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PEPSI Screening: A Case Study

Kira Abney

EDU 220

College of Southern Nevada

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Biography

“Timmy” was born on May 11th, 2012, weighing 6 pounds and 11 ounces. According to

his mother, “Ronica”, her pregnancy with Timmy was normal and easy, while the birth was

quick. After he was born, Timmy immediately began crying, but stopped completely once he

heard his mother’s voice. A lot of mucus was found in his lungs and airway for several days.

Ronica began wondering if she should worry that her son wasn’t crying at all. She thought of it

as a good thing at first, but always had worries in the back of her mind. More worries came about

when Timmy refused to breastfeed. This caused him to lose several ounces, leading to a longer

stay in the hospital. More bad news came to Ronica when the doctors informed her that Timmy

was tongue-tied and had penile torsion.

Further into his infancy, he was a mellow baby, constantly wanting to be around his

mother all of the time. At around 3 months old, Timmy started gaining weight rapidly. He grew

into being a chunky baby. He started to grow interested in rolling around and learning how to

crawl. Once he became comfortable with crawling, he would travel all around his house, pulling

himself up to surfaces quite easily. He also grew interested in watching television, getting as

close as he could to the TV. His mother explained how excited he was to see all of his favorite

characters and see many colorful videos. However, as time went on, Ronica began noticing how

he didn’t like being away from his parents, especially his father, “Tim”. Timmy began to become

very stressed whenever there were a lot of people around or much commotion.

At one year old, he experienced his first traumatic experience when he had to get surgery

to fix his penile torsion. Timmy spent weeks on pain medicine and would become hysterical,

waking up from sleep constantly. It took a while for him to feel normal again after this

experience. However, he still was not talking. At eighteen months, there was still no sign of
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Timmy talking and many people started questioning why. Friends and family started expressing

their concerns to Ronica and Tim. Ronica noticed other things as well, such as how he was very

slow to walk, didn’t hold a spoon or fork correctly, and mostly ate with his fingers. He wasn’t

hitting the milestones that other children his age started hitting. At this age, Timmy was

frustrated very frequently and constantly threw fits. He was happy and pleased as long as he was

able to play with his toys and watch his shows. This was his comfort. His diet, however, wasn’t

very healthy. There wasn’t much that he would eat.

At this point, Timmy’s parents invited the Developmental Disabilities Institute (DDI) to

work with him. The DDI would play with him and try to transition him to try new things. Timmy

did not like these transition periods though and began to become very difficult to work with. He

was visibly upset. They noticed he started having aversions to foods with certain colors or

textures as well. He also didn’t like being around the DDI workers. He only liked being around

his sister or parents. He felt overwhelmed very easily and continued throwing fits.

Timmy’s family began communicating with him by using a picture board. This board had

pictures of common activities and food items he enjoyed. He started using this board to point at

certain images that he would want. Ronica and Tim began to slowly understand the sounds he

was making and correlated them with the pictures he was gesturing at. That was their starting

point with him communicating and talking.

At three years old, Timmy started school. It was recommended to Tim and Ronica that he

would start Pre-Kindergarten before most children. Timmy didn’t enjoy going to school and he

disliked his teacher very much. He expressed to his mother, Ronica, that he thought she didn’t

like him very much either. Ronica described this teacher as “old and grumpy,” so Timmy’s first

experience with school wasn’t very positive. In his Pre-K class, all the students were children
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with special needs and included services such as potty training or diapering. At this time, Timmy

was still in diapers and he didn’t start to potty train until he was 5 years old. He was fully potty

trained by 6 years old. When he continued into his second year of Pre-Kindergarten, it was a

much more positive experience for him. He was placed with a different teacher who made

Timmy feel more comfortable. At this time, Ronica and Tim had Timmy diagnosed with Autism

and acute anxiety. That was when they asked for help from additional resources. After this

discovery, Timmy slowly learned how to tell others what he wanted more effectively. By the end

of his second year of Pre-K, he had improved tremendously.

The biggest barrier that Tim and Ronica had before with Timmy was that he had a

difficult time expressing to others how he felt and what emotions he dealt with. They decided to

place Timmy in cognitive behavior therapy for his aversions to food and stimulus. During this

time, Timmy’s parents were able to find several ways to help Timmy express his emotions. They

also learned a couple of techniques to help with his outbursts. Ronica expressed that the teachers

were such an important part of Timmy’s progress. He finally felt comfortable enough to express

himself and to slowly begin talking. After, he only progressed further and further.

Kindergarten was stressful for Timmy since he was very anxious about being placed with

a new teacher. He got used to adjusting to different situations though. His schools guided him

throughout his educational journey and taught him how to get used to his classmates being

around him. By first grade, he was able to interact and socialize with his classmates. Now in

second grade, Timmy is eight years old. He has become very comfortable with his normal

schedule and only needs small adjustments made for him to help with his anxiety. He is brought

into school earlier than others so that he is able to settle into the classroom before things become

too chaotic. He tries very hard to maintain the status quo and is quick to tell when someone is
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doing something they shouldn’t be doing. He is very friendly, which was seen as a huge

improvement to all of his family and close ones. He is also very expressive now but needs to be

approached by others first.

Physical Development

Although having autism can lead to having physical delays, Timmy’s physical age is 8

years old. He is greatly active. He enjoys spending time outside, swimming, and throwing balls

around. He is as active as his friends and classmates. His autism and anxiety don’t set him back

physically. For example, according to “Psychology Applied to Teaching,” it is stated that,

“Primary grade children are still extremely active” (Snowman, 2014). Before COVID-19, he

would spend his recess time engaging in physical exercises with his friends, such as running.

Now with the fear of COVID, he doesn’t play with his friends as much as before. For a while, he

didn’t engage in much physical activity when classes transitioned to online learning. However,

his mother, Ronica realized that there was a loss of motivation for his school work. She

implemented his own recess time so that he would still get to exercise and enjoy outside time,

instead of staying inside, playing video games. “Piaget believed that children’s ability to think

beyond their own perspective is greatly facilitated by peer interaction because such interactions

involve other points of view that must be comprehended and accommodated” (Snowman, 2014).

Piaget’s beliefs were seen in what Timmy had experienced. Now, he is able to play with his

close friends and his sister to keep up with physical activities. After hard work, he likes to

reward himself with video games. At eight years old, it is very common for children to have been

exposed to video games. This is also improving Timmy’s coordination. For example, “...many

children at this age have had extensive exposure to computer games and video games and
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therefore have begun to develop greater eye–hand coordination with images on screen”

(Snowman, 2014).

Physically Timmy is a very healthy eight year old with a good Body Mass Index. With a

weight of 56 pounds and a height of 4 feet, 2 inches, he has a BMI of 15.7. He is in good

physical condition even though in his age group, more students are experiencing obesity.

“...21.3% and 9.3% of 8-9 year-old children are still overweight and obese by BMI, respectively

(Nardone et al., 2018), and may suffer many adverse health effects if not decreasing their

excessed body mass…” (Casolo, 2019). When Timmy was faced with the challenge of the new

all online classes, his physical health did decline slightly when he spent all of his time indoors

with no physical activity. This is a problem that a lot of students face. For example,

“Unfortunately, although a growing body of evidence suggests that physical education (PE) and

non-curricular time spent in school (e.g. recess) could significantly contribute to enhance

children's physical, social and emotional health in addition to cognitive and behavioral

development (Barros, Silver, & Stein, 2009; Pellegrini & Bohn, 2005), time devoted to such

activities is constantly being reduced (e.g. for punitive or behavioral reasons) or reallocated to

accommodate more time to other academic subjects” (Casolo, 2019). Family and home life also

play a role in a child’s physical age. Especially with COVID-19, many students have been in a

home environment, rather than a school environment. This could mean that either the children

are more influenced to be active or inactive depending on their home setting and family

members. “The family and home environment may affect children’s physical activity in a

number of ways. Parents can act as role models, sources of support and gatekeepers through their

control over children’s opportunities for physical activity. Similarly, other family members are

also likely to influence children’s physical activity through role modelling and social support.
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The home environment can additionally impact on physical activity behaviour through the

provision of opportunities to be physically active (e.g. having play equipment available) or to be

sedentary” (McMinn, 2013). In Timmy’s case, at first, Timmy started to have a decrease in

physical activity, but when Ronica and Tim saw the effect no physical activity had on him, they

encouraged him to start playing outside again. His sister, “Emily” was a good role model and set

a good example by also going out to play with him. Now, Timmy still is going outside to play

and exercise to get all of his energy out.

Emotional Development

Emotionally, Timmy is slightly immature. He does still have outbursts, even though it

isn’t as frequent as when he was younger. He has a hard time reading people’s faces or

determining someone’s emotions. He is getting better at explaining how he feels and what

emotions he is experiencing due to the help of his counseling. Timmy’s emotional age is 5 years

old. For example, “Kindergarten children tend to express their emotions freely and openly.

Anger outbursts are frequent” (Snowman, 2014). In kindergarten children are around four to five

years old, and in some scenarios, six. Timmy has gotten much better at expressing how he feels,

which is much more frequently seen in kindergarten children. If they are happy, they will express

that. If they are angry, those kindergarten children will express that as well. Timmy is also able

to express those emotions and many more also. However, what sets him back in his emotional

age is how he still does have frequent outbursts and how he isn’t used to reading someone else’s

emotions. “A number of studies have found that children with ASD were less able than their age-

matched, typically-developing counterparts to recognize emotional reactions in certain

situations” (McHugh, 2011). According to “Brief Report: Teaching Situation-Based Emotions to

Children with Autistic Spectrum Disorder,” it is normal for children with Autism, like Timmy to
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be emotionally immature. Those certain situations that Timmy has trouble with are dilemmas

where someone else is sad or upset, especially if someone is upset with him. “People, especially

children, diagnosed with diseases such as autism, Alzheimer's disease and/or Parkinson's disease

often lack or have impairments in some set of representation abilities such that they have

difficulties operating in our highly complex social environment … As a result, they have

difficulties in tasks such as envisioning another's state of mind in social behavior or imaging

future states to plan a task” (Smitha, 2015). For example, Timmy has a hard time understanding

that he could be hurting someone’s feelings. Therefore, his emotional age is five due to him

being able to express his own emotions but has a hard time understanding others’ feelings.

Philosophical Development

Timmy’s philosophical development age is 8 years old. Timmy’s thoughts can become

very mature. He does have many deep conversations with his mom, dad, and sister. However,

this is normal for eight year olds. They too have philosophical thinking. For example, at eight

years old it is normal for children to grasp morals: what is right and what is wrong. “There is

typically a real understanding of goodness and badness, right and wrong. The child will express a

belief that some actions (people) are bad and some are good” (Ellsworth, 1998). His mother,

Ronica, had explained how Timmy often expresses questions about death or happiness and what

those two things mean. At eight years old, this is quite normal. Many other children around that

age also express similar questions, which come as a surprise to some parents. “Thoughtful and

insightful discussions like this are not unusual for children who are given the opportunity to

have them … However, students’ regular classroom materials, works of art, thought

experiments, or even the daily news can be used to trigger philosophical discussions of moral

concerns” (Pritchard, 2018). When Timmy isn’t asking questions about strong philosophical
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ideas, such as the meaning of life, he is discussing his own thoughts with others he is close

to. These types of conversations interest him. In most eight year old or primary grade

students, they enjoy these conversations as well and are quite mature in the

philosophical/cognitive thinking field. “The most fascinating thing about watching 8-year-olds

bicker politely about philosophical dilemmas — doubly so during an election year — is how

consistently respectful they are toward each other. Exuberant group discussions end with a call-

and-response measure of claps — from John Fogerty’s “Centerfield” — that signal a transition

from talking to listening” (Pinkston, 2016).

Social Development

Like Timmy was slightly emotionally immature, he is also slightly socially immature.

Due to him not being able to interpret other’s emotions very well, it can cause some issues when

making friends. There are some friends who get offended when he doesn’t understand he is being

rude with what he says. His social age is 6 years old. Students who are six years old socially

have a small group of friends, but do have trouble being social. Their best experience with social

interactions is the interactions they experience with their family. For Timmy, he is most social

with his mom, dad, and sister. Besides his close family, he does talk with a very small group of

friends with whom he plays video games with in his free time. “Most children have one or two

best friends, but these friendships may change rapidly. Whereas some children prefer to play

alone or observe their peers, others lack the skills or confidence to join their peers. In those

cases, you might want to provide some assistance” (Snowman, 2014). In a regular classroom

setting, he does need some assistance with becoming more comfortable approaching others first.

Currently, he is only able to make friends or improve his social skills if another student

approaches him first. It, however, is not unusual for children with autism to experience a lack of
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maturity with their social skills. “Ultimately, individuals diagnosed with ASD often do not

realize what opportunities they may miss through a lack of social skills” (Leaf, 2017). Also,

“When an individual, with or without a diagnosis of ASD, does not engage in appropriate social

behavior, it may lead to a lack of meaningful friendships or prosocial relationships.

Unfortunately, this can lead to serious negative consequences such as loneliness…” (Leaf, 2017).

Having a lack of social development causes future negative consequences. With COVID-19, it is

more difficult to share social interactions with other students. It is very beneficial for Timmy that

he does have a small group of close friends. Students who do have trouble with social

interactions, like Timmy, are more withdrawn from conversations or don’t feel comfortable

speaking as much as other children. “By comparison to typically developing children in

collaborative contexts, they can be aggressive or withdrawn, show more irrelevant behaviours

and share less, ignore others’ questions and requests and give poorer directions” (Murphy, 2019).

Intellectual Development

Intellectually, Timmy does have certain strengths and weaknesses. His intellectual

development age is 6 years old. He is very good at solving puzzles and playing interactive

thinking games. He enjoys playing games that challenge his brain. However, he does have

weaknesses with reading and writing, which should be an already learned skill as an eight year

old. Timmy is a child with Autism Spectrum Disorder, which is a cause for why he does struggle

highly in certain subjects. “For children with ASD who have significant early learning skill

impairments, behavioral training focused specifically on functional behavior skills may be of

greater benefit than interventions, such as IBI, which are aimed at improving cognition and

language” (Reitzel, 2013). It is common for ASD to affect children’s learning skills. With an

eight year old, they start taking on bigger problems with fractions, money, space, and a lot of
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reading. However, Timmy is more comfortable with smaller and simpler problems. For example,

“Some intellectual development milestones you may notice in five and six-year-olds include:

Vocabulary increasing to 2,000 words, sentences of five or more words. Can count up to 10

objects at one time, can copy complex shapes. Begin to reason and argue, uses words like why

and because. Understand concepts like yesterday, today and tomorrow. Are able to sit at a desk,

follow teacher instructions and do simple assignments independently” (Fraser Health Authority,

2021). Especially with different types of interactive learning games, he is used to being

introduced to different shapes, visuals, deep conversations, and following instructions. “Children

with autism spectrum disorder (ASD) have difficulty seeing the ‘big picture’. They can get lost

in the details, rather than pulling together different sources of information and seeing the

situation as a whole … For example, after reading a story, a child might remember the small

details but forget what the story means overall. A younger child might look at a picture book and

focus on details in the background, rather than the characters and the storyline” (Raising

Children Network (Australia) Limited, 2020). Timmy does experience these difficulties with

learning. Therefore, he is slightly behind his actual age when it comes to intellectual

development. He is six years old in this department.

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PEPSI Screening Chart

8 years old

Recommendations

Physically, Timmy is at his normal age. However, some recommendations to keep him

from declining in physical age is to keep him active in playing outside. Spending time outside

and continuing to play games that work out his muscles are important for allowing Timmy to

continue growing appropriately. For example, “Specifically, school recess offers an ideal

opportunity for children to be physically active on a daily basis and hence enhance their health.”

(Casolo, 2019). Another way to keep his physical age up is by avoiding too much time playing

video games or on the phone.

Since Timmy is five years old, he is three years behind his emotional age. Some

recommendations to improve his emotional age is to continue his counseling. There are also

some great intervention programs that other students with Autism Spectrum Disorder have used

in order to increase their emotional skills. “The results of this study verified that children with
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ASD could be taught to tact emotions, which then generalize to untrained stimulus items. Thus

providing the rst demonstration that children with ASD, can be taught to label situation-based

emotions using multi-component intervention (discrete trial instruction, prompt, error correction

and reinforcement).” (Mchugh, 2011). He already has greatly improved his emotional age by

learning how to express his feelings. Now, he just has to get more comfortable with

understanding the emotions of others. These types of interventions may help with that.

Timmy’s philosophical age is eight years old, so he doesn’t have to improve on this

developmental area. However, it is important that he continues to increase his philosophical

development as he gets older. One of these recommendations is to have Timmy’s teachers

implement philosophical discussions into the classroom. Some teachers do already implement

these types of discussions and have seen great results. “‘There’s not really a right answer.

There’s no objective goal. There’s not a Common Core standard to meet,’ she said, already

relishing this last point. ‘I hope when I potentially have my own classroom, I can help (my

students) think critically and deeper than what’s just given to them.’” (Pinkston, 2016).

Since Timmy’s social age is 6 years old, he is two years behind from his normal age. In

order to improve his social development, his teachers should spend more time focusing on social

skills, not just academic skills. For example, “We commonly encountered the desire for

professionals, and sometimes parents, to teach academic skills (e.g., math facts) at the expense of

teaching social behavior.” (Leaf, 2017). Teachers tend to spend more time focusing solely on the

academic curriculum, that they don’t have enough time to teach other skills, such as social

development. Spending more in-time class teaching Timmy important social skills, such as

developing friendships can help him with this development.

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Lastly, Timmy’s intellectual age is also 6 years old. There are many recommendations

that can help increase children’s intellectual development. For example, “Spend as much

uninterrupted one-on-one time with your child as you can. Avoid prolonged viewing of

television, video and computer games. Set up a homework space and routine in your home.”

(Fraser Health Authority, 2021). Continuing Timmy’s educational adjustments can help him to

become more intellectually developed. Another recommendation could be to have an after-

school tutor to focus on the subjects, such as reading and writing, that he really struggles with.

By following these recommendations, Timmy can become developed in each area.

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