Psycho diagnostic Report

Case 1
Bio data
Name: M.I.
Father name: Muhammad Rmzan
Age: 14 years
Sex: male
Siblings: 7 (4 brother 3 sister)
Birth order: 6th
Education: II-B grade training class
Residence: Faisalabad.
Religion: Islam
Father’s occupation: shopkeeper
Mother’s occupation: house wife
Socio economic status: middle class
Identifying Information:
The client is 14 year old boy and the student of II-B. He has 7 siblings in which his birth order is
6th. He lives in Faisalabad and belongs to middle class family.
Presenting complaints and source of referral:
Client was referred by the school Psychologist for the psychological assessment with these
complaints. Child has intellectually disability IQ level is below average. He is down syndromes
he has speech problem, congenital heart problem, behavior problem like stubborn and
aggressiveness shows and his adaptive functioning is poor.
Psychological assessment:
Informal Assessment
 Behavioral observation
 Mental Status Examination
 Clinical interview
Formal Assessment
 Sollosson Drawing Coordination Test (SDCT)
 Sollosson Intelligence Test (SIT) Urdu version
  Standard Progressive Matrices (SPM)
 Human Figure Drawing Test (HFD)
 Portage Guide to Early Education (PGEE)
 Corner Parents Rating Scale (CPRS)
 Corner Teacher Rating Scale (CTRS)

Informal Assessment
Clinical interview
According to his father, he is 47 years old and works at his own Shop. His mother is 40
years old and she is house wife. Their marital relationship is normal. According to him they are
very friendly and cooperative. And there is no any psychological and physiological problem in
family. Their relationship towards their child is friendly loving cooperative and over protective.
His father reported that the child was mature at the time of birth but there are some
complications during pregnancy. He told me that child was born in hospital and his birth was
normal. After birth he cried after few second his color was white and average weight his medical
history shows he has a heart problem after birth.
 Child milestones were reported to be delayed
Milestones Duration Normal Duration
Neck holding 5 months 3 - 4 months
Sitting 2 ½ - 3 year 5-8 months
(delayed)
Crawling 3 – 4 years (delayed) 7 – 8 months
Standing/Walking 5 – 5 ½ years (delayed) 1 ½ - 2 years
Speech 5- 6 ½ year (one word) 1 year (one word)
(delayed)
Complete sentence 6½- 12 years (delayed) 2 – 2 ½ years sentence of
only 4-5 words
Controlled bladder 7 years (delayed) 2 years

He reported that the child relationship with his family member is good his brother and
sister are studying in different grades and he started school 5 years ago and study in II grade. The
child attitude towards their siblings is normal and satisfactory. Other sibling’s behavior towards
child is good. He likes to play with toys and also like bread biscuits and mango. He dislikes rice
and other fruits.
His class teacher reported that that he is obedient child in class he share everything with
other peers fellows and he protect to his friends and fellows. He is intellectually disabled. Some
time he shows aggressive behavior in class when anything is done against him. He does not pay
attention toward their task easily distract. He does not interrupt to others during playing games or
any other activity.
During the session child is in school uniform, his speech is not clear his eye contact is not
good. He can speaks only few words he is friendly and cooperative but some time he looks
stubborn. His general health is satisfactory his hearing and appetite is normal his general
behavior is good.
Formal Assessment
Slosson Drawing Coordination Test (SDCT)
Quantitative analysis
Age 12 years
Error 18
Accuracy score 50%
Cut of score 85%
Qualitative analysis:
Eye hand coordination does not seem to be intact.
Slosson Intelligence Test (SIT)
Quantitative analysis:
Chronological age (C.A) 14year-3month
Mental age (M.A) 4year-6month
Intelligence Quotient 36.2%
(I.Q)
Qualitative analysis:
From the above mention score his IQ score is 36 it shows that the subject lies in grade II this
grade represent that subject seems to be intellectually below and class of trainable.
Standard Progressive Metrics (SPM)
Quantitative analysis:
Subject age 14 year
Total score 18
Percentile 5
Discrepancy -2,0,+2,0,0
Grade V
Level of intelligence Intellectual detective
Qualitative analysis:
From the above mention total score and percentile represent that the client lies in grade V and the
grade represent that the client seems to be intellectually defective class of trainable
Human Figure Drawing (HFD)
Emotional Indicator
Qualitative analysis:
Client make poor integration of part of figure that shows none of the good student is shy children
revealed this indicator on this drawing. Gross asymmetry of limbs seems to be associated with
poor coordination and impulsiveness. Tiny figure seems to reflect extreme insecurity, feeling of
inadequacy and depression. Omission of neck on HFD seems to be representing immaturity
impulsivity and poor inner control. Omission of nose on HFD seems to related with shy and
withdrawal behavior, lack of overt aggressiveness and inability to go forward with self-
assurance. Omission of mouth on HFD seems to be related with feeling of anxiety, insecurity and
withdrawal. Transparencies on HFD are associated with immaturity, impulsivity and acting out
behavior. Vacant eye on HFD associated with vague perception of world with emotional
immaturity, dependency, lack of discrimination and depression.
Intelligence Indicator
Quantitative Analysis:
Chronological age (C.A) 14year-3month
Mental age (M.A) 5year-0 month
Intelligence Quotient 35
(IQ)
Qualitative analysis:
The client seems to have severe intellectual disability.

Portage Guide to Early Education (PGEE)

Quantitative analysis:
Area Developmental profile
Socialization 4 year 2 months
Language 3 year 1 months
Self help 3 year 7 months
Cognitive 4 year 5 months
Motor skills 3 year 6 months
Qualitative analysis:
PGEE was administered to get his developmental profile of the child of motor area is 3 year and
6 months his motor skills are very poor. His developmental profile of socialization is 4 year 2
month. He does not able to welcome to strangers. He is unable to develop the peer relationship.
His developmental profile in the area of cognition is 4 year and 5 months. It depict that he is very
slow from his age group he does not able to solve three piece picture his developmental profile
of self-help is 3 year and 7 months. He does not know how to eat thing. His developmental
profile of speech is 3 year and 1 month. He does not speak proper line he just say two words of
line
Corner parent rating scale
Quantitative analysis:
Scale name Obtain score T –score level
Oppositional 12 71 Moderate
Inattention 9 59 borderline
Hyperactivity 5 63 Moderate
ADHD 14 57 borderline
Qualitative analysis:
The client seems to be high score in oppositional. His scale is likely to break rules. Have
problem with person in authority and are more easily annoyed and angered than most individuals
their age.
Corner teacher rating scale:
Quantitative analysis:
Scale name Obtain score T –score level
Oppositional 11 84 Markedly
Inattention 9 67 Moderate
Hyperactivity 6 59 Slightly
ADHD 5 49 Average
Qualitative analysis:
The client seems to be high score in oppositional. His scale is likely to break rules. Have
problem with person in authority and are more easily annoyed and angered than most individuals
their age.
Diagnosis:
Diagnosis
318.1 intellectual disability of (F72) sever level
Down syndrome
Disability severity

Down syndrome and poor cognition that magnified the problem of child and her learning
and adaptive functioning

Prognosis:
The prognosis of the child is poor because Down syndrome has influenced by intellectually
disability. But his condition can be improved with proper treatment, guidance, assistances and
his parents and teacher struggle.
Case Formulation:

Child is a 14 years old boy. He belongs to a Muslim Punjabi speaking middle class
family. The presenting complaints as reported by his father include aggression, shyness, slow in
learning, anxious behavior. The child is a down syndrome. His delivery was non instrumental.
Precipitating factor 3 months after birth suddenly he suffered from jaundice and skin problem by
that his milestone delayed, Fever and weakness in muscles. The Child was thoroughly accessed
by formal and informal assessment method includes, Interviewing information, Behavior
observation, Slosson Drawing Coordination Test (SDCT), Slosson Intelligence Test (SIT)
Human Figure Drawing test (HFD), Potrage Guide to Early Interventions (PGEE) and These test
scores reveal that the child has below I.Q and poor adaptive functioning as compare to her
fellows. The child diagnosis is 319(F 72) Sever intellectual disability. The child some symptoms
fall with communication disorder and specific learning disorder but his deficits in intellectual
and adaptive behavior and the criteria are not fully met. The child is suffered with sever
intellectual disability with poor adaptive functioning. The prognosis is poor. After formal
informal assessment behavior therapy techniques is used to management plan rapport building
positive reinforcement relaxation training to manage the child problem.

Management Plan:

Short term goals.

 To make child able to understand the sentences

 To make the child able to write 1-5
 To reduce shyness and anger.
 To make child able to follow the commands.
Long term goals
 To make child able to manage himself
 To make child able to understand speech
 To make the child able to respond appropriately
 To make child able to improve motor skills
 To make child able to improve his speech.
 To make child able to improve his cognitive abilities.

Therapeutic Intervention and Recommendations

 Encouragement
  Self-instructional training
 Social skill training (SSK)
 Motor skill training
 Behavioral techniques

Positive Reinforcement

Shaping of behavior

 Family counseling

Family counseling is not implemented because of non-availability of parents but

recommended to school psychologist.

Conclusion:
Child is of 14 years old suffering from severe intellectual disabilities, inadequate
discipline. His eye hand coordination is not intact. Projective analysis reveals that he has feeling
of poor self-image. He has diagnoses 318.1 intellectual disability of (F72) sever level Down
syndrome. Through adequate way and with the help of behavioral modification, Homework
assignment can be better treatment of choice. On the basis of these assumptions he has poor
prognosis because down syndrome influenced by intellectual disabilities.
 Internship Sessional Work Report

1st Session
First session was held on 4th of November. Child’s introduction took from the school
psychologist. Child’s behaviors were observed in class room setting that give batter
understanding about problematic behavior. Child’s behavior during class is obedient. He share
things with other class fellow and avoid communicating with strangers even does not
communicate with me a little bit. Child sits in the posturing of head down whole the time in the
class and rarely walks.

2nd Session

Child shows some +ve communicating sign at the start of session and rapport is built in
2nd session. Some of the problematic behavior was identified in the in 2nd session such as
aggressive behavior only when something going wrong not as he will. Observation of the
behavior of student with other classmates shows that student has communicative problem,
problem in utterances of words and shyness but cooperative with only peer groups but overall
cooperative. History taking is done by interacting with his teacher and school psychologist.

3rd Session

In the 3rd session testing session was started. Psychological assessment was started from
Solosson Drawing Coordination test was administered and assesses the eye hand Coordination which
results that child’s eye hand coordination does not seems to be intact. And Human Figure Drawing
Test (HFD) was administered to assess emotional indicators of child as well as to check the
intellectual level of the child. Emotional indication shows child is immature instable shy and
withdrawal behavior, lack of overt aggressiveness and inability to go forward and has very low
intellectual level. Collection of information about the cognitive and behavioral functioning is taking
from the teacher. His teacher explore that child has very poor cognitive ability. Child has learning
disability also has some writing problem.
4th Session

A well and cooperative rapport was builds with child in 4th session. In that session
explore about child’s interest that is games that he play and also about his socialization. Solosson
Intelligence Test (SIT) was administered to assess the Intellectual level of child that results child
has very low intellectual level.

5th Session

Child history taking from father is done in 5th session because availability of his father at
that time. Portage Guide to Early Education (PGEE) was administered on the child’s father to
assess adaptive functioning in areas of Motor, Socialization, Self Help, socialization and
cognitive. That indicate child seems to be poorly adaptive in these areas. Corner parent rating
scale (CPRS) was administered to assess the hyperactivity and inattentiveness.
6th Session

In the 6th session short term and long term goal is set for the client according to child’s weakness.
Child has poor motor skill so to enhance the motor ability building block, grip of pencil and
write on copy 1 and walk slowly 10 to 15 min are suggested and also implemented. To improve
the cognitive ability concept of left and right was given to the child. And told him to shake hand
with the right hand.

7th Session

Some strategies were made to improve patient’s performance. Some management Plan was
conducted to solve problems. Self-help training and some plans were made to develop their
cognitive and motor activity. Such as Motivation, encouragement, shaping of behavior these
types of strategies was implied so that their problem can be solved. To work with child shyness
and lack socialization child was taken in another class and learnt to hand shake with other
children. And also instructed to hand shake with right hand Child was learnt, motivated and
encouraged to perform that behavior.
8th Session

In 8th session child positively reinforce to perform 1-5 on the copy and hand shaking with
other classmates and say assalam o alikum. That is helpful to enhance the child motor ability,
reduce shyness and improve socialization of the child. Some Self-help techniques learnt to the
child.

9th Session

In 9th session child is encourage to hand shake with classmates of his class and another
class that is helpful to improve his self-concept and reduce anxiety during class work. Child
encourages writing 1-5, learnt to go to his teacher and check his copy.

10th Session

Child’s motor skill improve by write 1-5 and somehow steadily walk 0f 10 min. Child’s
socialization improve and shyness reduce to some extent by shaping of new behavior that is hand
shaking with right hand Feedback is taking from the child’ class teacher and some suggestion are
given to her for the continuing of that behavior and also for shaping new behaviors.

Internal supervisor External supervisor

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