Final Project

TOPIC

CASE STUDY

Submitted by: Bilal Pervaiz

Submitted to: Mam Bakhtawar saeed

Roll no: 191520153

Course: PSY408-B

Date:1 September 2021

 Case study

Identifying information:

Name: M.A

Initial of school: M.H.S

Gender: Boy

Age: 14th years

Grade: 9th C

Marital status: Single

Occupation: Student

Source and reason of referral:

The child was referred by her teacher for the purpose of assessment and management of his
academic and emotional behavioral problems. . The child was referred with some behavioral,
emotional and academic problem, but he was unaware of his academic problem as it was
reported by the child he was good in studies and having no problems expect little trouble in
chemistry.

Initial Information

The 14th years old child entered the session room very anxious, he didn’t answer the greeting of
the school counselor. The child was wearing messy uniform and his height and health was not
age appropriate. The child was hesitant in the beginning of the session, but became relaxed
gradually. The speech of the child was developed appropriately and he was very talkative, he
was using excessive detail about each question. The child was appropriately maintained his eye
contact and rarely blink eyes during conversation.
 The rapport built successfully with the child because he was very talkative and a good
listener as well. The child was referred with some behavioral, emotional and academic problem,
but he was unaware of his academic problem as it was reported by the child he was good in
studies and having no problems expect little trouble in chemistry.

Background Information

Personal history:

The child used to get up early in the morning, use to offer prayers in the mosque and then recite
the verses of Holy Quran. After back from mosque the child gets ready for school, then tuition
and in the evening he used to play with cousins. The child likes to visit the Zoo and Baa e Jinnah.
The aim of the child life was to help his father in his job. The child didn’t elaborate any wish
merely belongs to him. His all wishes were related to his father. It was reported by the child that
his uncle wants him to join his business In Malaysia but the child decided not to leave his father
at any cost.

Family history:

The child belongs to the joint family system. The client was the only child of his parents. There
were father, aunt, uncle and their four kids’ lives together in the child’s home.

The father of the child was a painter by profession. He was handicapped by one leg having polio.
The child showed extreme attachment to his father. It was reported by the child that his father
didn’t get marry just because of him because stepmother doesn’t care for step children. It was
reported by the child he was waiting to get older to take care of his father and will not allow him
to work. It was reported by the child that he had a lot of fun with father. He has shown the child
so many places.

The aunt of the child takes care of him, but she sometimes gets so aggressive to the child. The
child was not saying anything about him.

The uncle of the child works in an office, and used to bring toys for the child. Somehow the child
was assessed to be little attached with the uncle.
 The child showed attachment with his cousins. All were younger to him, the best friend
of the child was the elder brother among cousin. They used to play computer games and sports
together.

Educational history:

The schooling of the child was started at the age of four years. In the beginning the child had
been a good student in the beginning till primary. After changing school the source of language
changed, the child started having trouble in Urdu. The child could not study Urdu as
appropriately as he was in English that’s why the child performance gets worst day by day. The
next incident which affected the child academic performance was the theft arrival to his home
which affected the mind of the child badly.

The child has been a good speaker in the class he has won the price twice in the speech
competition. He was good in extracurricular activities as well.

The child was talkative but having a few friends in the class. It was reported by the child that he
used to keep contact with all students but none was his best friend except his cousin.

The child having anxious behavior towards teachers and used to reserve from teachers. It was
reported by the child that he feel comfortable from female teacher than male because female
teacher verbally punish the child rather than male.

History of psychiatry and medical illness:

The father of the child having polio problems. He could not walk appropriately. The mother of the child
was died due to insignificant child birth complication

Presenting complaints:

Sabaq yad nai hota. It was reported by the child that whenever he tried to learn the lesson, he
remains unable to learn the lesson by rote. According to the client he wants to keep all the
chapter in mind as it is mentioned in the book but he was failed to do so.
Bhool jata hai. It was reported by the child that whenever she got successful in learning the
lesson, so before the class she forgets all the lessons, then she feels helpless and becomes sad.

Time py manage nai hota. It was reported by the child she has plenty of books, but shortage of
time, teacher used to give excessive work, which was impossible to complete on time
appropriately. According to the child perfect learning cannot happen this way.

Math mushkil lgta hai. It was reported by the child that she find mathematic difficult because
she could not give proper time to math. She finds algebra and Geometry difficult to learn.

Symptoms list:

 Withdrawal from activities and friends

 Irritability and impatience
 Changes in appetite -- either not eating or eating too much
 Constant worrying.
 Racing thoughts.
 Forgetfulness and disorganization.
 Inability to focus
 Poor judgment
 Being pessimistic or seeing only the negative side
 Sleep problems
 Easily getting annoyed or nervous
 Having difficulty in handling frustration
 Often appearing angry

Assessment

For the assessment tool was used to assess the academic, behavioral and emotional
problem of the child.

 Clinical Interview
  Behavioral Observation
 Subjective Rating
 Operational Definition of Terms
 School Children Behavioral Scale
 Reading and Writing Test
 Paired association Learning Test
 Digit Span

Clinical interview:

Clinical interview was conducted to assess the client insight about his academic, emotional and
cognitive problems.

Clinical Interview is a main tool of gathering information from client, parents, and other
informants (Raynold 2014).

Behavioral observation:
Behavioral observation was done to assess the appearance, posture, speech, verbal, non-verbal
cues and eye contact of the client. Behavioral Observation is a systematic way of recording the
observable responses of behavior (Pellering, 2014).

Subjective rating scale:

The subjective rating scale was used to take his belief about his cognitive errors about studies.
Subjective rating scales are measurement tools for assessing the sequence or rating of
phenomena (Splieger, 2013).

Table 1

The subjective rating of the client about his enemies are listed below

Beliefs Subjective Rating (1-10)

Fear of failure 8
Cannot learn the lesson on time 10
Forget the lesson 10
Chemistry and math 8
It was reported by the child that he has a fear of failure because he could not learn the lesson on
time. He tries to manage the entire book regularly, but due to the shortage of time he finds
difficulty in completing homework. It was reported by the child that he find Math and Chemistry
difficult, these two subjects took excessive time of the client. It was reported by the child that if
any day, he gets successful in learning all the lessons, so he forgets before class starts. The
results of this test indicate that the child had high pressure of academic achievements.

Operational definition of terms:

The definition of terms used by the client to describe his problem is listed below.

Sabaq yad nai hota. It was reported by the child that whenever he tried to learn the lesson, he
remains unable to learn the lesson by rote. According to the client he wants to keep all the
chapter in mind as it is mentioned in the book but he was failed to do so.

Bhool jata hai. It was reported by the child that whenever he got successful in learning the
lesson, so before the class he forgets all the lessons, then he feels helpless and becomes sad.

Time py manage nai hota. It was reported by the child he has plenty of books, but shortage of
time, teacher used to give excessive work, which was impossible to complete on time
appropriately. According to the child perfect learning cannot happen this way.

Math mushkil lgta hai. It was reported by the child that he find mathematic difficult because he
could not give proper time to math. He finds algebra and Geometry difficult to learn.

Social children problem scale:

SCPS scale was used to assess the social problem of school children, which will provide a
baseline for adjustment problem faced by the child.

SCPS refers to the social problems of the school children caused in difficulty achieving the class
equivalent grades..

Table 2

Quantitative Results of the child’s score on School Children Problem Scale

 Factors Obtained Score Category
F1 25 Anxiety
F2 18 Academic
F3 13 Aggression
F4 10 Rejection
F5 12 Somatic

Total 87
The child obtains 25 scores on the anxiety scale, which shows lack of confidence of the
child towards himself and toward the teacher and peers as well. He doesn’t ask for support in
studies rather gets anxious about his weakness. The child secure 18 score on academic
performance which shows that the child hide his weakness rather he uses defense mechanisms to
overcome his weaknesses because his class grades indicating that he had been a poor student.
The child obtained 13 scores in aggression scale which shows that the child was cool minded.
The child secured 9 scores on withdrawal scale which showing the child lack of interest in life.
The child secured 10 scored in rejection scale, which is showing the internal gaps and conflicts
of the child towards his family. The child secures 12 scores on somatic scale which was
indicating that the child has stressful thoughts and describes his emotional disturbances in
medical terms.

Reading test:
The reading test was used to assess the current level of difficulty in English and Urdu subject as
well.
Reading test consists of a student’s ability to read text appropriately, including pronunciation,
fluency, phonemes, and vocabulary (Ref……).

Table 3

Corrected words Mistakes Grade equivalent

89 11 90
The client was given a reading paper, with important instruction about the test. The client
made eleven mistakes with pronunciation, and phonetics. The child obtained 89 scores in that
test, one number was less to meet the grade equivalent scores. The scores of the client indicate
that the Urdu reading ability of the client was appropriate.

The client was asked to read a paragraph from his English book, he made 10 mistakes in
pronunciation in a small paragraph, but when the child was asked to rehearse it 3 times then the
child made 4 mistakes. The results of the reading test indicate that the child has the reading
skills, but due to lack of attention and concentration and revision he was having trouble.

Paired association learning test:

For the assessment of short term memory paired association test was administered. It will be
helpful in clear understanding about the lack of rehearsal problem of the child.

Paired association test refers to the attention, learning and short term memory of the student

Table 4

Trail No Easy Difficult

Trail 1 error 1 1
Trail 2 error 0 0
Trail 3 error 0 0
Total 1 1
Total no of error 1+1 = 2

The child was given a list of pairs of word to listen attentively. He was given necessary
instructions that listen attentively the list of words, then he has to recall the second word of pair.
There were ten pair of words consist of six easy and four difficult words. Then the child listen
the first list carefully and made one mistake in easy item and 1 in difficult. The total no of errors
of the child was 2, which was indicating that the child has good attention and learning ability. In
the second and third trail the child did not make any mistake which was showing hIS good short
term memory.

Digit span:

It was reported by the child that he has spelling problem, he cannot retain the words in his
memory. For the assessment of his retention level digit span test was used.
Digit span measures the memory of span which is the number of items, usually words or
numbers that a person can retain and recall.

Table 4

Quantitative interpretation of digit span.

Forward scores Backward scores Total

5 2 3-7
The child was given a list of numbers to listen. There were many numbers which were
located hierarchy in the list from least to most. The child correctly responds the 5 items in the
forward list and two from the backward list. The total no of score of the child 3-7, which mean
the child could retain a word from 3 to 7 digits. The child scores on test were fulfilling the
norms.

Reinforcement identification:

Reinforce identification was used to assess the reinforce of the child so that she could reinforce
herself after hectic routine and feel relax.

Reinforcement is a process in which the occurrence of behavior is followed by a consequence

that results in an increase in the future probability of behavior (Millitenberger, 1997).

The child was asked about his favorite tasks and activities, he used to do in his spare
time. The child described that he likes Barbie cartoons and to sit alone is his reinforce. He
usually spends a lot of time with him on Sunday.

Case formulation

The child was 14 years old young boy studied in 9th standard. The child was referred by
the school teach for the purpose of assessment and management of academic, behavioral and
cognitive problems.

The formulation was done according to the bio, psycho, and social model. According to bio
model the temperament of the child was very easy as the child was very talkative and giving
excessive details of each question. The father of the child having polio and the mother of the
child died due to pregnancy complications after the birth of the child.

According to social model the child belongs to the joint family system. The child was
brought up by her aunt and uncle. The child had been neglected for basic needs as it was
observed by the school counselor that the child was wearing messy uniform and his mouth was
not properly washed. The height and weight of the child was not age appropriate, so it could be
hypothesized that he was not well nourished by her aunt. As the mother of the child died in his
infancy, the separation from mother also caused feeling of loneliness among the child as he used
to fear of being alone at home. The father of the child was handicapped, which also effected the
mental stability of the child as it was reported by the child that God snatch her mother from her
but could not give back the leg of the father.

The other social factor of low performance in studies of the child was the academic
background of the child. The child could not take help from family members and always depends
on other for academic help which could be a maintain factor of the low performance of the child.
The changing of school also caused adjustment issues for the child. He finds difficulty in making
new friends and comfort level with the teacher. He mostly stays silent in the class because of the
new environment and peoples.

All these factors caused difficulty in academic achievement and he could not properly
study. The child felt psychological disturbance due to a lot of stressors. The death of the mother
brought complex and feeling of loneliness in the child as he started comparing himself with his
cousin, when they used to talk about her mother’s attention towards their studies. It was reported
by the child that his aunt takes a lot of care to her kid, her mother do the same if she lives with
the child, which was showing sense of complex and feeling of loneliness. The child started
defining his emotional problems in physical condition like having headache, backache, fast
heart beating etc.

The goal of the case was made according to the results of assessment tools. The
assessment will be done on three levels. The relaxation training will be given to the child for the
management of somatic complaints. The child will be taught to manage time, she will be taught
different learning style.
 Summary of Case Formulation

mother death
polio of father
epoure with theifs
somatic compalints
abscence of
mother
polio of father
changing of aunt
source of case
formulatio difference to
language kids
n
language
child interest problem
her concern in
study
interest in extra
curricular activities

behavioral
observation
clinical
interview relaxation
sabaq yad nai reserverd therapy
reading test
hota nature time
paired management
urdu mushkil shy
association
lgti hai confused learning style
digit span
ACIT
reinforcemnet
identification
Intervention plan

The intervention plan was made according to the current level of the child functioning.
Currently the child having time management problem, difficulty in Urdu reading and writing,
fear of thief and terrorist, somatic complaints and loneliness.

The child will be psycho-educate about his academic problems, acceptance of mother absence.
Motivation about study and carrier will be developed to make him financially strong to help his
father in the future. The relaxation training will be given to the child for the management of
somatic complaints.

Counselling Strategies

For the management of the child problem different management strategies were used which are
listed below.

 Rapport maintain

The rapport was built to make the client comfortable with the therapist so that he could easily
share his problems, then collaborative work will be done to find out the solution of the client’s
problems.

Rapport building is important in interpersonal relationship, to communicate in a more relax and

effectively. (Millitenberger, 1997)

The client was so introvert and hesitant to share his problems with the therapist. The
rapport was built with the discussion of daily routine, his likes and dislikes, the client somehow
interactive but at some points become so defensive and start using reaction formation. The child
was not forced to talk and he was entertained by the school psychologist, which proved very
helpful as the child showed little trust for school counselor.

 Relaxation training

As the child has headache, backache and fast heart beat problem, so he was even a relaxation
training to get relaxed in stressful situation.
Relaxation technique are consisted of activities relieve muscle tension, induce a quite body
response, and rebuild energy resources, this may include, deep breathing, imagery, meditation
and other techniques (Leahy, 1996).

The client was asked to close his eyes, open and close your hands with intervals, then he was
asked for long inhaling and exhaling, then he was asked to turn your neck on the both left and
right side one by one. The client followed all the instructions and reported to feel relaxed after
having these exercises.

Outcome

Outcome will be mention after post test assessment.

Limitation

Many limitations were faced by the school counselor in conducting session, which are
listed below.

 The new classes were started, the new teacher was handling new classes, they don’t know
much about the child performances, so referral form was not fulfilled by the teacher
which cause difficulty in report writing.
 The teacher of the school was less co-operative as they used to say that in the next class
child will be sent for the session, but in the next period, the other teacher replies the
same.
 Children were not regular, which was also causing disturbance in conducting the session.
Recommendation

Following recommendation could be helpful in conducting session successfully.

 The teacher should be psycho-educate about the importance of session activities.

 The teacher should pay attention on the absentees and take a step for that, it will affect
the performance of the child.