Delayed Development

Dear Ashley,
Another thing you said scared you was feeling like time stopped when you got sick, while everyone else's lives kept going.  I understand you feeling like it is hard to keep up with this fast-paced world, and I want you to know that we all feel that.  I think the most important thing is making sure you feel connected to your friends because that is a huge part of how we grow to learn about ourselves.  I hope you can stay connected to friends who enjoy the same hobbies you do; horseback riding might be challenging now, but you have other things you're passionate about.  I think it is incredible you are taking classes online to finish high school, and you even talked about college in the future.  Let me know if I can help you on that journey in any way.
-Amanda

Risk for delayed physical and psychosocial development related to chronic illness. 

• Assess Ashley’s stage of development according to Erikson’s theory.  As a young teen, she should be experiencing the crisis of Identity vs. Role Confusion, when she will develop a strong sense of identity and plan for her future career (McLeod, 2013).  However, she has been so preoccupied with maintaining her health that she has not been able to reach optimal well-being, and appears to some extent to still be experiencing Industry vs. Inferiority (McLeod, 2013).  She has not had the opportunity to master skills in school or hobbies, and has not had this social outlet.  Understanding this and working from this baseline will help her grow into the next stages. 
• Assess anthropometric measures for delayed physical development.  This has been addressed in Altered Nutrition; moving forward her diet should support her optimal health.
• Meet her where she is in every way.  Activities that may be normal for other adolescents her age may be too strenuous or challenging for her, even activities she was comfortable with previously.  Considering this will help prevent the excess stress of being in situations that are too taxing (Schuler, 2012). 
• Mastering the stage of Industry vs. Inferiority typically involves achieving confidence in peer relationships, often in the school setting (McLeod, 2012).  As Ashley cannot maintain a normal high school schedule, she should become connected with a strong peer group centered around academics or hobbies that she enjoys to grow from these social relationships.  It is essential, though, that she can engage in hobbies and passions that will not exhaust her (Schuler, 2012). 
• Ensure support within her social circles to make sure she has someone who understands what she is going through and can support her in difficult situations (Schuler, 2012).  
• Another aspect of mastering Industry vs. Inferiority is building confidence in her intelligence in the school setting (McLeod, 2013).  She should be connected with tutoring resources so she move forward academically and does not feel inferior to her peers.  This will also be important as she progresses into Identity vs. Role Confusion, when she needs to choose a field to pursue as a future career (McLeod, 2013). 
• Refer to a support group for adolescents with similar chronic illnesses that have some of the same daily struggles, another peer group she may benefit from (Carpenito-Moyet, 2010).