Identifying Data

Name D.R

Age 11

Gender Male

No. of Sibling 3

Birth Order 2nd

Informant Mother

Institute Initials S.S.S

Source and Reason for Referral

The client’s parents brought him to the institute and he was referred to a trainee clinical
psychologist by his school teacher. The reason of referral as such having problems with writing,
Being socially immature, impaired motor skills, poor memory and impaired speech and
language.

Presenting Complaints

Table 4.1

Presenting Complaints by Mother

‫دورانیہ‬ ‫مسائل‬
‫ سال‬5 ‫اپنی عمر سے بہت پیچھے ہے‬
‫ سال‬2 ‫لکھنے میں مشکل ہوتی ہے پنسل صحیح سے نہیں پکڑپاتا‬
‫سال‬3 ‫صحیح سےچل نہیں سکتا‬
‫سال‬3 ‫خود کو سنبھال نہیں سکتا‬
History of Present Illness

The client’s mother reported that her pregnancy was complicated as she got ill and at the
time of delivery some complications occurred. That’s why the child was delivered through C-
section. His birth weight was low about 3-4 pounds. He had tonsils by birth, due to which he
couldn’t suck his mother’s milk. The family took him to different hospitals, including the
children's hospital. They all provided him with medical treatment, but till his complete recovery,
he couldn’t suck or swallow properly. He became very weak as for about a year he didn’t eat
properly. Due to weakness, his developmental milestones were delayed. He didn’t have an early
sucking response or a social smile. He started neck holding at the age of 6 months, sitting at the
age of 13 months, he didn’t crawl, he stood without support at the age of 16 months, and he
walked at the age of 2 years. He could speak a single word at the age of 20 months and could
speak a complete sentence at the age of five years. He observed his bladder control at the age of
4, and he couldn’t bathe without help. At present, his one eyelid has been turned downward, so
his eye couldn’t open properly. And my eyesight was also weakened.

Background Information

Family History

The client’s father age is 42years. He is qualified till matric and working in a factory. He
is physically and psychologically healthy. He is reported to be loving and supportive towards the
client. His mother’ age is 32years, got educated till middle and worked as a tailor. He is
physically and psychologically healthy. He is reported to be loving and supportive towards her
children and shares healthy relationship with client. The eldest of the siblings was 11years old
boy studying in class 5. His physical and psychological health is good. The 2 nd born is client. The
third born is 8years old girl studying in class 2. Her physical and psychological health is good.
The relationship of client with his siblings is loving and normal. The sibling’s attitude towards
client is loving.

Family Psychiatry History

No specific psychiatric illness was found in family.

General Home Environment

The relationship between parents is good so the home environment is friendly. They are
living in joint family system and he has very friendly and supportive relationship with his aunty.
 Father Mother

Client

Sibling

Healthy Relation

Siblings

Parents

Personal History

The child was born through C-section during 9th month of pregnancy. His birth weight
was 4-5 pound. His first cry was normal. The client had by birth tonsils due to which he could
swallow or suck so it results in weakness. This weakness affected his milestones. He didn’t have
any neurotic trait. He suffered from muscular weakness due two which his left eye was almost
closed. The deviation in other eyeball was also seen.

Table 4.2

Developmental Milestones of Child corresponding to Normal Age of Achievement

Developmental Milestones Achieved age Normal Age
Neck Holding 6 months
4-6 months
Sitting 13 months
6 months
Crawling Nil 7-8 months
Standing 16 months 9-11 months
Walking 2 years 14-15 months
One Word sentence 25 months 15 months
Complete Sentence 5 years 2-3 years
Toilet training 48 months 18-24 months
Psychological Assessment

Psychological Assessment is the gathering and integration of data to

evaluate aperson’s behavior, abilities, and other characteristics, particularly for the
purposes of making a diagnosis or treatment recommendation (APA).
Psychologists assess diverse psychiatric problems (e.g., anxiety, substance abuse)
and no psychiatric concerns (e.g., intelligence, career interests) in a range of
clinical, educational, organizational, forensic, and other settings. Psychological
assessment is the attempt of a skilled professional, usually a psychologist to use
the technique and tool of psychology to learn either general or specifics facts
about other person, either to inform others of how they function now, or to
predict their behavior and functioning in the future. The assessment procedure
was done on formal and informal levels the include interviews and operations.
Informal assessment
It is a method of evaluation where the instructor tests participants' knowledge
using no standard criteria or rubric. Informal assessments are those assessments
that result teacher’s spontaneous day to day observations of how students behave
perform in class (Melisa hurt). Informal psychological assessment of the client
was done through:
 Clinical Interview
 Behaviour observation
 Symptoms Rating of complaints
 Rein forcer identification
Clinical Interview
Clinical interview is a face-to-face encounter between a mental health professional and a
patient in which the former observes the latter and gathers data about the person’s behavior,
attitudes, current situation, personality, and life history. The key aim of interview is to identify
target behavior, generate hypothesis, guide subsequent assessment and ultimately to assist in the
creation in the creation of intervention (Sturmey, 1996).Clinical interview was conducted to
obtain presenting complaints and symptoms in detail along with information about duration and
degree of impairment. Clinical interview was conducted by the trainee clinical psychologist
during the clinical interview, trainee psychologist gathered information regarding the child’s
 problem, presenting complaints, family history, personal history and developmental milestones.
This assessment provided a comprehensive picture of child life which was helpful in assessment
ant therapeutic interventions.
Behavior Observation
The client was wearing neat and clean cloths his hygiene was normal. He didn’t maintain
eye contact as when he was asked something he looks towards the therapist and then started
smiling. His imitation was good. The on-seat behavior was not as good as he seemed restless and
continuously moves his hands and legs. The compliance was quite normal. Due to the weakness
his one eye couldn’t open properly and the other eyeball was good. He spoke in low tone and it
was not easy to understand whatever he was saying. But he repeated his words whenever asked.
He could write 3-4 English and Urdu alphabets and also the digits and he could recall complete
alphabets with minor mistakes. He could recall 1-25 counting. He was more interested to observe
the surrounding. He had the orientation of person, place and time. He could select his weather
appropriate clothes.

Reinforcer Identification

Reinforcers is something that used in increasing the likelihood of a response to occur.

Therapists use reinforcers when a behavior is to be learnt (Cherry, 2018). In client’s case
reinforcers were identified by the trainee clinical psychologist by asking client’s mother (see
Appendix B). The following reinforcers as given in the table below were identified.
Table 4.3
Types of Reinforcers and Identified Reinforcers of the Child
Type of reinforcers Identified reinforcers
Activity reinforcers Coloring
Social reinforcers Praise, star
Edible reinforcers Candies, cupcakes
Formal Assessment

 DSM-V Criteria
 Portage Guide Early Education
 Slosson Intelligence Test
DSM-V Criteria

Table 4.4

DSM-V criteria Child’s Symptoms Present/Absent

Deficits in intellectual The client has deficits in his Present
functions, such as reasoning, executive functioning and it has
problem solving, planning, been confirmed by assessments.
abstract
thinking, judgment, academic
learning, and learning from
experience, confirmed by
both clinical assessment and
individualized, standardized
intelligence testing.
Deficits in adaptive functioning The client couldn’t meet the Present
that result in failure to meet developmental standards as He
developmental and sociocultural scored lower in portage guide for
standards for personal early education.
independence and social
responsibility. Without ongoing
support, the adaptive deficits
limit functioning in one or more
activities of daily life,
such as communication, social
participation, and independent
living, across multiple
environments, such as home,
school, work, and community.
Onset of intellectual and The client’s problem also began in Present
adaptive deficits during the early developmental period
developmental period.

Portage Guide to Early Education

The Portage Guide to Early Education (PGEE) was developed to serve as an aid to teachers,
parents or others who need to assess the child’s behavior and plan realistic curriculum goals that
lead to additional skills. There are five goals of PGEE; to enhance a developmental approach to
teaching, to concern it with several areas of development in cluding cognitive, language, motor,
socialization and self- help skills, to provide a method of recording the existing skills and
recording skills learned in the intervention period, to provide suggestions on how new skills
could be taught (Bluma, Shearer, Froham& Hilliard, 1976).Revised edition of PGEE was
administered on the client.
Results
Chronological age: 11 years
Table 4.5
Areas Developmental Age Developmental age
(months) (Years)
Socialization 50.5months 4years 2month
Self Help 65.5months 5years 5months
Language 57.6 months 4years 9months
Cognitive 59.2months 4years11months
Motor 58.6months 4years 10months
Qualitative Analysis. The clients’ current level of functioning in socialization is 4years 2months.
Discrepancy of this age is 7 years. The clients’ current level of functioning in self-help skills is 5years
5months. Discrepancy of this area with chronological age was 6.6 years. The client’s current level of
functioning in language skills is 4years 9months. Discrepancy of this area with chronological age was 5.6
years. The clients’ current level of functioning in cognitive skills is 4years 11months. Discrepancy of this
area with chronological age was 6 years. The clients’ current level of functioning in motor skills is 4years
10months. Discrepancy of this area with chronological age was 6 years. On the whole the portage guide
scoring represents that the clients’ level of adaptive functioning is remarkably below than his
chronological age.

Slosson Intelligence Test

A brief individual test of verbal intelligence designed for use with individuals ages 4 and
older. It consists of 187 oral questions assessing six cognitive domains: vocabulary, general
information, similarities and differences, comprehension, quantitative ability, and auditory
memory Originally developed in 1963, the SIT was revised in 1991 (SIT–R) and in 2002 (SIT–
R3). [Richard Lawrence Slosson Jr. (1910–1970), U.S. psychologist]. Slosson Intelligence test
was administered on the child to assess his intellectual functioning.
Quantitative Analysis
Table 4.6

Shows the scoring of child on SIT.

Date of Administration 28-02-2022

Date of birth 15-07-2010
Chronological Age in years 11years 7months
Chronological age in months 139 months
Basal age in months 9months15 days
Mental age in years 5.2years
Mental age in months 62months
Ratio IQ 45
Ratio IQ standard Error of Measurement 4.3
IQ score 44.6
Qualitative Analysis

The child’s mental age came out to be 5years 2months while his chronological age is
11years 7months this shows that his mental age is below than his chronological age.

Diagnosis

318.0 (F71) Intellectual Disabilities (Moderate)

Prognosis

Through better treatment client can overcome his problem. The prognosis seems to be
favourable.

Case Formulation

The client was referred to the trainee clinical psychologist for the assessment and
management of problems and the assessment indicated marked deficits in intellectual as well as
adaptive functioning and the client was diagnosed as the intellectually disable (moderate).
According to DSM-V the client with intellectual disability has deficits in intellectual functioning
including reasoning, problem solving, decision making and also deficits in adaptive functioning
so the client will fail to meet the developmental and sociocultural standards of personal
independence and social responsibility. And the problem must be started during the
developmental period. Following are the reasons which may cause child’s impairment.

According to biological perspective, the low nutritional intake combined with poor health
care access leads to the intellectual disability in infants (Raina et al, 2016). In the following case
the client had nutritional deficits when he was an infant and he couldn’t eat any proper meal till a
year so it could be the etiological factor of causing intellectual disability in him as the family
also didn’t provide any health care in the beginning as they didn’t understand the severity of the
problem. The enlarged tonsils result in weight loss as the child would be unable to intake
sufficient nutrients as he find it difficult to swallow (Shah, 2022). The following child also had
tonsils which resulted in low body weight and the child delayed to achieve his milestones.

The studies indicated that the maternal infection during prenatal period can result in
cognitive delay (Bonnin, 2007). In this case the client’s mother got ill during her pregnancy and
it may be the reason of developmental delay in child. Low body weight is significantly related
with the delayed milestones including teeth eruption, sitting without support, walking without
support, speaking, bedwetting cessation (Liu et al, 2000) child history also indicated that the
client birth weight was low then the normal.

Precipitating Factorsthe Client’s mother reported the presence of aggressive behaviour, Lack of
confidence, stubborn behaviour in client. He hit his brother when they took his toys and he also
shouted when someone did not give attention to him. Crocker et al. (2006) reported that
aggressive behaviour is usually prevalent in children with intellectual disability. It is also seen
that in many cases aggressive behaviour served a social function. In the present case the client
was using aggressive behaviour to get attention (Matson and Mayville, 2001).
Maintaining Factors the Client’s mother reported that the client’sJoint family
systemClient’s. Researcher reported that the most sensitive early marker for intellectual
disability is language development (McMillan et al, 2006). All the factors suggest the presence
of intellectually average with behavioural issues in the client. Interventions are required to
manage client and to improve his adaptive functioning.
 Case Conceptualization

Presenting Complaints
Assessment Tool
‫اپنی عمر سے بہت پیچھے ہے‬
‫لکھنے میں مشکل ہوتی ہے‬ Informal Assessment
 Clinical Interview
‫پنسل صحیح سے نہیں پکڑپاتا‬
 Behavioral Observation
‫صحیح سےچل نہیں سکتا‬  Visual Analogue (Subjective Ratings of the
‫خود کو سنبھال نہیں سکتا‬ Symptoms)
 Identification of Reinforcers
Formal Assessment

 DSM 5 Checklist for Intellectual Disability

Disorder
 Portage Guide to Early Education
 Solloson Intelligence Test

Predisposing Factors Precipitating Maintaining Factors Protective Factors

 Lack of quality care of Factors
Delayed Milestone
mother during pregnancy  Family Support
 Malnutrition Current Symptoms
 Therapeutic
 Delayed Milestones alliance

Management Plan

A symptom based management plan was devised which was based on techniques
of Behavior Therapy to improve child’s developmental skills.
The following management plan was checked for the client

Short-Term Goals
The short term goals were as follows

 Structured individual sessions were conducted in an assessment room. 2 sessions were

conducted per week. In initial sessions, informal assessment was done. In further
sessions, main focus was maintained on improving development skills of the child and
for that purpose different behavior modification techniques were applied.
  Rapport was built with the child and his mother to build a trusting relationship with them
in order to made therapy effective.
 Psycho-education was given to the child’s mother for her better understanding of the
child’s problem and to effectively play her role in therapeutic intervention.
 Positive reinforcement was used with the child to increase his desirable behavior to
improve his problem.
 Prompting was used to engage the child in the correct behavior at the correct time.
 Fading was used to gradually elimination of the prompts given to the child.
 Chaining was used to teach difficult tasks to the child.
 Individualized Education/Training Plan was devised to teach the child developmental
skills.
Long-term Goals
The long term goals were as follows:
 Short term goals will be continue to keep improvement in child.
 Individualized Education/Training Plan will be continue to teach further
developmental skills to child according to his need.
 Follow up sessions will be conducted to make sure and increase
improvement in child.
Summary of Therapeutic Intervention
Rapport Building
Rapport building defined as “the ability to connect with others in a way that
creates a climate of trust and understanding” (Zakaria & Musta'amal, 2014).
Rapport was built with the child and his mother to engage them in therapy. It was
built with the mother by actively and empathetically listening and showing genuine
concern and giving unconditional positive regard to her (Resident Assistance Program
Newsletter, 2009). It was easily built with the child by just making compliments and
talking about his interests. As a result of this technique, the child and his mother showed
cooperation with the trainee clinical psychologist.
Psycho-education
The term “psycho-education” was first employed by (Anderson et al, 1950s) .Psycho-education is
the education of a person in subject areas that serve the goals of treatment and rehabilitation. It
involves teaching people about their problem, how to treat it, and how to recognize signs of relapse
so that they can get necessary treatment before their difficulty worsens or occurs again. Family
psycho-education includes teaching coping strategies and problem solving skills to families, friends,
and/or caregivers to help them deal more effectively with the individual. When behavioral or
psychological difficulties arise, people need specific information about what is happening: the
diagnosis of specific symptoms, what is known about the causes, effects, and implications of the
problem in question. The more family and friend know, the less they will blame the person who is
experiencing it or themselves for thinking they had somehow caused it (Psycho-Educational
Counseling Services, 2002).
In the present case, the child’s mother was psycho-educated about child’s problem. It consisted of
information on meaning of intellectual disability, its nature and causes, treatment etc. Its rational
was to reduced distress, confusion, and anxiety of mother, which might in turn help the child to
improve life style.
Mother was told about the child’s diagnosis. He was psychoeducated that Intellectual disability is a
disability characterized by significant limitations both in intellectual functioning (reasoning,
learning, problem solving) and in adaptive behavior, which covers a range of everyday social and
practical skills. This disability originates before the age of 18.Down syndrome is major cause of it.
It also consists of delayed developmental milestones in child. Through behavior modification
techniques, child can acquire social and practical skills. Results of PGEE were discussed with
mother. He was consoled to reduce her distress. Significant of homework assignments were told to
mother to improve child’s problem.
He was told about procedure of giving reinforcement. As He had received some information
from doctor about child’s problem, so He faced no difficulty in understanding further information.
At the end, He told that now He had clear view of child’s problem and it also helped her to reduce
her distress (See Appendix A3).
Positive Reinforcement
Reinforcement is the process in which a behavior is strengthened by the immediate
consequence that reliably follows its occurrence. When a behavior is strengthened, it is more likely to
occur again in the future. There are two types of reinforcement: positive reinforcement and negative
reinforcement. Positive reinforcement is defined as the occurrence of a behavior is followed by the
addition of a stimulus (a reinforcer) or an increase in the intensity of a stimulus, which results in the
strengthening of the behavior (Miltenberger, 2012).Positive reinforcement was given to the child and
for this purpose continuous reinforcement schedule was applied for the acquisition and learning the
desirable behavior of the child. It is a schedule in which each occurrence of a response is reinforced
(Miltenberger, 2012). Afterwards an intermittent reinforcement schedule (fixed ratio) was applied
so that the child continued to engage in the desirable behavior. It is a schedule in which each
occurrence of the response is not reinforced (Miltenberger, 2012). Whenever the child gave correct
response, he was being reinforced with watching videos of Doraemon or Tom and Jerry cartoons. It
resulted in increase his number of correct responses that was desirable behavior.
Prompting and Fading
Prompts. Prompting are used to increase the likelihood that a person will engage in the
correct behavior at the correct time. They are used during discrimination training to help the person
engage in the correct behavior in the presence of the discriminative stimulus (S D). These are stimuli
given before or during the performance of a behavior. They help behavior occur so that the child can
provide with reinforcement. Various types of prompts are used in behavior modification; the two
major categories are response prompts and stimulus prompts. A response prompt is the behavior of
another person that evokes the desired response in the presence of the SD. Verbal prompts, gestural
prompts, modeling prompts, and physical prompts are all response prompts. Verbal prompts are
when the verbal behavior of another person results in the correct response in presence of the S D. It is
a verbal prompt when we say something that helps the person engage in the correct behavior. Verbal
prompts may include instructions, rules, hints, reminders, questions, or any other verbal assistance.
Physical prompts include physically guiding or touching the child to help him use the target
behavior or skill. They are used when the child does not respond to less restrictive prompts (e.g.,
modeling, verbal, visual). They are useful when teaching motor behaviors (Miltenberger, 2012).
Both verbal and physical prompts were used with child to teach him developmental skills. For
example, while doing a cognitive task in which the child drew a vertical line, the trainee clinical
psychologist assisted him verbally as well as physically. He held hand of him and also verbally
instructed that “now draw a straight line.”
Fading. Fading is the gradual elimination of the prompt as the behavior continues to occur in the
presence of the SD. Fading is one way to transfer stimulus control from the prompts to the S D
(Miltenberger, 2012). For example, the trainee clinical psychologist started to provide less and less
verbal and physical guidance when the child started to drew a correct vertical line. It resulted in
maintenance of his behavior.
Chaining
A complex behavior consisting of many component behaviors that occur together in a
sequence is called a behavioral chain. Each behavioral chain consists of a number of individual
stimulus-response components that occur together in a sequence. For this reason, a behavioral chain
is often called a stimulus-response chain. Each behavior or response in the chain produces stimulus
change that acts as an SD for the next response in the chain. The first response produces an SD for the
second response in the sequence. The second response produces an S D for the third response in the
sequence, and so on, until allthe responses in the chain occur in order. Of course, the whole stimulus-
responsechain is under stimulus control, so the first response in the chain occurs when a particular SD
is presented. There are three types of chaining: forward chaining, backward chaining, and total task
presentation.
Forward chaining. Forward chaining was used with the child. It is a type of chaining in
which one component of the chain at a time is teach and then chain the components together, and
prompting and fading is used to teach the behavior associated with the S D at each step in the chain.
We move from the front of the chain to the end. The process of analyzing a behavioral chain by
breaking it down into its individual stimulus-response components is called a task analysis
(Miltenberger, 2012).
Individualized Education/Training Plan
An Individualized Education/Training Program (IEP) is a written statement of the educational
program designed to meet a child’s individual needs. Every child who receives special education
services must have an IEP. That’s why the process of developing this vital document is of great
interest and importance to educators and families alike (The Short-and-Sweet IEP Overview, 2017).
An IEP was established for the child which was based on the areas of PGEE to meet the
distinctive needs of him. It consisted of targets and the techniques such as reinforcement, prompting,
chaining, and fading to achieve those targets(See Appendix A3).
Post Assessment. Post- assessment of the child was done on the basis of visual analogue (subjective
ratings of symptoms)after applying therapeutic intervention. A clear difference can be seen between
pre-assessment and post-assessment of the child.
Visual Analogue (Subjective Ratings of the Symptoms)
Subjective ratings of the child’s symptoms were taken by the mother and the
trainee clinical psychologist by using 0-10 rating scale in order to see improvement after
applying therapeutic intervention.
Pre and Post Treatment rating of problematic areas

Table 4.6

Pre and Post Treatment Rating of Problematic Areas by Mother

Problems Rating by Ratings by trainee

mother clinical psychologist
Pre Post Pre Post
cognitive 8 6 9 8
skills
Lack of 8 7 8 7
independent
functioning
Socialization 8 6 8 6
Adaptive 9 8 9 8
Skills
Graphical Representation of Symptoms Ratings by Mother

10
9
8
7
6
5 Pre
4 Post
3
Column1
2
1
0
cognitive skills Lack of Socialization Adaptive Skills
independent
functioning
Graphical Representation of Symptoms Ratings by Trainee Clinical Psychologist

10

5 Pre
4 Post
3

0
cognitive skills Lack of independent Socialization Adaptive Skills
functioning

Limitations and Suggestions

Limitations
 Lack of stimulation at home.
 No separate room was provided for interview

 Sessions with the client were conducted mostly on consecutive weeks, which may
have resulted in tiredness on the part of the client in term of mental effort.
Suggestion
 The client and his family need to realize that they have to work together in order for
the treatment of work.
 Child’s parents need to assist him and practice school activities at home.
 The client and his family should be prepared that it may be slow and long process for
the client to learn to adjust to his current state.
Session Report
Structure of session
The therapeutic process was continued for 12 sessions. Each session was of 45
minutes. The initial 60 minutes were given to the client to work on his cognitive and
adaptive skills. The last 10 minutes were provided to the client`s mother to give his
understanding of the client’s condition and mental level, homework assignments,
techniques to manage undesirable behaviors, procedures to develop his self-help skills
(wash hands mouth with soap, comb hair) and listen to his concerns regarding the client.
Session Record Form
Session No. 1
Time duration
45 minutes
Behavioral observation
Client showed alliance with trainee psychologist.
Session goals
 Rapport building
 Observation of client
Session structure and outcomes
During the 1st rapport was building with client. Different activities performed,
such as coloring and drawing, given a sheet for coloring, and also draw vertical and
horizontal lines, all these activities was for rapport building so it would be helpful for
future sessions with the client. Rapport with the client was built gradually. Identification
of reinforcer was done, checked client gross and fine motor movements, and also checked
client’s onset behavior, and compliance. Through 1st session, it was checked that his
gross and fine motor movement was appropriate and also shown compliance and has
onset behavior.
Session No. 2
Time duration
45 minutes
Behavioral observation
Client was in smile face but on-seat behavior of client was short time of duration
and does not maintain eye contact.
Session goals
 Observation of client
 History of client’s problem from class teacher
Session structure and outcomes
During the 2nd session information about client’s problem was asked from his
class teacher. Conduct information about client’s attitude during class. The client drew
lines on the paper given by therapist. Client likes to play with colors. Reinforcement was
used in the session when the client showed desired behavior.
Session No. 3
Time duration
45 minutes
Behavioral observation
The client has one some activities related o fine and gross motor skills.
Session goals
 Identification of reinforcers
 Check Motor Skills
Session structure and outcomes
The target of the session was administration of the reinforce identification checklist.
Prompting and positive reinforcement were used for showing compliant behavior and
reinforce identification checklist was also administer to identify the further reinforcer.
The reinforcer of the client was identified because it would be helpful for modifying the
maladaptive behavior of the client and teaching him new things. The therapist identified
that the client likes drawing and coloring, thumbs up. Revision of the last activities of
color identification and cutting of shapes was done. Trainee Clinical Psychologist done
some activities related to gross and fine motor skills.
Session No. 4
Time duration
45 minutes
Behavioral observation
The client was showing interest in activities and cooperative with Trainee Psychologist
during the whole 4th session
.
Session goals
The goal of the session was to conduct test.
 PGEE
 Revision of previous task
Session structure and outcomes
During 4th session used the client’s reinforcer and checked clients self help skills
hoe to close buttons, how to wear socks, how to clean nose and hands. Through that
session, PGEE was administered, some items were missed that were asked from client’s
mother when she visited school and find out the client’s function age of all the areas of
PGEE. Attention increasing activities was also done. Revision of last activity of color
identification was done which client has achieved partially.
Session No. 5
Time duration
45 minutes
Behavioral observation
The client was in a pleasant mood. He was wanted to play out-door.
Session goals
The goal of the session was to conduct test.
 PGEE
 Colors identification and Tracing
Session structure and outcomes
During 5th session used the client’s reinforcer and checked clients motor areas
such as jumping, kick the ball, and also fine motor skills such as pick the pencil, snip
with scissor. PGEE was administered, some items were missed that were asked from
client’s mother when she visited school and find out the client’s function age of all the
areas of PGEE. Color identification was taught to the child through using different color
pencils. Trainee Clinical Psychologist taught him tracing with physical prompts.
Session No. 6
Time duration
45 minutes
Behavioral observation
His mood was not so good. He was not showing compliance properly. He had a
little fever.
Session goals
 Administration of Sollosson Intelligence Test (SIT)
 Revise previous Task
Session structure and outcomes
In this session colored progressive matrices that measure the learning
difficulties and issues of cognitive processes who may think clear was administrated.
Different body parts names were asked by showing cards. Revision of last activities of
color identification and Tracing was done which client has achieved partially.
Session No. 7
Time duration
45 minutes
Behavioral observation
The client was lethargic He responded to allquestion and performed activates
according to the instructions but he was taking some time to respond.
Session goals
 Self help skills
 Greetings
 IEP
Session structure and outcomes
In this session, due to the client’s condition and mood trainee psychologist revised
previous task. Tracing of alphabet was done with physical and verbal prompts.
Session No. 8
Time duration
45 minutes
Behavioral observation
The client was in a pleasant mood. Feedback of previous session was recorded.
Session goals
 To review the all previous sessions
 Worked on child previously managed behavior
  Work to strengthening them and some proposed management
 Self help skills
Session structure and outcomes
Self help skills were taught how to tie shoes laces. Exercises were done and
interventions were used for strengthening the desired behavior of child. Review all the
sessions and improvement in child’s behavior.
Session No. 9
Time duration
45 minutes
Behavioral observation
Client was interested to do different activities. He was cooperative during the
whole sessions.
Session goals
The goal of the session was to teach him following
 Revision of previous skills
 Socialization
Session structure and outcomes
In this session, previous skills were revised after that Trainee clinical psychologist
performed a group activity in which the Trainee clinical psychologist played with toys
and make a circle round game with the client and children to allow the client to play with
others. All the previous skills were revised. IEP was learnt to client how to ask for
permission when wanted to use other person’s belongings. How to greet first, when to say
thank you and please etc. Self helpskills were also taught how to communicate and team
work with class fellows.
Session No. 10
Time duration
45 minutes
Behavioral observation
The client was in a pleasant mood.
Session goals
The goal of the session was to teach him following
 Revision of previous skills
  Learning, Tracing and coloring
Session outcomes
In the 10 session different activities were arranged side by side and client was
involved and show compliance. The client did not do proper coloring inside of the shape
so the Trainee clinical psychologist asked the client to color inside of the shape (verbal
prompt) and whenever the client tried to color outside of the shape Trainee clinical
psychologist kept one hand outside of the shape. All previous sessions activities were
revised.
Session No. 11
Time duration
45 minutes
Behavioral observation
The client was in a pleasant mood. He responded properly on previous task
revision.
Session goals
 Revision of previous skills
 Termination
Session structure and outcomes
In the 11 session different activities were arranged side by side and client was
involved and show compliance. The end of therapy was positive experience with a long
lasting impact on both the client and therapist. Successful termination was done and the
goals were achieved. Specified time for working was ended.
Session No. 12
Time duration
45 minutes
Behavioral observation
The client was in a pleasant mood. He was enjoying the revision of tasks.
Session goals
 Revision of previous skills
 Termination
Session structure and outcomes
In the 11 session different activities were arranged side by side and client was
involved and show compliance. The end of therapy was positive experience with a long
lasting impact on both the client and therapist. Successful termination was done and the
goals were achieved. Specified time for working was ended.
Reference

Chambers & Pinnock, (2011). Psycho-educational interventions. Retrieved from:

https://www.ons.org/intervention/psychoeducationpsychoeducational-interventions
Cooper, J. O., Heron, T. E., & W. L. Heward. (1987) Applied behavior analysis. Columbus:
OH.Merrill Publishing Co.
Doyle, L. W., Crowther, C. A., Middleton, P., & Marret, S. (2009). Antenatal magnesium sulfate
and neurologic outcome in preterm infants: a systematic review. Retrieved from: http://www.
cdc.gov/ncbddd/cp/causes.html
Jafferson, T. (2012). Supportive psychotherapy training manual. Retrieved from:
http://www.willseye.org/sites/all/files/ST%20MANUAL.pdf
Miltenberger, R. (2012). Behavior modification, principles and procedures. (5th ed.). USA:
Wadsworth Publishing Company. doi:10.1016/S0004 9514(14)60183-5
Shoai, S. (2014). Instructor's manual for clinical interviewing: intake, assessment, and
therapeutic alliance. Retrieved from: http://www.psychotSherapy.net/data/uploads
/52d99900de254.pdf
Vernon, A. (2002). Counseling Clientren & adolescents (3rd ed.). Denver, CO: Love Publishing.
Whitaker, S. (2008) The stability of IQ in people with low intellectual ability. Intellectual and
Developmental Disabilities. Retrieved from:
https://tShepsychologist.bps.org.uk/volume25/edition-6/defining-learning-disability
Wison, K. and Ryan, V. (2005). Play therapy: a non-directive approach for Children and
adolescents, (ed. 2nd). London: Elsevier Science