1

Biodata

Name: AS

Age: 22 years

Religion: Islam

Gender: Male

Education: MCC

Siblings: 1

Birth Order: Last born

Marital status: Unmarried

Father Occupation: Business

Father’s Education: Matric

Mother Occupation: Housewife

Mother’s Education: Matric

Socio-economic Status: Middle Class

 2

Presenting Complaints

The client has issues with his speech with the articulation of words along with difficulties in

learning and memorizing. This difficulty with learning information is related to the academic

domain; the client has issues memorizing and then recalling classroom tasks, homework

assignments comprising of new words or alphabets learnt in the class the previous day. The

speech difficulties are not of severe nature, the client can efficiently communicate his thoughts,

feelings and events with unclear enunciation, as per the classroom teacher his speech articulation

was of severe level when the client got enrolled in the school. As reported by his classroom

teacher, he has difficulty paying attention during classroom tasks and has low class participation

during tasks related to learning, he does participate actively in activities. His parents reported

that he engages in quarrels, depicting aggressive behavior when provoked. These behavior

patterns although, haven’t been observed in classroom setting or during sessions depicting that

they are not present in all settings.

History of the problem

The problem was initially observed by his mother due to delayed developmental

milestones (i.e. see table milestones). The main concern of client’s parents were his speech and

language difficulties as well as his lack of performance in academic area. His behavioral issues

such as aggressive tendencies led his parents to decide to enroll the client in a special education

school.

Prenatal History

The mother of the client reported having severe stress during her pregnancy period. She

had taken abortion pills due to her elated stress without a consultation from doctor or physician.
 3

Milestones/Developmental History:

Milestones, Normal Age and Child’s Age of Achievement.

Milestones Age of Achievement

1st Cry Immediate

Head Holding 4 Months

Sat alone 1 year

Crawling 2 years

Standing 2.5 years

Walking 3 years

Fed self 5 years

Self-dressed 6 years

Bladder and Bowel Control 9 years

One-word Speech 4 years

Complete Sentences Nill

Medical History

No substantial medical history of the client has been reported.

 4

Family History

The client’s family relationship history likely involves fairly good interactions and

dynamics with his parents and his elder brother. His mother reported that he is quite close to his

elder brother and shares affectionate bonds with his extended family members as well especially

his cousins. No serious medical illness or psychiatric/psychological disorder is observed in the

family.

Educational History

The client had previously enrolled in a normal school for a small period of time in his

childhood. Later his parents took him out from there due to notable issues in academic area and

now since some years he is enrolled in a special education school.

Social History

The client has positive interactions with family members, he has a great relation with his

elder brother and friends in the classroom. He’s even friends with other kids at school

irrespective of age differences with them. The client takes part in sports during recess whenever

he sees any group of kids/peers playing a game. However, some stubbornness is reported by

parents, particularly when he’s bullied or made fun of. In such situations the client responds with

physical aggression.

General Characteristics

The client is generally friendly open and eager to perform and take part in new tasks. He

is great at holding conversations and love to share about sports especially. The client is an avid
 5

sportsman and is involved in national level running competitions. He helps out his brother in his

shop in his free time. The client also has basic levels of computing skills.

Level of Functioning:

Personal

The client is warm and engages in conversations. Once interested in an activity he tries to

work hard on it. In case of errors the client tries to redo the activity so ensure perfection. The

most favorite area of client is to talk about his sporting career. He expresses when he doesn’t like

a particular thing or remembers previously held conversations as well. The client can manage

simple daily tasks as well as self-care. He may need reminders but he’s good in self-

management.

Cognitive

The client shows the ability to learn and memorize academic material with difficulty.

Attention is inconsistent, requiring focused, engaging activities to sustain his interest. He needs

support in academic tasks such as cutting, learning, mathematics and recalling memorized

material.

Social

The client demonstrates good social interactions with family and peers but can display

impulsive and stubborn behavior when mistreated. He thrives in supportive environments but

may need guidance to develop appropriate anger management skills.

Psychological Assessment
 6

 Mental Status Examination

The mental status examination of the client will indicate important details relating to his

appearance, mood, and perception, several cognitive functions such as orientation,

attention and memory. MSE also includes the evaluation of client’s abstract reasoning

and whether or not he has insight of the problem.

 Rey Auditory Verbal Learning Test (RAVLT)

RAVLT is used to access the memory functions including immediate recall,

delayed recall and recognition memory.

 Children’s Emotion Management Scale (CEMS)

The Children’s Emotion Management Scale (CEMS) - Anger Scale measures a

client’s ability to regulate anger, with higher scores indicating greater difficulty in

managing frustration and controlling impulsive reactions.

 Slosson Intelligence Test (SIT)

Slosson Intelligence Test is used here to determine the intelligence quotient of the

client as well to evaluate the level of intellectual functioning.

1. Mental Status Examination (MSE)

The client’s appearance was well kempt. His hair were brushed and set and he was wearing

clean and ironed clothes. He was cooperative and easygoing. His posture was relaxed but not

slouchy. He maintained good eye contact and often smiled. His mood during the sessions was

pleasant. The client had orientation of time and place, his attention during the sessions was

focused when given a task. During tasks of slight difficulty or learning material, his attention

would diminish a bit. The client had insight only about his speech problems as he was told by

his parents as the reason for getting enrolled in this school. The client also had the knowledge
 7

that his school was for ‘special children with several issues like not being able to hear or

speak’ as stated by him.

2. Rey Auditory Verbal Learning Test (RAVLT)

Quantitative Analysis

Measure Raw Score Interpretation

Immediate Recall 28/75 Average learning ability. Mild verbal memory

(List A) recall.

Proactive -3 words
Slight interference, indicating mild difficulty in
Interference
shifting focus from previously learned material.
Retroactive
-2 words Moderate difficulty recalling earlier information after
Interference
learning new material.
Delayed Recall
4/15 Below-average delayed memory retention, suggesting
slightly poor long-term retention

Recognition Below average recognition performance, indicating

6/15
Memory typical ability to differentiate target words from
distractors.

Qualitative Analysis

The client demonstrates moderate verbal memory recall with an average ability to learn and

retain information immediately, as seen in the Immediate Recall score. However, there is mild

interference due to proactive interference, where previously learned material slightly hinders the

ability to focus on and recall new information. Additionally, retroactive interference suggests
 8

moderate difficulty in recalling earlier material after learning new words. The Delayed Recall

score indicates below-average long-term memory retention, with some difficulty in retaining

information over time. Recognition memory is also below average, as the client shows typical

ability to differentiate target words from distractors but with some challenges in recognizing

previously learned material accurately. These results suggest that while the client can initially

learn and recognize material albeit with difficulty, they experience moderate level difficulties

with long-term retention and distinguishing between old and new information.

3. Children’s Emotion Management Scale (CEMS)

Quantitative Analysis

Client’s score Range Outcome

19 11-33 Moderate difficulty

Qualitative Analysis

A score of 19, which falls in the moderate range, suggests that while the client does not exhibit

severe anger dysregulation, he does struggle with frustration tolerance and impulse control in

certain situations.

4. Slosson Intelligence Test (SIT) (Richard L. Slosson 1963)

Quantitative Analysis

Basal Age Mental Age Chronological Age I.Q

144 158.4 264 60

Qualitative Analysis:
 9

The individual assessed with the Slosson Intelligence Test demonstrates cognitive abilities

consistent with mild intellectual disability. With an IQ of 60, his intellectual functioning aligns

with the capacity for basic literacy and numeracy skills. This result shows him experiencing

difficulty with abstract reasoning, planning, and problem-solving but show potential to develop

practical knowledge. Socially, he is likely capable of forming and maintaining relationships but

might struggle with interpreting complex social cues or handling unstructured situations.

Tailored vocational training and life skills education can enhance his independence and overall

quality of life.

Diagnosis

Intellectual Disability (Intellectual Developmental Disorder with Mild level) 317 (F70).
 10

Management Plan

 Improve math  Regular maths sums with visual aids

skills  Snakes and ladders game
Enhancing academic  Compound
skills numbers
recognition  Use of different colored textures
 Colors  Color spellings chart
recognition with  Crayons, paints and color pencil activities
spellings
 Reduce the  Deep breathing exercises
frequency of  Technique to counter anger:
Working on anger angry outbursts in counting to 10 whenever anger
management stressful is building up.
situations  Role Playing activity
 Improve memory  Activity chart involving colors
in academic to enhance learning.
tasks.  Repetition and recall
Enhance learning and  Use of visual aids for
memory functions memorizing material.
 Improve attention
 Use of pictures, flashcards,
cardboard activities to hold
attention.
 11

Session Reports
Session 1

In this initial session, I focused on building rapport with the client. I administered various

activities like coloring tasks, drawing tasks along with initiating conversation with the client. I

asked about his interests and he shared his love for sports. The client was easygoing and

enthusiastic to share details about his favorite sports and players. The client was cooperative and

completed the drawing and coloring tasks with reasonable effort. He often passed smiles during

the sessions depicting his comfort. I also asked client questions about his family and he shared

how he enjoy spending time with his elder brother. He also shared that he spends his free time

with his brother on his shop and helps him out there. I transitioned to the Rey Auditory Verbal

Learning Test (RAVLT) and introduced it as a game to the client. I read the first word list aloud

and asked the client to recall as many words as they could. During the initial trials, the client was

attentive and tried their best to recall the words. However, as the test progressed to include

interference and delayed recall tasks, he began to express mild frustration, particularly during

repeated recall trials. Despite his frustration, he completed all phases of the test with

encouragement and a consistent effort. Throughout the session, the client demonstrated a

willingness to participate and engaged actively in tasks. The initial session left the client satisfied

and he expressed that he was initially anxious about the session but had fun contrary to his

expectations.

Session 2

In this session, I administered the Children’s Emotion Management Scale (CEMS) - Anger Scale

with the client’s mother during a parent-teacher conference to gain insights into the client’s anger

regulation patterns. The classroom teacher led most of the conversation, discussing the client’s
 12

behavior in school. She noted that while the client can be impulsive, he does not display anger

outbursts in the classroom setting. Instead, he shows frustration only when he doesn’t get his

way or when classmates don’t engage with him as he wants.

The mother provided a different perspective, explaining that the client exhibits more intense

anger reactions outside of school, particularly when provoked by neighborhood children. She

described situations where he shouts, argues, and refuses to back down when conflicts arise with

peers in his area. However, she also noted that at home, he tends to storm off and later return

once he has cooled down, indicating some ability to self-regulate. I prompted additional

questions, asking how he typically reacts to discipline, how long his frustration lasts, and

whether he uses any self-soothing strategies independently. The mother stated that while he can

be stubborn, he usually does not escalate to physical aggression and can be calmed down with

distractions or time away from the conflict.

The session highlighted the contrast between the client’s school behavior and community

interactions, reinforcing the need for structured emotional regulation strategies that he can apply

across different environments. I thanked the mother for her input and emphasized that these

insights would help in developing targeted interventions to enhance his frustration tolerance and

impulse control in settings where he struggles most. The discussion concluded with the teacher

and mother agreeing to collaborate on reinforcing self-regulation techniques at school and home.

Session 3

In this session, I administered the Slosson Intelligence Test (SIT) to assess the client's verbal

intelligence and abstract reasoning abilities. The SIT is a well-established test used to evaluate an

individual's ability to reason, solve problems, and think logically. The client's performance on
 13

the test indicated an IQ score of ‘60’ within the mild intellectual disability range “50-69”. This

result suggests that the client experiences difficulty with more complex cognitive tasks that

require abstract reasoning. While the client was able to answer some of the simpler items, he

struggled with the more challenging items. Given the mild level of intellectual disability, the

client will benefit from continued guidance in these areas, especially in tasks that require abstract

thinking. Since this test requires attention and focus, this session was mainly focused on its

administration along with the activities that I included to maintain client’s interest.

I positively reinforced client’s irritable behavior by involving his favorite activity of dice and

math, where he would roll the dice twice and then add the two numbers that would occur both

times. Since the client could do simple math sums and knew counting through rote method, it

was difficult for him to recognize numbers individually which was worked on in later sessions as

well.

Session 4

In this session, I worked on reinforcing the client’s academic skills. I observed that the client was

more engaged in tasks when visual aids were used. We focused on color recognition and simple

math exercises. For example, I used colorful flashcards to help the client identify and spell color

names, which seemed to engage him more actively. These activities were simple yet effective for

reinforcing the client’s memory and attention skills. I further worked on developing the client’s

math skills. For this purpose I introduced a simple number recognition game using a Snakes and

Ladders board game, where each square represented a number. The client had to recognize and

say the number on each square as we moved along the game board. This activity helped improve

his math skills in a fun, interactive way and kept him engaged. I also initiated working on the
 14

anger management skills of the client by incorporating deep breathing exercises. I taught the

client on how to deep breathe and use this relaxation technique in stressful situations.

Session 5

In this session, I focused on enhancing the client’s memory and attention through interactive

activities. For cognitive enhancement, I used a color-coded activity chart that outlined different

tasks, with each task associated with a specific color. The chart also helped improve attention by

breaking the session into clear, manageable segments. The chart had colored pictures of scissors,

dice, pencil and book along with written headings under each, denoting scissors as cutting

activity, snakes and ladders game, drawing time and alphabets reading time respectively. This

visual representation helped the client track his progress throughout the session.

I continued working on memory in academic tasks by using repetition and recall exercises. For

instance, I asked the client to recall and repeat simple math problems and color names from

earlier in the session. The client engaged well with the visual aids, including flashcards and

picture charts, which supported his memory retention. Regarding anger management, I revisited

the deep breathing exercises. Whenever the client became frustrated with a task, I encouraged

him to pause, close his eyes, and take several deep breaths. I also introduced the "count to 10"

technique, where the client would count to 10 whenever he felt his anger rising. The client

practiced these techniques a few times during the session, and I observed that he was able to stay

calmer and focused on his tasks.

Session 6

In this session, I focused on reviewing the client’s progress in both academic skills and anger

management. We practiced number recognition and math exercises again, but this time I added
 15

flashcards that included both the number and the corresponding number of objects (e.g., “15”

with a picture of 15 apples). This visual association supported the client’s learning by linking the

abstract concept of numbers with concrete visual representations, making the task more

understandable and engaging.

To address anger management, I continued with deep breathing exercises. I observed that the

client was more confident in using the technique independently when feeling frustrated during

tasks. I also introduced a simple reward system: after successfully using deep breathing or

counting to 10 during moments of frustration, the client was allowed to choose a small reward,

such as a star sticker or playing with a ball. This reinforcement helped the client internalize the

benefits of using the anger management strategies. For attention and cognitive functions, I used a

visual schedule to break down tasks into smaller, manageable steps. This visual prompt helped

the client focus on one task at a time, which improved his overall attention and reduced feelings

of overwhelm.

Session 7

In the final session, I reviewed the progress the client had made in cognitive areas, academic

skills and anger management. The client showed improvement in number recognition and color

identification. We completed a final round of color recognition activities using flashcards and

color charts, which the client successfully completed with more accuracy and confidence. For

anger management, I reinforced the deep breathing and counting to 10 strategies by providing

the client with a visual checklist of the techniques he had learned. I had him practice using the

techniques in various scenarios, such as when tasks became difficult or when he felt frustrated
 16

with the pace of the session. The client was able to use both techniques with greater

independence and confidence.

I also revisited the reward system we had implemented in previous sessions. The client

responded well to the positive reinforcement, and this helped reinforce his use of the anger

management strategies. For academic skills, I encouraged him to continue practicing his number

recognition at home with the help of a simple colorful chart. Overall, the client demonstrated

increased independence in applying both cognitive strategies and anger management techniques.

I discussed how to continue using these strategies at home and in school with the client and his

classroom teacher, ensuring he can continue to develop and apply these skills in everyday

situations.

Long Term Goals/ Suggestions

 IEP plans for managing difficulties in academic domain.

 Behavioral therapy is recommended for consistent positive change in outbursts.

 Vocational support and guidance is recommended since the client is inclined towards

sports.

 Teach basic financial literacy and self-management skills (money handling, daily

planning).

 Encourage participation in community-based programs to build confidence and

independence.

 Life skills training and social skills training through therapy.

 17

Biodata

Name: MJ

Age: 23 years

Religion: Islam

Gender: Male

Education: MCC

Siblings: 4

Birth Order: third born

Marital status: Unmarried

Father Occupation: Business

Father’s Education: Graduation

Mother Occupation: Housewife

Mother’s Education: FA

Socio-economic Status: Middle Class

 18

Presenting Complaints

The client has issues in performing age appropriate academic tasks. He has difficulties in

learning and memorizing in academic area as well as long term retention. The client has issues in

solving complex mathematics problems, learning simple English/Urdu words and phrases as well

as complex sentences of course curriculum. He does remember the basic colors, shapes, some

fruit names but often mix up the basic learned information upon evaluation. The client has

speech difficulties but only in terms of rate and rhythm of the words. As reported by the

classroom teacher, he used to go for speech therapy which has helped diminish the problem.

History of the problem

The problem was initially observed by his uncle when the client was 5 years old, due to

delayed developmental milestone of uttering his first word (i.e. see table milestones).

Prenatal History

The mother of the client reported having stressful pregnancy period. The mother was 50

years old during pregnancy.

 19

Milestones/Developmental History:

Milestones, Normal Age and Child’s Age of Achievement.

Milestones Age of Achievement

1st Cry Immediate

Head Holding 6 Months

Crawling 2 years

Standing 3.5 years

Walking 4 years

Self-dressed 7 years

Bladder and Bowel Control 9 years

First Word 6 years

Medical History

No substantial medical history of the client has been reported.

Family History

The client’s family relationship history likely involves fairly good interactions and

dynamics with his parents and siblings. The client is most close to his younger brother, who’s a

year younger than him and studies in the same class as him in special school. The client shared

that he and his younger brother love to spend time with their older brother and sister. They live

in a joint family system and have fairly positive relationship with extended family. His younger
 20

brother is diagnosed with intellectual disability disorder and studies in special school along with

the client.

Educational History

The client had previously enrolled in a normal school but due to his speech delay and

learning disabilities his academic performance was poor. Later he was enrolled in a special

education school.

Social History

The client has positive interactions with family members, he has a great relation with his

siblings and friends in the classroom. The client is also quite close to his classroom teacher and

prefers to sit in the front seat and initiates conversations with teacher and peers.

General Characteristics

The client is generally friendly open and cooperative. He is great at holding conversations

and love to interact with everyone. He likes to share about his present life events or about the

places he has visited in past. He often crack jokes about his classmates. Due to his attachment

with classroom teacher, he becomes down and sad if scolded by her due to severe negligence in

tasks. He also expresses his emotions by explaining thoroughly about events.

Level of Functioning:

Personal
 21

The client is warm and open. He likes to joke and involve others in conversations. The

client can manage simple daily tasks as well as self-care. He may need reminders but he’s good

in self-management.

Cognitive

The client shows issues in the ability to learn and memorize academic material. Attention is

inconsistent, requiring focused, engaging activities to sustain his interest. He needs support in

academic tasks such as cutting, learning, mathematics and recalling memorized material.

Social

The client demonstrates good social interactions with family and peers. He thrives in

supportive environments.

Psychological Assessment

 Mental Status Examination

The mental status examination of the client will indicate important details relating to his

appearance, mood, and perception, several cognitive functions such as orientation,

attention and memory. MSE also includes the evaluation of client’s abstract reasoning

and whether or not he has insight of the problem.

 Rey Auditory Verbal Learning Test (RAVLT)

RAVLT is used to access the memory functions including immediate recall,

delayed recall and recognition memory.

 School Function Assessment Test (SFA)

 22

The School Function Assessment (SFA) form serves as a crucial tool, developed by

Pearson Education, Inc., to evaluate students' performance, participation, and support needs in

academic and non-academic activities within the school environment.

 Slosson Intelligence Test (SIT)

Slosson Intelligence Test is used here to determine the intelligence quotient of the

client as well to evaluate the level of intellectual functioning.

1. Mental Status Examination (MSE)

The client’s appearance was well-kempt. His hair were brushed and he was wearing clean

and ironed uniform. He was cooperative and easygoing. His posture was relaxed. He

maintained good eye contact. His mood during the sessions was pleasant and cooperative.

The client had orientation of time and place, his attention during the sessions was maintained.

The client had no insight about his problem.

2. Rey Auditory Verbal Learning Test (RAVLT)

Quantitative Analysis

Measure Raw Score Interpretation

 23

Immediate Recall 26/75 Below-average learning ability and verbal

(List A) memory recall.

Proactive 1 words
Slight interference, indicating mild difficulty in
Interference
shifting focus from previously learned material.
Retroactive
-2 words Moderate difficulty recalling earlier information after
Interference
learning new material.
Delayed Recall
4/15 Below-average delayed memory retention, suggesting
slightly poor long-term retention

Recognition Below average recognition performance, indicating

6/15
Memory typical ability to differentiate target words from
distractors.

Qualitative Analysis

The client demonstrates moderate verbal memory recall with a below average ability to learn

and retain information immediately, as seen in the Immediate Recall score. However, there is

mild interference due to proactive interference, where previously learned material slightly

hinders the ability to focus on and recall new information. Additionally, retroactive interference

suggests moderate difficulty in recalling earlier material after learning new words. The Delayed

Recall score indicates below-average long-term memory retention, with some difficulty in

retaining information over time. Recognition memory is also below average, as the client shows

typical ability to differentiate target words from distractors but with some challenges in

recognizing previously learned material accurately. These results suggest that while the client
 24

can initially learn and recognize material albeit with difficulty, they experience moderate level

difficulties with long-term retention and distinguishing between old and new information.

3. School Function Assessment (SFA)

Quantitative Analysis

Participation Task Supports Activity Performance

2 1 2

Qualitative Analysis
The client demonstrates moderate difficulty in participating in school activities, reflected in a

participation score of 2. While he engages in some tasks, his impulsivity, inattentiveness, and

disruptive behaviors limit his full involvement. He struggles with task completion and focus,

leading to a task support score of 1, indicating a high need for external assistance and frequent

redirection from teachers to stay engaged. His activity performance score of 2 suggests

inconsistent performance across tasks, where he can sometimes complete activities but struggles

with sustained effort, following instructions, and retaining learned material.

4. Slosson Intelligence Test (SIT) (Richard L. Slosson 1963)

Quantitative Analysis

Basal Age Mental Age Chronological Age I.Q

142 156.5 276 58

Qualitative Analysis:

The individual assessed with the Slosson Intelligence Test demonstrates cognitive abilities

consistent with mild intellectual disability. With an IQ of 58, his intellectual functioning aligns
 25

with the capacity for basic literacy. This result shows him experiencing difficulty with abstract

reasoning, planning, and problem-solving but show potential to develop practical knowledge.

Socially, he is likely capable of forming and maintaining relationships but might struggle with

interpreting complex social cues or handling unstructured situations.

Diagnosis

Intellectual Disability (Intellectual Developmental Disorder with Mild level) 317 (F70).

Management Plan

 Improve math  Regular maths sums with visual aids

skills  Snakes and ladders game
Enhancing academic  Compound words
skills recognition
 Shapes and object  Use of different shaped objects
recognition with  Object names chart
spellings  Crayons, paints and color pencil activities

 Use of origami  To engage fine motor skills in

papers learning and creativity (paper
Working on creative boats, airplanes, flower making)
skills
 Drawing/Painting
 Improve memory  Activity chart involving colors
in academic tasks. to enhance learning.
 Repetition and recall
Enhance learning and  Use of visual aids.
 Improve attention
memory functions  Use of pictures, flashcards,
cardboard activities to hold
 Enhance learning
attention.
through creative
 Object identification through
arts
drawing
 26

Session Reports
Session 1

In this initial session, I focused on building rapport with the client. I administered various

activities like coloring tasks, drawing tasks along with initiating conversation with the client. I

asked about his interests and he enthusiastically shared about the activities he likes most of

which included the classroom activities that his teacher prepares for the class. The client was

easygoing and friendly. He excitedly shared about an upcoming event in the family and how he

was planning to get ready for that. The client was cooperative and completed the drawing and

coloring tasks with reasonable effort. He often passed smiles during the sessions depicting his

comfort. I also asked client questions about his family and he shared how he enjoy spending time

with his siblings. Since one of client’s brother studies in the same class as him, he joked about

him as well as his other friends. After the session client asked whether there will be more

sessions or not because he wanted to keep them going.

Session 2

Since I had established rapport with the client in the previous session and due to client’s open

and cooperative nature I planned to administer psychological tests for further screening of

presenting complaints. I began the session by starting a light conversation and asked the client to

recall the names of all fruits he know in English as this was part of his curriculum. The client had

just learned the names in the previous class prior to the session so he enthusiastically began

listing the names. Then I used his pleasant mood as a way to shift his attention towards a similar

‘new activity’.
 27

I transitioned to the Rey Auditory Verbal Learning Test (RAVLT). I read the first word list

aloud and asked the client to recall as many words as they could. During the initial trials, the

client was attentive and tried their best to recall the words. However, as the test progressed to

include interference and delayed recall tasks, he began to express mild annoyance, particularly

during repeated recall trials. Despite his annoyance, he wanted to complete all phases of the test

because he wanted to have a ‘higher score’. Throughout the session, the client demonstrated a

willingness to participate.

Session 3

In this session, I administered the Slosson Intelligence Test (SIT) to assess the client's verbal

intelligence and abstract reasoning abilities. The SIT is a well-established test used to evaluate an

individual's ability to reason, solve problems, and think logically. The client's performance on

the test indicated an IQ score of ‘58’ within the mild intellectual disability range “50-69”. This

result suggests that the client experiences difficulty with more complex cognitive tasks that

require abstract reasoning. While the client was able to answer some of the simpler items, he

struggled with the more challenging items. Given the mild level of intellectual disability, the

client will benefit from continued guidance in these areas, especially in tasks that require abstract

thinking. Since this test requires attention and focus, this session was mainly focused on its

administration along with the activities that I included to maintain client’s interest.

Session 4

In this session, I administered the Raven’s Coloured Progressive Matrices (CPM) to assess the

client’s non-verbal reasoning and problem-solving skills. Before beginning, the client mentioned

that he had taken this test in a previous session and expressed a desire to complete it quickly so
 28

that we could move on to more interactive activities. Despite this, he remained cooperative and

engaged, carefully examining each matrix before selecting an answer. Initially, he seemed

interested in the task, but as the test progressed, he occasionally glanced away and shifted in his

seat, indicating mild impatience. At times, he tapped his fingers on the table or sighed softly,

suggesting a desire to move on. However, when encouraged to take his time and focus, he would

pause momentarily and attempt to analyze the patterns more carefully. He completed the test in

20 minutes, showing persistence despite occasional moments of distraction. While he did not

express frustration, he asked a few times how many questions remained, further reinforcing his

eagerness to conclude the test. Once finished, he appeared relieved and quickly inquired about

the next activity, demonstrating his preference for more dynamic and engaging tasks.

Session 5

I administered a series of academic skill-building activities to enhance the client’s recognition of

shapes, objects, and words. To begin, I introduced a shapes and object recognition task, where

the client matched different shaped objects to their corresponding names on a chart. He was

engaged and excited, especially when using crayons and paints to color the objects after

identifying them. I then transitioned to a math skills activity, using visual aids to help him

recognize and differentiate numbers in a more interactive way. To keep the session dynamic, I

incorporated the Snakes and Ladders game, where he had to identify numbers, count aloud, and

move his token accordingly. This activity helped reinforce number recognition while keeping

him motivated. Throughout the session, I observed that he was more focused when given

colorful materials and hands-on activities. His attention span wavered slightly during the

structured chart activity, but he remained engaged when visual elements were introduced.
 29

Overall, the session was productive, and the client responded well to the interactive learning

approach.

Session 6

I focused on enhancing the client’s creative skills and fine motor development through art-based

learning. I introduced origami, guiding him in making simple paper boats and airplanes, which

he found fascinating. As he folded the paper, I provided step-by-step instructions, encouraging

him to follow along at his own pace. While he initially struggled with precision, he showed

persistence and was excited when he successfully completed a paper boat. To further engage his

creativity, I administered a drawing and painting activity, where I asked him to draw and color

different objects from memory. This exercise aimed to improve his recall skills, and I observed

that he was able to accurately reproduce some shapes and objects from previous sessions. His

enthusiasm increased as he selected colors and added details to his drawings. Although he

occasionally got distracted, he quickly refocused when I praised his efforts and reminded him of

the next step. By the end of the session, he had created multiple drawings and origami figures,

appearing proud of his work.

Session 7

In this session, I worked on strengthening the client’s memory and learning abilities through

repetition and recall exercises. I first introduced an activity chart with different colors to help

structure the session and keep him engaged. The chart included sections for numbers, shapes,

and words, allowing the client to track his progress visually. I administered a flashcard recall

activity, where I presented flashcards with words and corresponding images, then later asked him

to recall and name them. While he initially hesitated, he became more confident with repeated
 30

exposure. To enhance his attention span, I engaged him in a cardboard puzzle activity, where he

had to piece together different shapes to form complete images. He was attentive and enjoyed the

challenge, though he occasionally required guidance when he struggled with certain pieces.

Throughout the session, I observed that he retained information better when activities were

hands-on and visually stimulating. He remained cooperative and showed improvement in

recognizing and recalling objects.

Session 8

I focused on object identification through drawing to integrate both memory and creative skills. I

started by presenting the client with everyday objects and asking him to name them, then later

challenged him to draw and label the objects from memory. He was eager to use his crayons and

paints, showing enthusiasm in adding small details. While he sometimes needed prompts to

recall certain objects, he demonstrated increased confidence compared to previous sessions. To

further reinforce learning, I engaged him in an interactive storytelling activity, where I described

a scene and asked him to draw what he imagined. This activity helped improve his

comprehension and expressive abilities while making the session more engaging. Toward the

end, I introduced another shapes and objects matching task, encouraging him to reinforce what

he had learned earlier. The client remained actively engaged, enjoying the artistic aspects of the

session the most. His ability to stay focused and complete each activity showed progress in both

his learning and attention skills.

Session 9 (Termination Session)

As this was the final session, I reviewed all the skills the client had worked on throughout our

time together. I encouraged him to participate in a recap activity, where he identified numbers,
 31

colors, and objects he had learned during the sessions. He showed noticeable improvement in

memory recall and was more confident in his responses. To provide a sense of closure, I allowed

him to choose his favorite activity from previous sessions, and he excitedly opted for Snakes and

Ladders as well as a drawing task. While engaging in these activities, he expressed sadness that

this was our last session together, stating that he enjoyed the sessions and would miss them. I

reassured him that he had made great progress and encouraged him to continue practicing the

activities at home. I also discussed his progress with him, reinforcing his strengths and

acknowledging his efforts. As the session ended, he lingered for a moment before leaving,

showing that he had formed an attachment to the sessions. I provided positive reinforcement,

reminding him that he had developed valuable skills and could continue to grow. The

termination process was handled with care, ensuring the client felt supported and encouraged

despite the conclusion of our sessions.

Long Term Goals/ Suggestions

 IEP plans for managing difficulties in academic domain.

 Therapeutic sessions for extended time to maintain progress.

 Vocational support and guidance is recommended to explore opportunities that align with

his interests.

 Life skills training and social skills training through therapy.

 32

Biodata

Name: YN

Age: 11 years

Religion: Islam

Gender: Male

Education: MCC

Siblings: 5

Birth Order: Second Last

Father Occupation: Worker

Father’s Education: Matric

Mother Occupation: Housewife

Mother’s Education: 8th standard

Socio-economic Status: Lower Class

 33

Presenting Complaints

The client has speech difficulties and does not communicate in complete sentences as age

requirement. The client utter some words and through limited words and gestures he

communicates his needs. He has behavioral issues and depicts aggressive behaviors. He pokes

his classmates and annoys other children without any substantial reason. The client also shows

stubbornness while performing tasks and is managed only if handled with slight strict tone or

demeanour. The client has below average academic performance and understanding.

History of the problem

The problem was initially observed by parents. 2 sisters of client have previously been

diagnosed with developmental disorders.

Prenatal History

The mother of the client reported having a stressful pregnancy period.

Milestones/Developmental History:

Milestones, Normal Age and Child’s Age of Achievement.

Milestones Age of Achievement

1st Cry No
Head Holding 6 Months
Sat alone 7 Months
Standing 8 Months
Walking 3 years
Fed self 5 years
One-word Speech 3 years
 34

Medical History

The client had fever and fits at the time of birth and was given medications to recover. That was

the only time the client suffered from fits.

Family History

The client’s family relationship history involves good relationships with parents and

siblings. The client is close to his mother out all his immediate family members. A cousin of

client’s mother has been diagnosed with multiple disabilities. The client’s two elder sisters have

also been diagnosed with intellectual disability disorder.

Educational History

The client has never been enrolled in a normal school before. When the client’s parents

observed developmental difficulties in him as his two other sisters, they enrolled him in his

present special school where his elder sisters are also enrolled.

Social History

The client has positive interactions with family members. He engages with aggressive

behaviors with his classmates. Often he would snatch a fellow’s toy or activity they are doing.

The client would then refuse to return the object unless the teacher intervenes, the client seems to

enjoy disturbing his fellows.

General Characteristics

The client has impulsive nature and is stubborn. He does often smiles and appears to be

friendly but he shows his stubbornness when things aren’t going his way or if he wants to do
 35

some other task than the one he’s currently been asked to do. The client enjoys sports such as

football and throw ball games. He teases his classmates and gain pleasure in doing that.

Although the annoying tactics he generally uses are harmless in nature.

Level of Functioning:

Personal

The client has speech and language difficulties and he communicates in limited words

and phrases. He doesn’t talk in complete sentences but understands tasks.

Cognitive

The client shows difficulties in the ability to recognize basic objects, shapes, colors.

Attention is inconsistent and he is impulsive, requiring focused, engaging activities to sustain his

interest. He requires learning of basic objects, creative tasks and self care.

Social

The client demonstrates difficulties in maintaining good relations with peers requiring focus

in this domain to form strong, sustained relationships.

Psychological Assessment

 Mental Status Examination

The mental status examination of the client will indicate important details relating to his

appearance, mood, and perception, several cognitive functions such as orientation,

attention and memory. MSE also includes the evaluation of client’s abstract reasoning

and whether or not he has insight of the problem.

 36

 Child Behaviour Rating Scale (CBRS)

CBRS is a rating scale to examine child’s well being and behavior with other

children, adults and material in classroom or virtual classroom setting.

 School Function Assessment (SFA)

The School Function Assessment (SFA) form serves as a crucial tool, developed

by Pearson Education, Inc., to evaluate students' performance, participation, and

support needs in academic and non-academic activities within the school

environment.

 Slosson Intelligence Test (SIT)

Slosson Intelligence Test is used here to determine the intelligence quotient of the

client as well to evaluate the level of intellectual functioning.

1. Mental Status Examination (MSE)

The client’s appearance was unkempt. His clothes were mostly messy and untidy. His

posture was relaxed and he was cooperative most of the time, he did show some stubbornness

but it was manageable. The client had some issues retaining attention. He lacked insight of

his issues.

2. Child Behavior Rating Scale (CBRS)

Quantitative Analysis:

Age Classroom self-regulation score Social Skills Score Total Score

11 38 07 45

Qualitative Analysis:
 37

The CBRS data indicates a significant challenge in both classroom self-regulation and

social skills for this client. With a Classroom Self-Regulation score of 38, the client may struggle

to stay focused, follow directions consistently, and complete tasks without substantial support.

The Social Skills score of 07 indicates severe difficulty with peer interactions, likely involving

challenges with taking turns, sharing, and cooperating. The Total Score of 45 reflects the need

for targeted interventions that focus on enhancing social-emotional skills, self-regulation, and

developing strategies to improve academic engagement and peer relationships.

3. School Function Assessment (SFA)

Quantitative Analysis

Participation Task Supports Activity Performance

1 1 1

Qualitative Analysis

The score of 1 for participation indicates that the client is only minimally engaged in school

activities. They may show reluctance to engage or require redirection to remain on task. With a

score of 1 for task behavior, the client struggles with task completion and maintaining focus.

This score suggests that the client will require repeated prompts and supervision to stay engaged

in academic tasks. They are likely to display impulsive behaviors, such as switching between

tasks or becoming distracted easily. The client may struggle with following classroom rules,

completing assignments, and may require constant redirection.

4. Slosson Intelligence Test (SIT) (Richard L. Slosson 1963)

Quantitative Analysis
 38

Basal Age Mental Age Chronological Age I.Q

84 84 132 55

Qualitative Analysis:

The individual assessed with the Slosson Intelligence Test demonstrates cognitive abilities

consistent with moderate intellectual disability. With an IQ of 55, this client experiences

significant delays in acquiring basic literacy, numeracy, and adaptive skills compared to their

peers.

Diagnosis

Intellectual Disability (Intellectual Developmental Disorder with Moderate level) 317 (F71).
 39

Management Plan

 Improve basic  Simple sentence repetition exercises

speech and
Speech and communication  Use of picture communication cards
Communication skills

 Turn-taking games (e.g., board

 Enhance social games, sharing toys)
Social Interaction interaction  Reinforce positive behavior
through reward and
diminishing maladaptive
interactive behavior.
 Positive reinforcement for
calm behavior (stickers,
 Reduce impulsive praise)
Behavior and aggressive  Role-playing appropriate ways
Management behaviors to ask for things
 Use of visual reminders (e.g.,
"Stop" card)

Session Reports
Session 1

The first session focused primarily on building rapport with the client, as establishing trust and

comfort is crucial. To engage him, I used a ball-throwing activity, as he enjoys sports and

physical activities. We played a simple game where I threw the ball and encouraged him to pass

it back, giving him praise whenever he did. At times, the client was stubborn and reluctant to

participate, especially when he was not interested in the game or when the ball didn’t reach him.

I managed his stubbornness by remaining patient and offering small rewards (like stickers) for

his participation. This helped create a positive atmosphere and encouraged him to stay engaged.
 40

Session 2

In this session, I administered the School Function Assessment (SFA) with the help of his

teacher. The activity involved simple coloring tasks alongside the SFA test. I gave the client

crayons and a picture to color, providing verbal prompts when needed to guide him through the

activity. He showed some difficulty staying focused and completed the task with interruptions,

switching between colors and becoming distracted at times. When he became stubborn and

didn’t want to continue, I gently redirected him by giving a visual reminder of the task and

reinforcing his participation with praise.

Session 3

This session involved the administration of the Child Behavior Rating Scale (CBRS) by the

teacher, while I conducted the Slosson Intelligence Test (SIT). The client struggled with staying

focused during the assessments, showing impulsive behaviors, such as fidgeting and shifting his

attention to other objects. Despite the difficulty, I was able to manage his behavior with frequent

redirection and positive reinforcement. During the SIT administration, the client had trouble with

some tasks, but I used simple, clear instructions and encouraged him to take his time. I

reinforced his positive behavior with praise when he focused or attempted tasks.

Session 4

In this session, the focus shifted to improving speech and communication. I worked with the

client on simple sentence repetition exercises, encouraging him to repeat short phrases after me.

He showed some difficulty with pronunciation and needed multiple cues to complete the
 41

sentences. At times, he became frustrated when he couldn’t say the words correctly and exhibited

stubborn behavior by refusing to repeat the phrases. I used visual aids, such as picture cards, to

facilitate understanding and prompted him with a visual cue when he struggled. The session

ended with praise and a sticker reward for completing the tasks.

Session 5

This session focused on improving social interaction through turn-taking games. I introduced a

board game where we took turns moving pieces. The client was initially reluctant and tried to

take more than his turn, which was a challenge. I used verbal reminders and reinforced the

importance of sharing and taking turns. He became more engaged after a few rounds, and his

behavior improved when he received praise for waiting his turn. I also used a “Stop” card to

remind him when he was being impulsive and needed to wait for his turn. Positive

reinforcement, such as a small reward after each round, helped sustain his focus.

Session 6

In this session, I focused on behavior management by using positive reinforcement to encourage

calm behavior. The client and I engaged in a simple puzzle activity. Whenever he completed a

section of the puzzle or demonstrated patience in waiting for the next step, I offered verbal praise

or gave him a sticker as a reward. He showed some impulsivity, like trying to place pieces

incorrectly or getting distracted, but I managed this by calmly redirecting him and reinforcing the

positive behaviors he demonstrated. The session went smoothly with steady engagement.

Session 7
 42

This session was centered on practicing appropriate social behaviors through role-playing. I

acted out simple social scenarios, such as asking for help or asking for a toy, and encouraged the

client to participate. At first, he was hesitant and tried to change the subject, but I used visual

cues and simplified the tasks to keep him engaged. He showed some stubbornness, but I gently

guided him to finish each role-play exercise by using positive reinforcement whenever he

successfully participated. He responded better after receiving verbal encouragement and praise

for his attempts.

Session 8

The final session of this plan focused on reinforcing behavior management techniques. We

revisited the “Stop” card and practiced using it when the client began to show impulsive

behavior. We engaged in a simple interactive activity, like building a tower with blocks, where

he had to wait for his turn to add a block. At times, the client became frustrated and tried to rush

the process, but I reminded him to use the "Stop" card to help regulate his impulses. Positive

reinforcement was used each time he followed the instructions. The session ended with a review

of his progress and a reward for his efforts.

Long Term Goals/ Suggestions

 IEP plans for managing difficulties in academic domain.

 Speech Therapy to enhance communication skills, focusing on word production and

sentence formation.

 Cognitive Behavioral Therapy (CBT) for impulse control and emotional regulation,

addressing impulsivity and aggression.

 43

 Occupational Therapy to improve fine and gross motor skills, particularly for self-help

tasks like feeding and dressing.

Biodata

Name: UF

Age: 5 years
 44

Religion: Islam

Gender: Female

Education: MCC

Siblings: Nill

Birth Order: Only child

Father Occupation: Waiter

Father’s Education: 5th grade

Mother Occupation: Housewife

Mother’s Education: 5th grade

Socio-economic Status: Lower Class

Presenting Complaints

The client has a below average understanding which is not consistent with developmental age.

The client has severe difficulties with her speech, she doesn’t utter any word, phrase or sentence

other than one word ‘mama’ denoting towards her mother. She does understand simple sentences
 45

and commands such as if asked ‘did your mother help you get ready today?’ she would nod in a

‘yes’. Other than basic simple sentences, she doesn’t understand complex sentences even one as

‘if you run towards the class you’ll fall down’. She only communicates through pointing at

things she wants or by nodding yes/no. The client has not been enrolled in any school before

hence her understanding of basic academic material lack severely. Recognition of basic shapes,

colors and objects is not present. The child has impulsivity and depicts aggressive behaviour

when poked by other classmates. She shows impulsivity during tasks.

History of the problem

The problem was initially observed by parents at birth because the client was feverish and

severely weak. At the age of 6 months, the mother noticed the client’s declining health even

more. The parents became concerned due to her delayed speech and language development.

Prenatal History

The mother of the client reported having a full term pregnancy but the delivery was a C-

section.

Milestones/Developmental History:

Milestones, Normal Age and Child’s Age of Achievement.

Milestones Age of Achievement

 46

1st Cry Immediate

Head Holding 5 Months
Sat alone 8 Months
Crawling 1 years
Standing 2.5 years
Walking 3 years
Fed self 5 years
Toilet Training Not yet
One-word Speech 4 years

Medical History

The client had fever at the time of birth. At the age of 4 years, the client was admitted to the

hospital due to high fever and was given medications to recover.

Family History

The client’s family relationship history involves close relation with parents. The client is

a single child hence usually hangs out alone at home. As reported by the mother, the client has

good relationship with her grandparents and close cousins. No serious medical illness or

psychiatric/psychological disorder is observed in the family.

Educational History

The client has never been enrolled in a school before. When the client’s parents observed

developmental difficulties in her, they enrolled her in her present special school.

Social History
 47

The client has positive interactions with family members. She likes to spend time with

her classmates but occasionally indulges in aggressive behavior when provoked by her fellows.

Apart from that normally the client has positive interactions with others and she is cooperative

with her classroom teacher as well.

General Characteristics

The client has a friendly nature. She is eager to attend sessions and has a pleasant mood.

Level of Functioning:

Personal

The client has speech and language difficulties hence she only communicates through

hand gestures such as pointing towards things she wants. She has one word speech and usually

nods in a yes/no depending on whatever asked. The client is friendly but when provoked by

fellows, she displays aggressive behavior.

Cognitive

The client shows difficulties in the ability to recognize basic objects, shapes, colors.

Attention is inconsistent, requiring focused, engaging activities to sustain his interest. She

requires learning of basic objects such as body parts, everyday essentials and simple tasks.

Social

The client demonstrates good social interactions with family but can display impulsive and

aggressive behavior when mistreated. She requires a supportive and engaging environment to

grow in academic as well as social domain.

 48

Psychological Assessment

 Mental Status Examination

The mental status examination of the client will indicate important details relating to his

appearance, mood, and perception, several cognitive functions such as orientation,

attention and memory. MSE also includes the evaluation of client’s abstract reasoning

and whether or not he has insight of the problem.

 Child Behaviour Rating Scale (CBRS)

CBRS is a rating scale to examine child’s well being and behavior with other

children, adults and material in classroom or virtual classroom setting.

 School Function Assessment (SFA)

The School Function Assessment (SFA) form serves as a crucial tool, developed

by Pearson Education, Inc., to evaluate students' performance, participation, and

support needs in academic and non-academic activities within the school

environment.

 Slosson Intelligence Test (SIT)

Slosson Intelligence Test is used here to determine the intelligence quotient of the

client as well to evaluate the level of intellectual functioning.

1. Mental Status Examination (MSE)

The client’s appearance was neat. Her clothes were clean and ironed. Her hair were brushed

and tied in a ponytail. Her mood was pleasant. She has issues with attention and

concentration as well as speech. The client lacked insight about her issues.
 49

2. Child Behavior Rating Scale (CBRS)

Quantitative Analysis:

Age Classroom self-regulation score Social Skills Score Total Score

05 40 10 50

Qualitative Analysis:

The CBRS data indicates a significant challenge in both classroom self-regulation and

social skills for this client. With a Classroom Self-Regulation score of 40, the client may struggle

to stay focused, follow directions consistently, and complete tasks without substantial support.

The Social Skills score of 10 indicates difficulty with peer interactions, likely involving

challenges with taking turns, sharing, and cooperating. The Total Score of 50 reflects the need

for targeted interventions that focus on enhancing social-emotional skills, self-regulation, and

developing strategies to improve academic engagement and peer relationships.

3. School Function Assessment (SFA)

Quantitative Analysis

Participation Task Supports Activity Performance

1 2 1

The client demonstrates moderate challenges across various areas, In participation and activity

performance, the client requires substantial support to engage in activities and remain focused.

Physical task skills and motor coordination are also limited, though progress is possible with

practice. The client has basic self-care skills but still requires assistance with more complex
 50

tasks. Significant difficulty is noted in social behavior, where the client struggles with peer

interactions, indicating a need for social skills development.

4. Slosson Intelligence Test (SIT) (Richard L. Slosson 1963)

Quantitative Analysis

Basal Age Mental Age Chronological Age I.Q

120 100 60 50

Qualitative Analysis:

The individual assessed with the Slosson Intelligence Test demonstrates cognitive abilities

consistent with moderate intellectual disability. With an IQ of 50, this client experiences

significant delays in acquiring basic literacy, numeracy, and adaptive skills compared to their

peers.

Diagnosis

Intellectual Disability (Intellectual Developmental Disorder with Moderate level) 317 (F71).

Management Plan

 Improve  Use pictures of objects and shapes.

recognition of  Sensory Activity with play dough to shape
Academic skills objects, shapes, objects and colors.
development and colors.  Use interactive matching games and
Enhance attention puzzles with basic objects.
span.

 Enhance social  Scratch wooden pencil diaries

interaction, for calming tactile activities
Social and Emotional manage  Reinforce positive behavior
 51

Skills emotions, and through reward and

improve impulse diminishing maladaptive
control behavior.
 Practice self-feeding skills
using utensils.
 Improve basic
Adaptive Behavior self-help and  Engage in fine motor skill
Development daily living skills. activities with play dough for
hand-eye coordination.
 Engage in gross motor skills
activities with
throwing/passing ball games.

Session Reports
Session 1

The initial session was focused primarily on observation and gathering information, using the

SFA (School Function Assessment) test with the support of the teacher. The session was

designed to assess the client’s functioning in a school setting, and I observed her behavior and

responses. The client displayed limited communication, primarily through gestures, and showed

some impulsivity when interacting with peers. She was able to follow simple instructions, such

as nodding in agreement or pointing to express her needs. The session was used to gather

baseline data on the client’s abilities, and I aimed to build rapport by engaging her with crayon

paper and pencil coloring activities. These activities were chosen to establish trust and encourage

the client to feel comfortable with me.

Session 2
 52

During the second session, I administered the SIT Intelligence Test, which aimed to assess the

client's cognitive abilities. The test involved tasks that measured problem-solving, pattern

recognition, and attention span. The client had some difficulty staying focused during longer

tasks but showed some responsiveness to simpler items. Throughout the session, I used crayon

paper and pencil to maintain the client’s interest and make the environment more engaging. This

rapport-building activity helped the client remain calm and cooperative. While the results of the

test highlighted certain cognitive challenges, it was evident that with ongoing support, the client

has the potential to make progress.

Session 3

In session 3, I administered the CBRS (Child Behavior Rating Scale) to assess the client’s

behavioral tendencies, including aggression, attention, and emotional regulation. This process

was done with the teacher’s support, ensuring that accurate observations were made in both the

classroom and home settings. During the session, I focused on rapport-building by engaging the

client in coloring activities using crayon paper and pencils. These activities helped reduce any

initial discomfort and encouraged the client to participate. The client displayed some impulsivity

and frustration during the session, but she was able to calm down when redirected. The data from

the CBRS provided important insights into the client’s behavioral patterns, particularly regarding

aggression and social interactions.

Session 4

In session 4, I focused on academic skills development, specifically working on body parts

recognition. The client already had some knowledge of her body parts, so we expanded on this
 53

foundation by engaging in activities such as pointing to or naming different parts of the body.

The client was able to identify several body parts, and with further practice, she could improve

this recognition. Additionally, I incorporated a sensory play dough activity, encouraging her to

create shapes and objects related to body parts (e.g., a head, arms, etc.), which helped engage her

fine motor skills and attention.

Session 5

Session 5 focused on social and emotional skills development, particularly improving impulse

control and emotional regulation. We engaged in a calming tactile activity using scratch wooden

pencil diaries, which helped soothe the client during moments of agitation. The client displayed

some impulsivity and frustration when the activity didn’t go as expected, but through redirection

and positive reinforcement, she was able to complete the activity calmly. In addition, we worked

on managing emotions through turn-taking games, where the client practiced waiting her turn. I

reinforced positive behaviors and used praise to encourage cooperative play. These activities

were designed to help the client practice emotional regulation and social interaction in a

structured manner.

Session 6

The sixth session was dedicated to adaptive behavior development, specifically focusing on self-

feeding skills. The client had some difficulty with using utensils, so we began by practicing with

a spoon during snack time. I provided verbal and visual cues, and the client attempted to use the

utensils with varying levels of success. Throughout the session, I emphasized the importance of

practice and positive reinforcement. I also included a play dough activity to improve hand-eye
 54

coordination. The client enjoyed manipulating the dough into shapes. While the client’s attention

span was inconsistent, the session was engaging and she had fun as well.

Session 7

In session 7, we focused on gross motor skills by engaging in ball passing games. The client

demonstrated some coordination and interest in the activity, although her attention was

inconsistent. I used visual prompts and encouraged her to pass the ball back and forth. She

enjoyed the activity, and it seemed to help channel her energy in a positive way. This physical

activity also helped her practice following simple instructions, such as “pass the ball” or “throw

the ball to me.” The session allowed the client to work on both her motor skills and social

interaction, as she had to wait her turn and engage with others during the game.

Session 8

The final session focused on reinforcing academic skills, specifically working on body parts

recognition and furthering the client’s understanding of these concepts. We used flashcards with

images of body parts to reinforce learning. The client responded well to the visual aids and was

able to identify several body parts correctly. Additionally, we continued with sensory play dough

activities, creating body part shapes to help solidify the learning. The client was engaged

throughout the session and demonstrated a growing understanding of the concepts. I provided

praise and positive feedback, emphasizing her progress and encouraging continued learning. This

last session helped establish a strong foundation for future academic development.

Long Term Goals/ Suggestions

 IEP plans for managing difficulties in academic domain.

 55

 Speech Therapy to enhance communication skills, focusing on word production and

sentence formation.

 Cognitive Behavioral Therapy (CBT) for impulse control and emotional regulation,

addressing impulsivity and aggression.

 Occupational Therapy to improve fine and gross motor skills, particularly for self-help

tasks like feeding and dressing.

Biodata

Name: AN

Age: 7 years

Religion: Islam

Gender: Male

Education: MCC
 56

Siblings: 2

Birth Order: 1st born

Father Occupation: Business

Father’s Education: BA

Mother Occupation: Housewife

Mother’s Education: BA

Socio-economic Status: Middle Class

Presenting Complaints

The client has difficulties in learning and shows stubbornness in following instructions of elder.

He shows verbal aggression with peers and class-fellows. The client has poor attention span

during class activities and tasks. He often shouts and depicts impulsive behavior. When seated,

he would squirm in his seat and would change positions in seat. He talks excessively about

random things such as would begin asking when is lunch time and would go and on about what

his mother packed him for lunch and how he wants to eat immediately.

History of the problem

 57

After two and half years of age, the mother noticed behavioral issues.

Prenatal History

The mother of the client reported having a normal full term pregnancy.

Milestones/Developmental History:

Milestones, Normal Age and Child’s Age of Achievement.

Milestones Age of Achievement

1st Cry Immediate
Head Holding 7 Months
Sat alone 9 Months
Standing 11 Months
Walking 1 year 6 months
Fed self 5 years
One-word Speech 2 years 6 months

Medical History

The client had epileptic fits at the age of 1 year and 7 months. They never occurred after that.

Family History

The client shares fairly positive and good relationship with his parents. As reported by

the mother, the client is close to his siblings as well as they are younger than him he shows

affection towards them. There is no medical/psychiatric illness repported in the family.

Educational History
 58

The client has never been enrolled in a normal school before. When the client’s parents

observed behavioral difficulties in him they enrolled him in his present special school.

Social History

The client has positive interactions with family members. He engages with aggressive

behaviors with his classmates and peers. The client shows stubbornness and shouts at his peers if

they are playing an activity that he wants. He also uses sassy remarks on classmates to instigate

them and then laugh when they are annoyed.

General Characteristics

The client appears to have an easy going attitude but he shows impulsivity and inattention

more than normalcy. The client engages in verbal aggression and witty remarks to his peers to

annoy them.

Level of Functioning:

Personal

The client has impulsive behavior and some difficulties in expressive speech. He would

communicate in phrases and often in sentences but he lacks the ability to express in detail. He

shows aggressive behavior.

Cognitive

The client shows difficulties in learning as required by the age appropriation. He knows basic

objects, shapes, colors and body parts but he often depicts issues in learning new information,

recognizing the and recalling the previously learned material.

 59

Social

The client demonstrates difficulties in maintaining good relations with peers requiring focus

in this domain to form strong, sustained relationships.

Psychological Assessment

 Mental Status Examination

The mental status examination of the client will indicate important details relating to his

appearance, mood, and perception, several cognitive functions such as orientation,

attention and memory. MSE also includes the evaluation of client’s abstract reasoning

and whether or not he has insight of the problem.

 School Function Assessment (SFA)

The School Function Assessment (SFA) form serves as a crucial tool, developed

by Pearson Education, Inc., to evaluate students' performance, participation, and

support needs in academic and non-academic activities within the school

environment.

 Slosson Intelligence Test (SIT)

Slosson Intelligence Test is used here to determine the intelligence quotient of the

client as well to evaluate the level of intellectual functioning.

 Connors Rating Scale

The Conners Rating Scale is a widely used psychological assessment tool

designed to evaluate attention-deficit/hyperactivity disorder (ADHD) and other behavioral,

emotional, and cognitive difficulties in children and adolescents.

 Vanderbilt Assessment Scale

 60

The Vanderbilt Assessment Scale is primarily a screening tool used to identify

ADHD symptoms and related behavioral concerns in children aged 6-12. Developed for use

in primary care and educational settings, this scale is completed by parents and teachers to

assess core ADHD symptoms along with associated difficulties like oppositional behavior,

conduct problems, and anxiety/depression.

1. Mental Status Examination (MSE)

The client’s appearance well kempt, neat and tidy. His hair were combed and he was well

groomed. He was active and cooperative mostly. His mood was pleasant and elevated mostly.

He has difficulties maintaining attention and concentration and lacked insight about his

issues.

2. School Function Assessment (SFA)

Quantitative Analysis

Participation Task Supports Activity Performance

2 1 2

Qualitative Analysis
The client demonstrates moderate difficulty in participating in school activities, reflected in a

participation score of 2. While he engages in some tasks, his impulsivity, inattentiveness, and

disruptive behaviors limit his full involvement. He struggles with task completion and focus,

leading to a task support score of 1, indicating a high need for external assistance and frequent

redirection from teachers to stay engaged. His activity performance score of 2 suggests
 61

inconsistent performance across tasks, where he can sometimes complete activities but struggles

with sustained effort, following instructions, and retaining learned material.

3. Slosson Intelligence Test (SIT) (Richard L. Slosson 1963)

Quantitative Analysis

Basal Age Mental Age Chronological Age I.Q

60 60 84 71

Qualitative Analysis:

The individual assessed with the Slosson Intelligence Test demonstrates cognitive abilities

consistent with mild intellectual disability. The client’s IQ score of 71 falls within the borderline

to mild intellectual disability range, indicating below-average cognitive functioning with

difficulties in learning, memory, and problem-solving.

4. Connors Rating Scale

Quantitative Analysis:

Subscale T score
Inattention >70
Hyperactivity/Impulsivity >70
Oppositional Behavior 60-70
Note: T-scores above 60 are considered elevated, with scores above 70 indicating more severe

concerns

Qualitative Analysis:
 62

The client is likely to exhibit significant challenges in maintaining attention, following

instructions, and staying on task, as indicated by elevated inattention scores. Elevated

hyperactivity/impulsivity scores suggest difficulties with impulse control, excessive talking, and

fidgeting. Moderately elevated oppositional behavior scores may reflect stubbornness and verbal

aggression toward peers and authority figures.

5. Vanderbilt Assessment Scale

Quantitative Analysis:

Subscale T score
Inattention ≥ 6 out of 9
Hyperactivity/Impulsivity ≥ 6 out of 9
Oppositional symptoms ≥ 4 out of 8
Performance 4-5
Note: Scores of 2 or 3 on symptom questions reflect often-occurring behaviors, while scores of 4

or 5 on performance questions indicate problems in performance.

Qualitative Analysis:

The client is expected to meet the criteria for the Combined Inattention/Hyperactivity

subtype of ADHD, given the frequent occurrence of symptoms such as inattentiveness,

impulsivity, and hyperactivity.

Diagnosis

Attention-Deficit/Hyperactivity Disorder (ADHD) – Combined Type (F90.2) with Intellectual

Disability – Mild (F70)
 63

Management Plan

 Improve focus  Interactive Games: Use memory games and

and attention simple puzzles to enhance attention span.
Working on  Visual Schedules: Implement clear visual
Inattention schedules to provide structure and help
sustain focus.
 Use of Scratch notepad to enhance interest
in academic learning (shapes, alphabets)

 Turn-taking games (e.g., board

 Control games, sharing toys)
Impulsivity/Behavior impulsive actions  Behavior Charting: Use a
reward system to track
positive behavior, rewarding
the child for controlled
actions.
 Engage in tasks such as
tracing, basic math games, and
 Enhance learning hands-on crafts for better
Improve Learning and task engagement.
completion  Task Breakdown
 Use of Picture Communication
sheets.

Session Reports
 64

Session 1

In this first session, I worked on building rapport with the client through a simple, engaging

activity of coloring with crayons. The client showed some interest initially but was easily

distracted by outside noises, constantly asking when his break would be. I gently redirected his

attention back to the task and praised him for staying focused for short bursts. During this

session, I also administered the School Function Assessment (SFA) with the teacher’s aid. The

client had some difficulty maintaining attention during the administration of the assessment,

often fidgeting and squirming in his seat. To manage this, I provided breaks and used visual

schedules to help keep him focused. His attention span was brief, and I noticed a tendency to

rush through tasks. Positive reinforcement, such as verbal praise, was given when he made

progress.

Session 2

This session focused on using the Conners Rating Scale and the Vanderbilt Scale to assess the

client’s symptoms further. I also incorporated some interactive activities like playing a memory

game and simple puzzles. The client was eager to start the puzzle but showed impatience when

the pieces didn’t fit immediately, often throwing the pieces aside. To handle his impulsivity, I

used a behavior chart to track his reactions and reward him for staying calm. I explained that if

he stayed focused and worked through the puzzle without throwing pieces, he would receive a

sticker. This approach seemed to encourage more patience, though there were moments when he

still struggled to focus. During the rating scale administration, he had a hard time staying quiet

and often shouted out unrelated questions, which I managed by giving him small breaks and re-

engaging him with questions related to the activity.

 65

Session 3

In this session, I administered the Slosson Intelligence Test (SIT). The client was very impulsive

and found it difficult to focus for extended periods. He would frequently ask, “Are we done yet?”

and had trouble following through with instructions. I used a strategy of offering him short

breaks, ensuring that the break time was brief enough to keep him engaged but long enough to

alleviate some of his restlessness. To manage his impulsivity, I provided clear and concise

instructions and reinforced him for completing tasks calmly. When he became too distracted or

started showing frustration, I would use a “first-then” approach: first, finish the task, then take a

break. The session ended with positive reinforcement, and I emphasized the progress he made

despite his difficulties in attention and behavior.

Session 4

This session focused on improving the client’s attention using memory games and a visual

schedule. I used a memory matching game with cards that had pictures of shapes and colors. The

client initially struggled to pay attention to the cards, repeatedly asking questions unrelated to the

game. To keep him engaged, I used a visual schedule to show him the order of activities, starting

with the memory game, followed by a short break. The visual schedule helped provide structure,

and he responded positively when he knew what was coming next. After a few rounds of the

game, I reinforced his behavior with a sticker for staying on task. He did show some impatience,

especially when he didn’t win, but I reminded him that the goal was to focus and follow the

game’s rules, not just to win. The session ended with him making some progress in focusing on

the task for longer intervals.

 66

Session 5

In this session, I focused on reducing impulsivity and improving turn-taking skills. We played a

board game that required waiting for one’s turn. The client initially struggled with waiting, often

trying to take turns before it was his time. I used a visual reminder (“wait for your turn”) and a

behavior chart to reward him for controlling his impulse. For every successful turn taken without

interruption, he received a sticker on his chart. The client seemed motivated by the rewards but

still had difficulty waiting and would often shout when it wasn’t his turn. I continued to reinforce

calm behavior and gently reminded him that turn-taking was an important skill. By the end of the

session, he showed improvement in waiting for his turn and was more engaged in the activity.

Session 6

The focus of this session was on enhancing the client’s learning and task completion skills. I set

up a task that involved tracing basic shapes and letters. The client was interested in the activity

initially but showed some frustration when the tracing didn’t turn out as he expected. To address

this, I used a scratch notepad to learn shapes and alphabets so that the colored textured surface

helps him keep engaged and it helped substantially. I used positive reinforcement for every

completed step and praised him for completing each letter with care. While he was still

impulsive and had difficulty staying seated, the use of a structured task helped him stay engaged

for longer periods. He was able to complete most of the tracing with minimal redirection.

Session 7
 67

In this final session, I worked on improving both the client’s learning and behavior by engaging

him in a simple craft project involving shapes and colors. The task required the client to paste cut

out shapes to a piece of paper. Although he was interested in the activity, he struggled with

keeping his attention on the task and often wanted to move on to something else. I used a visual

schedule again to provide structure, and after each step (cutting, gluing), I allowed him a small

break. To reduce impulsivity, I incorporated a behavior chart, rewarding him for staying on task

for each part of the project. His impulsivity was still evident, especially when he wanted to rush

through the steps, but I calmly redirected him and emphasized the importance of completing

each step carefully. By the end of the session, the client had completed the project with more

patience and focus than before.

Long Term Goals/ Suggestions

 IEP plans for managing difficulties in academic domain.

 Speech Therapy to enhance communication skills, focusing on word production and

sentence formation.

 Occupational Therapy to improve fine and gross motor skills, particularly for self-help

tasks like feeding and dressing.

 Behavioral therapy for improvement of behaviors.