Running head: THE GIRL WHO CANNOT SIT STILL

The Girl Who Cannot Sit Still

Harpreet Kaur and Bobbie Chahal
California State University Stanislaus

THE GIRL WHO CANNOT SIT STILL

The Girl Who Cannot Sit Still

Tanvi is a 4-year-old female preschooler who is currently experiencing behavior
problems related to Attention deficit hyperactivity disorder (ADHD). Tanvi lives in an extended
family in Modesto made up of her grandparents, father, and a sister. Her grandmothers name is
Davinder. She is a 62 year old housewife. Her grandfathers name is Santokh, a 65 year old
property owner. Her father, Parneet, is 45 year old and assists his father in managing several
family owned properties. Tanvis elder sister, Yasmin, is 5 years old and is currently in
Kindergarten.
The family works together to handle all of the property they own, making their work
schedule extremely flexible. One example is the liquor store they own. The employees working
for the family usually manage the liquor store. The grandparents have had high school education
from India while Tanvis father has had high school and some college education with a focus on
business management classes. Tanvi is home all day on Tuesdays, Thursdays, and weekends (no
school). She goes to school in the mornings and is usually dropped off by her father and picked
up by her grandmother. The family speaks fluent English but they communicate at home
primarily in Punjabi. Tanvi speaks both Punjabi and English appropriately for her age. She does
still baby talk and slightly mumbles sometimes especially when she is feeling shy. Also, when
Tanvi is asked a question, usually the question must be repeated several times to get her to open
up and reply.
The grandmother and father work together to take care of the two daughters. The
grandfather is more concentrated towards managing the property business. Even during our
assessment, the grandfather did not care to join in. The grandmother and father were very
involved and helpful during the assessment. During the assessment, it was apparent that the
family uses the Permissive/ hands off style of parenting (Hockenberry & Wilson, 2013, p33).
They do encourage the children to perform certain tasks or follow specific schedules, but nothing

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in strictly enforced and it is left up to the children in how they want to approach any tasks at
hand (Hockenberry & Wilson, 2013, p33). The grandmother and father are the socializing agents
for Tanvi. Tanvi perceives her grandma as her mother. The grandmother cooks, cleans, dresses
the girls, and coordinates the care of her granddaughters with her son. The father takes the girls
out to fun activities, enjoys playtime with his daughters, and helps coordinate the care with his
mother. The family values the children a lot. The house has been modified to meet the childrens
needs. There is a gate on the stairs. There are toys available in every room. Even at the entrance,
we saw a wooden bench with the daughters names engraved above two carved out hearts.
Tanvis father faces stress in raising his daughters because there is an absence of a partner
(Parneet Sidhu, personal communication, September 17, 2013). He is planning on getting
married soon so they are hoping that family dynamics improve (Parneet Sidhu, personal
communication, September 17, 2013). The grandmother goes through stress as well because she
is an elderly woman and lacks the energy to keep up with being the mother in her
granddaughters lives (Davinder Sidhu, personal communication, September 17, 2013). Despite
these stressors, both father and grandmother have good communication and seem to make a great
team in taking care of Tanvi and her sister.
The family perceives the childrens good health as the daughters being able to play,
laugh, eat, drink, and sleep without hassles. They describe bad health as someone who is on bed
rest, dependent on others, and having limitations in daily activities (Parneet Sidhu, personal
communication, September 17, 2013). The family described their health status as being healthy,
normal and happy. When asked about any religious or cultural beliefs related to health, the
family said that they do not mix the culture/religion with health (Davinder Sidhu, personal
communication, September 17, 2013). They fully rely on western, commercial medicine. The
family incorporates both American and Indian food into the familys diet. Tanvi has no problem

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with eating Indian food, but her favorites tend to be American dishes such as pizza, string cheese,
pasta, BBQ chicken, and sandwiches. Tanvi loves to drink lots of water (Tanvi Sidhu, personal
communication, September 17, 2013). The family really emphasized on that because her sister
prefers soda. The family starts to get the daughters in bed at 9 p.m. However, the sisters do not
end up sleeping until 10 p.m. Tanvi seems to love her sleep and has no problem getting a full
nights rest. She does not have any history of waking up in the middle of the night with tantrums
or nightmares. Tanvi is very active. She runs around the house, has no problem going upstairs by
herself, loves to play outside and with her bicycle. In other words, there is not a problem of a
sedentary lifestyle. The family says that they all enjoy drinking alcohol. When asked if they have
issues with alcohol use, the family said that they could probably decrease on their alcohol intake.
They hesitated in discussing it any further. Based on our assessment, the frequent alcohol use
creates a very hands off environment for Tanvi. In other words, she lacks structure, supervision,
and the characteristics of an otherwise sober and attentive parent. This might be why there is a
predominantly Permissive parenting style.
Tanvi is 40 inches tall and weighs 35 pounds. She had a clean blue dress on. Her hair was
her natural brown color. However, it was very messy because she had just woke up. It took her a
while to get out of bed and be able to concentrate. Her skin was warm to the touch, dry, smooth,
tan in color, clean, and free of lesions or bruises. Her nails were smooth, clean, shiny, no
clubbing, and had a capillary refill of less than 2 seconds. She was not experiencing any
discomfort anywhere in her body. She was extremely shy and refused to let go of her dad and
refused to make eye contact. We let her stay in her dads lap and just asked her simple playful
questions like how many toes she had. Her dad had to prompt and coax her many times for any
assessments or questions. She was very easily distracted and we had to start over in getting her to
cooperate and focus many times. According to Theresa Lavoie (2008), having difficulty

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remaining seating and intolerance of boredom is one of the signs that parents should consider for
ADHD. Although her family and physician suspect and have discussed Tanvis risk for ADHD,
we cant confidently finalize the diagnosis due to the lack of screening done so far. Attentiondeficit/hyperactivity disorder (ADHD) is a chronic condition that is known to have multiple
behavior problems such as: difficulty sustaining attention, hyperactivity and impulsive behavior
(Mayo Clinic Staff, n.d.). Her head was erect, centered on shoulders, appropriate to body size,
had no ticks or involuntary movements. Her eyes were equal in shape and size, PERRLA present
but Tanvi had problems following our finger. Her ears had slight cerumen, no lesions. Her nose
was upright, symmetrical, no trouble breathing, no deviations of the septum. She is not a mouth
breather. Mucosal membranes were moist, pink, no lesions. She has no cavities and all of the
deciduous teeth were present. Good oral hygiene was obvious. Lips were moist, no lesions, and
she has no trouble swallowing or coughing. Lungs were clear, easy breathing, S1 and S2 normal.
Tanvis muscle strength, coordination and balance are ahead of the children among her age
group. This might be due to her constant need to be moving around related to her intolerance to
boredom. The inability to focus and excessive fidgeting demonstrated by Tanvi provides
evidence for a possible diagnoses of ADHD in the future.
Tanvis family did not keep track of the exact ages that she reached her milestones.
However, they estimated that she started to walk at two years of age and she started crawling
sometime within the first year of life (Parneet Sidhu, personal communication, September 17,
2013). The typical age for crawling is around 9 months and walking is around 12 months.
(Hockenberry & Wilson, 2013, p312). She is currently very egocentric (normal for age) and has
trouble sharing things. According to Piaget, this is a normal finding based on the preoperational
cognitive development stage (Hockenberry & Wilson, 2013, p73). Tanvi is in the
preconventional stage of moral development according to Kohlberg. When Tanvi would not

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follow our instructions, her father and her grandmother would help. Surprisingly, as soon as we
were able to get her to focus, she would obey her grandmother and father easily. This
demonstrates her focus on avoiding punishment as described by the preoperational stage
(Hockenberry & Wilson, 2013, p73). The fights she usually gets into with other children are a
result of her not wanting to share. She does not like to do things for others and is focused
primarily on her needs. She often throws tantrums when things are not done her way. She is able
to grip and lift objects and has achieved fine motor skills. We observed her playing games on her
dads phone and fidgeting with her dads fingers. She does not have any apparent breast buds.
Tanvi is toilet trained, however, she occasionally wets the bed at night (Dalvinder Sidhu,
personal communication, September 17, 2013). Bedwetting incidents are a normal finding for
Tanvis age group (Hockenberry & Wilson, 2013, p73). For spiritual focus, the family has taught
Tanvi the prayer positions and how to say some religious phrases (Parneet Sidhu, personal
communication, September 17, 2013).
While discussing food, we found out that Tanvi loves string cheese and water. We showed
the family and Tanvi a picture of the plate from the MYPLATE program and asked them what
food groups the meals generally consist of. The family said that most of the food cooked consists
of meat (Dalvinder Sidhu, personal communication, September 17, 2013). We went over meal
guidelines that are outlined in MyFoodPlate: making half of all grains of the whole grain variety,
making half of plate fruits while half of plate vegetables, eating lean meats, focusing on high
calcium dairy products, and ensuring the child gets enough water every day (United States
Department of Agriculture, 2011, p1). One idea we came up with is to put string cheese into side
salads with bright vegetables and fruits so Tanvi can feel more comfortable exploring healthy
food. We then discussed oral care. The grandmother told us that even though Tanvi can brush her
teeth on her own, she prefers that her grandmother help her (Dalvinder Sidhu, personal

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communication, September 17, 2013). We discussed the importance of encouraging Tanvi to

master the skill and to feel confident enough to begin to brush her teeth independently. We came
up with the plan to encourage Tanvi to do the skill on her own and to praise Tanvi often so she
gains confidence in herself. We noticed the father expressed concern over Tanvis temper
tantrums. We asked him how he dealt with the tantrums. He said he lets her cry and whine, but it
bothers him that she refuses to compromise and refuses to share with other children (Parneet
Sidhu, personal communication, September 17, 2013). We all talked about this and came up with
the plan of having the father and grandmother model the behavior they wanted to see in Tanvi.
The father gave examples of situations in which he could do this such as sharing the remote with
his mother and sharing food at the dinner table instead of distributing full plates of food. When
we had discussed hygiene, the father had mentioned that the girls love baths over showers. We
asked how much help the father and grandmother provide to the sisters in setting up the bath.
They said they let the girls do the bath on their own since the older sister is able to turn on the
bath faucet (Parneet Sidhu, personal communication, September 17, 2013). We brought up the
point that drowning accidents are common amongst children even if the children know how to
swim or in shallow bodies of water (Hockenberry & Wilson, 2013, p5). We suggested keeping
the bathroom door open so the children can shout for help, check the water temperature and
amount, use slip resistant rugs next to the tub, and provide adequate supervision. We emphasized
that presence of the parent is safer than the parent being out of the bathroom.
The family feels comfortable with affluence in the society. They also expressed that they
are very happy and comfortable with their financial status as well (Parneet Sidhu, personal
communication, September 17, 2013). Their goal as a family is to provide a secure environment
for the children and to work on restoring the presence of a motherly presence in the family so
that the grandma can take a break and the father can have support as well (Parneet Sidhu,

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personal communication, September 17, 2013). The family fully supports education and is very
excited about Tanvis goal of becoming a doctor. The family thinks Tanvi can work on her
communication skills because she does mumble. However, they do not believe she is too behind
on her development. Tanvis family states that the Sikh Temple is the only institution they seek
help from for spiritual needs. They dont rely on any other organization or institutions.
Tanvi is being monitored for ADHD. We asked the family how they felt about the
possible treatments that might be in the upcoming future. They said that they are scared if she
will need the medications for her problem because of the side effects (Parneet Sidhu, personal
communication, September 17, 2013). They said they would not be okay with too many
medications because she is too young for anything like that (Parneet Sidhu, personal
communication, September 17, 2013).

References
Brown, T. E. (2007). A New Approach to Attention Deficit Disorder. Educational Leadership,
64(5), 22-27.
Lavoie, T. (2008). How to know if your child has ADHD or learning differences: the importance
of an accurate diagnosis. Exceptional Parent, 38(5), 68-69.
Mayo Clinic Staff. (n.d.). Attention-deficit/hyperactivity disorder (ADHD) - MayoClinic.com.
Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/adhd/DS00275
United States Department of Agriculture. (2011). Choose MyPlate: 10 Tips to a Great PlateChooseMyPlate.gov. MyFoodPlate. Retrieved from http://www.choosemyplate.gov/foodgroups/downloads/TenTips/DGTipsheet1ChooseMyPlate.pdf