Biopsychosocial Case Study Analysis of Carlos

Running head: BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS Biopsychosocial Case Study Analysis of Carlos (Name) 1 BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 2 There are various factors to consider when devising any intervention plan, but especially when it is for a child. Careful thought is essential in cases such as the case of Carlos, because he is so young and he is still developing. Age influences not only physical development but cognitive abilities as well, which can in turn affect the outcome of the plan created. Carlos is eight years old. This implies certain biological characteristics, a certain degree of psychological maturity, and a specific level of social skills. However, before examining his current set of biological, psychological and social abilities, it is important to look at these same factors at the time that his parents left him, because prior development or interruption to normal development, can and often does have an effect later on in life. Carlos’s parents left him to stay with an aunt and his grandmother when he was four years old. He had developed normally and had no health conditions. His cognitive development, as explained by his mother, was also normal. According to Zastrow and Kirst-Ashman (2016), at the age of four, a child is “less likely to conform, in addition to being less responsive to the pleasure of displeasure of adults…Fouryear-olds are in the process of separating from their parents” (p. 83). However, for Carlos this process was interrupted, because the separation happened abruptly. Additionally, children at this age are “unable to see things from anybody else’s point of view” (Zastrow & Kirst-Ashman, 2016, p. 134). Although Carlos’s parents may have tried to explain the situation to Carlos, it is possible that he was unable to understand from their point of view. His cognitive ability only allowed him to see the situation from his own perspective—which was that his parents were abandoning him. At age eight, Carlos was once again separated from his main caregivers, this time his aunt and grandmother. This could have played a role in the lack of social interest which he currently has. It is possible that he does not want to form relationships with peers for fear of being separated again. BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 3 Now that he is eight years old, Carlos has had various issues in adapting to his new home. He has a few physical problems, which are that he is sick all the time, and has a sensitive stomach. Both of these were rare before he came to the United States. A possible explanation for this is that he may not be used to American food, and he does not have immunity to the different viruses, bacteria and other microorganisms which may be native to this country but not found in El Salvador. This weakened immunity could also be accelerated by stress. Additionally, being sick all the time can influence his emotions. This creates a two-way relationship, in which his health affects his emotions, and his emotions affect his health—in this case negatively. He is also displaying psychological problems, including anxiety and withdrawal. At eight years old, Carlos is in Piaget’s concrete operations stage. He is able to think logically, feel empathy and see things from others’ point of view, and understand symbols to represent events, although he is still unable to think about ideas (Zastrow & Kirst-Ashman, 2016, p. 136). Lev Vygotsky also had a theory about cognitive development. One of the points of his theory was that “a child’s development will differ depending on what’s going on around the child” (Zastrow & Kirst-Ashman, 2016, p. 141). In other words, Carlos’s development can be affected by his environment. If he is in a nurturing environment he will develop healthily, but if he is surrounded by people who constantly criticize him, his development may be slowed. Lastly, Carlos still does not speak English despite being in the country for eight months. While it appears that this is because he does not want to, we should also consider the possibility of a learning disability. According to Zastrow and Kirst-Ashman, (2016), “Although people ‘with learning disabilities typically may have average or above-average intelligence,’ they may experience weaknesses in one of more areas; a learning disability may involve cognitive, academic, or social/emotional characteristics” (p. 166). Carlos is a smart boy, but he does have difficulties both academically BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS and socially. I am not saying that he 4 have a learning disability, only that it is possible given his performance in school. He has also had some social problems. At his age, a normally developing child has increasing social skills, and playing with others his age is important to him (Zastrow & KirstAshman, 2016). However, Carlos does not participate in class, he has poor attendance at school and he is not interested in anything social with his classmates. We would need to know if he has made any new friends at all since coming to the United States. We do know that he does enjoy spending time with his siblings, and playing soccer. Another characteristic of the developmental stage he is in is that he is “becoming more sensitive to reactions of those around them…There is some tendency to react negatively when subjected to pressure or criticism” (Zastrow & KirstAshman, 2016, p. 84). Carlos is being told he is not doing well in school, and he needs to try harder and actually go to school. These criticisms are counterproductive because he may choose to (and has chosen to) react to them negatively. Instead of attempting to learn English and do well in school, he tries even less. Language is an important component of this developmental stage. According to Vygotsky’s theory of cognitive development, “children must use a scheme of symbols such as language in order to process what they see and learn new skills” (Zastrow & Kirst-Ashman, 2016, p. 141). In other words, in order for Carlos to be able to learn anything, he must first learn a language for which to learn it in. Of course, he knows Spanish, but if his school is teaching in English, it will be extremely difficult for him to learn anything new unless he first learns English. There are many systems which interact and influence Carlos’s current circumstances. The micro system in this case is Carlos. As mentioned earlier, he has had trouble biologically with a sensitive stomach and frequent sicknesses. He also has problems academically which may be a BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 5 result of psychological problems, such as anxiety and withdrawal. Finally, he also has some social issues, showing no interest in making friends or learning English. There are many mezzo systems which interface with our focal system, Carlos. These include his family, the school he attends, the neighborhood in which he lives, and his church. There seem to be no major problems in his family. His mother works part-time and his father works full-time. He also has two older siblings. Generally, family is able to influence a person’s attitude on ideas, especially for a child. His family might inadvertently be giving Carlos the message that adjustment to the culture of the United States is not important. More information would be needed on how the family interacts with each other, because we do not know how well Carlos functions within the family, although we know for certain that there is no alcohol or drug abuse and no violence. The elementary school that Carlos goes to also influences him. The teachers and students, and the way in which they interact with Carlos can have a great impact on him. Currently, since Carlos refuses to speak English, it might be hard for him to communicate with teachers and classmates. If he is not simply refusing to speak English, and he actually does not understand, it is even more difficult for him, and of course his poor academic performance reflects this. However, school has most likely taught him other things besides what is on the curriculum, such as how children interact with each other and aspects of the culture in this country. The neighborhood in which Carlos lives can also shape his life. The location of it will determine what kind of people live there, and what sort of people Carlos will meet. We were not given any information on where Carlos lives besides the city of Hyattsville. According to www.hyattsville.org, there was a 34.01% of Hispanics in the city’s population. Blacks, White alone, and “some other race alone” had similar percentages in the 20-35%. According to BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 6 www.cia.gov, in El Salvador the majority of people are mestizo, at 86.3%, followed by white at 12.7%, and then Amerindian (0.2%) and only a very small percentage of blacks (0.1%), and other 0.6%. Clearly, there is a significant difference in diversity between Hyattsville and El Salvador. This sudden change in the kinds of people who surround Carlos could cause him to experience culture shock. Another subsystem which interacts with Carlos is his church. His mother said that it seems to be the only place where he is happy. Everyone there speaks Spanish, so it might be the only place in which Carlos feels comfortable and is able to understand everything that is going on. Involvement in the church has had a positive effect on him since he is content in this setting, if only for a short while. Finally, we should consider the macro system in this case, which is the United States government, that indirectly affects Carlos. Carlos’s father Jose was here illegally, and that is why it took so many years to bring Carlos to the United States. Carlos was separated from his family for four years. This is one of the way in which the laws made by the government of this country have affected Carlos. Additionally, Carlos’s status as a citizen or non-citizen will determine what resources are available for him, now and later on in his life. As shown, there are various systems, both at the mezzo and macro levels which interact with the micro-system of Carlos as an individual. There are a few diversity issues that Carlos faces. His culture is one of the minority cultures in the United States. Some of his beliefs or traditions may be different from the majority of the people here. According to Galan’s multidimensional transactional model of bicultural identity, Carlos is in one of four stages—assimilation, acculturation, marginal, or traditional. Assimilation refers to when a person lets go of their former culture and completely adopts the BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 7 new culture. Acculturation occurs when the person keeps aspects of their old culture, but also embraces the new culture. Marginality is when the person is not a part of any culture and finally, the traditional person is one who maintains a high adherence to his old culture. From the way in which Carlos is acting, it seems he is in the traditional phase. He refuses to adopt the new culture, which is why he does not want to speak English. For him to be most successful, he would need to be acculturated. Carlos’s ethnicity might also be a problem for him. Carlos is now a part of the minority, when at home in El Salvador he used to be a part of the majority. He might look different from his classmates, so these differences in ethnicity are more obvious than the cultural differences. This difference in appearance could lead to other problems at school, including possible bullying by peers. A third factor which is impacting Carlos is his family’s social class. The family came here due to financial struggles back at home, and it seems they may still have some problems since Carlos’s father is gone much of the time due to work, and Sara has a part-time job. Social class will affect what resources are available to the family. For example, having a tutor for English or schoolwork for Carlos may not be a realistic option for the family if they are unable to afford it. Although Carlos is having many difficulties, he also has various strengths worth mentioning. There are some activities that he enjoys. He has always enjoyed spending time with his siblings. He also used to play soccer back home and he loves to draw. Since arriving to this country, he does not show much interest in doing anything, but he does show contentment while at church. He is fluent in Spanish, so once he learns English this will be a strength for him because he will be bilingual. Resources available to him are his older siblings, classmates who speak Spanish and English, and the church. His older siblings can help him to learn English, as well as help him with his homework. Classmates who are bilingual can help translate for him BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 8 while at school. Furthermore, since Carlos is comfortable with the people at church, they might be able to involve him more in their activities, especially with other kids his age who may be experiencing the same situation. Carlos’s parents could also look into getting him to join a soccer team or to take art classes, or even simply to buy him art supplies so that he can draw at home. Carlos’s development stages, problems, diversity issues, strengths and different factors all interact and affect his life overall. His developmental stage determines how he will deal with the problems he has. Although he is able to see things from others’ point of view, he still cannot think about ideas abstractly. For example, he might understand that his mother wants him to go to school and do better in school, but he may not comprehend why. He is unable to grasp the idea that education is important, and that it will be a benefit to him in the future. Other factors can affect or even hinder his development. These factors include the location of his neighborhood, and his family’s socioeconomic status. If they live in a neighborhood with high crime rates, Carlos may be in more danger. If the family has a sufficient amount of money, more resources are available to them, such as proper health care. However, if they do not have enough money, Carlos may have a lack of nutritional food or he may not be able to spend a lot of time with his parents. A third factor which affects Carlos’s social life is his ethnicity. If he feels he is different from everyone else, it is harder for him to make friends at school. This can lead to feelings of withdrawal, which then affects his relationships at home. This can heighten his negative feelings, and create a downward spiral effect, both in his academic performance at school, and his social life overall. The problems with which I believe we are able to help Carlos with are his attendance to school, his participation, his grades, and his lack of interest in social activities. Some challenges he also needs help with are his English and making friends. BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 9 Considering all of the factors mentioned earlier and the ideas in the systems theory, we must include Carlos’s family in our intervention for Carlos. If everyone works together, we will be much more successful. Since his siblings have been in the United States longer, they can help Carlos with learning to speak English, and also with his school work. They can also help him to become accustomed to the new culture in this country. His family could also consider finding a tutor for Carlos, or sometimes there are free after-school programs of volunteer tutors. His parents can develop a system to reward Carlos every time he does well in school, or when he speaks English at home. It seems that Carlos is not very happy, and perhaps the family should spend more time together. A specific time could be set aside each week for them all to spend time with each other. They should also continue going to church, since this is where Carlos is happiest. To be more involved in social activities, Carlos could try to make friends with the children at church. He can also join a soccer team of other Spanish-speaking boys his age. This way, he could keep aspects of his old culture, but also begin to adopt parts of the new culture. At school, the teacher should assign one of his classmates who speaks both English and Spanish fluently to translate for Carlos and make sure he understands everything that is going on. Carlos will soon speak both English and Spanish, and can even benefit from knowing two languages. There are many effects of speaking a second language. Several studies have been conducted exploring how a person who is bilingual is different from a person who is monolingual, and how language can affect cognition. In one study titled authors sought to answer the question of whether or not people who spoke two or more languages viewed themselves differently depending on what language they were thinking or speaking in. The authors hypothesized that their study would confirm former theories that state that bilinguals have different ways of thinking and different “selves” depending on which BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 10 language they choose to speak in. This is something which has long been debated, and at one point in time, bilinguals were thought to have a form of schizophrenia. The article emphasizes that the concept of self and the concept of identity are entirely different, and that bilinguals may have different selves in different languages, but their identities remain the same from language to language (Salmani Nodoushan and Garcia Labora, 2014). In the study, participants were given a personality test and also a questionnaire on what their ideal personality is. Both tests were given one time in English, and one time in Persian with a three-week interval between tests. Participants were randomly divided into two groups—one which received the English versions of the tests first, and one which received the Persian versions first. Their scores on the personality tests versus the ideal personality tests were compared to see how closely they matched. Researchers found that regardless of which group participants were in, the results were very similar. When given the tests in English, the participants’ actual self and their ideal self closely matched. When the tests were given in Persian, the participants’ actual self and ideal self were very different. The authors concluded that the results supported past studies. Bilinguals have slightly different personalities depending on which language they are thinking in (Salmani Nodoushan and Garcia Labora, 2014). However, this study did have a couple of problems. To begin, the sample size was very small—only 183 people. Furthermore, the results of this study cannot be generalized to all bilinguals. It can only be said for those who speak both English and Persian. Another study titled , investigated memory in five year olds and six year olds. Researchers hypothesized that bilinguals who were less fluent in Dutch would outperform monolinguals— despite the monolinguals’ higher Dutch proficiency—on certain memory tasks. Tests included recalling where a dot was on a screen and recalling sets of numbers, both forwards and BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 11 backwards. There were no significant differences between the monolinguals and the bilinguals in the five-year-old group. However, in the six-year-old group, the bilinguals performed much better than the monolinguals on both tasks, supporting the theory that “bilingualism enhances executive control” (Blom, Küntay, Messer, Verhagen, & Leseman, 2014). Again, this study is not generalizable to bilinguals of other languages, and is also not generalizable to other ages. A third study discussed the effects of expressive writing among bilinguals. Korean-English and SpanishEnglish bilinguals were all asked to wear a tape recorder for two days to measure their typical social behavior. They were then divided randomly into four groups. One group was assigned to write in English only, one group in their native language only, one group was asked to alternate between languages on different days, and there was a control group which was not asked to write. Groups were told to write on four consecutive days. One month later, the participants once again wore the tape recording device to measure their social behavior. They also had various questionnaires to fill out regarding emotions and social behavior. In general, those who were in the language alternating group were more socially active after a month than the other groups. Those in the language alternating group spent more time with other people and less time alone. They also reported the most benefits. Researchers theorized that this is because speaking more than one language can benefit psychological health (Kim, n.d.). However, they state that this study is preliminary, the sample size was small, no biological measures of health were taken and there was no analysis of the writing. Furthermore, changes in behavior and feelings were selfreported, and thus subjective (Kim, n.d.). Another article discusses theories about bilingualism. In the study , authors conducted a study to test the hypothesis of whether or not bilingualism influences social functions. However, this left them with another question: “Does knowing a second language BIOPSYCHOSOCIAL CASE STUDY ANALYSIS OF CARLOS 12 make a person more intelligent or does higher intelligence make a person more likely to learn a second language?” (Cox, et al., 2016). Regardless of that answer which we still do not know, these studies show a bilingual advantage on both memory tasks and social behavior. Although more research needs to be done, these articles point to the idea that learning another language can have its benefits (Cox, et al., 2016). Knowing this, it is important for Carlos’s family to make every effort possible for him to learn English. If the theories mentioned are correct, then learning English will help Carlos both socially and psychologically. As mentioned earlier, his siblings can help him with his English at home, and with his homework. Considering the results of the study done on the effects of writing, Carlos should be encouraged to write (or possibly even assigned to write by his teacher) both in English and in Spanish. He should join a soccer team and begin drawing, either at home or in an art class. To make more friends, his parents should encourage him to socialize more at church, since this is where he is most comfortable. At school, his teacher can assign a Spanishspeaking classmate to be a translator for him, so that he practices his English and makes friends at the same time. Finally, as stated earlier, the family should set aside one day of the week to spend time as a group so that Carlos knows he has their full support. If all of these steps are taken, Carlos will soon become used to the culture and his new home, and continue to develop normally.