Introduction
This paper explores a case study with one family with a child displaying slower language development, examining the case in the light of well-known theories around child development. These theories, which include scientific approaches, social approaches, and applied approaches to understanding and supporting child development, are evaluated in the light of the existing literature and in relation to health visiting practice.
The Case
Child A is a 2 year old male, the only child of a same sex lesbian couple, living in an ex-council house within a village environment. The area of the village in which they live is predominantly local authority housing, but they bought their house as a private sale from its previous owner. The biological mother, who for the purpose of this essay will be called Mother A, was brought up in this village, and left to attend university and have a career, returning when the child was 3 months old. Mother A works 21 hours a week as a nurse, and also works ad hoc shifts as an agency nurse. Mother B is a university graduate who left full time employment to move in with Mother A, and now works for a local women’s charity part time, as a child support worker.

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Child A displays normal development in most areas, and demonstrates clear cognition and understanding of language and interactions, potentially beyond the standard for his stage of development. However, Child A does not use verbal language himself very much, and at times displays behaviour which suggests he is withdrawn and not interested in socialising. Mother A states that Child A socialises well in the Creche he attends 3 days per week. However, Mother A also states that as a family they are very socially isolated. Mother A’s extended family lives within 3-5 miles of them, but has very limited contact, because of discomfort with their lifestyle. The family attempted to join a mother and toddler group, but were made to feel unwelcome, and both parents state that they are ostracised by their local community, and cannot access social support from a wider lesbian community because they have no childcare other than the crèche. They have been unable to secure a childminder or babysitter because of their alternative family arrangement.
Observations of interactions between parents and child demonstrate good, positive attention from both parents. Mother A is very ‘attuned’ to the child and ‘interprets’ behaviours and expressions, anticipating the child’s needs. Interaction between health visitor and child suggests the child is capable of proper linguistic expression. On one occasion, the child corrected the health visitor, to inform her that a shell in his ‘collection’ was grey, not white. The child also shows some ability to recognise alphanumeric characters. Despite this, verbal communication seems very limited.
Discussion
This case provides an interesting dilemma in exploring the theories which would explain the apparent linguistic retardation this child displays. Bowlby’s attachment theory, for example, might suggest that the child’s linguistic restriction is due to some element of attachment, and that the primary attachment figure for this child is Mother A. In the absence of what others might describe as a normal social sphere for the child, the attachment between Mother A and Child A may never have been challenged, and this close attachment means that the child feels no motivation to speak, because his needs are being anticipated by his primary caregiver. Discussion with both parents does not indicate that the child undergoes separation distress (Bowlby and Bowlby, 2005)), but this could be anticipated from what might be an overly strong and exclusive attachment to Mother A. However, this author feels that attachment theory does not provide a model to explain what effect this kind of relationship might have on linguistic development. Behavioural theories of child development might also provide some insight, particularly if the child views that his current behaviours are being rewarded and reinforced by one or both of his parents (see, for example, the theories of Skinner, Pavlov and Watson).
Scientific and biological theories of linguistic development may shed some light on the situation. Chomsky (2007), for example argues that the development of language in the individual child depends on a combination of genetic factors, which precipitate language learning in terms of a biological imperative, experience, which relates to the placement of the child as interacting with its social world, and principles of development which are not specific to the faculty of language. What this demonstrates is a move away from Cartesian dualism, and the reintegration of the processes of the mind into the functional and developmental processes of the body (Chomsky, 2007). In this case, therefore, Child A is likely to have biological imperatives precipitating linguistic development, but may not be achieving his potential due to a possible deficit in his interactions with the social world. It may be that this theoretical perspective highlights the single most important feature in this case, the lack of social integration into the wider social world, or into normal society. This is not to say that if a same sex lesbian family were socialising in peer groups or social networks, that this would not be normal – far from it. What is notable about this case is that the family are isolated from both general, “heterosexual” society and from peer-related social groups. If there are, then, elements of linguistic development which are founded on social interactions, a deficit in these areas would likely indicate a potential reason for Child A’s linguistic retardation. The family have attempted to ensure the child is with his own peer group by placing him in a crèche, a group childcare environment, rather than a single carer environment, which is a positive move. However, it could be that even this is not sufficient to precipitate the linguistic development that would be expected of Child A at this point.
Classic theories such as Piaget’s constructivist theory, which posits certain developmental stages, might be useful here. In Piaget’s theory, constructivism is an alternative to simple biological understandings of child development, and the development of children’s thinking and cognition is segemented into four stages, which are viewed as progressive (Dawson-Tunkin et al, 2004). Piaget’s stages suggest that children must all move through these stages, sequentially, in order to develop ‘normally’. It is unsurprising that many theorists argue against the centrality of these sorts of stages, as being too restrictive and rigid and not necessarily universally applicable (Dawson-Tunkin et al, 2004). Piaget posits that equilibration, the process of learning wherein the individual reflects on previous experiences to assimilate new concepts and knowledge into current knowledge, is perhaps the most significant of the features of children’s development (Dawson-Tunkin et al, 2004). So, although Piaget understood that biological maturation may set the timetable and limits of some aspects of child development, but stresses that the environment in which children are placed, and their interactions with that environment, is essential to them developing as they should. “Children who have severely limited interactions with their environments simply will not have the opportunities to develop and organize their cognitive structures so as to achieve mature ways of thinking” (Cook and Cook, 2005). There appears to be an almost inbuilt dissatisfaction with equilibrium, requiring individuals to extend their cognitive structures by seeking out, assimilating and processes new information (Cook and Cook, 2005). This is complemented by reflective abstraction, in which individuals take note of something in their environment, then reflect on it (Cook and Cook, 2005). However, Piaget also argues that “children do not passively absorb structures from the adults and other people around them…[but] actively create their own accommodations and so construct their own understandings” (Cook and Cook, 2005). Feldman (2004) criticises Piaget’s theories because they do not properly allow for the individuality of children, and for differences in development which might be quite marked between children in different circumstances (Feldman, 2004). This author also questions whether there is any need for such rigorous demarcation of stages of development, because if they are still only theories, then labelling children as failing or falling behind might be detrimental to the child and his/her family. However, many theories of development, general and linguistic, do suggest that social environment and/or interactions affects cognitive and linguistic development.
Therefore, it could be that in this case, Child A, through his experiences to date, which have been somewhat limited in wider social interaction, has developed his own understandings of the role and function of language in his life, and has perhaps come to the conclusion that the verbalisation of language, at least for him, is rarely necessary. Cognition is not absent, this is evident from interactions with him. He can speak, or at least, it is evident that he understands language, symbols and complex sentence structures, but he does not have any motivation to speak. If asked to carry out a relatively complex task, such as ‘put the shells back in the truck, and put the truck away”, he can do this, readily, and willingly. But if asked to describe what he is doing or to describe his truck, he uses one word answers, gestures and facial expressions to communicate.
Cole et al (2004) discuss how positive emotions are important in child development, suggesting that “emotions organise attention and activity and facilitate strategic, persistent or powerful actions to overcome obstacles, solve problems and maintain wellbeing (Cole et al (2004). This might suggest that perhaps Child A is not being placed in situations where he is emotionally tested enough, in order to motivate him to utilise language in ways that other children might do.
Bell and Wolfe (2004) also suggest that there is a need to better understand and explore the role of emotions in organizing and regulating a child’s thinking and learning, and also in understanding the role and of thinking, learning and action in the regulation of children’s emotions. Certainly both Piaget and Vygotsky both argue that children working together learn more than children attempting to, for example, solve problems alone (Cole et al, 2004). It would be no great stretch to see the connection between these collaborative or interactive experiences, the emotional responses of children, and their development, and this must include linguistic development, because these interactions would require the use of language, and perhaps, the development of new linguistic capabilities. Callanan (2006) states that children’s cognitive processes are connected to the language they hear around them. In this case, therefore, it could be argued that Child A may be limited linguistically because the language he hears around him is only that of his two main carers, and of course, the language he hears on television. His social isolation may be affecting the ways in which he is thinking about the world, because he is exposed to limited verbiage.
A Freudian analysis of this situation would be both problematic and challenging. If Child A is passing through Freud’s stages of psychosexual development, it could be said that he is perhaps arrested in his oral stage of development, and has not moved out of this stage because of his relationship either with Mother A alone or with both of his female parents. Freudian analysis here is fraught with difficulties, however, because this is not a typical heterosexual relationship, and so the parameters within which Freud’s psychoanalytical theories are framed simply to do not apply. The whole issue of gender here could be a difficult one, because there may be those who believe that a male child needs a gender-similar role model, and his current parenting situation does not provide this. However, contemporary theories on child care and child rearing have veered away from gender-specific behaviours and advocated for gender-neutral child rearing, a reorientation which has followed in the wake of radical and second wave feminist theories (Martin, 2005). These feminist theories have at times rejected concepts such as socialisation in the development of children’s social and personal awareness and in developing gender identity (Martin, 2005). However, this author believes, as does Martin (2005), that socialisation is an important feature in child development, and that while Freudian theories posit primary socialisation as occurring within the home, socialisation also occurs once the child is exposed to new environments. If the child is only exposed to limited social environments, this might also mean the child does not become socialised to as many environments and behavioural codes as it should do. Certainly, this author has met colleagues who have argued that the lack of a male role model, or male role models in the home situation, would constitute a problem. However, it would seem that many would argue that gender neutral parenting would not affect development, particularly if gender and chld development is fixed by biology (Martin, 2005).
Vetegodt and Merrick (2003) suggest that there are five important needs that children have, in relation to formation of their identity and in relation to their cognitive development. These needs are: “the need for acknowledgement, acceptance, awareness, or attentions, respect and care” (Vetegodt and Merrick, 2003). There is a suggestion that if children do not have these needs met, they may then modify their own identities to adjust to their parents and the situation (Vetegodt and Merrick, 2003). While this may not necessarily be true, in the case of Child A and his family, it might be that his needs are met in the home situation, but his needs may be being met in other situations. Certainly, conversations with the parents suggest that they fear his needs, of the nature described above, would not be met outside the family environment because of the nature of his family. There is an ongoing belief that childhood is of primary importance in children forming ‘healthy identities’ (Taylor, 2004).
The Role of the Health Visitor
These theories are mere explorations of potential reasons for an apparent deficit in linguistic development in Child A. Addressing this developmental issue with the parents, in this context, is likely to be somewhat challenging, particularly as the relationship between the health visitor and the parents is of primary importance (Jack et al, 2005). Certainly the child’s home situation is a positive one, and there are no issues in relation to economic or other deprivation. Both parents are intelligent and open to discussion about development and the child’s social needs, but both are also, understandably, sensitive about their continued social exclusion. However, the role of the health visitor is to promote the child’s health and wellbeing (Condon, 2008), and so part of the role in this situation is to assess this wellbeing and ensure the child is offered full participation in all the aspects of health promotion and disease prevention available (Condon, 2008). In this case, as Mother A is a nurse, and Child A has been subject to all necessary health checks, immunisations, and the like. Engaging with the family has allowed the health visitor to identify elements of the home situation which could affect maternal wellbeing, and so affect child development and wellbeing, but there are no signs of postnatal depression or anything else to raise any warning signs (Peckover, 2003)
Here, the role of the health visitor may be to assist the family in identifying ways of extending their social sphere and social life, and integrating their child into social groups and networks which might be more accepting of their alternative family construct. However, there are limits to what a health visitor can advise, and it might be necessary to look at other disciplines, other professionals, and other agencies to support this family. Certainly with changes in the law and social life in recent years, it is becoming less challenging for alternative families to find support and inclusion, but in this case, it would seem that social inclusion may be negatively impacting upon their child’s development.
The public health dimension of the health visitor role is very much vaunted in the literature and in governmental policy, but is less easy to realise in practice (Cameron and Christie, 2007). Yet activities such as those discussed in this essay contribute to the public health dimension of the health visitor’s role, in concrete ways. Perhaps it is most important to view the macrocosm of public health policy in relation to the microcosm of the daily work of the health visitor, although it is not always easy to evaluate the day to day function of this role in relation to wider public health improvements.
Conclusion
It would appear that, whatever the theoretical standpoint, there seem to be a range of ways of defining child development, and many of these relate to the way that children relate to their environment. While there may be a biological imperative to develop cognitively, developing cognitive and, in the case of Child A, linguistic processes, there can be factors which can negatively affect these processes. If these factors are socially mediated, then the social environment that the child finds itself in may be as important as providing good nutrition and health protection. The author deliberately chose a family which was not characterised by typical socio-economic deprivation, or domestic violence, or drug abuse, to demonstrate that child development is fundamentally about the child learning to interact with others, peers and adults alike, in a range of social contexts, and it would seem, from this case, that linguistic development may be more psychologically mediated by such contexts. It may be more than a simple biological/cognitive process, and may require exposure to a range of social settings to fully develop properly, to motivate the child to use language effectively.
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