At this point in the clinical reasoning process:

1. What do you believe are the underlying causes of the child and family’s identified needs, concerns, or problems?

Many of the concerns that the family has identified may be linked to her early developmental experiences. She was in an orphanage, and may not have gotten the attention and challenges needed for early skill development. She may have had less social interactions than she needed to develop both play and social skills. She may not have had routines and schedules to develop sleep patterns, social interactions and eating routines. Additionally, she needed early intervention services to address the impact of her movement difficulties on her play, eating, socializing and movement and did not receive them.

2. What theory is guiding your reasoning?

DEVELOPMENTAL and SOCIAL theories provide a framework for understanding MyaGrace's current status and possibilities for the future.

3. What practice models or frames of reference would you select at this point to guide your further reasoning?

DEVELOPMENTAL models inform us about what to expect of children at different ages. NEUROMUSCULOSKELETAL models of practice help us understand expectations for movement and interactions. FAMILY CENTERED CARE models help us keep focused ont he family's priorities. BIOMECHANICAL models will help us consider positioning and simple movement needs. SOCIAL/ BEHAVIORAL models will provide strategies for family interactions and supports.

4. What additional information do you need to competently move forward?

The therapist administered the Infant/ Toddler Sensory Profile. Findings of Sensory Profile (this will open in a new window)

Although we have some strong hypotheses about MyaGrace's behaviors, some of MyaGrace's behaviors may also be due to some sensitivities in sensory processing. IT may be helpful to identify MyaGrace's sensory processing patterns to determine whether there are factors to consider in intervention planning. We need to give her parents an Infant/ Toddler Sensory Profile, and look at the patterns in relation to our skilled observations and the parent interview information. With this additional strategy, we can be more confident in the source of her behaviors, and then we can design more precise interventions.