PSYCHODIAGNOSTIC REPORT

Name: Farwa Ali

Father’s Name: Gulzar Ali
Age: 5 years 03 months
Date of Birth: 5th December’ 2016
Gender: Female
Dates of Assessment: 28th, 29th & 30th March, 2022
Assessment by: Rida Khan

Referral Source & Presenting Complaints:

Farwa Ali was referred to Umeed-e-Nau, Institute of Professional Psychology by Special

Children School for a comprehensive psychological assessment in consideration to concerns
of limited speech, hyperactivity and inability to perform age -appropriate

Investigation Conducted:

 Clinical Interview
 Quick Neurological Screening Test ----------------------------------------------(QNST)
 The Vineland Adaptive Behavior Scale -----------------------------------------(VABS)
 Informal Assessment

Clinical Interview
Farwa was brought by her mother to the clinic with issues of speech, impulsivity and it to
perform age -appropriate. She is the youngest among three other siblings and belongs from a
middle-class family. She is recently enrolled in any educational institution one month ago.
mother is the homemaker while the father is a Naval officer. Her mother had constant
vomiting during pregnancy due to which she was hospitalized in 08 month of pregnancy
while the doctors also predicted about presences of certain abnormalities in child. A full
trimester of pregnancy was completed and the client had Normal Vaginal Birth. In third
month of birth, she was diagnosed with down syndrome followed by pyrexia and constant
emesis which resulted in immediate hospitalization for 13 days. The following delayed
milestones were indicated: Neck holding (06 months), Sound intonations (04 months),
Crawling (01year), Sitting (1.5 years), and Walking (02 years). However, the speech has not
developed till date.
No attachment issues are indicated. No history of psychological disorder in family.
Psychological Evaluation:

Quick Neurological Screening Test (QNST) was administered on client and she falls in
suspicious range. According to the score, there is a high probability of neurological
impairment or dysfunctioning which can be confirmed thorough neurological investigation.
Vineland Adaptive Behavior Scale (VABS) shows that her Adaptive Behavior Composite
falls in low level of adaptive functioning. This indicates her lack of ability to deal with
activities of daily living; and to meet the standards of personal independence is inappropriate
according to her chronological age which can be contributed to the neurological impairment
and observed features of down syndrome.

The client's main domains (Communication, Daily living skills,Socialization and Motor Skill)
along with adaptive levels are given below:

Domain Adaptive Level

Communication Low
Daily Living Skill Low
Socialization Low
Motor Skills Low

The Communication, Daily Living Skill and Socialization domain score lies in low range.
This indicates that she face difficulty in comprehending written information and struggles in
articulating her thought in verbal and written domains. Moreover, she struggles to perform
everyday living tasks. However, this may be due to minimal opportunities provided by
mother to work independently. Also, it can be indicated that the client finds harder to interact
in social settings which can be attributed to client’s limited speech with the presence of
significant impulsivity in behavior.

Client’s sub domains adaptive levels and age equivalents levels

Sub-Domain Adaptive levels Age Equivalent

Communication
Receptive Low
Expressive Low
Written Low
Daily Living Skills
Personal Low
Domestic Low
Community Low
Socialization
Interpersonal Relationship Low
Play and Leisure Time Low
Coping Skills Low
Motor Skills
Gross Low
Fine Low
On Receptive, Expressive and written sub domains, the client score lies in low range which
indicates her ability to listen, comprehend and follow instruction is below her chronological
age. Moreover, her use of words and sentences to express herself is not sufficiently
appropriate. This also manifest into hindered ability to socialize with others. She is unable to
hold a pencil appropriately and randomly scribbles only. It should be noted that child is
recently exposed admitted in formal educational set up which can be a reason for this
limitation..

On Personal , Domestic , and Community sub-domain scores lies in low range which suggest
that client is not capable enough of eating, dressing, washing and maintaining hygiene as
reported by mother as well. This can be attributed to limited exposure provided to child for
involvement in self-help activities by the family. However, she may be able to perform these
tasks independently if training is given as observed in informal assessment. Apart from this,
she is cautious to harmful objects around her and have understanding of simple house chores
as reported by mother. Therefore, with minimal efforts an improvement can be obtained.
Moreover,she has negligible concept of engagement in activities including money
management and safety and travelling.

On Interpersonal Relationships,Play and Leisure Time, and Coping Skills sub-domain, the
client’s score lies in low range. This reveals that she does not have proper social interaction
within environment.However, it can be ascribed to her speech limitations. Furthermore, she
seems to have inability to cope with emotional and behavioral situations which assessor also
found that may be due to presence of impulsivity and negligible concept of seeking consent
or requesting for desired objects that also alter to immediate rushing and snatching.

On sub-domain of Fine and gross motor skills, the client scored low which suggest that
manipulation of objects, drawing and use of scissors is difficult for her which is evident by
constant requirement of efforts from assessor for correct imitation. Also, there are observable
difficulty and need of support in playing, walking & running.

Client’s Maladaptive Behavior Index adaptive level are as follows:

Adaptive Level
Maladaptive Behavior Index Elevated
Internalizing Elevated
Externalizing Elevated

Her Maladaptive Behavior Index elevated range suggests difficulty in paying attention to her
environment which is validated by clinically significant indicators in neurological screening
which makes her unable to listen to people and understand them. On domain of Internalizing
and Externalizing the client score lies in elevated range. This reflects that the client is overly
dependent on her mother for every task, such as, brushing her hair, reading, eating, dressing
etc. Also, there is a presence of hyperactivity in him. The propensity of defying authority was
also observed during informal assessment by her behavior of refusing to perform certain tasks
and passing a mischievous smile.

Informal Assessment

Physical and Neurological Development

The client appears to have flattened face, upward slanting eye lids (palpebral fissures),
protruding tongue, broad short hands with a single crease in the palm, and short height.
Hence, these physiological features evidences that she has down syndrome which is also
supported by earlier diagnosis by a pediatrician. Moreover, her mother reported that she does
not seem ready to learn to start dressing and undressing independently as of yet. This
indicates that her skillset lacks fine and gross motor co-ordination, body awareness, bilateral
co-ordination, right/left discrimination, postural stability, and motor planning. Moreover, she
has not developed control over bowel and bladder, and has not learnt to urinate and defecate
in toilet without assistance.

Her capacity for social learning and reproduction was evaluated by observing her appropriate
and functional use of toys, and her ability to imitate the assessor when unsure about
manipulating the objects in a correct manner. However, imitation was quite preliminary in
nature, and required a great deal of persistence and help from the assessor to get the client to
engage. When it comes to motor abilities, she has a steady gait and can go up and down the
stairs with two feet on each step while holding onto a banister. However, she could not
extend her arm at the shoulder or elbow to throw a ball in the given direction even upon using
physical prompting to guide her through the entire action. This can be said to indicate poor
muscle strength and delays in visuospatial functioning. On the other hand, his fine motor
skills are evolved enough for her to be able to hold a pencil and use it to scribble when it is
handed to her, turn a door knob with little help, or zip/unzip zippers. On contrary, her
capacity for hand-eye co-ordination is sufficiently developed, which became apparent by her
inability to imitate pre-writing strokes (e.g., vertical line, horizontal line, circle, or cross) or
hold the bead and maneuver it along the wire on the bead maze.

Apart from this, she can successfully recognize and identify the few parts of the body which
shows that she can create the cognitive link between visual cues and words. As far as her
capacity for cognitive mapping is concerned, the client was able to navigate her way to the
playroom without assistance which shows the presence of visuospatial long-term memory
and executive control.

Mood and Affect

Client can stay seated in one place in presence of desired object and was walking around the
clinic, searching different rooms that were vacant. She seemed pretty curious of her
surroundings as she steps into the common room with random people inside and begins to
explore different things. Although, she was having a hard time recognizing and reciprocating
facial expressions such as a smile or frown, she was receptive to the tone of voice; for
example, stern voice used by mother while making verbal reprimands and understanding of
tone when she seemed irritated.

Human Relationship Capacity and Communication:

The Client adapted and adjusted pretty well when the parents had to leave her alone with the
assessor in the middle of the session. In the place of socially accepted strategies to meet
interpersonal goals, client was using inappropriate behaviors, such as sudden rushing and
precipitous intervention, to gain objects, stop demands, or receive attention. These forms of
communication are very effective for gaining attention; however, they result in negative
attention and do not provide the client with the opportunity to learn appropriate forms of
communication. She has no a difficulty maintaining eye contact, she seemed fairly
comfortable while playing with assessor.

Use of the Environment

He seemed a little hesitant and confused when he was being escorted to the playroom by the
assessor; however, she transitioned very smoothly and displayed immediate interest in the
toys without having to be prompted once he entered inside. This points toward client’s
curiosity, self-directed discovery, and concentration, which lays the foundation for all future
learning. she made a fair attempt to respond affirmatively to directive play, but did not
display sustained engagement with the task. Her interest in toys was decently typical in
nature and has no difficulty engaging in interaction play when attempts were made by the
assessor to play with him.

Behavioral Observation:

Client is observed to be comfortable with examiner. Few of given instructions were

understood and followed by her. However, there was impulsivity in her behavior which is
attributed to minimal concept of waiting and requesting. She was properly dresses and well
kempt. Moreover, her speech was limited till sound intonations.

Conclusion:

In the light of clinical interview, psychological evaluation and informal assessment it is

concluded that client have neurological impairment. She is diagnosed with down syndrome
which is evident from certain features. Her adaptive functioning falls in low range as revealed
by VABS and informal assessment. Hence, this can be ascribed to her cognitive limitations
and speech deficit along with other challenges such as limited grasp on pencil holding and
inability to understand and reciprocate test instruction given by the assessor. However, based
on informal assessment, it is concluded that he has slightly favorable prognosis if adequate
training is provided to her.

Recommendations:
 Applied behavioral Analysis(ABA) is recommended for reducing impulsivity and
maladaptive behaviors.
 Psychoeducation of parents is recommended so that they can learn behavior modification
techniques.
 Neurological consultation and investigation are recommended for treatment.
 Speech therapy is recommended for enhancement of vocabulary and improvement in
speech impediment.
 Occupational therapy is recommended for learning daily living skills and intrapersonal
independence.

________________ _____________________ ______________________

Rida Khan Dr. Zara Israr Dr. Kiran Bashir Ahmad
M.Phil. Internee Internship Supervisor Head of Department
IPP-BUKC