CHILD CASE REPORT

Submitted to

Ms. Hidna Iqbal

Submitted by

Fozia Bibi

Roll No

BS-CP33F20

BS-VII

2020-2024

Centre for Clinical Psychology

University of the Punjab

Lahore

Table of Contents

No. Contents Page no.

1. Case Summary 4

2. Bio data 5

3. Reason and source of referral 5

4. Presenting complaints 5

5. History of presenting illness 6

6. Background information 6

7. Psychological assessment 9
 8. Informal assessment 9

9. Formal assessment 12

10. Summary of psychological assessment 14

11. Diagnosis 15

12. Case formulation 15

13. Management Plan 16

14. Limitations 21

15. Suggestions 21

16. References 22

17. Appendices 24

List of Appendices

Appendices
Appendix A Permission Letter

Appendix B Reinforcement Survey Schedule

Appendix C Baseline Chart

Appendix D Slosson Intelligence Test

Appendix E Colored Progressive Matrices (CPM)

Appendix F Individualized Education Plan (IEP)

List of Tables

Table No. Title Page No.

Table 1.1 Presenting Complaints 5

Table 1.2 Developmental Milestones 7

Table 1.3 DSM-5 Based Symptoms Checklist 10

Table 1.4 Reinforcer Identification11

Table 1.5 Subjective Ratings of Problematic Behaviors 10

Table 1.6 Slosson Intelligence Test (SIT) 13

Table 1.7 Color Progressive Matrices (CPM) 14

Table 1.8 Childhood Adaptive Behavior Scale (CABS) 14

Case Summary

The client was a boy of 17 years and 9 months old, who was dressed neatly according to the weather. He
was enrolled at Rising Sun Institute of Special Education. He was assigned to trainee clinical psychologist
for his assessment and proposing a management plan to fulfill trainee clinical psychologist course
requirement. Client was assessed both formally and informally. Informally, Clinical Interview, Behavior
Observation, Subjective Rating of Problematic Behaviors, Baseline Chart, and Reinforcement Survey
Schedule were done. In formal assessment, Slosson intelligence Test (SIT), Colored Progressive Matrix
(CPM) and Children Adaptive Behavior Scale (CABS) were administered on the client. His diagnosis of
severity Intellectual Disability was confirmed by the trainee clinical psychologist and management plan
was also proposed accordingly. The proposed management included rapport building, psychoeducation,
individualized education plan (IEP), play therapy and behavior principles of modeling, shaping, chaining,
positive reinforcement and prompting.

Bio Data

Name Z.A
Gender Male

D.O.B 02.04.2004

Age 17 years 9 months

Number of Siblings 2

Birth Order 1st born

Religion Islam

Informant Client’s Teacher/ Record file

Source and Reason for Referral:

The client was enrolled at Rising Sun Institute of Special Education with presenting complaints of
learning difficulties, slow academic progress, poor retention, not age-appropriate comprehension, poor
understanding, and delayed development. He was assigned to trainee Clinical Psychologist by the school
administration for his assessment and to devise a proposed management plan to fulfill the requirement
of the course. Permission was granted from the Institute. (See Appendix A for Permission Letter)

Presenting Complaints

Table 1.1

Presenting Complaints According to the Teacher of the Client

Complaints Duration
Poor understanding Since childhood

Learning difficulties Since childhood

Poor comprehension Since childhood

Slow academic progress Since childhood

Poor retention Since childhood

History of Present Illness

Client was born after consanguineous marriage. Client’s mother had poor diet during her pregnancy. She
has passed through some stress and emotional disturbance due to some family and domestic issue.
Client was delivered at home by midwife and few complications were reported. Client had low birth
weight at the time of birth.

In 2005, when client was 1 year old, he suffered from diarrhea, despite taking treatment he remained ill
for one year. Client had delay in some developmental milestones. When client reached schooling age, he
tried getting admission in a school, but management refused to take his admission because he could not
pass the test. In 2010, at age of 6 years, he took admission in Rising Sun Institute of Special Education
with the complaints of poor understanding, learning difficulties, poor comprehension, slow academic
progress, and poor retention.

Background Information

Family History

Client’s father was 40 years old. He had taken education till primary school. His profession is driver. His
father is cooperative and friendly. Client’s father shared a congenial relationship with the client and his
brother. He had no history of any physical or psychiatric illness.
Client’s mother was 38 years old. She had taken no education and she worked as a house help. She is
cooperative. Client’s mother had caring relationship with the client. She had no history of any physical or
psychiatric illness. She had four pregnancies. Out of which 2 were abortions. Age of mother, at time of
client’s birth was 20.

Client’s parents were first cousins. They had cousin marriage. Client’s mother had total four
pregnancies. Two of them were abortions. Client had one younger brother. Client brother is one year
younger than him. Client reported that he had friendly relationship with his brother and liked to play
with him.

General Home Atmosphere

The client belongs to a low Socio-Economic Status family. He lived in a nuclear family. Client’s General
home environment is satisfactory. Client’s parents are caring towards the client. Client’s father is
authority figure at home and take most of the decisions.

History of Psychiatric Illness in Family

There is history of psychiatric illness in Client’s family. Client’s maternal 1st cousin had Intellectual
Disability (ID) with Cerebral Palsy.

Personal History

During pregnancy, mother had poor nutrition and was going through some emotional stress due
to domestic issue. Client was born through normal delivery at home. He had low birth weight at the time
of birth. Client had immediate first cry. At birth, he was diagnosed with tongue tie. In 2005, at the age of
one year, he had diarrhea. Diarrhea remained for one year despite taking the treatment. Client had
undergone surgery of tongue tie. Most of the developmental milestones achieved were delayed as
shown in table. The achieved milestones according to the record file of the client are:

Table 1.2

Developmental Milestones, Normal Age of Achieving and Client’s Age of Achieving Milestones
Developmental Milestones Normal Age of Achievement

(Santrock, 2018)

Client’s Age of Achievement

Sitting without support 7 -8 Months 10 Months

Crawling 9 Months 1.5 Years

Walking 13-14 Months 3.5 Years

Speech single word 1 Year 5 years

Complete sentence 4 – 5 Years 10 years

Bladder control 2.5 years 2 Years

Bowl control 3.5 Months 1 Years

Her personal history reveals a complicated set of events that have affected her

The. Single word speech was achieved at 5 years of age; the normal age of achievement is 1 year. The
developmental milestone of sitting with support was achieved at 10 months of age. The normal age of
achievement is 7-8 months. The developmental milestone of sitting without support was achieved at 10
months of age. The normal age of achievement is 6 to 7 months. She started walking at the age of 3.5
years. The normal age of achievement is 13,14 months. He started crawling in 1.5 year and the normal
age of achievement is 9 months. He complete sentence in 10 year and normal age of achievement 4-5
year .He started bowl control in 1 year the normal achievement age is 3.5 months.
The response, crawling and social smile were achieved at appropriate age. Client did interact with some
class fellows only when he wanted to but most of the time, he used to sit idle in his chair at one corner.
He liked to play racing games on mobile. He liked to listen to stories. He liked to watch Doraemon
Cartoon and the one that had panda in it. He used to play football with his brother. He liked to ride 4
wheels bicycle. A few of his favorite eatables were dairy milk chocolate, Rio biscuit and Cocomo.

Educational History

At schooling age, Client tried to take admission in a school. School’s management

refused to take Mr. Z.A admission because he could not pass the test. He had slow academic progress
according to fellows of his age. In year 2010, he got admission in Rising Sun Institute of special
education. He had learnt basic self-help skills until now. His academic functioning is of nursery level. He
can write ABC till E. He can write counting till 20. According to her teacher, he had also learnt few
starting Urdu alphabets He can name all the basic fruits, vegetables. He had concept of weather. All
these things, he had learnt in Rising Sun Institute.

Psychological Assessment

Client was observed both formally as well as informally.

Informal Assessment

Informal Assessment included:

• Clinical Interview

• Behavioral Observation

• DSM-5 Based Symptoms and Severity Levels Checklists

• Reinforcement Survey Schedule

 • Subjective Rating of Problematic Areas

• Baseline Chart

Clinical Interview

Confidentiality was ensured. The informed consent was obtained from the client’s mother and the
purpose and nature of the assessment was explained (See Appendix A for the Informed Consent).

The clinical interview was conducted by the trainee Clinical Psychologist with the teacher of the client to
gather information regarding the client’s problem. During clinical interview, predisposing factors i.e.,
parent’s cousin marriage, first cousin is ID, stress during pregnancy, poor nutrition during pregnancy,
delayed milestone, and perpetuating factors i.e., low SES. The clinical interview helped in providing a
comprehensive picture of client’s life, which assisted in confirming diagnosis.

Behavioral Observation

Client’s behavior was observed during the session. The client was boy of appropriate
height and weight. He was wearing school uniform and a cardigan which was weather appropriate. He
was neatly dressed. He was wearing a cap. He was sitting comfortably on his chair. At the beginning, he
was not maintaining eye contact, but after rapport was built, he maintained adequate eye contact. He
responded on his name. When he was asked to do coloring or write ABC or to do CPM, he looked at the
paper or booklet very closely. After coloring, he was asked the name of different fruits, vegetables, and
other things of daily use such as table, clock, chair, car, bicycle etc. While identifying bicycle, he said that
he rode bicycle. While recognizing boat, He told, that he had once rode a boat. The client was listening
carefully to the trainee clinical psychologist.

DSM-5 Based Symptoms and Severity Levels Checklists

The checklist based on DSM-V criterion of Intellectual Disability was used to assess the symptoms and
severity level of Intellectual Disability.
Table 1.3

Table shows DSM-5 Based Symptoms Checklist for Intellectual Disability.

Criteria Yes/No

Deficits in Intellectual Functioning Yes

Deficits in Adaptive Functioning Yes

Onset of Intellectual and Adaptive deficits during the developmental period Yes

The checklist based on DSM-V criterion of Intellectual Disability was used to assess the severity level of
Intellectual Disability.

Reinforcement Survey Schedule:

The therapist asked the child and her mother about the child’s favorite food items and games to identify
reinforcers. According to the mother, the child enjoys playing games like playing with dolls. She also likes
observing other children playing. Her mother mentioned that she enjoys eating bananas and chicken.
(See Appendix B for Reinforcement Survey Schedule)

Table 1.4

Table shows types of Reinforcers and Identified Reinforcers of the Child

Types of reinforcers Identified reinforcers

Consumable reinforcers Candies, chocolates, candies

Social reinforcers smile, clap, praise

Manipulative reinforcers

Activity reinforcers Playing

Play gun

Subjective Rating of Problematic Areas

Subjective ratings of problematic areas were taken from the mother of the client by the trainee clinical
psychologist on the scale of 1 to 10. 10 represents a severe problem, 5 represents an average problem,
and 0 represents no problem at all.

Table 1.5

Subjective rating of problematic areas as reported by mother

Complaints Subjective Rating

Poor academic performance 6

Stubbornness 5

Disobedience 6

Fights with the children 9

Gets angry easily 8

Baseline Chart

To identify the frequency, duration and intensity of the behavioral problems, a baseline chart was given
to the mother of the client. Behavioral problems, i.e., fighting with children and getting angry were
identified. The client’s mother was asked to fill in the chart each time the client is involved in the
identified behaviors. (See Appendix C)

The mother reported 2 incidents in a day.

Incident

1. His brother took his toy to play.

2. I was making his breakfast.

Client’s Behavior

1. He started making noise.

2. He got angry and started shouting.

Intensity

The average intensity of the client’s behavior is 9, which is above average.

Duration
The average duration of the client’s behavior is 30 minutes per day.

Consequences

1. I gave his football back to him.

2. I slapped him, he cried for some time and then silently ate breakfast.

Formal Assessment

Formal Assessment included:

• Slosson Intelligence Test (SIT)

• Colored Progressive Matrices (CPM)

• Childhood Adaptive Behavior Scale (CABS)

Slosson Intelligence Test (Slosson, 1963).

Sit was used to assess mental age and IQ of the client. The purpose of the Slosson
Intelligence Test (SIT) is to serve as a quick estimate of general verbal cognitive ability or index of verbal
intelligence.

Table 1.6

Table Showing the Result of Slosson Intelligence Test.

Date of Administration 6.12.2023

Date of Birth 02..2004

Chronological Age (Years) 17 years 9 months

Chronological Age (Months) 213months

Basal Age (Years) 5 years 8 months

Basal Age (Months) 68 months

Credit Months 28 months

Mental Age in (Years) 8 years 0 months

Mental Age (months) 96 months

Ratio IQ 45.07

Standard Error of Measurement 4.3

IQ Range 40.77-49.37

Table showed that client’s mental age 8 years which showed that his scores on mental age was lagging
behind his chronological age. His scores indicate his IQ range was 40.77-49.37. This show that her IQ
range falls under mental retardashion (Weschler, 1997).

Colored Progressive Matrices (CPM)

 Colored Progressive Matrices, a performance test, was administered to assess
intellectual capacity of the client. Reason by analogy is used to solve the items of CPM.

Table 1.7

Table showing Percentile Rank, Grade and Category

Raw Score Percentile Rank Grade IQ in Subnormal Group Category Time Taken

11 Below 5th 1 40 Intellectually Impaired 16 minutes

Children’s Adaptive Behavior Scale (Kicklighter & Richmond, 1980)

CABS was used to assess to current level of adaptive functioning of the client.

Table 1.8

Show Areas, Raw Scores and Age Equivalent

Areas Raw Scores Age Equivalent (years)

Language Development 24 7+

Independent functioning 22 9-
Family-role performance 25 8

Economic vocational activity 19 7-

Socialization 22 7+

Total Score 111 8-

Table indicated that client’ s scores were lagging her chronological age in all the areas. In language
development, he missed on items reading or writing three or more letter words. In Independent
functioning, he could not answer address, time. On economic vocational activity domain, he missed on
items asking identification of money. As client’s age is 17 years and 7 months so these age equivalent
scores are not appropriate to her chronological age, hence this indicates that client’s adaptive
functioning is below average.

Summary of Psychological Assessment

Client was assessed both formally and informally. SIT and CPM indicated deficits in
intellectual functioning. The result of Slosson Intelligence Test (SIT) and Colored Progressive Matrices
were in line. CABS indicated deficits in adaptive functioning. It was revealed that client was lagging
behind his chronological age in adaptive as well as intellectual functioning. The assessment aided in
confirming the diagnosis of the client. The assessment will help to propose proper management plan for
the client.

Diagnosis

319 (F71) Intellectual Disability, Moderate.

Case Formulation

According to DSM-V, Intellectual disability is the disorder having onset during the developmental period
that include deficits in intellectual functioning (confirmed by both clinical assessment and standardized
intelligence testing) and adaptive functioning deficits in conceptual, social, and practical domains. Client
suffered from these problems since his early childhood and currently enrolled in a special setup to learn
life-care skills.

According to DSM-5, Moderate Intellectual disability is characterized by markedly limited progress in

reading, writing, mathematics and understanding of time, money as compared to peers if his age. Client
has also little understanding of money and time, while his concept of money and time is far behind the
peers of his age. In social domain, spoken language is primary tool of communication and much less
complex than that of peers. Social judgement and decision making abilities are limited. In practical
domain, individual can take care of personal needs such as eating, dressing, elimination, and hygiene as
an adult, but an extended period of time is required to become independent in this area. Client had
been enrolled in Rising sun Institute since 2019, age the age of six. Since then, he had been learning all
these basic self-care skills and had learnt skills such as buttoning, zipping the shirt etc. The informal and
formal assessment has confirmed the diagnosis of client i.e., moderate intellectual disability.

According to DSM-5, males are more likely than female to be identified with intellectual disability. Client’
gender is also male.

Client parent’s had cousin marriage and his first cousin also had Intellectual Disable. A study by
Madhavan & Narayan (2001) indicated that if there is a history of intellectual disability in the family and
if the parents are consanguineously married, the risk of mental retardation in the offspring is significantly
high.

As reported in history, client’s mother during pregnancy passed through some stress and emotional
difficulty due to domestic issue. Study has indicated that prenatal stress is associated with reductions in
brain grey-matter density. Such altered grey matter may be associated with neurodevelopmental
problem such as Intellectual impairment (Glover,2014).

The risk of mild to moderate ID is highest among children of low socioeconomic status (Szumski &
Karwowski, 2012). As child belongs to low socioeconomic status, this factor could also be associated
with intellectual disability.

Client had diarrhea when he was one year old. Diarrhea remained for one year despite taking the
treatment. A study suggested early childhood diarrhea (ECD) has been associated with impaired physical
growth and cognitive function (Lorentz et al., 2006).
Client has achieved delayed milestones. A study showed that children with ID were more likely to show
delayed walking in the absence of autism spectrum disorder (Bishop et al., 2016).

Proposed Management

Management plan will be included short term and long term goals and will be proposed according to
problematic areas and complaints of client.

Short Term Goals

Rapport Building

Rapport will be built in order to make client comfortable. Rapport Building is extremely
important and is cornerstone in therapeutic process. Rapport building will make client comfortable and
will help in developing trust. Reinforcers will be identified by the trainee clinical psychologist. Trainee
clinical psychologist will build rapport with child by doing his favorite activities like coloring, reading a
story book, or giving him his favorite eatable.

Rapport will also be built with parents to the client. Rapport building with parents is also
important as parents are responsible for bringing child to the sessions. The relationship formed between
the trainee clinician psychologist and the parent can significantly influence the outcome of intervention
and is associated with positive intervention outcomes for young children (Ebert,2010). Rapport will be
built with parents by empathetically listening to them and developing trust.

Psychoeducation

In psychoeducation, Parents will be given briefing concerning the illness and

fundamental understanding of the therapy and further be convinced to commit to more long-term
involvement (Bauml, 2006). Psychoeducation will be done with the rationale of reducing stress,
confusion, and anxiety within the family which in turn would be helpful for them to manage the
problematic behavior of client in a better way. Client’s parents and caregiver will be briefed about the
disorder, its severity, therapeutic techniques used etc.

Positive Reinforcement
 Reinforcement is defined as a process in which a behavior is strengthened by the
immediate consequences that follows its occurrence. When a behavior is strengthened it is more likely
to occur in future (Miltenberger, 2016). In Positive reinforcement, 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.

Every time, client do a desirable behavior that will be included in client’s IEP like writing
English Alphabets correctly etc., identified reinforcers are provided to strengthen the behavior of the
client.

Chaining

Chaining procedures involve the systematic application of prompting and fading

strategies to each stimulus response component in the chain (Miltenberger, 2016).

In forward Chaining, Learner is taught first component first, then the second component, and so
on. Learner is presented the first (Discriminating stimulus) SD, correct response is prompted, and after
the response the learner is provided with a reinforcer. Prompt is faded when the person is performing
the first response when the first SD is presented.

Forward chaining will be used to teach to fixing the sandwich. First, task analysis will be
done, and task will be divided into components. For instance, first he will be reinforced on spreading
sauce on bread, then on putting salad and chicken and after that placing the second bread slice on the
chicken.

Chunking

Chunking will be used to teach client learn his parent’s phone number and his home
address. In Chunking technique, Concepts that are difficult or complex should be broken down into more
simple components. As the client learns each component, additional components can be added until the
larger concept is taught and learned (Colclasure, 2016).
Modeling

With modeling, the correct behavior is demonstrated for the learner. The learner

Observes the model’s behavior and then imitates the model. For this technique to be effective, the client
must be able to imitate and give attention to the model.

Modeling may be live, or it may be symbolic. In live modeling, another person demonstrates the
appropriate behavior in the appropriate situation. In symbolic modeling, the correct behavior is
demonstrated on video, audio, or possibly in a cartoon (Miltenberger, 2016).

Modeling can be used to learn skills like cutting shapes, fixing a sandwich, learning to write
English Alphabets, 1 to 20 numeric etc. For Instance, the model will cut the circle and the learner will
attend the behavior and imitate it. The learner could be reinforced if he imitates the behavior correctly.

Shaping

Shaping is defined as the differential reinforcement of successive approximations of a

target behavior until the person exhibits the target behavior. In shaping, successive approximation of
behavior is reinforced and preceding approximations of behavior is not reinforced (Miltenberger, 2016).

Prompting

A prompt is the behavior of another person that evokes the desired response in the
presence of SD. Prompt can be verbal prompt, gestural prompt, physical prompt etc.

Verbal prompting can also be used to learn to read three to four letter words. When the verbal
behavior of another person results in the correct response in the presence of SD, this is called verbal
prompt. For instance, if client will be learning to say “car,” the trainee clinical psychologist can show him
the flashcard with the word CAR and said car. By saying “car” trainee psychologist, prompted client to
make the correct response.
 For identification of money, prompting can also be used. Visual and verbal prompts will
be used. The trainee clinical psychologist can use flashcard having pictures of 1, 2 and 5 rupees coins.
The psychologist will say 1 rupee every time, 1 rupee coin flashcard is shown, and learner will also repeat
it.

Individualized Education Plan

The IEP will be developed collaboratively. It will include input from many sources. The curriculum will be
designed around client’s needs and abilities. The focus will be to help the client to improve her academic
skills. IEP will be made t make client learn the concept of time and money, learn to write English
alphabets, Arabic counting, cutting a shape, memorizing his home address and caregiver phone number.

Long Term Goals

• Continuation of short-term goals will be carried out in order to enhance the skills that the client
will learn throughout the therapy.

Conclusion

The client was a boy of 17 years and 9 months old, who was dressed neatly according to the weather. He
was enrolled at Rising Sun Institute of Special Education. He was assigned to trainee clinical psychologist
for his assessment and proposing a management plan to fulfill trainee clinical psychologist course
requirement. It was revealed that client was lagging behind his chronological age in adaptive as well as
intellectual functioning. The assessment aided in confirming the diagnosis of the client. The assessment
will help to propose proper management plan for the client. The child was diagnosed with moderate
Intellectual Disability.

Limitations and Suggestions

• It was not permissive to interview parents. Due to this, limited information was gathered about
the history of the client.
 • There should be separate room for conducting session with client and parents to avoid
distraction.

References

Rathnakumar, D. (2020). Play Therapy and Children with Intellectual Disability. Shanlax International
Journal of Education, 8 (2), 35–42. https://doi.org/10.34293/ education.v8i2.2299

Bishop, S. L., Thurm, A., Farmer, C., & Lord, C. (2016). Autism spectrum disorder, intellectual
disability, and delayed walking. Pediatrics, 137(3).

Glover, V. (2014). Maternal depression, anxiety and stress during pregnancy and child outcome; what
needs to be done. Best practice & research Clinical obstetrics & gynecology, 28(1), 25-35.

Colclasure, B. C., Thoron, A. C., & LaRose, S. E. (2016). Teaching Students with Disabilities: Intellectual
Disabilities. EDIS (6), 3-3.

Szumski, G., & Karwowski, M. (2012). School achievement of children with

Intellectual disability: The role of socioeconomic status, placement, and parents’ engagement. Research
in Developmental Disabilities, 33(5), 1615–1625. Doi:10.1016/j.ridd.2012.03.030
Ebert, K. D. (2018). Parent perspectives on the clinician-client relationship in speech-language
treatment for children. Journal of Communication Disorders, 73, 25-33.

Raven, J. C., Court, J. H., & Ravens, J. (1984). Colored Progressive Matrices & vocabulary scales. J. C.
Raven Ltd.

Kicklighter, R. H., & Richmond, B. O. (1980). Children’s Adaptive Behavior scale. Stoelting CO.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
ed.). American Psychiatric Pub.

Wechsler, D. (1997). Wechsler adult intelligence scale (3rd ed.). Psychological Corporation.

Madhavan, T., & Narayan, J. (1991). Consanguinity and mental retardation. Journal of Intellectual
Disability Research, 35(2), 133-139.

Miltenberger, R.G., (2016). Behavior Modification: Principles and Procedures (6 th ed.). Cengage
Learning

Lorntz, B., Soares, A. M., Moore, S. R., Pinkerton, R., Gansneder, B., Bovbjerg, V. E., … & Guerrant, R. L.
(2006). Early childhood diarrhea predicts impaired school performance. The Pediatric infectious
disease journal, 25(6), 513-520.

Appendix A

Permission Letter

‫معلوماتی شیٹ‬
‫میں تعلیمی مقاصد کے لیے آپ کے بچے کی مسئلے کی تشخیص اور عالج کروں گی مگر اس سے پہلے آپ کو چند باتوں کا علم‬
‫‪:‬ہونا ضروری ہے جو درج ذیل ہیں‬

‫معلومات حاصل کرنے کا مقصد ‪1-‬‬

‫آپ سے اور آپ کے بچے سے جو بھی معلومات حاصل کی جائے گی وہ صرف اور صرف تعلیمی مقاصد کے لیے استعمال ہوں‬
‫گی جس میں آپ کے بچے کی موجودہ صورتحال کو بہتر طور پر سمجھنا‪ ،‬مسئلے کی شناخت اور اس کا عالج شامل ہیں ۔ ان‬
‫مقاصد کے لیے آپ سے اور آپ کے بچے سے سواالت پوچھے جائیں گے‪ ،‬اور ذہنی صالحیت کا اندازہ لگانے کے لیے کچھ‬
‫سرگرمیاں کاروائی جائیں گی۔‬

‫اس لیے آپ سے درکار ہے کہ آپ تمام معلومات مکمل سچائی اور ایمانداری سے فراہم کریں۔‬

‫آپ کے حقوق ‪2-‬‬

‫‪:‬مندرجہ ذیل حقوق ہیں‬

‫•‬ ‫اگر اس سارے دورانیہ میں آپ یا آپ کا بچہ کسی قسم کے ذہنی دباؤ کا شکار ہوتا ہے تو ہمارے ادارے کی جانب سے‬
‫مدد دی جائے گی۔‬

‫•‬ ‫آپ اور آپ کے بچے کی شناخت کو مکمل رازداری میں رکھا جائے گا۔‬

‫•‬ ‫اس دورانیہ میں بچے کی باقی سرگرمیاں معمول کے مطابق ہوں گ‬

‫•‬ ‫آپ جب چاہیں اس عالج کو بغیر وجہ فراہم کیے چھوڑ سکتے ہیں اور آپ پر کسی قسم کا جرمانہ عائد نہیں کیا جائے گا۔‬

‫رازداری ‪3-‬‬

‫آپ سے یا آپ کے بچے سے جو بھی معلومات حاصل کی جائے گی وہ مکمل رازداری میں رکھی جائے گی۔ سوائے ان چند حاالت‬
‫‪:‬کے‬
 ‫•‬ ‫آپ کی یا آپ کے بچے کی دی ہوئی معلومات عدالت کسی سلسلے میں طلب کر لے۔‬

‫•‬ ‫ایسی معلومات جس سے یہ اندیشہ ہو کہ بچے یا کسی اور کو جانی یا مالی نقصان ہو جائے۔‬

‫اجازت نامہ‬

‫•‬ ‫اپنی رضامندی ظاہر کرنے کے لیے نیچے دستخط کریں۔‬

‫•‬ ‫۔ میں نے تمام معلومات کو پڑھ اور سمجھ لیا ہے جیسا معلوماتی شیٹ میں فراہم کی گئی ہے۔‪1‬‬

‫•‬ ‫۔ مجھے معلومات کے بارے میں سواالت کرنے کا موقع فراہم کیا گیا ہے۔‪2‬‬

‫•‬ ‫۔ میں سمجھتی ہوں کہ میں کسی بھی وقت بغیر وجہ بتائے پیچھے ہٹ سکتی ہوں۔ نا مجھ سے کوئی سوال کیا جائے گا نہ‪3‬‬
‫کوئی جرمانہ عائد کیا جائے گا۔‬

‫•‬ ‫۔ رازداری سے متعلق طریقے کار کو واضح طور پر بیان کیا گیا ہے مثال کے طور پر ناموں کو خفیہ رکھنا۔‪4‬‬
‫•‬ ‫۔ مجھے معلومات کا مقصد اور طریقہ کار بتایا گیا ہے۔‪5‬‬

‫•‬

‫•‬ ‫_________________‪:‬والدین (‪ /‬استاد) کا نام‬

‫•‬ ‫_________________‪:‬والدین (‪ /‬استاد) کے دستخط یا انگوٹھےکےنشان‬

‫•‬ ‫______________‪:‬نمبر‬

‫•‬ ‫_______________‪:‬تاریخ‬
‫‪Appendix B‬‬

‫‪Checklist for severity levels of intellectual deficits‬‬

‫‪Profound‬‬ ‫‪Severe Moderate‬‬ ‫‪Mild‬‬ ‫‪Conceptual Domain‬‬

‫‪‬‬ ‫آپ کے بچے کو اپنا سبق یاد کرنے میں‪ ،‬لکھنے میں‪ ،‬یا پڑھنے میں کوئی مسئلہ ہوتا ہے؟‬

‫‪‬‬ ‫کیا آپ کے بچے کو حساب کرنے ا ور وقت دیکھنے میں مشکل ہوتی ہے؟‬

‫‪‬‬ ‫کیا آپ کو لگتا ہے کہ یہ اپنی پڑھائی ا ور روزمرہ کےکاموں میں اپنی عمر کے باقی‬
‫بچوں سے پیچھے ہے؟‬

‫‪‬‬ ‫کیا اس کو لکھی ہوئی بات سمجھ آتی ہے؟‬

 ‫‪‬‬ ‫کیا یہ خود سے فیصلہ کر لیتا ہے؟‬

‫‪‬‬ ‫آپ کا بچہ کسی کام کو کرنے کی منصوبہ بندی کر لیتا ہے؟‬

‫‪‬‬ ‫کیا اس کو کچھ وقت پہلے کی باتیں یاد رہتی ہیں جیسے صبح ناشتے میں کیا کھایا تھا؟‬

‫‪‬‬ ‫کیا اس کو یہ معلوم ہوتا ہے کہ کون سا کام پہلے کرنا ہے ا ور کون سا بعد میں؟‬

‫‪‬‬ ‫جو کچھ اس نے اپنی پڑھائی سے سیکھا ہوتا ہے اس کو اپنی روزمرہ زندگی میں استعمال‬
‫کرتا ہے؟‬

‫‪Social Domain‬‬

‫‪‬‬ ‫کیا اس بچے کو سماجی اشارے سمجھنے میں مشکل ہوتی ہے؟‬

‫‪‬‬ ‫کیا یہ اپنی عمر کے حساب سے بات چیت یا گفتگو کر لیتا ہے؟‬

‫‪‬‬ ‫کیا یہ اپنی گفتگو میں مشکل ا ور بامعنی الفاظ کا استعمال کر لیتا ہے؟‬

‫‪‬‬ ‫کیا یہ بچہ اپنی عمر کے حساب سے رویوں ا ور احساسات کا اظہار کر لیتا ہے؟‬

‫‪‬‬ ‫کیا اس بچے کو اس بات کی سمجھ ہے کہ اس نے آپ کو بتا کہ گھرسے باہر جانا ہے یا‬
‫کسی اجنبی سے کوئی چیز نہیں لینی؟‬

‫‪‬‬ ‫کیا یہ ا پنے گھر والوں کے عالو ہ باقی لوگوں سے میل جول رکھ لیتا ہے؟‬

‫‪Practical Domain‬‬
 ‫‪‬‬ ‫کیا آپ کا بچہ اپنے ذاتی کام خود کر لیتا ہےجیسے کھانا کھانا ‪،‬منہ دھونا‪ ،‬ہاتھ دھونا‪ ،‬واش‬
‫روم جانا ‪،‬کپڑے بدلنا وغیرہ‬

‫‪‬‬ ‫کیا آپ کا بچہ اپنی صفائی کا خیال خود رکھ لیتا ہے؟‬

‫‪‬‬ ‫کیا اس بچے کو روزمرہ کے مشکل کاموں میںکسی کی مدد کی ضرورت پیش آتی ہے‬
‫جیسے کہ دکان سے کچھ خریدنا یا پیسوں کا حساب کتاب رکھنا؟‬

‫‪‬‬ ‫کیا اس کو کھیلنے کے لیے چیزوں کو ترتیب دینے کے لیے مشکل ہوتی ہے؟‬

‫‪‬‬ ‫کیااس بچے میں کچھ حد تک نامناسب رویے موجود ہیں جو اس کی سماجی زندگی کو‬
‫متاثر کر رہے ہوں؟‬

‫‪Appendix C‬‬
Baseline Chart
Appendix D
Slosson Intelligence Test

Appendix E
Colored Progressive Matrix

Appendix F
Childhood Adaptive Behavior Scale (CABS)

Appendix G

Individualized Education Plan (IEP)

Name: Z.A

Age: 17 years 9 months

Diagnosis: Moderate intellectual disability

Strengths
 • He had Fine visual and auditory senses

• He had developed some fine and gross motor skills

• He showed on seat behavior

• He was imitating

• Draw circle,square,triangle

• Colouring

• Counting 1-20

• Alphabet

• Urdu harof

Weakness

• Limited attention span

• Easily distracted while doing something

Goals

Table

Showing behaviors and skills absent in the client, techniques that could be used to teach skills and
mastery level that must be achieved

Behaviors and Skills Techniques

Language

Writing English alphabets from E to Z, counting from 1 to 20 and all Urdu alphabets properly. Physical
prompting, positive reinforcement.

Reading three letters’ words Verbal Prompt, Shaping, Repeated reading

Independent Functioning

Watch and Tell the Time Verbal prompting, gestural prompting

Cutting shapes (circle) Modeling, Forward Chaining

Learn to tell address Verbal prompting and positive reinforcement

Family Role Performance

Fixing a sandwich Modeling, Forward Chaining

Economic-Vocational Activity

Identification of Money Role play, Prompting

Socialization

First Name of parents Modeling

Task Analysis

We will use reinforcement at any effort made by the client to do the tasks. Finally, differential
reinforcement will be used.

Language Development: Counting from 1 to 20.

1. Z.A. will count from 1 to 20 on verbal prompt 50% of the time.

2. Z.A. will count from 1 to 20 on verbal prompt 70% of the time.

3. Z.A. will count from 1 to 20 on verbal prompt 100% of the time.

4. Z.A. will be able to count from 1 to 20 without any prompt 70% of the time.

5. Z.A. will be able to count without any prompt 100% of the time.

Independent Functioning: H.M. will tie his shoes.

 1. Z.A. will cut shapes in imitation of the adult, i.e., physical prompt is used.

2. Z.A. will cut shapes; use shadowing to fade physical prompt.

3. Z.A. will cut shapes 30% of the time on verbal prompt.

4. Z.A. will cut shapes 100% of the time on verbal prompt.

5. Z.A. will cut shapes 30% of the time without any prompt.

6. Z.A. will cut shapes 90% of the time without any prompt.

Family Role Performance: H.M. will make tang.

1. Z.A. will fix a sandwich, i.e., physical prompt is used.

2. Z.A. will fix a sandwich; use shadowing to fade physical prompt.

3. Z.A. will fix a sandwich 30% of the time on verbal prompt.

4. Z.A. will fix a sandwich 50% of the time on verbal prompt.

5. Z.A. will fix a sandwich 70% of the time on verbal prompt.

 6. Z.A. will fix a sandwich 100% of the time on verbal prompt.

7. Z.A. will fix a sandwich 100% of the time without any prompt.

Economic-Vocational Activity: Identification of money

1. Z.A. will identify money in imitation of the adult, i.e., physical prompt is used.

2. Z.A. will identify money; use shadowing to fade physical prompt.

3. Z.A. will identify money 50% of the time on verbal prompt.

4. Z.A. will identify money 70% of the time on verbal prompt.

5. Z.A. will identify money 100% of the time on verbal prompt.

6. Z.A. will identify money 100% of the time without any prompt.

Socialization: First name of parents.

1. Z.A. will say first name of parents in imitation to adult (here physical prompt is used)

2. Z.A. will say first name of parents; we will now use shadowing to fade physical prompt.

3. Using verbal prompt, Z.A. will say first name of parents.

4. Z.A. will be able to say first name of parents 20% of the time without any prompt.

5. Z.A. will say first name of parents 80% of the time without any prompt.

6. Z.A. will say first name of parents 90% of the time without any prompt.