Occupational Therapy in Community-Based Practice Settings 2nd Edition by Marjorie Scaffa, Maggie Reitz

Exercise 4

CASE STUDY
Juan is a 22-month-old toddler with developmental delay. He has just been referred to early intervention by his pediatrician. Juan lives in a small apartment with his parents. His mother stays at home to care for him and she is currently 4 months pregnant. The language spoken at home is Spanish; however, both parents know some English. Parental concerns include Juan's lack of eye contact, not eating more foods, getting upset with noises, and difficulty taking him to unfamiliar environments. His mother reports he can finger feed, eats fewer than 10 different foods on a regular basis, and only drinks room temperature water. Some days he will just play with his food, and his mother then attempts to feed him. He has lots of toys but plays with the same toys each day, mostly dropping them, throwing them, or lining them up in a pattern. He wakes up two to three times per night. His mother has been leaving him in his crib, and sometimes he will go back to sleep. Lately he is starting to try to climb out, and the parents are concerned he will get hurt. They want to transition him to a bed before their new baby is born but do not want him roaming around the apartment at night. They sometimes bring him into their bed, but he is restless and does not go back to sleep. When outside, he runs around and sometimes spins around. He likes the sandbox and will sit and watch the sand fall through his fingers. He loves television, especially Diego, but the TV volume must be low and he wants to stand right at the screen. Your observation of play identifies repetitive play patterns, lining up of toys, lack of eye contact, inconsistent response to his name, and some self-stimulation with hand flapping.
What occupations would you observe as part of your skilled observation?