CASE II

CASE II

Bio Data

Father Name MU
Age 11 years
Gender Male
Education Special
Religion Islam
Birth Order 3rd
Siblings 3
Parents Alive
Father Occupation labor
Mother Occupation House-wife
Social Economic Status Middle class
Address Faisalabad
Examiner Aneeza Farooq
Identifying Information

Client is 11 years old. He is studying in special school. Client is first born living in

a nuclear family with three of his brother. Her father is a labor by profession and her mother

is a house wife. He belongs to a middle class family.

Source of Referral

Client was brought by his family for psychological treatment of the clients
problems. Client was referred to trainee clinical psychologist to administration for the
purpose of psychological assessment and management of intellectual disability.
 Presenting Complaints

Presenting complaints and their duration as reported by mother and teacher.

Presenting Complaint Duration

Attention Deficit Hyperactivity 2 years

Difficulty Staying Focused 2years
Impulsive Behavioral Patterns 4years
Emotional Regulation Difficulties 5 years
Social Interaction Challenges 5 years
Hyperactive Behavioral Tendencies 5 years
Impaired Cognitive Functioning 2 years

Initial Observations
Upon initial observation, MU presents with physical characteristics commonly associated
with Down syndrome, including specific features, e.g., facial structure, short stature. He also
exhibits behaviors consistent with Attention Deficit Hyperactivity Disorder (ADHD), such as
fidgeting and difficulty maintaining eye contact. MU appears to have difficulty initiating and
maintaining conversations. His overall demeanor is hyperactive.

Background information
Past Personal History
Client's mother mentions that there is family history of mental disability, specifically,
client's first cousin (uncle’s son) has a mental disability. The client has a medical history
significant for cerebral palsy.
Table 2
Milestones, Normal Age and Child’s Age of Achievement.
Milestones Normal Age (Gerber, Wilks Age of Achievement
& Erdie-Lalena, 2010)

1st Cry Immediate Immediate

Head Holding 4-6 Months 8 months
2 years
Walking 12-18 Months
Bladder and Bowel Control 2-3 Years No
One-word Speech 8-12 Months
3 years
Complete Sentences 12-24 Months No

Family History
The client hails from a middle-class family, characterized by a nuclear-patriarchal structure
within a joint family system. His family constellation comprises both parents, who are alive
and actively involved in his life. He is the second-born child, with two older brothers older.
His father, the primary breadwinner, engages in manual labor as a daily wage earner,
contributing to the family's financial stability. The client's father exhibits a propensity for
aggressive behavior, while the client's mother reports a marital relationship characterized by
persistent conflict and discord.

Educational History
The client, aged 10, has experienced significant academic delays, evident in his repeated
retention in Grade 2 for 3 consecutive years. Despite chronological age, the client's academic
functioning is commensurate with that of a typical Grade 2 student, indicating substantial gaps
in academic achievement. Academic history reveals persistent struggles with reading
comprehension, problem-solving, necessitating targeted interventions.

Medical History
The client has a documented history of pneumonia& epilepsy, characterized by recurrent
seizures, which occasionally manifest as sudden falls, necessitating prompt medical attention
and safety precautions. He experiences episodic seizures, often accompanied by loss of
consciousness and post-ictal confusion, impacting his daily functioning and academic
performance. The client's seizure disorder, requires ongoing medical management and
monitoring to minimize the risk of injury and optimize control.

General Home Atmosphere

According to client their home atmosphere is pleasant. Parent’s attitude toward client is
friendly and cooperative.
Test Administered

 Clinical interview

 Portage Guide for Early Education (PGEE)

 Conner’s Rating Scale-Revised

 Slosson Drawing and Coordination Test (SDCT)

 Colored Progressive Matrices (CPM)

Clinical Interview

Interview was conducted with the client and her teacher to get an information about the

presenting complaints, history and nature of presenting complaints and background

information of client to have the clear picture of client’s problem.

The client’s teacher reported according to her case history that she achieved

developmental milestones at a delayed pace during her early childhood. Her weight was

average and caught fever (pneumonia) at first month and suffered with jerks and fits.

At first, the client’s behavior was observed in a class for the whole week. The client

showed limited progress in academic subjects, challenges in grasping and retaining

information. He was unable to perform simple tasks which every child of her age group can

perform. He has difficulty in remembering information. He is able to remember the information

after repeating the information several times. His on seat behavior was good and her personal

hygiene was good.

The client was little anxious during the initial assessment sessions, but after some

sessions, he became relaxed.

For the assessment of problems, I used Conner’s Rating Scale SDCT (Solloson Drawing and

Coordination Test) which is basically a neuropsychological screening test and .And used

intelligence test CPM (Colored Progressive Matrices) on my client which shows his

intelligence and percentile. After all these assessments, I started therapeutic work on my client.

Portage Guide for Early Education (PGEE)

Qualitative Interpretation.
According to the Portage Guide for Early Education (PGEE), MU exhibits a

diverse range of developmental ages across various domains. The client's score in

developmental areas indicates significant delays across the motor, cognitive, language, and

socialization domains. In Self-help domain, client resembles 4.2 years old, motor skills are akin

to a 4.6 years-old, cognition resembles a 4.9 years-old, language mirrors a 4.8years-old, and

socialization is at a 3.8 years-old level. This comprehensive assessment underscores the

pervasive nature of the client's developmental challenges, highlighting the urgent need for

targeted interventions to address their complex needs across multiple domains. Overall, the

PGEE indicates a delayed developmental profile for a client, with weaknesses in certain areas

and potential for targeted support in all domains.

Quantitative analysis. The areas of PGEE and client’s functional level are shown in
the table.

Table 4
Areas and Functional Level of Child on Five Domains of PGEE
 Areas Age range on PGEE
Socialization 3.8
Cognitive 4.9
Language
4.8
Self-help 4.2
4.6
Motor

Conner’s Rating Scale

Qualitative Interpretation.
The results of the Conner’s’ Teacher Rating Scale–Revised (S) indicate moderate
to severe concerns across all domains, including oppositional behavior, cognitive
problems/inattention, hyperactivity, and the ADHD Index. These scores suggest significant
challenges with attention, impulse control, and compliance with rules, as well as pronounced
hyperactive and oppositional behaviors. The child likely struggles in academic and social
settings, exhibiting difficulty following instructions, sustaining attention, and regulating
behavior. These findings are consistent with ADHD characteristics and warrant further
evaluation and targeted interventions to support the child’s academic and behavioral needs.

Quantitative analysis.

Sr.no Subscales Raw score T-score Interpretation

1. Oppositional 11 83 Moderate to severe

2. Cognitive 15 77 Moderate to severe

problem/inattention

3. Hyperactivity 20 81 Moderate to severe

4. ADHD Index 32 76 Moderate to severe

SDCT (Solloson Drawing Coordination Test)
Scoring and Interpretation:
Based on the client's performance:
Age Total time Accuracy score Errors Percentile rank

10 years 20minutes 13% 26 5th

Qualitative Interpretation:
Considering the client's age and performance (13%):
- Fine motor skills: Below average
- Hand-eye coordination: Delayed
- Cognitive-motor integration: Struggling

CPM (Coloured Progressive Matrice)

Quantitative analysis

Age Total time Total score Discrepancy Grade

10years 25minutes 11 -1,0,1 V

Qualitative analysis:
According to score of Coloured Progressive Matrice, client falls in 5th grade which indicate
that client is intellectually detective and shows presence of intellectual disability.
Diagnosis

Child was diagnosed according to DSM-5 with Intellectual Developmental disorder of

mild level.
 Treatment Plan

Intellectual
Disability

Precipitating Perpetuating
factors Protective factors
Predisposing factors
factors Late recognition of Access to treatment
Challenges in
Development delays academic progress problem Teacher’s attention
Lack of skill and and motivation
Down Syndrome Neurodevelopmenta
l issue training Supportive school
Cerebral Palsy
Lack of knowledge environment
about problem Family affection
Uncooperative
behavior of family
with problem

Organization Peer Total

Behavior Parental
al skills interaction sessions
Therapy skills
traning
training Social skills
Task planning training
Treatment Plan

Positive
Positive and
parenting Peer support
reinforcement prioritization Overall 10
techniques groups
Behavioral Time sessions
Communicati Peer
activation management
on skills modeling and
skills
training role playing
Speech
therapy
Session Reports

Session 1 to 3

A comprehensive Clinical Interview was conducted with the client and her teacher to

gather the information about presenting complaints, developmental history, and behavioral

challenges. The client’s medical history, including early developmental delays and medical

issues during infancy was discussed with the teacher. During initial sessions the major focus

was on rapport building and behavioral observation of the client to explore the nature of the

presenting complaints. A standardize test which is PGEE was also administered on the client

to assess the client's developmental functioning across various domains, including cognition,

communication, and motor skills.

Session 4 to 6 Date: (26 to 30-10-24)

Human Figure Drawing Test and Slosson Drawing and Coordination test were

administered on the client. Client's behavior was observed during structured social tasks,

including initiating conversations, joining group activities, and responding to peer interactions.

Identified deficits in social initiation, reciprocity, and nonverbal communication. The client’s

existing concept of color identification was reinforced and further elaborated upon, with

minimal effort on my part to introduce new concepts. The client was taught about the names

of days of the week.

Session 7 to 8 Date: (31 to 02-11-24)

Slosson Intelligence Test and Colored Progressive Matrices were administered on the

client. Task of cutting with scissors, cutting shapes, cutting strawberry picture from paper was

also practiced. Also different coloring activities were performed by child. Three basic shapes

were also taught. Different reinforces was also given to child and her responses were recorded.

So the child was able to work independently. Therapy sessions were conducted focused on

implementing treatment interventions based on assessment findings. Cognitive-behavioral

techniques were utilized to address cognitive restructuring, and coping skills development.

Organizational skills training were integrated with the help of teacher to improve academic

performance and task management. Social skills training were facilitated to enhance peer

interaction and socialization.

Session 9 to 10 Date: (13 to 14-10-24)

Client was taught to distinguish and match basic shapes and letters. All the things which

were taught in previous sessions were recalled like color name, days of the week, months of

the year and tying the shoelaces. Regularly monitored progress, addressed barriers to treatment,

and adjusted interventions as needed.

Limitations and Recommendations

Limitations

 Limited session’s frequency

 Potential comorbidity

 Standardized Assessment Constraints

Recommendations

 Psycho-education to the family (Family Involvement)

 Speech and language therapy

 Behavior therapy

 Regular monitoring and follow up