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Introduction :

This is a case study of a healthy three year old boy, named Timothy.  His mother Mrs. Andres, who happens to be a single mom after a divorce, works as an office clerk nearby.  Their humble home is located in Anahuac, Texas.

Case study of a healthy three... TOPICS SPECIFICALLY FOR YOU

Timothy, as a young boy, happens to do almost about anything which is typical for most children at the age of three. Communicating with him, according to his mom, is one of the most pleasurable and rewarding experience for her and her child. Timothy learns by absorbing information through daily interactions and experiences with other kids, adults, and the world.

Mrs. Andres loves to engage her son to many activities because the more interactive conversation and play his kid is involved in, the more Timothy learns. Reading books, singing, playing word games, and simply talking to kids will increase his vocabulary while providing increased listening opportunities.

The Visit

I paid a visit to the humble home of Mrs. Andres. The house is a single-detached, one storey structure with an approximately three meter by two meter cozy living room, two bedrooms, a small dining area and a kitchen.

I found Timothy lying at first on the carpet next to the television in the living room.  I started to observe how Timothy spends his time inside the house.  Like typical three year old kids, Timothy loves to play, jumps all over the place, messes up with things and makes loud noises.  But one particular thing that disturbs his mom is him getting too close to the television monitor.  Sometimes he would stick his face onto the monitor while viewing some cartoon shows.  As I was continuing my observation, he would also crawl underneath the carpet, hide behind the tall curtains, and crawl underneath the dining table, throw things around, and batting almost about anything with his plastic baseball bat. Like any other kid, Timothy is a normal healthy boy, who enjoys any activities that require physical movements.



As a young kid, I can say Timothy exhibits good health because he demonstrates a physical stature within the typical range of three to four year old kids, a developing ability to coordinate eye – hand movements, and he got large motor skills like jumping, galloping and running. Mrs. Andres, his mother also sees to it that she is promoting a healthy development for her child. She seeks a source of continuous and accessible health care. She and her child visit a health care provider on a schedule of preventive and primary health care to ensure that problems are quickly identified and addressed.


Mrs. Andres shared a few exciting events that she did before with her son. She shared that Timothy is just beginning to learn how to use materials as they are meant to be used. They play and it is mainly exploratory, helping Timothy learn about the properties and characteristics of materials and equipment. As a three year old, Timothy showed emerging flexibility and inventiveness by taking play dough to the housekeeping area to fill the muffin tins before putting them in the play oven. They also did some paintings.  Timothy got excited when yellow and blue paint turn into green after being mixed. One time, there were some leftover carrot scrapings after Mrs. Andres cooked; Timothy suggested that they feed it to the rabbit.

Young boys like Timothy are really very curious. They naturally explore and study most common objects and living things. They will study an ant crawling on the sidewalk or an interesting twig they find lying on the ground. They are more apt to express their wonder about the world by commenting about their observations than by asking meaningful questions. There were few more observations that Mrs. Andres shared about her son Timothy. One time timothy was curious about the pine cones and pointing out every detail he sees and feels such as the points and the sticky stuff, Timothy would tell his mom about him noticing a bulb stalk grow taller each day, and wondering what the “fat ball” on top will become.


Timothy speaks in short sentences. There are articulation errors that are present, but speech is usually clear enough to be understood with little difficulty. Mrs. Andres gives her son many opportunities to talk, because she believes the length and complexity of the kid’s sentences will increase through those exposures.  Mrs. Andres with her son would sometimes watch television and she would then describe an event, in return Timothy asks some questions, then she answers those questions. Other things she did to improve the language skills of her son are, signing or using a communication board to indicate Timothy’s food choices at snack, telling a story using words, props and gestures to convey meaning, and using common social conventions, such as “hello”, or “thank you,” with occasional prompting.


Few children books bought by Mrs. Andres for her son have made the kid very excited about it.  She exposed him to story books and coloring books. She believes that there are key factors that would make kids sit still and stay focused during story reading or coloring the books, like the kids’ interest in a specific story or character, and the appropriateness of the text and illustrations. Her kid loves colorful stuff and pictures of robots and cars.


There was this small event outside of the house called in by a neighborhood for children to come and make some school activities. Mrs. Andres brought her son to the event to participate. Timothy demonstrated some confidence. He joined this bunch of kids in the coloring activity. He seems to feel competent about it. Some kids really take pride in their ability to do familiar things. However, when an experience is unfamiliar, a kid can be very tentative.

Timothy showed a positive sense of self by joining other children playing; responding to our neighbor’s greeting and exchanging a few words; coming to the snack table and participating in conversations; choosing individual activities, such as doing puzzles, painting, or helping feed the pets.


I had a chat with Timothy’s mother, Mrs. Andres while her son was lying again on the carpet after a grueling exhibition around the house.

Mrs. Andres told me that there were many times her son would drive him crazy. Timothy at times is a very strong willed and stubborn child but she tries herself to handle him and would redirect him when needed. In essence, Timothy does not want to do anything that her mother would tell him or ask him to do. If she tells him that he is too close to the television and to please back up, he says “No!”, and doesn’t. If she puts him into timeout for not doing what she asked, he will sit in the corner and mouth the entire time. He will say things like, “I’m the boss, I’m mad at you”. Mrs. Andres cannot get him to close his mouth. She has tried to explain to him that he is not allowed to say mean things to her. She has also explained to him that he has to do as she tells him because she is the boss, not him, but it is not like she does not give him an opportunity to make his own choices when reasonable. She has turned off the television and that stops it for the time, except that the mouthing continues. If she then reminds him that he is too close to it, the next few times he will backup as asked. But that does not last long, and he will push up against it and they go thru the same fight all over again. She cannot seem to get him to understand that he is always going to get into trouble for the same things until he quits. She said that the problem is that these same kind of things have been going on since he began moving as an infant, but quite often there where moments Timothy is good all day. She prays for someone who could answer her question like when can she expect Timothy would quit, any suggestions for getting him to quit talking when she tells him too. In everything, she said Timothy interrupts. She cannot find a way to discipline him that works. She cannot take him anywhere that she would expect him to be quiet because if he chooses to talk he will. She has tried to take away toys, spanking, soaping his mouth for mean words, time out and etc.


There are good ways on how to discipline the kids. Children in nature love doing any crazy things without knowing its consequences.  I do not believe in a rewards and punishment, spanking and shouting as a means of discipline.  The reward – and – punishment system does a poor job at teaching kids to be responsible for their own behavior; it makes parents responsible for it. It does not encourage personal decision-making by kids. It reinforces the notion that appropriate behavior is demanded only in an authority figure’s presence.  Punishment, spanking and shouting at the kid take away respect and threatens the culprit with a loss of affection and approval.

I strongly favor an alternative called logical and natural consequences. This method encourages kids to be responsible for their own behavior while encouraging them to make decisions about appropriate behavior. Natural and logical consequences allow kids to learn from the natural and social order of the real world.  Kids who refuse to eat get hungry.  Kids who scream and kick when it is time to go outside to play are given the option to cooperate or show by their behavior that they are not ready to have fun.  There is no power game here, the logical consequences fit the behavior and the child can “own: the outcome.


If You Suspect a Problem

If you suspect your child is having trouble with hearing, language acquisition, or speech clarity, call your doctor. A hearing test may be one of the first steps in determining if your child has a hearing problem. Two years of age is not too young for a referral for a speech/language evaluation, particularly if your child is not following directions or answering “yes” or “no” to simple questions.

A speech-language pathologist (an expert who evaluates and treats speech and language disorders) may recommend:

direct therapy

referral to a developmental pediatrician if there is suspicion of a global developmental delay (delays in more than one area of development, including gross motor, fine motor, problem-solving, language, and social skills)

early intervention services

a follow-up assessment to see if your child will catch up over time

Typical Communication Problems

Communication problems for 2- to 3-year-olds include:

hearing difficulties

problems following directions

poor vocabulary acquisition

speech dysfluencies (difficulty initiating or sustaining sounds)

delayed acquisition of phrasing skills

unclear speech

Problems — such as stuttering — may be a developmental process that some kids will outgrow. For others, more intensive therapy may be needed. Medical professionals, such as speech pathologists, therapists, or your doctor, can help your child overcome these communication problems.

Some parents worry that a toddler who is not speaking may have autism. Children with autism and related conditions may have delayed speech or other problems with communication, but poor social interactions, and limited or restricted interests or patterns of behavior are also hallmarks of this disorder.

If you have any questions or concerns about your child’s development, talk with your doctor.

Reviewed by: Steven Dowshen, MD
Date reviewed: July 2008


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