies regarding childhood depression:

Depressed children have low levels of self-esteem and of perceived social and academic confidence (Asarnow, Carlson, & Guthrie, 1987; Kasow, Rehm, & Siegel, 1984). Kaslow et al. (1984) reported that depressed children evaluated their own performances stringently, which in turn was related to distorted perceptions (Haley, Fine, Marriage, Moretti, & Freeman, 1985; Rehm & Carter, 1990). This distorted thinking is seen in negative self-perceptions (Asarnow & Bates, 1988; Asarnow et al., 1987; Hammen, 1988; Kendall, Stark, & Adam, 1990). (Kendall, and Panichelli-Mindel)

Following the original assessment taken from the maladaptations of the psychosocial stages of Freud and Erickson, a possible pattern seems to be emerging. In this case study we find parents who have relegated some of the primary care giving roles to others rather early in the development of the child, twelve weeks after birth. And although for the period of several months while under the maternal grandmother's care there was apparently few signs of problems, there may have been unseen treatment by the grandmother that may have helped to facilitate this social anxiety. For instance, if the grandmother was over indulging the needs of the child during the Oral / Trust vs. Mistrust stages, Jason may have developed subsequent dependent behaviors that have not allowed him to foster his own sense of independence at this latter stage of his development. Consequently, he now presents as shy and reserved around other children or situations outside the home.

While these two psychosocial theories seem to help us fit the profile for Jason, other factors should be considered as well. One of the flaws of both Freud and Erickson is that they do not significantly account for societal and other cultural elements' impact upon human development at large. While these studies may apply to a homogeneous upper to middle-class white European-American cohort, they do not expand well to a cross-cultural segment. Furthermore, Freud's psychosexual theory is often difficult to evaluate for it makes few predictions that can actually be tested by conventional methods of evaluation (Vander Zanden). Therefore, one must certainly consider other factors in analyzing the situation as well.

Hardening back to the diathesis-stress theory, one must evaluate if Jason may or may not also have a genetic predisposition to anxiety or depression. Studies have shown that these disorders have a tendency to run in families. "Some children, probably for genetic reasons, are 'behaviorally inhibited.' Even at the age of four months, their hearts beat faster, and they shrink back when they encounter strangers." ("Separation Anxiety") Therefore, no true assessment would be complete without a medical and psychological history of both parents and child. However, quite often these are seldom preformed as a global evaluation process unless far more extreme childhood difficulties are apparent.

It must also be considered that children are imitators from birth through two years of age and often beyond, constantly mimicking their caregivers and others in order to begin to assimilate behavior.

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This would be true of negative behaviors as well as positive ones:

Parental socialization has been identified as one of the key mechanisms through which children develop the skills necessary to function in emotionally competent ways, with the discussion of emotion and family emotional expressiveness identified as primary venues through which such emotion socialization occurs. (Suveg, Zeman, Flannery-Schroeder, and Cassano)

The parents themselves do present two opposite sides of the socialization spectrum. Michelle is obviously an energetic and socially adept individual, who is comfortable speaking to large groups as well as in smaller intimate settings to various types of individuals. However, John presents as somewhat withdrawn. His profession of choice is one that keeps him fairly isolated regarding interactions with outsiders. Furthermore, he often seemed uncomfortable during many meetings and spoke very little during them. So, regarding the nature or nurture role here, both certainly have plausible arguments.

It is interesting to note that while there are several studies regarding children who are exhibiting aggressive and disruptive behavior, there are very few that seem to address this symptom of withdrawn behavior. Even fewer studies have been conducted that analyze the risk factors involved with this group:

Yet few studies have actually assessed the risk status of socially withdrawn children. Limited data exist concerning the concurrent psychological adjustment of socially withdrawn children. Some studies suggest that, in early childhood, withdrawn behavior in its solitary-constructive/exploratory or unsociable form is not associated with intrapersonal or interpersonal problems (Coplan, Rubin, Fox, Calkins, & Stewart, 1994; Ladd & Burgess, 1999) and is not unusual (Rubin & Clark, 1983). With increasing age, however, social withdrawal may become more problematic. (Burgess, and Younger)

This absence of study is not unusual since shy children are often ignored or even praised by outside caregivers such as teachers who find the behavior a relief from the other children who are either simply normally energetic or are actually exhibiting aggressive and destructive behaviors. This is often the passive negative effect that the outside world has on withdrawn children, encouraging this behavior out of certain selfish motivations. The impact of this will often have ramification throughout the child's adult life. This can also foster continuing social phobias as well as generalized anxiety disorder and other specific phobias. Also noted is the fact that these developing phobias do not exist in isolation and can also be comorbid with other conditions such as addictive behavior and substance abuse as well as others later on in adult life. (McLoone, Hudson, & Rapee)

Children who are shy, overly sensitive, and interact infrequently with peers tend to experience a relatively poor self-concept. Furthermore, the findings that the withdrawn children, but not the aggressive children, differed significantly from normative control children with respect to self-perceptions suggest that such maladaptive self-perceptions may be uniquely important to social withdrawal as compared to other forms of maladjustment. (Burgess, and Younger)

In a child a certain amount of shyness and withdrawal from strangers is acceptable. Normal separation anxiety creates a natural and somewhat necessary fear of strangers as part of a survival instinct. However, at some point this in no longer a trait that is acceptable in the growing adult. While each personality certainly has a myriad ways of interacting with the adult world, survival and success in life critically depends on some amount of positive interaction with others. In a child this behavior may be considered cute, but in an adult it creates a possible increase in antisocial personality disorders.

In our case study, Jason could certainly be at the beginnings of maladjustment regarding his socialization skills. At the moment the impact may seem minimal, and even encouraged by other caregivers, but if not addressed may certainly lead to further long-term difficulties as an adult. While medications abound for children suffering from Attention Deficit Hyperactivity Disorder and the like, there are few prescriptions for this withdrawn syndrome. One excellent tool at this stage is cognitive-behavioral therapy. This therapy focuses on changing certain patterns of thought and behavior that may have been recently adopted which have led to feelings of anxiety in social situations.(Iconis) the therapist can than make suggestion to help the child to develop and assist the caregivers in implementing adaptive coping skills to help correct the.....

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