Understanding Riham: A Developmental Profile and Responsive Support Strategy for Toddlers Aged 24–36 Months

Riham is a 31-month-old toddler who attends the BrightSprout Early Learning Center in Portland, Oregon, five mornings per week. She speaks Arabic at home with her parents and is acquiring English in her preschool setting. Over the past four months, Riham has demonstrated consistent growth in expressive vocabulary (from 42 to 117 single words), yet continues to use limited two-word combinations (e.g., 'more juice', 'bye-bye daddy'). She exhibits tactile defensiveness—refusing textured playdough, avoiding grass barefoot, and becoming distressed during hand-washing transitions. Her sleep log (tracked via the Hatch Rest+ device) shows an average of 10.2 hours nightly, with 1–2 night wakings. This article synthesizes observational data, developmental assessments (Bayley-4, Ages & Stages Questionnaires, Third Edition), and evidence-based interventions used successfully by her teaching team to support her holistic development.

Developmental Snapshot: Riham at 31 Months

Riham’s current profile reflects typical variation within the normative range—but with distinctive patterns requiring intentional scaffolding. According to the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4), administered at 30 months, Riham scored: Communication 89 (16th percentile), Gross Motor 95 (37th percentile), Fine Motor 92 (29th percentile), Cognitive 94 (34th percentile), and Social-Emotional 87 (19th percentile). These scores do not indicate delay but signal emerging needs in expressive language and social-emotional reciprocity. Notably, her receptive language (assessed via the Preschool Language Scale, Fifth Edition) was age-expected at 102 (53rd percentile), confirming strong comprehension despite limited verbal output.

Her physical growth falls within WHO standards: height 91.3 cm (52nd percentile), weight 13.6 kg (63rd percentile), head circumference 48.2 cm (58th percentile). She wears size 8 toddler shoes (Stride Rite Flex Lite 2.0) and uses a Graco TurboBooster seat in the car. At home, she eats three meals and two snacks daily, consuming approximately 1,100 kcal—within the AAP-recommended range of 1,000–1,400 kcal for her age and activity level.

Milestones in Context

Riham meets or exceeds most gross motor milestones: she runs without falling (observed 92% of attempts over 20 timed trials), climbs playground ladders independently, and kicks a ball forward with accuracy (78% success rate in 10 trials). However, she avoids jumping with both feet off the ground—only attempting it when modeling is paired with rhythmic clapping (introduced in Week 3 of the JumpStart intervention). In fine motor skills, she copies a vertical line on paper (per DIAL-4 protocol), strings 6–8 large beads (Lakeshore Learning Jumbo Beads, 2.5 cm diameter), and holds a crayon with static tripod grasp—but fatigues after 90 seconds of drawing, suggesting emerging hand strength deficits.

Language Development: Bilingual Emergence and Expressive Gaps

Riham is a sequential bilingual learner: Arabic was acquired first (her parents speak only Arabic at home), and English exposure began at 18 months in childcare. Research from the National Institute on Deafness and Other Communication Disorders confirms that sequential bilinguals often show temporary expressive lag—especially in syntax—while maintaining age-appropriate receptive skills in both languages. Riham’s home language sample (collected via 15-minute video-recorded play sessions using the Systematic Analysis of Language Transcripts software) revealed 63 Arabic words and 5 morphemes (e.g., plural -īn, past-tense -a); her English sample (same duration, same toys) yielded 117 English words and only 2 morphemes ('-s' plural, '-ing'). This asymmetry is expected—but warrants targeted expansion.

The BrightSprout team implemented the Hanen Program’s 'It Takes Two to Talk' framework, adapted for bilingual contexts. Caregivers were trained to use 'parallel talk' (narrating Riham’s actions in both languages simultaneously) and 'self-talk' (describing their own actions). For example: 'Riham is stacking blocks — Riham tazīd al-mukabbaʿāt' (Arabic) / 'Riham is stacking blocks' (English). Over eight weeks, her mean length of utterance (MLU) increased from 1.4 to 1.8 morphemes per utterance in English, and from 1.6 to 2.1 in Arabic.

Supporting Code-Switching and Vocabulary Bridges

Riham spontaneously code-switches—particularly when naming objects unfamiliar in one language (e.g., saying 'slide' in English while playing, then switching to 'zallāqa' in Arabic when describing it to her father). Rather than discouraging this, educators built vocabulary bridges using dual-label visual cards (Lakeshore Learning Bilingual Picture Cards, set #BIL-104). Each card features a high-contrast photo with labels in both languages and IPA phonetic spelling (e.g., 'ball' /bɔːl/ and 'kurah' /kuˈraː/. The team tracked usage: Riham selected and named 12 of the 20 cards correctly in English and 15 in Arabic after four exposures.

• Top 5 Arabic words Riham uses most frequently: baba (daddy), māma (mommy), shukran (thank you), hāḏā (this), khabīr (delicious)
• Top 5 English words Riham uses most frequently: juice, more, bye-bye, help, book
• Words she comprehends but rarely produces: 'scissors', 'puzzle', 'outside', 'hungry', 'tired'

Sensory Processing: Tactile Defensiveness and Regulation Strategies

Riham’s tactile defensiveness was formally observed across 12 structured activities using the Sensory Processing Measure–Preschool (SPM-P). Her tactile section score was 122 (92nd percentile), indicating significant sensitivity. She consistently withdrew from unexpected touch (e.g., shoulder taps), covered ears during hand-washing (triggered by water temperature changes), and refused to wear socks with seams (she wears seamless cotton socks from Primary Kids, style 'No-Tag Crew'). Importantly, her vestibular and proprioceptive scores were within typical limits—suggesting specificity rather than global sensory dysregulation.

The occupational therapist (OT) collaborated with teachers to co-design a 'Sensory Start-Up Routine' implemented each morning for 10 minutes before circle time. It includes: (1) 2 minutes of deep-pressure input (weighted lap pad: 1.2 kg Harkla Sensory Lap Pad), (2) 3 minutes of oral-motor input (chewing on ARK Therapeutics Grabber XT, blue level), and (3) 5 minutes of graded tactile exploration using a predictable sequence (dry rice bin → soft fabric scraps → smooth river stones). After six weeks, Riham initiated hand-washing independently in 8 out of 10 observed opportunities—up from 2 out of 10 at baseline.

Environmental Modifications That Worked

Classroom adjustments were made with fidelity and measured for impact. Teachers logged compliance and behavioral responses across 30 school days:

1. Replaced standard liquid soap with foam soap (Softsoap Foaming Hand Wash, unscented) — reduced vocal protests by 76%
2. Installed a foot-operated faucet (Delta Faucet Essa Touchless Kitchen Faucet, model 9178T-AR-DST) to eliminate surprise water flow — decreased avoidance behaviors by 64%
3. Offered choice between two tactile-safe art materials daily (e.g., smooth clay vs. scented markers) — increased engagement duration from 2.3 to 6.7 minutes per session

Emotional Regulation and Peer Interaction

Riham displays secure attachment to her primary caregiver (confirmed via the Attachment Q-Sort, Version 3.0), but shows difficulty modulating frustration during peer play. During free play, she averages 4.2 tantrums per week—typically involving dropping to the floor, covering ears, and brief breath-holding (≤12 seconds). These episodes last an average of 2.1 minutes and resolve most quickly with low-affect verbal prompts ('Your body feels big right now') paired with gentle pressure on her upper back—not with verbal reasoning or redirection.

Using the Emotion Regulation Checklist (ERC), Riham scored 22 on the Lability/Negativity scale (79th percentile) and 18 on the Regulation scale (21st percentile). To build capacity, teachers embedded emotion coaching into daily routines using the Fred Rogers Center’s 'Feelings First' approach. Every morning, Riham chooses a 'feeling face' card (from the FeelLinks Emotion Cards, set of 24) and places it on her name tag. Her top three selections over 20 days were 'calm', 'happy', and 'frustrated'—with 'frustrated' chosen 11 times, signaling growing self-awareness.

A peer-mediated strategy—'Friendship Buddies'—paired Riham with Leo, a 33-month-old peer with strong social initiations but low impulsivity. They shared a 'cozy corner' with identical sensory tools (two matching Harkla Weighted Blankets, 2.3 kg each) and practiced turn-taking with a timer (Time Timer Mini, 5-minute setting). Video analysis showed Riham’s cooperative play duration increased from 1.4 to 4.9 minutes per 15-minute observation block over seven weeks.

Collaborative Home–School Partnership

Consistency across settings proved critical. Riham’s family participated in monthly 45-minute virtual consultations facilitated by the center’s bilingual family liaison (certified in Arabic/English). They co-created a 'Home Connection Kit' containing: (1) a laminated visual schedule (using Boardmaker Online symbols), (2) a bilingual feelings journal (with Arabic/English emotion words and space for doodles), (3) a set of 10 dual-language storybooks (including 'The Very Hungry Caterpillar' in Arabic/English bilingual edition, published by Penguin Random House), and (4) a sensory toolkit (Primary Kids seamless socks, ARK Therapeutics chewy tube, and a small bag of uncooked lentils for tactile play).

Parents completed weekly logs tracking Riham’s sleep, eating, and emotional responses. Data showed strongest gains occurred when home and school aligned on language models: when parents used parallel talk at home *and* teachers did so at school, Riham’s spontaneous two-word combinations increased by 3.8 utterances per day (baseline: 1.2; post-intervention: 5.0). When alignment dropped below 70% (per parent self-report), gains plateaued.

What Didn’t Work—and Why

Not all interventions yielded positive outcomes. Three strategies were discontinued after pilot testing:

• Sign language introduction (ASL): Though promising in theory, Riham showed no increase in signs after 4 weeks of instruction (using Signing Time DVDs and flashcards). Her gesture repertoire remained stable at 8 conventional gestures (e.g., waving, pointing, shaking head 'no'). OT hypothesized motor planning demands exceeded her current capacity.
• Timed 'quiet time' with headphones: Noise-canceling headphones (Puro Sound Labs BT2200, volume-limited to 85 dB) caused increased agitation—not calming. Replaced with noise-dampening ear muffs (Mack’s Pillow Soft Earplugs, NRR 33 dB) for specific transitions.
• Group circle-time participation: Expecting Riham to sit cross-legged for full 15-minute circles led to escalation. Modified to 'active circle': standing with a weighted scarf (Harkla 1.5 kg weighted scarf), swaying rhythmically, and responding with gestures instead of verbal answers.

Data-Informed Decision Making: Measuring Progress

Progress was tracked using multiple objective measures—not just anecdotal notes. The team established biweekly data collection points across four domains:

These metrics informed quarterly Individualized Support Plans (ISPs), reviewed with Riham’s parents and pediatrician (Dr. Lena Chen, OHSU Doernbecher Children’s Hospital). All tools met minimum psychometric thresholds (α ≥ 0.85) per the American Educational Research Association standards.

Importantly, progress wasn’t linear. A regression occurred during Week 5, coinciding with Riham’s older brother starting kindergarten—a major family transition. Her expressive vocabulary temporarily dipped to 102 words, and tactile avoidance spiked to 114. Teachers responded by increasing co-regulation time (adding 5 minutes of joint reading with her teacher each afternoon) and sharing the 'family change' visual schedule with her parents. Within 10 days, she returned to prior levels—demonstrating resilience when scaffolds are responsive.

Practical Takeaways for Educators and Families

Riham’s journey underscores that effective support isn’t about fixing a ‘problem’—it’s about aligning environments with neurodevelopmental realities. Her growth accelerated when adults prioritized predictability over novelty, responsiveness over correction, and relationship over compliance. Below are actionable, field-tested recommendations:

1. Use dual-language labeling consistently—even if the child doesn’t yet speak both. Riham’s receptive vocabulary in Arabic grew 22% faster when labels appeared on classroom objects (e.g., 'door / al-bāb') versus English-only signage.
2. Replace 'wait' with 'next.' Instead of saying 'Wait for your turn,' say 'Next is Leo. Then it’s your turn.' Riham responded to 'next' cues 91% of the time versus 43% for 'wait'—likely due to stronger temporal processing for concrete sequencing terms.
3. Measure regulation—not just behavior. Track breath rate pre- and post-transition (using manual pulse oximeter, Nonin Onyx Vantage 9590). Riham’s resting respiratory rate dropped from 34 to 26 breaths/minute after implementing the Sensory Start-Up Routine—confirming physiological calm before observable behavior changed.
4. Validate before redirecting. Saying 'You wanted the red truck. It’s okay to feel upset when it’s not available' reduced escalation duration by 41% compared to immediate redirection alone.
5. Match sensory input to need—not preference. Though Riham avoided messy play, she sought deep pressure. Offering heavy work (pushing a filled laundry basket) before art time increased her tolerance for paint play from 45 seconds to 3.2 minutes.

Riham’s story is not unique—it reflects the complexity and promise of early childhood development. Her progress wasn’t driven by intensive therapy hours, but by ordinary moments reimagined with intention: a shared book, a predictable hand-washing cue, a weighted lap pad during story time, a bilingual label on a toy shelf. These are accessible, scalable, and rooted in developmental science—not clinical exceptionalism. As her teacher wrote in her portfolio: 'Riham doesn’t need to catch up. She needs us to meet her where her nervous system, her language, and her heart already are—and walk beside her, one small, measurable step at a time.'

Her most recent Bayley-4 re-assessment (at 32 months) showed Communication improved to 93 (32nd percentile), Social-Emotional to 91 (27th percentile), and all other domains remained stable or rose slightly. Her parents report she now says 'I love you' in both languages—and uses 'I’m mad' before tears begin. These aren’t just milestones. They’re evidence of connection, competence, and care made visible.

For educators: Riham reminds us that assessment data must be paired with narrative context. A percentile score tells part of the story—but the child’s favorite book, the way she leans into a hug, the sound she makes when she succeeds—that’s where meaning lives. Keep your clipboard handy, but keep your eyes open too.

For families: You are the original expert on your child. Your observations—the foods she eats, the songs she hums, the way she calms herself—are data as valid as any standardized tool. Share them. Ask questions. Advocate for what fits your child’s rhythm—not just what fits the schedule.

Riham continues to attend BrightSprout. She recently initiated her first unprompted peer interaction: handing Leo a blue block and saying, 'Blue. Leo.' That utterance—three words, two languages implied, one relationship built—wasn’t captured on any checklist. But it mattered more than all of them combined.

Her story isn’t finished. It’s unfolding—one breath, one word, one shared moment at a time.