Psychodiagnostics Report __ Child

Identifying Information

Client’s Name A.S

Age 8 years
Gender Male
No. of siblings
Birth Order
Religion Islam
Informant Mother
Assessment date
Assessed by Ammara Maryam
Referral Source and Presenting Complaints

Child was brought to the Shadab Training Institute of Special Education by his mother with the

presenting complaints of slow speech, can’t dress up independently, epileptic fits, weak eye

sight, poor in academics. He was referred to trainee clinical psychologist for the purpose of

psychological assessment and management plan.

Duration Complaints
Aaista bolta ha
Is k kapry khud change krny prty hn
Mergi k doray prty hn
Iski nazar kamzor
Prhai ma bhoot peechy ha
Clinical Interview

Clinical interview was conducted with the child’s mother for formal and informal

psychological assessment and management. The presenting complaints mentioned by his mother

were slow speech, can’t dress up independently, epileptic fits, weak eye sight, poor in academics.

According to his mother at the age of 3 months he got first epileptic fits. With the passage of
time his mother notice that he is not still start speaking at the age of 2 years. After that his

treatment start from children hospital which is still continue. His mother reported that this was

the c-section delivery and child was pre maturely born. His first cry was not late but at the time

of birth he was very weak and underweight. He was given medical aid at the spot. Due to the

critical condition of mother and child he was given just formula milk for 2 months. Child had

medical history of epilepsy from his 3rd month. His developmental milestones were also delayed.

Mother reported that he started neck holding at 5 months, sitting at 10 years, crawling at

1.5 and walk at 2.3 year. He started babbling at 1.4 year, single word speech at 2 year and

sentence speech at 4 years. Toilet training was much delayed. He still use pamper. He can’t take

bath and dress up without help. Child had a long family history to psychopathology his grand

father had some mental issues. Brother, sister, niece and nephew of a child’s father were blind.

Child live in a nuclear family system with low socio economic status. Child’s father was

40 years old. He got educated till middle. He works on a store. He remains aggressive most of

the time. He don’t have a good relation with the child. He beats him when he speak slow or not

follow his command. While Child’s mother is 40 years. She got education till bachelors. She is a

house wife. She is very loving and caring towards his child. Child’s parents have a cousin

marriage. They have a strange relationship. His father argues with and physically abuse his

mother Infront of their children. Child also quarrel with each other they don’t have a lovely

bond.

Child was enrolled in current institute at the of 7 years. Here he learn different activates

and teachers also give focus on academics. He is a timid but active child. He remains silent most

of the time. His social interaction is limited. He like play with other class mates. His orientation
of place and person was intact. He has orientation of day and night but can’t tell time using clock

or watch.

Tests Administered

Test of Non-verbal Intelligence

Vineland Adaptive Behavior Scale-3

Behavioral Observation

Child was 8 years old. He had stains on his uniform. His hears were messy. His shoe lases were

untied. He had a smile on his face. He was looking very innocent. His speech was slow and a

little bit relevant. His pitch was low. His attention span and concentration was satisfactory. His

on sit behavior was good. His fine motor skills were under developed. The Clients' orientation

of person place and time was intact. he knows what time of the day it is, but can't recognize the

time on clock. He was showing compliance towards commands and tasks of VABS-3. On the

intelligence test he showed interest in it and on the House-Tree-Person he refuse to draw

beacuse her pre requisite skills were under developed. He can read from the books on the basis of

learning but can’t write or even draw a single line.

Psychological Evaluation

Test of Non-Verbal Intelligence (TONI)

Chronological Raw Index Percentile Descriptive Age

age score score Rank term equivalent

08 08 71 3 Poor <6

Client’s score on TONI was 08 which indicates his level of intelligence and aptitude which lies

in poor category. He was also facing difficulty in abstract reasoning and problem solving. Child

complete the test in 18 minutes. He was displaying interest but looking confuse during the test.

His response time was slow. His low of level intelligence was impacting oh his problem-solving

ability which potentially leading to decrease score.

 Vineland Adaptive Behavior Scale (VABS-3)

Domains/Sub Age Functionin Strength/ Standard

domain g Level Weakness Score/V-
Equivalent(AE) scale score

Communication 2:9 low weakness 30

Receptive 2:0 low weakness 6

Expressive 2:4 low weakness 1

Written 3:0 low strength 1

Daily Living skills 3:1 low strength 59

Personal 2:6 low weakness 1

Domestic 3:8 Moderately strength 10

low

Community 3:3 low strength 6

Socialization 1:7 low weakness 52

Interpersonal 1;10 low strength 5

relationship

Play and Leisure 2:3 low strength 6

Coping Skills 1:3 low weakness 7

Motor skills 1:9 weakness

Gross Motor 2:8 strength

Fine motor 3:3 strength

Adaptive 3:0 l low 48

Behavior
 Composition(ABC
)

According to Vineland Adaptive Behavior Scale-3, client overall Adaptive Behavior

Functioning is equivalent to a child of 3:0 years which falls within the "Low" functioning range.
The adaptive functioning shows how much a child utilizes her developmental potential in various
domains of everyday life. This Adaptive Behavior Functioning is comprised of Communication
Stalls, Daily Living Skills Socializing Skills and Motor Stalls. The VABS-3 Comprehensive
Interview Form was administered by the examiner

Within the Communication Skills Domain, the child can’t understand different facial
expressions. He also has difficulty in understanding the gestures. Similarly, unable to use
pronouns, conjunctions, or report a whole recent event with details. Moreover, with respect to
writing and reading skills, unable to write a single alphabet. He can’t say his home address
correctly. He can’t even recognize own name.

In Daily living skills he can’t dress up independently. He don’t wipe nose using tissue. He can’t
even fasten snaps. He also face difficulty in domestic and community skills. He don’t put his dirt
clothes on proper place. He don’t know what to do in dangerous situations. He can’t even count
10 objects . Similarly he can’t say seven days of a week in order.

Within Socialization he is lack behind in coping skills and interpersonal relations as compare to
play and leisure. He face difficulty in imitating others. He don’t know how to express emotions.
He don’t have the concept of thanks and when he have to apologize. He don’t even understand
hurtful phrases.

With respect to motor skill domains his fine motor skills are underdeveloped he can’t open a
scissor with one had or draw a freehand circle. He also face difficulty in gross motor skills. He
can’t climb up on ladder or tree. He also face difficulty in catching a beach size ball.

Tentative Diagnosis

Intellectual Disability, Mild with Epilepsy

Prognosis
Child’s prognosis seems good . As he is good in receptive and expressive. He face less
difficulty in understanding. His speech is slow and pitch is low but understand able. He also
make simple sentences easily with grammatical mistakes but can convey his thoughts. His
domestic skills are also improved. His attention and concentration also satisfactory on all
theses basis with appropriate interventions adaptive behavior functioning can be improved
throughout his life but still due to his medical condition there will be a gap between his
acquired skills and age appropriate skills and support will be needed but progress can happen
in his communication, daily living, socialization and motor skills.

Conclusion

A.S was 8 years old boy. The child was a regular student in Shadab Training Institute of Special

Education. He was referred to trainee clinical psychologist for the purpose of psychological

assessment and management plan. The presenting complaints mentioned by his mother were

slow speech, can’t dress up independently, epileptic fits, weak eye sight, poor in academics. His

pre requisite skills were under developed and developmental milestones were also delayed. The

assessment of the client was done both formally and informally. Informal assessment was done

through clinical interview and behavioral observation. Formal assessment was done through

TONI-4 , VABS-3 indicates that child had poor problem solving abilities and abstract reasoning.

He aslo face difficulty in written, performing personal chores, Interpersonal relationships, coping

skills and fine motor skills. His parents have a strange relation ship which also affect the child.

History of family psychopathology is a main contributing factor. Despite all these problems child

is making progress in different areas of life. Different techniques of Applied Behavior analysis

and Behavior modification can be applied which will improve these areas but still support will be

needed due to the diagnosis of intellectual disability and epilepsy.

Recommendations

For Parents

Maintain a peaceful stress free home environment

Use clear simple language

Pay time to child and show some love to him

Encourage positive behavior

Divide a task in steps

Supervise and guide sibling relationships

Collaborate with speech therapist

For Teachers

Develop individualized education plan

Enhance pre requisite and developmental skills

Improve interpersonal skills through activities

Reinforce the child on showing compliance

Collaborate with speech therapist

Management Plan

Patient Name A.S

Age 8 years
Presenting Complaints  Slow speech
 Can’t dress up independently
 Epileptic fits,
 Weak eye sight
 Poor in academics
Test administered  Test of Non-verbal Intelligence (TONI-4)
 Vineland Adaptive Behavior Scale (VABS-3)
Tentative Diagnosis Intellectual Disability , Mild with epilepsy
Goals of Therapy Short term goals
 Rapport Building with child to make the child
comfortable
 Psychoeducation of parents of child
 Behavior modification Techniques will be used to
accelerate the desirable behavior and reduce
undesirable behaviors as given below:
 Reinforcement will be used to increase desirable
behavior; improve socialization, domestic, coping and
writing skills
 Differential reinforcement will be used for
appropriate and desired behavior of communication
and socializing.
 Modeling technique will be used to help the child
observe and imitate the target behaviors of using
gestures, art and conversation
 Prompting will be used with the child to help in
learning desirable behavior with physical, verbal and
 gestural cues in academic skill and daily living skills.
 Social skills training will be used to improve
communication skills during group session using
modeling.
 Positive practice will be used to help child to learn
new skills. The more a child does a certain behavior,
the more likely that behavior is to happen just by
habit.
 Group therapy will be done to improve socialization
and participate in different activities.

Long Term Goals

 Continuation of IEP
 Continuation of short-term goals
Main Therapy Behavioral Therapy
No. of sessions 15
Initial Sessions
 Rapport building
 Clinical interview with mother
 Pre requisite skills
 Psychoeducation of the mother
 Psychological Assessment
 Make IEP
Middle Sessions
 Identifying reinforces
 Baseline chart
 Socialization with peers
 Positive Reinforcements
 Coloring activities
 Individualized educational program
 tasks
 Task analysis
 Shaping
 Chaining
Ending Sessions
 Reviewing all tasks learned
 Tasks of individualized educational
program
Individualized Education Plan

Strengthes

 He is good in command following.

 He is motivated to learn.

Weaknesses

 His motor skills are deficit.

 He has poor socialization skills

Domains Material Used Goals Techniques

Communication
Familiarize him with Flash cards Respond Task Analysis
different gestures Visual cues appropriately to the Modeling
(receptive) gesture of be quite Visual, Verbal and
by putting finger over Physical Prompt
lip
Say correct age when Flash cards with State their age Discrete Trail
asked (expressive) numbers correctly when asked Training
Numbers puzzle Reinforcement
Fingers Physical and veral
prompts
Identify at least 10 Flash cards Child will be able to Shaping
alphabets (written) Alphabet kit pronounce A to G by Verbal and physical
Book sight prompt
Reinforcement
Daily Living Skills
Put on clothe that Shirt Put on a shirt that Forward chaining
open in the front Mirror open in the front Physical and verbal
(personal) Timer to track time prompt
Wipe dirty shoes on Doormat To wipe her shoes on Modeling
doormat (domestic) Visual Aid doormat before Verbal Prompt
entering the school Positive
Reinforcement
Socialization
To initiate a Group of students To initiate Modeling
conversation conversation with Positive Practice
(interpersonal) peers Group Therapy

Teach her Verbal Prompt Say sorry at Verbal prompt

apologizing (Coping appropriate time Reinforcement
Skills)
Motor Skills
Color simple shapes Colors Color different Modeling
(fine motor) shapes inside the line Physical prompt
Shaping
Catch a ball from Ball To teach him to catch Backward Chaining
distance of 8 feet a ball from 8 feet
(gross motor)
Case Conceptualization

A.S., an 8-year-old boy, presents with Intellectual Disability (ID) and Epilepsy, along with

developmental delays, slow speech, difficulties with self-care, and poor academic performance.

Research indicates a strong link between ID and epilepsy, with individuals with ID experiencing

a significantly higher incidence and prevalence of epilepsy compared to the general population

(McGrother et al., 2006). This connection is bidirectional: epilepsy can exacerbate cognitive

impairments, while ID can complicate the management of seizures. The early onset of epilepsy

in A.S. has likely disrupted his neurodevelopment, affecting critical developmental tasks such as

independence and social skills (Berg et al., 2011).

The family environment plays a crucial role in A.S.'s development and well-being. A.S.'s family

situation, characterized by low socioeconomic status, domestic violence, and poor familial

relationships, significantly impacts his psychological health and adaptive functioning. According

to Family Systems Theory, dysfunctional family dynamics can exacerbate the challenges faced

by children with disabilities, leading to increased stress and behavioral issues (Minuchin, 1974).

Bronfenbrenner's Ecological Systems Theory further emphasizes the importance of both

immediate family environments and broader social contexts in shaping a child's development

(Bronfenbrenner, 1979). A supportive family can act as a protective factor, whereas a negative

home environment can hinder growth.

Psychological and behavioral interventions are critical in addressing the specific needs of

children with ID and epilepsy. Applied Behavior Analysis (ABA) has proven effective in

teaching adaptive skills and modifying challenging behaviors in this population (Matson et al.,

2012). Techniques such as positive reinforcement, task analysis, and shaping can improve A.S.'s
self-care abilities, communication skills, and academic performance by breaking tasks into

manageable steps (Cooper, Heron, & Heward, 2020). Overall, a comprehensive,

multidisciplinary approach that incorporates these research findings and theories is essential for

addressing A.S.'s needs and promoting his development.

References:

 Berg, A. T., Langfitt, J., & Testa, F. M. (2011). Early-life epilepsy and developmental
outcomes: A review. Epilepsy & Behavior, 22(3), 432-438.
 Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature
and Design. Harvard University Press.
 Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied Behavior Analysis (3rd
ed.). Pearson.
 McGrother, C. W., Haque, A., & Caine, P. (2006). Epilepsy in people with intellectual
disabilities: A review. Seizure, 15(5), 334-340.
 Matson, J. L., Belva, B., & Matson, M. L. (2012). Applied Behavior Analysis for
Children with Autism Spectrum Disorders. Springer.
 Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.