PSYCHOLOGICAL POST-ASSESSMENT REPORT

Name: S. A.
Father’s Name: I. A.
Date of Birth: 27- April- 2002
Dates of Assessment: 21st, 22nd, and 23rd of January, 2020
Examiner: Therapist
Identifying Information
Client is 17year-8months old boy. He is last born child and has one elder brother and one sister. He is
Muslim and belongs to Urdu speaking family with high socioeconomic status. His father is a professor
doctor and mother is died. He lives in a nuclear family set up in Islamabad.
Referral Source and Presenting Complaints
He was brought to clinical psychologist for assessment by his father. His presenting complaints as
reported by his father include: developmental deficiencies, absence of symbolic play, stereotyped and
repetitive patterns of behavior, interests and activities, impaired social interaction, imagination, social
communication and aggression. However, lack of verbal communication caused the greatest concern. As
a result, he had poor interpersonal relationships, driven by poor verbal and non-verbal comprehension. He
experienced delayed echolalia. Furthermore, client’s father reported his sleep disturbance too.
Interview Information
Client’s father reported that client is a full-term baby delivered with no complications and he achieved
major mile stones adequately. He started neck holding at the age of 4 month, sitting at the age of 7
months, walking at the age of 1 year. But his communication development was delayed; he began
vocalizations at 3 months of age but had developed no proper words by 3 years. Client’s father reported
that when he was of 3 years he admitted to the school. Then the teachers showed concern about the
mental wellbeing of the client for the very first time and informed that his psychological assessment is
needed by a professional. And once he got sick with sore throat and his father took him to the doctor.
That child specialist also mentioned that the child needs proper psychological consideration. When the
client was 4 year old, he was diagnosed with leukemia, its treatment involved chemotherapy. The
treatment continued when he was 4 years old and ended with the age of 10 years. During that time his
speech, communication and verbal skills, which were already disoriented, were affected more.
Furthermore, other symptoms were affected more after 10 years of age, which include highly impaired
communication skills and he was described as low tone with awkward motor skills and inconsistent
imitation skills. After sometime he became totally mute when brought to the psychologist/therapist by his
father. He has no family history of physical illness nor could any psychological disorder be found out in
his family. No history of any other psychological or physical disorder could be found in client.

According to informant client is very close to his family especially with his father. Mother was died when
he was six year old. His father’s attitude towards client was very caring and loving. He showed highly
concern about client. He has two elder siblings, 1 married sister and 1 brother. They both have good
relationship with him. Client’s relationship with his female caregiver at home was problematic.
According to the client she does not show good attitude towards him. When she ignored, shouted and
exhibit irritation towards client then client become highly aggressive and throw tantrums. Sometimes
client become out of control due to speech volume, body language and facial expressions of female
caregiver towards him. This highly caused to make him aggressive. Loud voices or fast talk made him
frightened, confused and violent that’s why he started meltdown.
Psychological Assessment
Informal Assessment
• Behavior observation
• Mental State Examination
• Clinical Interview
Formal Assessment
• Slosson Intelligence Test (SIT)
• Vineland Adaptive Behavior scale (VABS)
• Autism Spectrum Disorder Scale (ASDS)
Behavior during Assessment
Client’s behavior during assessment was adequate with good orientation and perception. Attention span
was more than half an hour. The overall appearance of client was looking very neat and clean. Now he
could maintain eye contact more than 15 mints and changed his body postures after every 45 minutes, his
emotions were not flat. He seemed very interested in music. Has no auditory hallucination or delusions.
He has strong memory and great direction sense. His memory was extremely coherent. He was able to
recall the information that was required of him during answering the questions and he showed strong
association with flash during assessment. He walks very fast and engages in self-talking some time, his
thought pattern was incoherent. His perception of the world and the people around him was very clear.
When he was asked to tell home address and phone number, he gave the correct answer and when he was
questioned that ‘Who is the founder of Pakistan?’ He also gave the correct answer ‘Quaid e Azam’. He
has proper orientation of time, work and place. He had mood swings but now mostly he seems relaxed.
Abstract reasoning is nil and do not much aware of general knowledge. Has neither somatoform
complaint nor psychosomatic or psychosexual problem. He does not have any type of addiction but
showed highly association with his father throughout the sessions over the period of 8 months. He himself
is not aware of his problem. He is calm boy but as he was very close to his father so his absence made
him aggressive, panic and problematic.
Psychological Evaluation
The scores on Slosson Intelligence Test (SIT) reveal that client’s intellectual functioning falls within
below average range (IQ = 66) [IQ = [MA/CA] × 100]. His mental age (MA) is equivalent to a child of 11
years and 8 months which is below to his chronological age (CA = 17 years 8 months) and lies in
percentile rank (PR = 2).
Chronological age (CA) 17 years-8months
Mental Age (MA) 11 years-8months
Intelligence Quotient (IQ) 66
Percentile Rank (PR) 2
The Adaptive Behavior Composite (ABC) provides an overall summary measure of client's adaptive
functioning. His Adaptive Behavior Composite (ABC) standard score is 46, with a 95% confidence
interval of 38 to 54. His percentile rank of <.1 and age equivalent of 8 year 2 months which means that
his score was less than to 1% of individuals in client's age group in the Domain-Level Survey Form
normative sample. These scores are below as expected given his reported IQ score of 66 and mental age
11 years and 8 months.
Domains Score Summary
ABC Raw Standar 95% Percentile Adaptive Age
scores d Score Confidence Rank Level equivale
(SS) Interval nt
Adaptive 148 46 38 - 54 <.1 Mod deficit 8–2
Behavior
Composite
Sub-Domains
Receptive 26 Adeq. 7 – 10
Expressive 58 Lo. 7–5
Written 17 Lo. 6 – 11
Communication Domain 101 36 22 - 50 <.1 Mod deficit 6 – 11
Personal 74 Lo. 9–4
Domestic 25 Lo. 9–2
Community 36 Lo. 8–4
Daily Living Skills 135 58 47 – 69 .3 Mild deficit 8 – 11
Domain
Interpersonal 42 Lo 7–0
relationship
Play and Leisure Time 27 Lo. 7–3
Coping Skills 29 Lo. 10 – 8
Socialization Domain 98 54 43 – 65 .1 Mild deficit 8–5
Gross 38
 Fine 32
Motor Skills Domain 70 - - - - -
Score Summary Profile
140

130

120

110

100

90

80

70

60

50

40

30

20

10
Communicatio

Socialization

Motor Skills
Composit
Adaptive
Behavior

Living
Skills
Daily
n
e

Standar 46 36 58 54 70
d Score
Conf Int
95% 38-54 22-50 47-69 43-65 -

The Communication domain measures how well client exchanges information with others. This includes
taking in information, expressing himself verbally, and reading and writing. His Communication standard
score is 36, with a 95% confidence interval of 22 to 50. This corresponds to a percentile rank of < .1,
mental age 6 years and 11 months. These scores are low relative to his reported IQ score of 66 and mental
age 11years and 8 months. Furthermore, his score shows that receptive sub domain is at adequate level of
age equivalent to 7 year and 10 months. Expressive sub-domain is at low adaptive level with 7 year and 5
months age equivalent. And in written skill client’s adaptive level is very low with 6 year and 11 months
age equivalent. This suggests that intellectual deficits do not explain (or fully explain) client's
communication deficits. Follow-up communication activities might focus on exploring and enhancing the
client's communication and verbal functioning.

The Daily Living Skills domain assesses client's performance of the practical, everyday tasks of living
that are appropriate in the school setting. Such tasks include various aspects of self-care (e.g., dressing,
hygiene), using numeric concepts, and meeting expectations at school. His standard score for Daily
Living Skills is 58, with a 95% confidence interval of 47 to 69 and a percentile rank of (.3). This
corresponds to mild deficits level of adaptive behavior with 8 year and 11 month age equivalent. However
scores of sub domains; personal, domestic and community exhibit deficits at low level of adaptive
behavior with age equivalent 9year-4months, 9year-2months and 8years-4months respectively.

Client's score for the Socialization domain reflects his functioning in social situations. This domain covers
his interpersonal relationships, play and leisure activities, and coping skills in social situations. His
overall Socialization standard score is 54, with a 95% confidence interval of 43 to 65. The percentile rank
is (.1). These scores exhibit mild level of deficits in adaptive behavior as his reported IQ score of 66.
Further sub domains of socialization; interpersonal relationships, play and leisure activities, and coping
skills reported functions equal to 7year, 7year-3months and 10year-8months respectively which are below
than his reported mental age 11year-8months.

Client's three domain standard scores were compared to his mean domain standard score 49.3 to
determine possible areas of strength and weakness. The results show that Daily Living Skills and
Socialization are relative strengths for client and that Communication and is relative weakness.
Domain Strength and Weaknesses
Domains Standard Differences Strength or Significant National
scores between weakness level standardizatio
Standard n Sample
Scores and
Mean
Communication 36 -13 W .05 Extreme 16 %
Daily L. skills 58 +9 S -
Socialization 54 +5 S -
Sum 148
Mean 49.3
*The examinee's Mean Domain Standard Score (Mean SS) = 49.3
**Significance level chosen for strength/weakness analysis is .05

In addition, pair wise difference comparisons were performed between all pairs of domain standard
scores. The findings are that the Communication score is significantly lower than the Daily Living Skills
score -13 at alpha .05, the Communication score is lower than Socialization -18, and the Daily Living
Skills score is higher than the Socialization score 4.

Pair-wise Comparisons between Domain Standard Score

Comparison Standard Significant National Standardization
Score Difference Sample
Difference
Communication < Daily Living Skills 22 Yes Extreme 16 %

Communication < Socialization 18 No

Daily Living Skills > Socialization 4 No
*Significance level chosen for pair-wise difference comparisons is .05

The domain includes brief scales measuring Internalizing (i.e., emotional) and Externalizing (i.e., acting-
out) problems. These scales are reported using v-scale scores, which are scaled to a mean of 15 and
standard deviation of 3. Higher Internalizing and Externalizing v-scale scores indicate more problem
behavior. If qualitative descriptors are desired, scores of 1 to 17 may be considered Average, 18 to 20
Elevated, and 21 to 24 clinically significant. He received v-scale scores of 6 for Internalizing and 4 for
Externalizing. His Internalizing and Externalizing scores exhibit the non-significant maladaptive
behaviors.
Maladaptive Behavior Results

Maladaptive Scale Raw Score Maladaptive Level

Internalizing 6 Non Sig.
Externalizing 4 Non Sig.
v-scale scores have a mean of 15, SD of 3

Severity level of Autism Spectrum Disorder is Mild and required support, without supports in place,
deficits in social communication cause noticeable impairments. Difficulty initiating social interactions,
and clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have
decreased interest in social interactions. For instance, an individual who can talk in full sentences and
participates in correspondence however who’s back and forth discussion with others falls flat, and whose
endeavors to make companions are odd and commonly ineffective. Inflexibility of behavior causes
significant interference with functioning in one or more contexts. Difficulty switching between activities.
Problems of organization and planning hamper independence.
Diagnosis
[319(F70.0)] Mild Intellectual Disability
[299.00(F84.0)]Mild Autism Spectrum Disorder
[V61.8(Z63.8)] Problem with Primary Support Giver
Prognosis
The prognosis of the client is good because he has been making good progress over the past few months
during sessions of management, but still shows notable deficiencies in communication, daily living skills,
socialization and motor domains. His condition can be improved with proper treatment, guidance,
assistance and his parents and care giver’s struggle.

Client's results were compared to those of a norm sample, which is a representative group of children of
the same age. The labels below describe his standing in the three broad areas described above, plus an
overall summary score.
Adaptive Behavior Area Level Compared to Others His Age
Communication Skills Moderately Low
Daily Living Skills Mildly Low
Social Skills and Relationships Mildly Low
Overall Summary Score Moderately Low
Recommendations
 Badly needed counseling of the caregiver to deal with client’s meltdown and tantrums and advise a
plan for them to take control of the client’s behavior issues.
 Behavior therapy techniques should be used to deal with his communication, daily living, social and
motor deficits.
 Parents and caregiver should learn techniques for teaching their child new skills and reducing
problematic behaviors.
 These opportunities should include not only didactic sessions, but also ongoing consultation in which
individualized problem-solving, including in-home observations or training, occur for a family, as
needed, to support improvements at home as well as at school.
 Families that are experiencing stress in raising their children with an autistic spectrum disorder should
be provided with mental health support services.
 Female caregiver’s counseling is highly recommended in order to increase awareness about child’s
problem and to provide constructive methods of training and counseling.

Supervisor: Examiner:
Dr. Zakia Bano Tasmia Ijaz
Clinical Psychologist Mphil Scholar
Assistant Professor Email: tasmiaijaaz@gmail.com
Department of Psychology
University of Gujrat
Email: zaqia.bano@uog.edu.pk