Max Braverman
Max is a 14-‐year-‐old male who was diagnosed with
Asperger syndrome at age 9. His struggles and triumphs with this syndrome affect much of what happens in his family. Max has a very loving and supportive family. His parents are married and very active in his life, and his older sister Haddie, a 21-‐ year-‐old straight A student is also very understanding and loving. Max also has a 3-‐year-‐old sister Nora.
Max Braverman
Family Structure • Very involved & supportive • Married parents Adam and Kristina, 21 yr-‐ old sister Haddie, 3-‐year old sister Nora • Very close with Grandfather and Grandmother, 3 Aunts, 2 Uncles, and five cousins
Parenting Style • Authoritative • Adam and Kristina are very good parents. They set rules and explain why. For example, Max is allowed to have 1 Hr of TV on school nights after doing homework/chores (ATI, 2013).
Life-‐Cycle Stage • Adolescent Stage (12-‐18 years) • A time of passage signaling the end of childhood and the beginning of adulthood (Ball, Bindler, & Cowen, 2015)
Social Network
Attends a charter school created by his mother. Chambers
Academy is for students with learning difficulties who do not respond to general or special education setting. At school he becomes romantically interested in a young lady named Dylan.
Favorite hobby is photography and sees it as a future career. Developed mentor relationship with Hank Rizzoli, his Aunt’s
boyfriend, who is a professional photography. Max and Hank connect as they both deal with the struggles of living with Asperger’s Syndrome.
The Braverman’s do not attend church, religion isn’t a main
focus.
Traditional cultural values: family meal time, family activities
such as going to movies and listening to music.
Physical Appearance
Max is a tall and slender male Caucasian. He appears well nourished and of his stated age. He has brown hair, brown eyes and black curly hair. His clothing is common for his age and consists of a T-‐shirt, jeans and tennis shoes. Growth & Development -‐Rapid growth of skeletal size, muscle mass, adipose tissue and skin. -‐Maturation of reproductive system; development of primary and secondary sexual characteristics -‐Onset of nocturnal emissions in males (Ball, Bindler, & Cowen, 2015) *Max has grown 4 inches since the Motor/Sensory start of this phase and his voice has -‐Awkward in gross motor activity at deepened.
first, matures as reaches end of age group -‐Easily fatigued -‐ in early adolescence may need more sleep -‐Fine motor skills improving to that of adulthood (Ball, Bindler, & Cowen, 2015) *Max’s fine motor skills are advanced displayed by the use of his camera and photography skills. He is also hypersensitive to touch. Sometimes he is awkward at playing soccer which is common during a growth spurt.
Developmental Stages Cognitive Development (Piaget)
Psychosocial Development (Erikson)
Moral Development (Kohlberg)
Formal Operational Thought -‐Increased ability to use abstract thought and logic; able to handle hypothetical situations or thought. Develops more internal growth of self-‐esteem and begins to develop an occupational identity (what I want to be) (ATI, 2013).
Identity vs. Role Confusion -‐A search for self-‐ identity leads to independence from parents and reliance on peers (Ball, Bindler, & Cowen, 2015).
Postconventional (12 years and older) -‐Decisions are based on internalized ethical standards and a social responsibility is recognized (Ball, Bindler, & Cowen, 2015).
Max is academically far above most others his age and older. He is very into photography and sees it as a future career.
Max is socially behind others. It’s difficult for him to make friends and hates being touched by others.
Developmental Stages
Max is very outspoken about his beliefs, but views his beliefs as “right” and others as “wrong.”
Nutritional Status Expected Nutritional Status:
Max’s Nutritional Status: Max is 5’7” and weighs 115 lbs putting his BMI at 18.0. According to the CDC, Max is at the 31st percentile for boys aged 14 years old (CDC, 2015). Max has very little interest in food and finds it difficult to sit through an entire dinner with his family. Although he gets frustrated when asked to remain at the table, he will only do so if he gets his favorite food – waffles.
Children in Max’s age group need quality nutritious snacks. Since this is a time for rapid growth, additional calcium, iron and zinc are needed (ATI, 2013). A balanced diet needs to be consumed by following the U.S. Department of Agriculture’s healthy diet recommendations (www.choosemyplate.gov) (ATI, 2013). Healthy practices needed at this age include avoiding fast-‐food and to avoid skipping meals.
Orem’s Self-‐Care Requisites Max is very close with his family. He gets along the best with his cousin Amber rather than his sister Haddie because Amber, “has a greater understanding of his condition.” His parents and extended family (Grandparents, Aunts, Uncles, and Cousins) are all very aware and supportive of his condition. He feels a sense of joy and fulfillment when he is behind the camera taking photos. He responds well to his mentor and friend, Hank, who is a 45 year old professional photographer who also has Asperger’s.
Max is not sexually active, but is romantically drawn to a young lady named Dylan. She attends school with Max and is the same age. When asked to be his girlfriend, she says she just wants to be friends. Max was very upset and rude at first. Now he has accepted their friendship after his mother helped him realize it’s ok to just be friends with girls. Max is not interested or involved with drugs or alcohol. Max’s self-‐image changes. When he is with Hank and working on photography projects he is happy with himself. When he is bullied at school he “feels different” from everyone else.
Concerns & Interventions Nutrition Although Max is at a healthy weight, there are potential nutritional concerns.
With his short attention span, it’s extremely difficult for Max to sit through an entire family dinner. He has zero interest in food with his thoughts constantly on the move and wanting to practice his photography skills or another favorite activity. His favorite food, waffles, is also high in sugar.
INTERVENTION Bright Futures suggests serving healthy food and eating together as a
family. Although the Braverman’s aim to do this, what they may find helpful is talking with Max about how his body is changing with puberty and the increased need to fuel his body with healthy food during this time (another suggestion from Bright Futures) (Bright Futures, 2016). Another intervention is collaborating with Max, his parents and a dietitian to provide a healthy, high-‐calorie, and high-‐protein meal that the Max enjoys (Ward, 2014). Collaboration ensures the diet will be appealing to the child as well. They could also make his favorite food option “light” and more nutritious using whole grain waffles and healthy toppings with bananas and strawberries.
Concerns & Interventions Physical Development Although Max’s BMI is within the normal range for his age, he may run into
physical development issues if his nutrition is overlooked. Max also likes sugary drinks. Due to lack of interest in food, he may not eat regularly and may not get the calcium, iron and zinc that he needs. INTERVENTION
Bright Futures suggests choosing water instead of soda, eating 5 fruits
and vegetables a day and 3 cups of low-‐fat milk, yogurt or cheese (Bright Futures, 2016). Max should learn the importance in incorporating healthy foods in his diet. His parents should involve him in helping prepare for dinner and verbalizing healthy options versus not so healthy. They could print an image of the “choosemyplate” for him to keep in his room as a reminder to get a good nutritional balance to remain a healthy weight and height.
Safety Max is very hypersensitive to touch. He does not like to be touched and will
carry on a tantrum when this happens. This is a safety issue for Max. He could shout at the top of his lungs to the wrong person who may come back and abuse him or threaten to do so. INTERVENTION Max should be spoken to about ways to manage his fear of touch. He should practice safe strategies to deal with situations that he is not fond of. His parents should talk to him about this and tell him they are there to support him through it. They could also nurture and hold him so he can get more used to the feelings and practice his responses in a safe environment.
Concerns & Interventions Social Development Max is socially behind for his age group. He doesn’t find it easy to
make friends and will sometimes say things without thinking of the other person’s feelings. Another concern is that he is spending a lot of time with Hank, the 45 year old, and not with people his age.
INTERVENTION Bright Futures suggests being involved in activities the
adolescent is interested in (Bright Futures, 2016). Max is into photography and to help with his social skills he should join a class at his school with other classmates who are interested in the same subject. This will give him something to talk about with his peers and help build his social skills.
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