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Case Reports

Group 1

Department of Applied Psychology, UMT

PSY330: Child Psychopathology

Ms. Amna Noureen

January 20th, 2025

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Task Division

Case Report 1

Task Students

1. Developmental History Areeba Fatima

2. Other History Safdar Iqbal

3. Mental State Examination Rabbia Akhtar

4. Assessment Eman Fatima

5. Management Plan Safoora Dastgir

6. Limitations and Recommendations Muzamil Abdullah

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Case Report 1

Identifying Details

Initials H.A

Age 5 Years Old

Gender Boy

Siblings 1

Birth Order Last Born

Reason for Referral

The client was referred to us by the teacher for assessment. He was with the presenting

complaints of delayed milestones in walking, speaking, fine and gross motor skills.

Initial Observation

H.A was a 5 year old boy. He was with his mother. The client was looking friendly as he

was smiling to see new faces. His head size was slightly bigger than a normal size and it was his

main problem. His appearance was fine but he was not attentive and he was not able to walk

properly. He was not communicating with anyone. His height was appropriate as per his age.

The client was sitting on the chair. His posture was fine while sitting but the client was able

to sit and walk only with his mother. The client was not so attentive in the class. Client had a less

attention span because the teacher was trying to communicate with him but he was not even

responding on his name. He was looking at somewhere else. He was not making eye contact and

was not paying attention. Even he was not listening to his mother. When the trainee spoke his

name loudly and on repetitive times, then he was able to listen oh his name. He was also showing

a less compliance.
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Developmental History

The client’s developmental history was taken from his mother. She reported that she went

to the hospital for his check up and they got to know that their child is with special needs. They

engaged in interview with the doctor and told him about their cousin marriage which is one of the

reasons of this disability in client. According to the mother, she was healthy during pregnancy and

did not take any medicines except those which doctor prescribed her for her better health. The

client’s mother didn’t face any difficulty at the time of labour but the child also had the oxygen

deprivation at the time of birth and he cried after 1 hour of the birth. The client is the youngest

sibling.

He often gets chest infection and fever because of over eating and it causes vomiting

because of in digestion. The client also had the jaundice at the age of 11 Month. He used to crawl

and speak properly but now he can’t speak a word properly. The client was doing normal almost

till one year. Then the child had a fever and it ended up that his walking ability decreased. After

that, he was diagnosed with the problem that his development of the brain was stopped and his

size of head got increased. This problem has been diagnosed almost 4 years and 5 months ago. But

now the child is much better after getting the special treatment as compare to his previous stage.

He developed some skills and started doing some activities. He could play games at once or twice

when someone train him and done the task with repetition in front of him.

Background Information

Personal History

The client is the last born child of his family. The child had disturbed eating habits. He

often gets chest infection and fever because of over eating and it causes vomiting because of in

digestion. He has less attention span and less compliance. Client likes to watch TV and play with
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his elder brother. He also plays with football because this activity exhibit on daily basis in his

school activities. He is friendly with everyone.

Milestones Achieved

This table shows that in which age a normal child achieve these milestones and in which

age this child achieved.

Milestones Normal Age Age Achieved

Speaking 4 to 8 months 1 year

Walking 10 to 18 months 1 year

Running 18 to 24 months Not yet properly

Family History

There are four members in the client's family. The Client father, mother, elder brother and

client himself. They live in a joint family system. Client’s father has done 5 classes in education

and now works with waste material from his home. He uses to be at home all time and only goes

out when he has some work. Client's mother is a house wife. She is not educated. At the time of

marriage, the father was 16 years old and the age of the mother was 17 years.

The client’s parents were cousins. They live a simple life and belong to poor background.

Furthermore, the client is more attached to his father. But in the institute whenever the mother

wasn’t present, client rush down from the chair and started crying. The client’s father also used to

smoke cigarettes with cannabis. He started smoking after his marriage and before the birth of the

child. The child also saw some clashes between his parents. The client enjoying to play with his

brother and his interaction is good with his father and brother.

History of Family Psychiatry/Medical Illness

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The client has a family history of the disability. His elder brother cannot speak and hear

but his parents and maternal side is humble towards them. Child’s father also used to smoke

cigarettes with cannabis which ultimately effect and made changes in the DNA. Besides this, there

is no any other family history of any disability.

Mental State Examination (MSE)

General Appearance and Behavior

The client, a 5-year-old boy, appeared physically well-groomed and dressed appropriately

for his age. His head size was slightly larger than average, which was a notable feature. Despite

this, his overall appearance was pleasant, and he displayed a friendly demeanor, smiling at new

faces. However, his behavior indicated significant developmental delays; he was not attentive and

demonstrated difficulty walking unassisted. While seated, his posture was appropriate, but he

required his mother’s support for mobility.

Mood and Affect

The client’s mood appeared neutral, with no observable signs of distress. His affect, while

mildly restricted, was appropriate to the situation, as evidenced by his smiles and general

friendliness. However, he showed minimal responsiveness to external stimuli and did not express

emotions verbally.

Speech

The client’s speech was absent during the assessment. He did not attempt to communicate

verbally or nonverbally with others, which aligns with his reported developmental delays. His

mother confirmed that his speech development had regressed after a fever episode during infancy.

Thought Process and Content

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There were no indications of abnormal thought processes or content. However, due to his

age and limited communication abilities, an in-depth assessment of thought patterns was not

feasible.

Perception

The client did not exhibit any overt signs of perceptual disturbances, such as hallucinations

or delusions. His lack of eye contact and limited responsiveness could indicate perceptual or

sensory processing issues, which warrant further exploration.

Cognition

The client displayed a limited attention span. He was unresponsive to his name initially

and required loud, repetitive cues to acknowledge it. His lack of engagement with his environment

and the people around him suggests significant cognitive delays. He also struggled to follow

instructions or imitate activities without repeated demonstrations.

Insight and Judgment

Given his young age and developmental delays, the client’s capacity for insight and

judgment could not be fully assessed. However, his dependency on his mother and lack of

compliance suggest limited understanding of his surroundings and situations.

Motor Functioning

The client demonstrated delays in fine and gross motor skills. He walked with difficulty

and required support from his mother for stability. His physical activity was notably constrained

compared to age-appropriate norms.

Social Interaction

The client was friendly but did not actively seek interaction with others. He failed to

establish eye contact and did not initiate communication with his peers, teacher, or mother during
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the session. While he seemed more at ease in his mother’s presence, his social responsiveness

remained minimal.

Assessment

Assessments are the methods to evaluate an individual’s functioning in multiple areas and

recommendations to improve functioning in one or more areas. In this case, the child’s assessment

was done through:

 Behavioral Observation

 Clinical Interview

 Portage Guide for Early Education (objective)

 House Tree Person Test (subjective)

These assessment were exhibiting to improve client’s fine and gross motor skills. The

rationale of telling poems was to check the memory of the client. The other exercises, jumping and

football activities were for checking the client’s interest and gross motor skills.

Behavioral Observation

The client was friendly nature and was smiling to see new faces. He was with his mother.

Whenever the mother wasn’t present, client rush down from the chair and started crying. They had

a belt for him to tie. Whenever client showed clingy behaviour they put that belt and tie him with

the chair. Client didn’t have communication skills as he was not speaking but he understood the

actions and signs. He had a milestone delay in speech as he was unable to speak a full sentence or

a word.

The client behaviour was observed through some exercises. At the end of the session, the

teacher of the school came for the exercise of the children. She was doing exercise of hands and

legs and all the clients had to follow her but the trainee’s client was not performing any exercise.
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He was not paying attention towards his environment. He was not any idea that what is happening

around him. The teacher asked the clients to jump. But the client was unable to jump properly. He

also had less gross motor skills. At last, the school teacher was speaking poems with the actions

of hands. All the clients had to copy her. But the trainee’s client was not listening to the teacher so

he was not performing the actions according to the rhythm of poem.

Clinical Interview

A clinical interview is a conversation between the psychologist and the client to help,

diagnose and treat a patient. If client is unable to speak then the psychologist takes the history with

client’s guardian. Clinical interview gives the psychological access to both verbal and non-verbal

information about the client. Clinical interviews build trust and good therapeutic environment

between psychologist and client.

It was a semi-structured interview. We conducted the interview with the client’s mother,

as the client was unable to speak. We began by asking questions about the presenting complaints,

focusing on the differences the mother had observed in the child’s behavior. We then inquired

about family information, including the father’s occupation and the mother’s role. The next set of

questions explored the client’s siblings and the family’s psychiatric history. We clarified that this

information was needed to determine whether any other family members had experienced similar

disorders.

Subsequently, we asked about the mother’s pregnancy, including its duration, whether the

delivery was normal or a C-section, and whether she faced any complications or used any

medications. Lastly, we explored the child’s developmental history, asking at what age milestones

were achieved, as well as questions about social development, speech and language, motor

development, and daily living activities.

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The client, H.A., was accompanied by his mother and showed difficulty walking. While

his posture was fine when sitting, he was only able to sit and walk with his mother’s assistance.

The client exhibited cognitive dysfunction and had a limited attention span, as he did not respond

even when called by his name. However, he showed signs of happiness when we introduced

reinforcers, such as playing with a football or coloring. These activities helped establish rapport

with the client.

Portage Guide for Early Education

A guide for teachers and anyone else who needs to evaluate a child's mental development

from birth to six years old. This is for preschool kids or more seasoned disabled youngsters. A

"Portage Guide" with regards to early schooling commonly alludes to an in directing and

supporting the expert improvement of small kids, frequently with formative deferrals or handicaps.

Portage is an instructive help administration that includes working intimately with families to

advance the kid's learning and improvement inside the home climate. The portage guide works

with parents or other caregivers to implement individualized strategies and activities that help the

child grow and develop as a whole. It consists on the five domains which are motor skills, self-

help skills, language development, cognitive development, and social development.

Table

Domains of Portage Guide for Early Education

Domains Functional Age Discrepancy Age

Self Help 5-6 3-4

Motor Skills 5-6 3-4

Language Development 5-6 3-4

Social Development 5-6 3-4

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Cognitive Development 5-6 3-4

House-Tree-Person (HTP) Test

The House-Tree-Person (HTP) test was administered to gain insight into the client’s

emotional state, personality, self-perception, and interpersonal relationships. This projective test

is particularly useful for assessing young children who may struggle to articulate their thoughts

and feelings verbally.

The client was provided with blank sheets of paper, a pencil, and colored crayons. He was

instructed to draw a house, a tree, and a person, one at a time, without any time constraints. Verbal

prompts were minimal to avoid influencing his responses. After completing the drawings, a brief

inquiry was conducted to understand his descriptions and perspectives regarding the drawings.

Interpretation of the Drawings

House

The client’s house was small and lacked detailed features such as windows or a door. It

appeared isolated on the paper with no surroundings or elements like a garden, chimney, or path

leading to the house.

The simplicity and isolation of the house suggest feelings of insecurity or a lack of

attachment to the home environment. The absence of windows and doors may indicate withdrawal

or difficulty in expressing himself or forming connections with others.

Tree

The tree was drawn with a thin trunk and sparse branches. The roots were missing, and the

overall structure appeared unstable. There was no foliage, and the tree seemed disconnected from

its environment.
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The thin trunk and lack of roots suggest the client may feel unsupported or unstable,

potentially reflecting his physical challenges and dependence on caregivers. The absence of foliage

could indicate low energy or diminished growth, possibly associated with developmental delays.

Person

The person drawn was disproportionate, with a large head and small body. Facial features

were minimal or absent, and the arms and legs were drawn as short, straight lines. The figure

lacked detailed features like clothing or accessories.

The disproportionate head may symbolize the client’s awareness of his physical condition

(enlarged head). The lack of detail and minimal features suggest low self-esteem, poor self-

concept, or difficulty in expressing his identity. The small body and simplistic limbs might reflect

his struggles with motor coordination and physical development.

Overall Interpretation

The drawings reflect the client’s emotional and developmental challenges. Themes of

insecurity, dependence, and withdrawal are evident across all drawings. The limited details and

lack of integration in his drawings may correspond with his cognitive delays and limited

engagement with his environment.

Diagnosis

Based on the client’s history, developmental milestones, and observed behavior, the client

presents with significant developmental delays consistent with Intellectual Disability. The

client’s history of oxygen deprivation at birth, regression in speech and motor skills, and enlarged

head size suggest an underlying neurological condition, possibly linked to hydrocephalus or

another neurodevelopmental disorder. The family history of disability, parental consanguinity, and
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the father’s substance use may have contributed to genetic or epigenetic factors affecting the

client’s development.

Clinically, the client exhibits delayed gross and fine motor skills, limited speech, poor

attention span, and reduced social interaction, which align with characteristics of a broader

neurodevelopmental disorder. His lack of eye contact, unresponsiveness to verbal cues, and limited

compliance with instructions further indicate possible co-occurring conditions such as Autism

Spectrum Disorder (ASD). However, these require further diagnostic assessments to confirm.

Management Plan for the Client

Psychoeducation for Parents

The first step in managing the client’s condition is educating the parents about intellectual

disability (ID) and its implications. Psychoeducation sessions will focus on increasing the parents’

understanding of the child’s developmental needs, limitations, and potential. Parents will be guided

on how to provide consistent support and encouragement in daily activities, avoid unrealistic

expectations, and celebrate small achievements. Special emphasis will be placed on the importance

of creating a nurturing home environment, structured routines, and engaging the child in sensory,

social, and cognitive activities.

Rapport Building

Building a strong therapeutic alliance with the client is critical to effective intervention.

Initial sessions will focus on creating a safe and friendly space for the child to feel comfortable.

This may involve engaging in playful activities, using positive reinforcement, and establishing a

predictable routine during sessions. Rapport-building activities will also extend to the parents to

ensure collaborative involvement in the therapeutic process.

Enhancing Social Skills

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Given the child’s difficulty with attention and interaction, activities aimed at improving

social engagement and communication will be integrated into the plan. Play-based interventions,

role-playing, and group activities involving peers will be used to encourage eye contact, turn-

taking, and appropriate responses to social cues. Parents and teachers will be taught to model and

reinforce positive social behaviors at home and in school. Gradual exposure to new environments

and people will also help the child adapt and build confidence in social settings.

Cognitive Skill Development

Cognitive stimulation is essential to support the child’s intellectual growth. Activities

designed to enhance memory, attention span, and problem-solving will be introduced in a playful

manner. These may include:

 Matching games and puzzles to improve visual-spatial reasoning.

 Repetitive sequencing tasks to build memory.

 Storytelling sessions to enhance comprehension and language development.

Tasks will be introduced at a level appropriate to the child’s abilities and gradually

increased in complexity to ensure engagement without overwhelming the child.

Physical Exercises and Motor Skill Development

The client’s delayed fine and gross motor skills require focused intervention through

physical activities and exercises. Occupational therapy sessions will target:

 Fine motor skills: Activities such as threading beads, coloring within boundaries, or

picking up small objects will improve hand-eye coordination and dexterity.

 Gross motor skills: Exercises like jumping, running, and ball games will enhance balance,

strength, and coordination.

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Games that combine physical activity with cognitive challenges, such as obstacle courses,

will also be employed to engage the child holistically.

Long-Term Goals and Interventions

A multidisciplinary approach involving occupational therapists, speech therapists, and

special educators will be pursued to ensure comprehensive care. The focus will be on setting

realistic, incremental goals for skill development, school readiness, and social adaptation. Regular

progress reviews will be conducted to adjust the management plan as needed.

Family Support and Counseling

The emotional well-being of the family is vital to the child’s progress. Counseling sessions

will be offered to help parents cope with the challenges of raising a child with intellectual

disability. Support groups and resources will also be recommended to provide additional guidance

and community support.

Limitations

During the therapeutic intervention, several limitations were encountered that impacted the

overall effectiveness of the sessions. One major limitation was the environmental factor, as

multiple sessions were being held in a single hall, leading to significant distractions. With several

clients being attended to in the same space, it became increasingly difficult to focus on the specific

needs of the client at hand. The lack of a quiet, private environment hindered both the trainee’s

ability to concentrate fully and the child’s ability to engage in activities without being distracted.

This environmental factor made it challenging to create the ideal setting for therapeutic work,

where the client could benefit from one-on-one attention.

Additionally, the carelessness of the client's mother during the sessions posed another

limitation. While the mother was responsive during the clinical interview, she was often distracted
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by other parents and their conversations during the activities. This lack of active involvement in

the sessions reduced the effectiveness of the interventions, as her attention and support were

divided. Although she seemed engaged when directly interacting with the trainee, her tendency to

be distracted during the child’s activities limited her capacity to reinforce the therapeutic objectives

at home. Active parental participation is a crucial factor in the child’s development, and the

inconsistent involvement of the mother presented an obstacle in fully optimizing the therapeutic

process.

Recommendations

In light of these limitations, several recommendations are proposed to enhance the quality

of care and ensure continued progress for the client. First and foremost, it is essential for the parents

to prioritize regular attendance at the institute for their child’s therapy sessions. Consistent

participation is key to the success of any therapeutic intervention, and regular attendance will

provide the child with a stable and continuous support system. Missing sessions or irregular

participation could slow down the progress that has already been made, as it may disrupt the child’s

learning and adaptation to new routines and expectations.

Furthermore, the parents, especially the mother, should be encouraged to remain fully

engaged during the sessions. This can be achieved by minimizing distractions and refraining from

conversations with other parents while the child is involved in therapeutic activities. The mother’s

active presence and involvement during the interventions would not only help maintain focus but

also enable her to replicate the strategies and techniques at home, reinforcing the skills learned in

therapy. It is crucial that the parents recognize the importance of their role in the child’s

development and actively engage in the therapeutic process.

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Lastly, it is strongly recommended that the child’s therapy continue without interruption,

as the current intervention has been beneficial and shows promising results. These sessions have

played a significant role in the child’s improvement, and ongoing therapy will be essential to

further enhance his skills. The combination of structured, focused therapy, regular attendance, and

parental involvement is vital for the long-term development of the child, helping to ensure

sustained improvement in cognitive, social, and motor skills. With these adjustments, the

therapeutic process is likely to become more effective, leading to better outcomes for the child’s

overall development.