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NADCA Assignment

UID- 2308726

St. Xavier’s College

PAPSY6005CR1: Normal and Abnormal Development in Childhood and Adolescence

Ms. Karen Almeida

March 10, 2024

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Normal and Abnormal Development in Childhood and Adolescence – CIA 2

Demographics:

Name: Riddhi Srivastava

Age: Almost 10 years (in 2 months)

Class: 4th grade

Height and weight: Within normal range

SES- Upper middle class

Hometown- Lucknow

Siblings- 1 brother and 1 sister (all same age, triplets)

Case Summary as taken from father:

Riddhi Srivastava is 10-years old (female) and studies in the 4th grade. She has
short hair (boy cut) and was described as ‘happy-go-lucky’ by her father. Academically,
Riddhi's performance is subpar, with teachers noting improvements over the past year,
albeit still at a D-level. Her performance improved with constant supervision from her
mother but distractions persist and she requires constant supervision. Otherwise, she is
quite easily distracted by anything and everything in her environment. Her teachers have
criticized her a lot and even at home, she has gotten a number of warnings regarding
improving her academic performance. Comparisons between the siblings are also made
frequently (in an effort to motivate her). In school, her teachers have also reported
constant movement from one place to another even while class is going on. She is also
seen looking out the window in class a lot and even dozes off in certain classes (namely
math and history, both of which she really dislikes).

Her father also mentioned that she keeps forgetting either to do her homework or
take it to school with her which is another reason for her getting scolded in school. She is
also not able to complete her classwork in time as reported by her teachers. Even in
exams, she is unable to complete the exam in the given time and loses marks because of
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that. She also has a hard time doing what is told to her, both at school and at home.
During play time, she does follow the rules of the games but occasionally will also flout
those. The father described her as ‘lazy’ since he felt that she avoids doing work assigned
to her and will simply keep lying in bed or in front of the TV despite being given work to
do. The father also reported a frequent excuse made by her to avoid work, ‘Mujhse utha
hi nahi jaa raha’ (I’m unable to get up).

Riddhi is described as non-confrontational, exhibiting caring behavior and giving

affectionate hugs. While she shows empathy towards others, her social skills are deemed
inappropriate, as she tends to speak her mind without regard for social cues. She
maintains a small social circle of friends even though she is talkative and open to people
who visit the house. She also displays reluctance in making decisions, possibly
influenced by her brother's dominance.

Riddhi’s cognitive profile highlights inattention, memory deficits and a lack of

abstract thinking, possibly contributing to academic struggles and difficulties with social
norms while displaying strengths in empathy and caring behavior.

Based on the above information, it seems like her executive functioning

(especially attention) is especially lagging as compared to other children her age.
Specifically, she seems to be facing the following concerns:

- High levels of distractibility

- Inability to complete tasks in time and follow instructions

- Forgetfulness

- Impulsivity (to some extent) or lack of self control

- Lack of motivation

Typical executive function of a child in middle childhood:

During the period of childhood the growth of function is closely linked to

transformations, in key brain areas and neural connections. The prefrontal cortex
experiences both functional advancements boosting skills like working memory,
inhibitory control and cognitive adaptability (Luna et al., 2010). White matter pathways
become more efficient aiding in communication between brain regions involved in
function (Nagy et al., 2004). Networks responsible for controlling impulses and
managing emotions such as the anterior cingulate cortex and amygdala undergo
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refinement resulting in self control and adaptive behavior (Rubia et al., 2007; Silvers et
al., 2017). In essence the maturation of these brain regions fosters the development of
executive function abilities during childhood. Overall, the maturation of these brain
regions supports the development of executive function skills during middle childhood.

The term executive function encompasses a range of processes that oversee and
coordinate behaviors, such as focus, memory, self control, adaptability, planning and
purposeful actions. These advanced cognitive abilities empower individuals to manage
their thoughts, feelings and behaviors to accomplish objectives, tackle challenges and
adjust effectively to circumstances. In a study by Best et al. (2011) the developmental
paths of function in school age children aged 6 to 12 were examined over time. The
research revealed enhancements in executive function capabilities during this period in
tasks involving self control and mental adaptability. Hence executive function abilities
evolve gradually throughout childhood and adolescence with progress observed from
early to childhood (Griffin, Freund & McCardle; Müller & Kerns).

Life success depends increasingly on the mastery of these executive functions

since they regulate behavior, also influencing and predicting the development of other
cognitive skills (Van der van et al, 2012). Executive function skills are better predictors of
academic success as well (Blair & Razza, 2007).

In Riddhi’s case, her problems seem to be stemming from her inability to focus
and lack of self control which is leading to problems in other areas including academics,
peer relations, her own view of herself and acting according to social norms. Most of the
problems mentioned by her father can be clubbed into a cluster of symptoms, which
together make up her executive functioning. For example, her inability to finish tasks on
time is a sign of poor time management which can be caused by problems in planning
and organizing or even cognitive flexibility. Similarly, her forgetfulness can also be a
function of her inability to focus which leads to an inability to transfer things from
sensory to short term memory and then further to long term memory, resulting in
forgetting or absent-mindedness. Another notable observation is that many of Riddhi’s
symptoms align with the symptoms for attention-deficit hyperactivity disorder
(ADHD) and can be looked at from that lens as well. It would possibly be helpful to find
interventions typically used with children who have ADHD to help Riddhi function better
in her day-to-day life. These problems might also be affecting her self esteem and self
image (Mazzone et al., 2013) which could be why she is unable to assert herself and
make her own decisions at home and in school as well.

This area was chosen since her father mentioned it multiple times and seemed
helpless while talking about it, suggesting that the parents may be out of their depth in
dealing with her inattention and lack of self control. The mother found constant
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supervision helpful but since she has two other siblings, it is not possible for her mother
to devote all her attention to Riddhi and her studies. Other, more effective interventions
are clearly needed here. For the purpose of this assignment, the area for intervention will
be inattention and impulsivity or lack of inhibition.

According to Erik Erikson’s theory of psychosocial development (Erikson, 1980),

Riddhi is at the stage of industry v/s inferiority where she should be learning new skills
and where school/academic performance becomes very important. If she is unable to
succeed here, she will develop inferiority, the beginnings of which are already being
observed.

Effective management strategies by parents:

- Constant supervision while studying: Watching over the child while they study helps
them stay focused and reduces distractions. It provides guidance and support, which can help
kids with attention issues who have trouble staying focused on their own. This is in line with
Vygotsky's Sociocultural Theory, which says that social interactions and guidance are important
for children's mental growth. Studies have shown that when parents help their kids with
homework and schoolwork, it leads to better focus and grades (Dumont et al., 2014).

- Positive reinforcement like TV/play time: Positive reinforcement makes it more likely
for a child to repeat good behaviors, like paying attention and finishing tasks. This is done by
connecting these behaviors with something the child enjoys. It's based on operant conditioning,
where people are trained to repeat certain actions that bring them rewards. Studies have proven
that positive reinforcement can help children with attention problems focus and stay on track
(Pelham & Fabiano, 2008).

- Physical exercise: Exercise benefits brain function, including attention. It improves brain
circulation, releases brain chemicals that boost attention, and makes the brain more adaptable, all
aiding attention. Studies find that physical activity can improve attention, decision-making skills,
and schoolwork in kids, even those with attention issues (Hillman et al., 2008).

Ineffective management strategies by parents:

● Yelling/scolding

● Comparisons with siblings/other children

● Punishments like no play/TV

● Labels like ‘lazy’, ‘slow’

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Interventions

Parental Education and Support: Parental education involves providing Riddhi's parents with
comprehensive information about her cognitive profile, including her challenges with attention,
memory, and executive functioning. It helps parents understand the underlying reasons for
Riddhi's difficulties and equips them with knowledge to support her effectively.

i. Explain the specific deficits Riddhi is facing, using layman’s language and
examples.

ii. Discuss the impact of these deficits on Riddhi's academic performance and
behavior and help the parents be more empathetic to her struggles.

iii. Offer practical tips and strategies for supporting Riddhi at home, such as creating
a structured routine, implementing positive reinforcement, and minimizing
distractions.

iv. Give resources for further reading where parents can connect with others facing
similar challenges. Also, encourage parents to get her tested for ADHD and work
from there.

Collaborative goal setting: Working with Riddhi and her parents, goals can be set for her
schoolwork and behavior that are clear and can be reached. These goals will fit Riddhi's abilities
and the things she needs to improve on. To make this a fun activity, we can have a "Dream
Board Night." In this, Riddhi and her parents can make a vision board together. It will show
their wishes and goals for Riddhi's education and personal development. They can use
magazines, stickers, and drawings to make this board. This will help them all feel like they own
the goals and want to reach them. While doing this, it would be helpful to create a less disturbing
space for her studies and activities which can aid her in focusing on the task at hand and
minimize distractions.

Cognitive attention training (CAT) can be used to improve her ability to focus. This type of
intervention focuses on improving inattention symptoms through targeted games and activities.

Riddhi exhibits attention deficits, which significantly impact her academic performance and
daily functioning. Cognitive Attention Training (CAT) aims to enhance Riddhi's attentional
abilities through targeted exercises and activities. By incorporating CAT into her intervention
plan, we can address her specific cognitive needs and support her academic success (Savulich et
al., 2019). Peng and Miller (2016) explored the impact of cognitive attention training programs
on attention and cognitive outcomes across ADHD, learning difficulties, and typically
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developing populations. They found that such programs led to improved attention performance
compared to control groups, with moderate effect sizes (Hedges' g = .25).

Steps/Procedure:

After conducting initial assessment of Riddhi's attentional strengths and setting

objectives, specific CAT activities can be selected. These can include computer-based programs,
interactive games, and mindfulness techniques to provide a diverse and engaging training
experience. Daily CAT Sessions can be scheduled as regular CAT sessions as part of Riddhi's
daily routine, allocating dedicated time for training activities. Start with shorter sessions (e.g.,
15-20 minutes) and gradually increase the duration as Riddhi's attentional abilities improve.

Specific CAT Activities:

● Sustained Attention Training: For example, one game can be watching two shapes as
they flash on screen and decide whether they meet certain criteria. The categories change
from color to shape to fill the interior or the categories double up.

● Selective Attention Training:This could involve sorting objects based on specific criteria
or completing worksheets with distracting elements. Here, even games like Shape
Seekers Scavenger Hunt, where you would need printed shapes (e.g., circles, squares,
triangles) placed around the room. Give Riddhi a list of shapes to find (e.g., "Find 5
squares, 3 circles"). Set a timer and challenge her to locate and circle the specified shapes
within the time limit, focusing on the task at hand while filtering out other distractions.

● Cognitive Flexibility Training: For example, she could practice alternating between
sorting tasks based on color and shape or solving puzzles with changing rules. Even apps
such as peak and lumosity which have easy games for children’s brain training in the
same areas as above will help and can be used.

Integration into Daily Life:

Encourage Riddhi to apply the skills learned during CAT sessions to real-life situations,
such as classroom tasks, homework assignments, and social interactions and track her
progress. Provide opportunities for Riddhi to practice attentional strategies in various
contexts, reinforcing their utility and relevance in her daily life.

Materials Created:
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● Progress Tracking Sheet: Develop a tracking sheet to record Riddhi's performance on

CAT activities, track her progress over time, and identify areas for further improvement.

An example sheet is given below:

● Visual Schedule with CAT Sessions: Create a visual schedule that incorporates daily
CAT sessions, indicating the duration and type of activity to be completed each day. An
example schedule is given below.

● CAT Reinforcement Chart: Design a reinforcement chart to track Riddhi's engagement

with CAT sessions and provide rewards or incentives for consistent participation and
progress. An example chart is given below.
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Implement Structured Routine: Giving structure to Riddhi’s day will bring stability in her life.
Studies have found that structured tasks and daily schedules are helpful for children with
attention problems (Malatras, 2016; Thomas & Karuppali, 2022). Some strategies that can be
implemented are:

● Preparation of daily schedules- A schedule can be prepared at the start of everyday that
assigns specific times for every activity, such as homework at 6 pm, lunch after coming
back from school, playtime at 8 pm, etc. To remove redundancy from this activity, two
general schedules can be created, one for weekends and one for weekdays. These
templates will only need minor adjustments everyday and hence, will save time.

● The schedule can be presented with the help of visual cues, and should ideally be pasted
in a place where Riddhi can look at it often. These measures will ensure she is constantly
reminded of the upcoming tasks.

● Incorporation of transition periods between activities- This implies that Riddhi should be
given mini breaks in the middle of scheduled activities, which will help her be better
prepared mentally and switch gears smoothly.

● An important step is to review the routine periodically and adjust it as needed, based on
Riddhi's feedback and evolving needs.

● An additional activity that can make planning fun would be to create a themed calendar
which incorporates different themes for each day, such as ‘Magic mondays’, where the
child can be scheduled to create something, like a painting or a craft item. This can be
incorporated into the daily schedule during play time or any other free time. An
alternative is having themed months, where each month, the child can try a new hobby or
activity and will have something to look forward to.

Meditation: Since physical exercise is something that has proved helpful, it would be a good
idea to incorporate mindfulness meditation as well (Posner et al., 2015). However, it would be
difficult for Riddhi to straightaway go into mindfulness practice which is why she should start
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with simply sitting and labeling what her body is experiencing and observing her thoughts,
feelings and emotions for 5-10 minutes everyday (Zylowska, n.d). Once she gets used to this,
slowly body scan scripts/mindful eating can be introduced. Sessions can then focus on
techniques such as focused breathing or body scans to promote present-moment awareness and
attentional control. It can also help in self regulation (Zelazo and Lyons, 2012).

Thus, it is hoped that implementing these interventions along with doing what is already
working, will help Riddhi function better in her day-to-day life. They can help improve her focus
and thus, help her perform better at school so that she can go through the stage of industry v/s
inferiority typically, with a feeling of achievement and pride in herself and her skills.
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References

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