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Role of Biological and social factors in Child Development

Behavioural Perspectives of Lifespan - Life Course Development NURS2003 Case Study Assessment – Child/Adolescent (15 years of age or younger)

Introduction
For this assessment you are required to collect developmental data for a single child, adolescent, or adult closely, and report your findings. By definition, a case study is: “an intensive analysis of an individual unit (as a person or community) stressing developmental factors in relation to environment” (Merriam-Webster, 2015). The purpose of this project is to consolidate your knowledge and understanding of human development through its specific application to an individual in the context of their family and community. Your challenge is to collect data through a combination of techniques that are currently used in research and produce a written report demonstrating your understanding of biological, psychological, and social processes of development as they apply to a person in the age group you select. You are also expected to demonstrate your ability to use the collected information to formulate reasonable and justifiable predictions about the participant’s future development (n.b. it is best not to use the word “subject” because people find the term demeaning).
Keep in mind that the purpose of every piece of assessment is to test your knowledge and understanding of the material presented in the unit you are studying. To get the best possible result you should make yourself familiar with the unit outline, lecture notes, textbook chapters, and articles in the reading list. As this unit focuses on research evidence that comes from a variety of different academic disciplines, such as psychology, neuroscience, and epidemiology, it will be important to demonstrate that you have engaged with this evidence-based literature. Use the marking rubric as a check-list to ensure project expectations are met. It is best to read the instructions very carefully before you begin. However, if you need clarification about any part of this assessment, do not hesitate to speak with your tutor.  First, you will select a suitable participant and obtain informed consent from the person or a parent (or guardian) in the case of a child or adolescent. Second, you will collect data. Third, you will write a report in which you will discuss your findings in the context of recent, evidence-based literature. Each of these steps is explained in some detail in the sections below.

Participant selection, informed consent and duty of care
The person you choose to study must be a child or adolescent 15 years of age or younger or an adult 60 years of age or older. The instructions contained in this document are specific to a child or adolescent 15 years or younger. If you wish to study an adult 60 years or over, see the separate instruction document. It is important that you do not know the child/adolescent or their family well. You should not choose your own son or daughter or a relative, such as a niece, nephew, or grandchild. You should ask if you can do the case study with the child of a colleague or an acquaintance. Another possibility is to ask a family member who has children to ask one of their friends to take part. Most parents are very interested and happy to participate.

When you have chosen a child/adolescent for your study, you must first secure the parents' informed consent (see Informed Consent – Assessment – Blackboard). The information sheet explains that you are doing this research for a course in life course development, that the child's/adolescent’s name will not be used in the report, and that the main purpose of the report is to help you see the relationship between textbook knowledge of child/adolescent development and real children. As with all research, you have a duty of care to protect the health and wellbeing of your participant. If you believe on the basis of your assessment that your participant’s level of development differs from that which is typical for children of the same age and the child’s parent or guardian is not aware of the issue, you should refrain from mentioning it as this may cause unnecessary worry. You should, however, immediately inform the unit coordinator of your concerns. The unit coordinator will follow the matter up with the parent or guardian as necessary. An assessment with a qualified health professional will be organised if required.   Internal students must place a hard copy of the signed consent form in the unit coordinator’s mailbox (level 3 building 405 where reception is) by 4:30pm on Friday at the end of Week 4. External students must email a pdf copy of the signed consent form to the unit coordinator by 4:30pm on Friday at the end of Week 4.  The signed consent form you submit will be stored in a locked filing cabinet in the office of the unit coordinator. Following submission you should allocate your participant and all family members false names (pseudonyms) that you can use in your assignment. For example, if the child’s real name is Anika, call her Susan and state in your introduction that this is not her real name. This way, there is little chance that the tutor who is marking your assignment will be able to identify the participant and their family. The separation of identifying information (names and contact details) and personal information, such as survey responses and blood test results, is mandatory in research

Answer

Introduction

Research has shown that the combination of biological, psychological, and social elements of parents influences the improvement of the emotional expression of their children, thus interfering with the development of the internalizing symptoms. However, inadequate research, analyzed the sense of socializing practices that wardens use to mitigate their children's feelings about how these practices can differentially expect depressive evidence in their sons and girls (Gembeck et al., 2017). Children who face abuse or neglect are in danger of building up a psychological problem. These may include posttraumatic PTSD, anxiety and self-harming, nervousness and even sexual behavior (Feldman, 2015). This essay is aimed at elaborating the role of biological, psychological, and social factors in relation to human development through its specific application the case study of a 6-year-old male named Ryan. The essay will begin with discussing the background information of the case study. This will be followed by elaborating the role of biological, psychological, and social factors in relation to the effect on the development process of Ryan. In the end, reasonable and justifiable predictions for the future development of the Ryan will be assessed.

Background Information 

The participant selected in this case study is a 6-years-old male child named Ryan. His mother is an Indonesian while her father is Australian. His mother is 24 years of age, while her father’s age is 30 years. Ryan is the first born child and he has a younger brother who is 4 years old. Ryan’s mother is a salesgirl in a local mart while his father works as a sales manager in a company nearby. They live in a quiet suburb and most of their family and friends live nearby in a radius of eight kilometres. Ryan was sad and emotionally depressed as his friends at school bullied him for his overweight, and that made him feel terrible for him (Appendix B).   

Biological Factors 

Ryan was born through a standard delivery without any complications (Appendix B). The Ryan family has no history of chronic disease except for diabetes (Appendix C). Ryan's mother said she was taking additional iron tablets during pregnancy that are needed to prevent neurological defects in the baby (Appendix C). Ryan told his mother that his friends at school made fun of him for his weight, which made him feel terrible (see Appendix B and C). His mother had been instigated at school, and this affected his assessments (Appendix C). For a six-year-old young boy, he was in an overweight category, as indicated by his BMI (Appendix C). Self-confidence and esteem are especially crucial for young children, with many overweight children experiencing tension and depressed (Sanders, Zeman, Poon & Miller, 2015). For physiological and psychosocial reasons, the prevalence of depression among males has increased significantly in the childhood period. During the interview with his mother, his mother stated that Ryan was fond of eating. His father stated that as he was not able to spend enough time with his son, he used to bring fast food for his to make his happy. Ryan is fond of pizza, burger, cheese, chocolates and spicy food. Due to excessive fast food eating habits Ryan had become obese. Chronic neglect of child by the parents can cause emotional distress in children. Children tend to show attention seeking behaviour to gain the attention of their parents (Singer, 2017).  

Early childhood malnutrition events are associated with elevated immune reactions that are known to be risk factors for the development of cardiovascular disease, diabetes, hypertension, and cerebrovascular diseases (Gembeck et al., 2017). Children who were subjected to extreme food shortages in utero revealed greater prevalence for coronary heart disease. Similarly, children who were kept in foster care during World War 2, showed higher levels of cardiovascular problems and side effects in contrast to normal individuals. His father is not able to spend enough time with Ryan. This can be a contributing factor for stress and emotional disturbance for Ryan (Feldman, 2015).

Also, although the risk of coronary heart disease is about four times more amongst adults with obesity than people who are not obese. These observations tend to obscure the different perception than about 80% of non-obese children do not develop coronary diseases later in life (Feldman, 2015).

Psychological Factors 


The habit of overeating in Ryan may be the result of chronic neglect and inadequate knowledge of his parents. Child neglect is "inability to give the adequate attention and enough monitoring to the children" (Kolk, 2017). This is the most widely recognized type of abuse of young people. As stated in the interview, the father of Ryan has a long working time. He often visits late when his daughter is already asleep (Kolk, 2017). Also, due to sales, he has to travel to work in other cities as well. Because of his busy schedule, he cannot give his daughter enough time. Children mainly are dependent on their parental figures for physiological, passionate and social control (Kolk, 2017). Particularly in stressful circumstances, mothers and fathers can become external controllers in the extreme emotions of young people. Without outside help, Ryan can never return to a healthy lifestyle and healthy eating habits. Shockingly, such neglected children often depend on inaccessible, problematic or capricious caregivers who may neglect the actual needs of the children (Kolk, 2017).

Various journals suggest that parent-child relation is severely affected and such parents face numerous difficulties while connecting with their children. Therefore, Ryan may be in danger of experiencing persistent, unpleasant mental states, regardless of when managing the stressful circumstances. Ryan is experiencing emotional disturbance due to the parental neglect. His parents are relying on fast food and unhealthy supplements to fulfill the nutritional requirements of their daughter which is leading to obesity and eating disorder (Sanders et al., 2015).

Early childhood is the foundation period for children to improve confidence and socialization. Different behavioral concerns in children are related to persistent neglect (Brumariu, 2015). Chronic neglect is also one of the most underrated but a heavy burden on the child protection framework. Child depression is perceived as a continuous relational trauma, which can be confronted exclusively with typical formal procedures, and regularly leads to long-lasting social, emotional and psychophysiological deregulations. It can become a stressor in the long run and may exaggerate the ongoing problems that Ryan is experiencing as a child (Sanders et al., 2015).

The National Science Council for Developing Children proposed the primary scientific classification to present three type of stressors- Positive, tolerable and toxic stress that could influence the development in children. Toxic stress is associated with excessive, frequent and delayed acceptance of the pressure response framework for the body without the security of the availability of support (Brumariu, 2015). Significant risk factors include constant physical or mental abuse, persistent neglect, serious mother's depressive state, parental substance abuse, and family aggression. Typically characteristic for lethal stress is that it interferes with psychological development, affects other organ structures and stimulates stress management frameworks that create a moderate reduction in responsiveness and decision making abilities that extends throughout life, increasing the risk of disease and psychological depression (Sanders et al., 2015).

Social Factors 


The categorization of guidelines for social and family work have five key active aspects for social and family work that are applicable to the well-being of young children. These include time, wages, human capital, mental capital and social capital (Britto et al., 2017).

The work status and social interaction of both parents are important in determining the wellbeing of their daughter (Menon, 2013). Although financial stability is likely to improve the living conditions of Ryan, equally important is the role of social interaction and family support (Brumariu, 2015). Parents who socialise more with family and friends and spend more time with their children were found to affect the wellbeing and emotional stability of their children (Galve et al., 2015). It is mentioned (Appendix B) that Ryan’s mother will be leaving her job in near future to take care of her 3-year-old son, as soon as her husband will be promoted in his company. This will help her to spend more time with her children and is likely to influence the emotional distress of her daughter. 

However, Ryan’s mother has low education levels. She is not aware about the importance of balanced and healthy nutrition that needs to be provided to her daughter. Children like Ryan from low-wage families and networks with low levels of education may be particularly vulnerable to disease (Bornstein & Bradley, 2014) as a result of their unbalanced performance to an extremely adverse impact, such as neighborhood violence, education issues, unhygienic state, and missing guardians (Patterson, DeBaryshe & Ramsey, 2017). These risk factors are often aggravated by limited access to strengthening resilience and high utilization of the active elements of vitality that contribute to the cognitive impairment and growth retardation, especially among low-socioeconomic children (Britto et al., 2017). Ryan is also more inclined to encounter altered and agitated parenting behavior and, moreover, moderately less positive encounters, such as changes in cognitive behavior (Ford, 2017). Neverthless, the combined burden of different risks reveal that early life can limit the adequacy of child development process, thus making it completely difficult to reverse the neurobiological and wellbeing outcomes of the growth (Menon, 2013).

Ryan is likely to face stress response due to parenting related issues related to lack of pay and education (Noble et al., 2015). Children from lower financial foundations, show increased triggering of stress-related response, and the growing confirmation recommends that parenting differentiations identified with low income and education interfere with the parent-child relationship, introducing new vocabulary and responsiveness, by affecting certain parts of the brain, such as, in frontal cortex (Bornstein & Bradley, 2014). These changes can affect Ryan's emotional state and her decision making ability.

Predictions for Next Five Years 


In the next five years, Ryan will be 11 years old. He will be doing well in school apart from facing trouble in making new friends in the school. Depending upon how much support he will be receiving from his parents especially his mother, will also influence his overall cognitive and emotional development. His mother is likely to leave her job in a short span of time (Appendix C). This will give him a chance of spending more time with her and will directly impact psychological development and growth (Shonkoff, Boyce & McEwen, 2009). Also, he will be able to eat balanced and homemade healthy diet. His current obese state is related to chronic deprivation and her mother’s inability to cook food at home due to her busy schedule at work (Appendix C). These circumstances are likely to improve in next five years. His BMI is likely to fall within normal limits within next few years. He is likely to excel in his academic as well as social front in his school.

The current efforts identified with advancing welfare and disease prognoses in most nations are guided through a majority of three techniques (Zubrick & Zubrick, 2000). Projects that improve the well-being of advanced adult practices, such as better nutrition and increased exercise, set the most basic methodology (Zubrick & Zubrick, 2000). Even though the potential benefits of prosperity are underestimated, these measures should be combined to prevent disturbances in the development process of the child.

Conclusion Findings 

In conclusion, a combination of biological, psychological and social factors impacts the development of their children’s emotion expressivity. Ryan is cognitively stable, however, chronic deprivation caused due to his parent’s socio-economic instability and busy work schedules is interfering with her wellbeing and growth and development process. He is surviving on fast food and unhealthy nutritional supplements which is causing obesity and emotional distress. He is being bullied in his school due to her overweight condition. Although, his financial needs are being fulfilled by his parents such as good and hygienic living conditions, however, chronic deprivation is the main cause of her inadequate development and growth. Efforts should be made to prevent such issues in his childhood itself, so that it might not progress to serious psychological problems such as anxiety, self-harming behaviour and depression.  

Appendix A


An hour observation




9:00Ryan showed his homework remarks and screamed, "Dad, Dad, see”, his father puts his phone and says," Okay, okay., this is a good score keep it up! But he continues to look at his phone "
9:01Ryan says “Dad please help me in this:. His father receives the pen and helps him in completing his homework "and returns Ryan's pencil 
9:02Ryan calls "What is the sum of 2 and 2," and his father responded "let me explain you" and leaves him to keep writing anywhere in the paper.
9:03Ryan continues to complete the addition, and his dad returns to check his phone.
9:04Ryan is trying to show some of his work, but is instructed to complete the work. Which he finished rapidly. His father corrects some of the questions that were done wrong by him
9:05Ryan tells his father that his friends at his school are not good.
9:06Ryan says, "Dad, do I look ugly and Fat." His father reacted to "Who told you this?" and starts enquiring him about his day at school.
9:07Ryan starts telling him “Riya and Ryan were laughing on me by calling me Fatso”. His father tries to console him and tells him not to mind what they are saying.
9:08Ryan then continues to watch Tv cartoon –good Dinosaur while his father gazes his phone.
9:09Ryan keeps looking and suddenly calls out, "Please save the good Dinosaur!" while touching his father's shoulder. His father says "Okay, really, yes, but without thinking about the TV screen".
9:10Ryan continues to look at the movie with his toy weapons shouts: "I don’t want to go to school from tomorrow” while his father continues to hang on to his phone.
9:11Ryan continues to play with his toys. 
9:12Ryan walks to the workplace and uses the shimmering pad to pick up another toy. He fights to look down but inevitably did. He selected a lock called the "Pizza Challenge Ryan Toys survey" and says "Oh, pizza!" and returns to the lounger and sits.
9:13He watches the video while saying "sweet pizza, sweet pizza."
9:14An advertisement screens on the TV in between the movie. The advertisement is of domino’s pizza. After watching the advertisement Ryan starts shouting “I want pizza, I want cheese burst pizza”
9:15As they keep watching Ryan starts yelling McDonald's! When the child is heard in the show, say "McDonald's". Ryan swings to his father and says, "Father McDonald's, McDonald's." his father tossed it and responded. - Yesterday, there was McDonald's. Then suddenly he says he responds to a video as they put cheese on pizza. Ryan's father says. "Cheese comes on their pizza," and Ryan emulates what his father says while he smiles.
9:15Another video shows chocolate and now Ryan says “Bring one chocolate with the pizza today evening Dad" Ryan's father laughed and Ryan stared at him and said, "Dad, they gave chocolate!" and his father answers jokingly. "You want everything that is shown on TV?”
9:1609:16 Ryan's father asks if he's stupid. Ryan answers yes. Ryan's father asks, "What would you like to eat in evening?" Ryan answers "pizza, burger, noodles and chocolates." Ryan's father asks, "Do you cheese pizza?" and Ryan answers yes. Ryan's father says, "Really, if you do not mind Father." Ryan also duplicates it. Ryan's father goes to the kitchen without paying attention to Ryan watching.
9:17Ryan's mom returns from her shift and greeted me. Moreover, Ryan welcomes: "Mother, look, pizza, chocolate, while at the same time enjoying a fun face." Ryan shouted again: "Look, mother look." His mother joins him and looks at her Ryan went to her and took her off to look at what she was looking at. Ryan's mother looked annoyed and said, "Really, I see him, Ryan." Ryan said, "that's stupid."
9:18They both keep watching the video. While Ryan's father is preparing them for breakfast.
Ryan descended from the chair and rushes to the room. His mother took out her phone. She finds a toy weapon in his grip. She goes to her son Ryan and tells him politely to put the sharp toy away. “Let’s played together” shouts Ryan to hi mother. "I am tired" says his mom. He runs and goes back to watch TV while holding his notebook again:" Mom! Please give me breakfast! "His mother did not respond and continued to look at her phone.


9:20Ryan repeated what he said. his mother replied. - really, pause, Ryan. And he's still looking through his phone. Ryan ignores her.


9:21Ryan continues to scream and run a video game to shoot the zombies. "Zombie, play the beasts." "The zombies have made me, mommy, zombies, they've caught me.
Ryan continues to play and shout. He welcomed me to look into his room, saying, "A close relative, come to check my toy room." Whether it is possible, I refused to tell him that I was busy. (Their way of life is to call a close relative or uncle, whether or not they are identified with the individual to show respect).
9:22His mom got up and Ryan turned and said, "Hi, where are you going, Mom?" "And Ryan's mother responded," I'm going to the kitchen. "And he answered," I want noodles”. "He was spinning around the room for a moment and then screaming," Daddy, Dad? " Where are you ?!"
9:24He turned and asked, "Where's Dad?" I told him he was in the kitchen. Ryan continued to run to the kitchen and said, "You're there!" and then he wondered. 'Hello! What are you cooking for? "And his father replied," Noodles. "Ryan sniffed the air and said," Mmm. Fragrances a lot, "his father called -" obviously! "And Ryan replicated him, which made his father giggle.


09:25Ryan's mother comes to the kitchen and asked, "What are you giggling?" And Ryan shows her the noodles packet. Ryan went to his mother and raised his hands. Saying "mother give, give up." His mother says, "You're too big," Ryan demanded. So his mother betrayed him and said, "ohh Ryan is so small," and it stimulates him. They stayed close to Ryan's father and watched him cook.
9:26Ryan's father wanted to help him set the breakfast table. To which I gave my consent.




9:27Ryan sits at the table for breakfast. Ryan sits without someone else and has his plate. Ryan sits in the middle of his people and gets help from his mother and father.
9:28Ryan can use a spoon, but he has difficulty removing food from the plate, so his mother encourages him, and she makes him eat.
9:29Ryan wants water, saying "my mother needs water, I need water," his mother reminds him to say "please," and wants Raian's father to take water. Ryan's father gave him water and asked, "What do you say?" and Ryan reacted. "please". his father included "thank you what?" and Ryan says, "thank you, Daddy." And Ryan's father applauded him saying, "Great child."
9:30Ryan repeats “I will not go to school tomorrow”. Ryan's mother felt devastated and replied “School is good, do pay attention to your friends, I will come with you. " Ryan, just stood silent while watching what his mother.
9:31She encourages him to eat. "There you go, eat more." Which Ryan was obliged to do


9:34Ryan asks and puts food in his mouth and makes strange faces as he bites. At the beginning of the swallow, he grabs his glass and drinks from it. Besides, his mother watches him as he does it.


Ryan says, "I'm not full mother, I want more." She wiped Ryan's mouth and said, "Go to the room and sit in front of the TV, I will cook more." Ryan replied. "Yayyy Thank you mom."


9:36Ryan's keep watching TV while talking with his toys, and Ryan sits on the couch watching the Toys. Ryan still looks unobtrusively.
9:38Ryan changes his position to sit on the chair to stand on his chair to look into the kitchen as he keeps calling his mother.


9:39Ryan stands up and responds to the show and says, "Wow, that's so cool." Ryan continues to watch his show.
9:41Ryan comes down from the couch and walks to his father and wants his mother's phone, "My mother needs my phone, I need my phone." his mother answers and says, "I'm using my phone, Ryan." Ryan asked, and he cried when he asked for his mother's phone. His father tells Ryan's mother to give him his phone.


9:42In the meantime his mother walks into the room with bowl full of ready to make cooked instant noodles. Ryan looks with wide eyes towards the bowl of noodles and jumps from his chair and runs towards his mother. His mother says “Wait, Wait-Don’t jump or you will break something”. However, Ryan gets excited after watching his favourite food.
9:43He sits beside his mother with the phone in his hands. He sings and shows me the phone that was assigned to the camera. Ryan takes pictures of himself and shows it to his everyone, saying, "Look”
9:45Ryan finishes his food and Ryan's mother instructed him to come to the kitchen to put his plate in the sink. Ryan's mother instructed him to complete his homework, but Ryan continues watching TV. Ryan's mother was irritated and asked for his father to take the TV remote from him. His father calls him and says, "Ryan, come here, mother is asking something" 
9:46Ryan's mother’s face becomes red with anger and she raised her voice to Ryan to complete his homework. However, Ryan still continues to watch TV. Ryan's father called him and said, "Ryan, please leave TV, we will watch it tonight with pizza and noodles!" Ryan immediately agreed to his father and shuts down the TV. Ryan sits calmly and carefully starts completing his homework. 


9:48Ryan's father becomes slightly relieved and continues to search something on his laptop.
 
9:49Ryan's father tells him "come here to sit." Targets the computer seat. Ryan says "Thank you Dad" and sits on the seat. 
Ryan's shows his notebook to his dad and he says, "Good." He sits politely and starts writing. "Ryan you are a good boy." His dad says while keeping his arm on Ryan’s shoulder. “Good boys listen to their mother. Ok?”


9:51Ryan's watches him as he completes his homework
Ryan starts counting the sum on his fingers, "two and two must be four!" and writes it on his notebook 


9:53Ryan's mother walks into the room and takes part to watch Ryan complete his homework "Ryan is a very good boy," “But I will not go to school”, Ryan shots. His father ignores. 
While his mother sits down beside him and asks him “Why ?”


9:56Ryan says, “Riya teased me and called me Fatso”. I don’t like Riya and her friends. She is bad. I hate my classmates. I don’t want to go to school”. “Do I look ugly ?” he asks


9:58

his father says, " you're wrong," says his father, "go to the school, I will talk to Riya." Ryan's mother screamed "Ryan you are not ugly, you are my cute little kid." Ryan rushes to his mother’s arms and starts crying. 
10:00Ryan’ mother and father both tries to console him.



 


 

Summary of time spent on activities alone/with parent(s) in a span of 1 hour in
percentage


Time spent writing with father 40%


Time spent writing alone 2%


Time spent watching television alone 30%


Time spent watching television with mother 2%


Time spent watching television with father 10%


Time spent playing alone 4%


Time spent eating with parents 40%


Time spent being eating assisted by mother 15%


Time spent playing computer games with father 8%


Time spent playing computer games with both parents 1.7%


Time spent doing other stuff on his own/ with little assistance from parents 90%


Time spent annoying or whinging to his parents 8%


Time spent on other activities 5%


Time spent conversing with father 15%


Time spent conversing with mother 17%


Time spent teaching good manners 1.5%


Overall time spent alone 45.7%


Overall time spent with Father 25.3%


Overall time spent with mother 17%


Overall time spent with both parent actively involved 18.6%




Appendix B 

Interaction with Ryan was modest when we met. In our first interaction of 15 minutes he seems to be restless to me until he saw his mother. It made it less difficult for me to cooperate with him. I motivated him to sit with me in my room where I pulled out a pen and paper and started painting random shapes and lines to take advantage of it. When he finally approached, he asked me with a sure voice: "Hello, what are you doing?" I turned to him and told him I was painting him. At that moment he was asking if he should try. He did not respond, and he looked extremely modest and undesirable to take the pen out of my hand despite the fact that I could see he needed it in light of the fact that he was huddled around. 1 put the pen on the table and asked if he could draw three rows. Like the one I drew in advance and pointed the line. He said "line"? in a tone that looked like a query. He took a look at my illustrations and took the pen and tried to draw three rows. Then we completed some exercises, such as distinguishing pictures and shades from his books. reproducing what I did. playing with balls. removing several paper states. correction. walking here and there on the stairs and drawing attention to the body parts and imagining. He could duplicate most of the things I did. whatever it may be, she often needed her own stuff. catch and kick the ball. 

During my communication with Ryan he was calm and I could see that he was still timid, but he responds well and takes instructions more often. I saw that he tends to change words or sentences by no less than twice, and has many language mistakes and cannot clearly pronounce a few words clearly and in some cases shudder. There were times when he did not answer your inquiries real "and deliberately give the wrong answer or turns out to be a very fun love and mess, especially when he is extremely pleased after about 20 minutes of co-operation. Ryan does not respond well and gets exhausted when asked about such inquiries over and over. There are a few exercises that he just has to do once and it does it effectively. I watched him in some cases yawning and rubbing his eyes while 1 showing him something like painting or helping him by admitting a picture they did as things. Despite the fact that 1 definitely knew his name, despite asking him, he responded impeccably to Ryan, continued to ask him how old he was and he categorically answered "six." Whether he has any books and can show me some things, he said "yes" and gave his consent to show a few, can distinguish shades, distinguish and define several parts of the body, there are very long sentences, eg "what happens to you" or "where is my bullet"? He can display the photos in the book. he tells his full name from time to time when he asked him what his name was. He can do most of the gross exercise exercises in the study. He is also doing well with his capabilities, critical thinking, and the individual social segment.

Appendix C 


Interview with primary caregiver (s) 

Biological components 

Unplanned pregnancy 

No dissemination aid 

No history of hereditary problem 

Iron tablets administered 

No complications in pregnancy 

One child 3.4 kg birth weight 40 weeks gestational age 

No inconveniences 3 1 inch inch; 14 kg sleeping at 1 h / min-7 h / 8 h can in any case breastfeed in the first hour of birth. 

She took healthy diet consisting of equal proportions of proteins, carbohydrates and fats.

 Afternoon walk 3 times a week 

Fine development of motor skills

Family history of diabetes

No medication 

Safe neighbourhood 

Psychological factors 

He starts throwing tantrums when his father does not bring anything for eating whie returning home from work in the evening. But at the same time he continues to give him what he needs, and he stops showing tantrums. He is being bullied in his school due to her overweight condition. Both parent were aware about this issue but they keep on ignoring. From time to time, the husband helps his wife in household work. When Ryan feels scared he rushes to his mother. His people lift him up and hold him tight and ask him what the problem is. They at that moment tell him that it is not something to worry about and shows to him that he needs to be brave and ignore such kids. When he needs fast food from his mother, or his father, they surrender to his tantrums, and complete his every food fantasies. At a time when Ryan is trying to hurt another child, his people are interfering, and I tell him that what he's doing is not right. it also inspires him to hurt other children more and more often than not and does not try to get away from them.

They come out with relatives sometimes to get Ryan to meet new people and communicate with them. When he is terrified, he shouts and finally shouts and says nothing and does not want to talk to any other kid. His father and his mother asked him for what good reason he was shouting. He also clarifies what he does not want to play and that he feels tired while running. He is an active chid but he avoids playing outdoor games with other kids as it makes him tired early.. he often does not participate with different children. He communicates with his relatives and to the members of his family well and boldly. 

Social factors that influence development

 His mother is an Indonesian while her father is Australian. His mother is 24 years of age, while her father’s age is 30 years. 

The indonesian language is spoken at home, but they speak English when they talk to Ryan. 

They are Catholic. Both guardians work all week (38-48 hours a week). 

The mother works at night shift and the father works during the day. Despite the fact that the father will promoted in his company next year, they recently had enough money to pay their bills and family expenses. 

His guardians have completed school. 

Father has graduated from computer engineering and recently completed his master’s in business administration (MBA), and the mother has just finished high school and could not study further due to financial issues.

 She is an Indonesian. Moreover, the mother works at a nearby 24-hour store during the night shift. 

The father of Ryan has a long working time. He often visits late when his daughter is already asleep. Also, due to sales, he has to travel to work in other cities as well. Because of his busy schedule, he cannot give his daughter enough time. 

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