Virtual University Of Pakistan

Case1: Attention-Deficit Hyperactivity Disorder (ADHD)

Case2: Intellectual Developmental Disorder (IDD)
Submitted By:
Sana Hameed
Bc210411675
Session: 2021-2023
Submission Date: 5/14/2024

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 ACKNOWLEDGEMENTS
I would like to express my sincere gratitude to several individuals for supporting me
throughout my Internship. First, I wish to express my sincere gratitude to my
supervisor, Miss Hira Awan, for her patience, insightful comments, helpful
information and practical advice that have helped me tremendously at all times in my
first step towards practical life.

I also wish my sincere thanks to my Psychologist Mam Aasma Munir for her time
and guidance. In addition, I am deeply grateful to Govt. Special Education Center,
Rawalpindi for giving me the opportunity to work for them.

Finally, last but by no means least; I am also grateful to everyone in my family for
tolerating me during this time and for helping me throughout my study.

Thanks for all your encouragement!

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 CASE SUMMARY:
In order to complete the course requirement of PSYI-619, I had been doing my
internship in Govt. Special Education Center, Rawalpindi. My Psychologist has
referred the cases of ADHA and IDD for my work.

MK was 8years old boy suffering from ADHD. For gathering case history, his parents
were contacted. They’ve told us that MK had delayed milestones and he was restless
all the times. His teachers also complained about his inattentiveness. So, in order to
confirm, we’ve conducted interviews and behavioral observation of MK. We
suspected ADHD in him so we gave NICHQ Vanderbilt Assessment Scale for
teacher and parent; and Portage guide in order to study the developmental delays
of MK. Further, we conducted Human Figure Drawing on MK. All these
psychological tests have revealed that MK was suffering from combined subtype of
ADHD. Medication and behavioral therapy were prescribed to improve his condition.

ISA was a 10 years old girl suffering from IDD. For gathering case history, her
parents were contacted. They’ve told us that she had delayed milestones and she had
trouble with understanding instructions and problem-solving. Her teachers also
complained about her having difficulty in learning new concepts. So, in order to
confirm, we’ve conducted interviews and behavioral observation of ISA. We
suspected IDD in her so we gave Portage guide to her informants in order to study
the developmental delays and mental age of ISA. Further, we conducted Human
Figure Drawing and Raven’s Colored Progressive Matrices on ISA. All these
psychological tests have revealed that ISA was suffering from severe intellectual
developmental disorder. Medication and behavioral therapy were suggested for the
betterment of ISA’s condition.

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 LETTER OF UNDERTAKING

I Sana Hameed Student VU IDBC210411675 hereby confirm that the internship

report I have provided is solely my own effort. I did not copy my report partially or
completely from any other student or from any other source either against payment or
free and I did not provide any plagiarized material in any section of my report. I
further confirm that the documents (internship completion certificate & evaluation
form) that I have provided are genuine (i.e. not forge/fake) and have been issued by
the authorized person in the organization. If I am found guilty of misstating,
misleading or concealing the facts about my activities (either academic or non-
academic but relevant to this course) at any stage, the university is authorized to take
disciplinary action against me according to university policies and regulations.

I hereby also confirm that I have carefully read and understood all the guidelines,
rules and regulations provided by the course instructor on VULMS. I assure that I will
follow the instructions regarding presentation & viva voce. I understand that I will be
declared as fail if I do not make suggested revisions and meet deadlines. I will appear
on the scheduled date for presentation & viva voce which will be intimated to me at
my VU-email ID by the Course Instructor. In case of any negligence, I shall be held
responsible.

Name: Sana Hameed

Date: 5/14/2024

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Table of Contents
CASE 1.............................................................................................................................7
Background Information/ History:...................................................................................7
Presenting complaints:..................................................................................................7
Psychological History:...................................................................................................7
1. Predisposing factors:...........................................................................................7
2. Precipitating factors:...........................................................................................8
3. Maintaining factors:...........................................................................................8
Family History:.............................................................................................................8
Father:.......................................................................................................................8
Mother:......................................................................................................................8
Siblings:.....................................................................................................................8
Medical, Psychiatric and Drug History:......................................................................8
Personal History............................................................................................................9
1. Prenatal History:................................................................................................9
2. Natal History:.....................................................................................................9
3. Postnatal History:...............................................................................................9
4. Vaccination and reactions:..................................................................................9
5. Developmental History:.......................................................................................9
6. Schooling and social relationship:.......................................................................9
Psychological assessment:...............................................................................................10
Informal assessment:...................................................................................................10
Behavioral observation:...........................................................................................10
Clinical interview:...................................................................................................10
Reinforcer Identification:........................................................................................11
Formal assessment:.....................................................................................................11
Analysis and Results of the Psychological Tests:.....................................................11
Tentative Diagnosis:....................................................................................................12
Recommended therapy:..............................................................................................12
Case Formulation:.......................................................................................................13
CASE 2:..........................................................................................................................14
Background Information/ History:.................................................................................14
Presenting complaints:................................................................................................14
Psychological History:.................................................................................................14

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 1. Predisposing factors:.........................................................................................14
2. Precipitating factors:.........................................................................................15
3. Maintaining factors:.........................................................................................15
Family History:...........................................................................................................15
Father:.....................................................................................................................15
Mother:....................................................................................................................15
Siblings:...................................................................................................................15
Medical, Psychiatric and Drug History:....................................................................15
Personal History..........................................................................................................15
1. Prenatal History:...............................................................................................16
2. Natal History:...................................................................................................16
3. Postnatal History:.............................................................................................16
4. Vaccination and reactions:................................................................................16
5. Developmental History:.....................................................................................16
6. Schooling and social relationship:.....................................................................16
Psychological assessment:...............................................................................................17
Informal assessment:...................................................................................................17
Classroom observation:...........................................................................................17
Clinical interview:...................................................................................................17
Reinforcer Identification:........................................................................................17
Formal assessment:.....................................................................................................18
Analysis and Results of the Psychological Tests:.....................................................18
Tentative Diagnosis:....................................................................................................19
Recommended therapy:..............................................................................................19
Case Formulation:.......................................................................................................20
APPENDICES.................................................................................................................21

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CASE 1
Background Information/ History:
MK was a male child admitted to Govt. Special Education Centre, Rawalpindi on 28-02-
2020. He was 8 years old at the time of assessment and born on 4-April-2015. He
was the eldest of his three siblings. He was studying in MCC (Mentally Challenged Children
Classroom). His parents observed his abnormal behavior and admitted him at this institute.

Main reasons for referral:

MK was referred by the Psychologist Dr. Aasma Munir and being assessed as an
academic course requirement and for the partial fulfillment of the degree of PSYI619
from the Virtual University of Pakistan.

Presenting complaints:
 Child’s verbatim:
Presenting Complaints Duration (in
weeks/months/years)
Mn thak jata hun N/A (He didn’t tell the
duration)
Sabaq yaad nahi hota 3 years

Mujhy sb danty hn kehty hn mn tikta nahi hun 3 years

Informant’s verbatim:

Presenting Complaints Duration (in

weeks/months/years)
Teacher Aik jagah tik kr nahi beth skta 3 years
Khamoshi se kuch bhi nahi krta 2 years
Careless h 1.5 years

Parents Bohat ulta seedha bolta h 4 years

Hr waqt phirki ki trah ghoomta rehta 5 years

h
Hr waqt bechyn rehta h 2 years

Psychological History:

1. Predisposing factors:
MK other siblings were also suffering from such anomalies. So maybe there were
some genetic factor were contributing in the disorder. When he was of 2-3 months, he
caught a fever that persisted for 2.5-3 months; this fever could be the cause of his

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disorder in such a way that maybe this fever was due to the problems in brain. But we
could only speculate about these causes as his parents hadn’t undergone any CT-scan,
etc. to know the cause of problem.

2. Precipitating factors:
Parents had reported that the child was having trouble with paying attention to the
commands of elders. Whenever, he was called he didn’t pay attention.

At first, they thought that MK had hearing impairment. But his hearing tests were
clear. Further they said that when MK was registered to a normal school, his teacher
complained that he was inattentive and needed a special school.

3. Maintaining factors:
He was spending too much time on TV watching and playing videogames on phone.
This could cause the symptoms of ADHD to become severe.

Family History:

Father:
MK’s father was alive and a shopkeeper. He was SSC passed male and 39 years old
and completely healthy in terms of mental health and physical health. His relationship
with MK and his siblings was loving and caring. As far as his father’s relationship
with MK’s mother was concerned, it was satisfactory. Friendliness, flexibility and co-
cooperativeness were his personality traits.

Mother:
MK’s mother was 39 years housewife and a matriculation pass alive female. She was
mentally and physically healthy. Optimism, cooperativeness and flexibility were her
personality traits. Her relationship with MK and his siblings was helping and
nurturing. MK mother’s relationship with his father was satisfactory.

Siblings:
MK was first born of his parents and he had two brothers and one sister. The physical
and mental health of his siblings was abnormal like MK. His relationship with his
other siblings was friendly.

The overall environment of MK’s family was caring and nurturing.

Medical, Psychiatric and Drug History:

Diabetes run in MK’s family. Cousin marriages prevail in MK’s family and MK’s parents
were 1st cousins. His siblings were also abnormal indicating some genetic anomalies in his
family.

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 No drug or alcohol abuse was found in the family.

Personal History

1. Prenatal History:
MK’s mother was mentally and physically healthy during pregnancy. The gestation
period was 9 months. Mother’s diet during pregnancy was healthy and she was using
food supplements in her pregnancy.

2. Natal History:
His mode of delivery was C-section and was conducted in hospital. His first cry was
sudden. He was a normal child at the time of birth.

3. Postnatal History:
He had continuous fever for 2.5-3 months. He had a chewing problem as he got older.

4. Vaccination and reactions:

MK got all of his vaccination and did not get any infection due to these vaccinations.

5. Developmental History:
Sr. no. Developmental Average age of Achieved Delayed time
age
Milestones achievement duration

1. Neck holding 1-2 months 9 months 7 months

2. Support 5-8 months 1 years 4 months

3. Sitting 5-6 months 2 years 1.5 year

4. Standing 9-12 months 2 years 3 1 year and 3 months

months

5. Walking 9-10 months 3 years 2 years and 2

months

6. Speech 1 year 5 years 4 years

7. Babbling 9-13 months 1.5 years 5 months

8. Toilet training 4 years 6 years 2 years

6. Schooling and social relationship:

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When MK got registered in a normal school, his teachers said that MK could not pay
attention to teacher’s command. He had troubles with initiating relationship.

Psychological assessment:
The assessment was done on two levels i.e. informal and formal assessment.

Informal assessment:
Behavioral observation:
Mk was observed by the internee for a week under the supervision of Dr. AasmaMunir.
During this time, his behavior had been observed for an hour daily. And it was concluded
that:

Sr. no. Behaviors Frequency

And Intensity
(Day 1-7)

1. He could not sit quietly during the whole time. F=3

I=2

2. He seems to ignore the commands of other or is F=5

inattentive I=2

3. He is always on the go. F=4

I=1

4. Can’t play quietly F=4

I=2

5. Forget important things. F=1

I=3

6. Can’t wait for the turns. F=6

I=1

7. Fidget and squirm on the seat. F=6

I=1

8. Frequently interrupts others F=6

I=1

(I =1 for severe, I=2 for average and I=3 for mild)

Clinical interview:
An interview is conducted with MK’s parents and MK to know the condition of MK. They
told that MK has Delayed Milestones. He was habitual of ignoring others (which later own
revealed that he was not ignoring he was suffering from ADHD) and not responsive. They
had also informed that he could not sit quietly and tend to interrupt other. We (the internee)
doubted that it was due to ADHD so we asked different questions related to ADHD and their

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responses were a clear indication of ADHD. So we gave them different questionnaires in
order to understand MK’s disorder.

Reinforcer Identification:
Primary reinforcement: MK was reinforced by two types of primary reinforcements:

Tangible:

Whenever MK sit quietly for a given time duration he is given his favorite cookies.

Intangible:

Whenever MK raised hand for answer, the teacher allowed him to sit with her.

Secondary Reinforcement: secondary reinforcements for MK are:

Tangible:

Whenever MK played quietly with his siblings, he was given money.

Intangible:

When MK wait for his turn during getting homework or blocks for playing, his teacher praise
him in front of his class.

Problem identification:

All of these symptoms and observations have revealed that MK has some disorder.
His symptoms like can’t sit properly, can’t wait for the turn and always driven by
motor indicate that MK might have ADHD which could further be confirmed by
psychological testing.

Formal assessment:
 NICHQ Vanderbilt Assessment Scale for teacher and parent was used to know
the presence or absence of ADHD.
 Portage Guide for Early Education (PGEE) was used to study the
developmental delays of child.
 Additionally, Human Figure Drawing (HFD) was used for the IQ
measurement of the child.

Analysis and Results of the Psychological Tests:

NICHQ Vanderbilt Assessment Scale for teacher and parent:

The parent and teacher copy of NICHQ Vanderbilt Assessment Scale was given to the
concerned persons. MK’s teacher and mother rated the Behavior of MK on a 4-point scale.

MK has scored 2 or 3 in 17 out of 18 items in teacher’s form and in case of parents

form he had scored 2or3 in 14 out of 18 items (from items 1-18) which revealed that

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MK has a combined subtype of ADHD having both inattention and
hyperactivity/impulsivity symptoms.

Other disorders like Oppositional-defiant disorder, Conduct or Anxiety or depression

are not found in MK.

The overall performance score by parents and teachers are 4 and 7 respectively. These
scores reveal that MK has some problem in academics, social interaction and
cognition.

Portage Guide for Early Education (PGEE):

PGEE commonly known as portage guide or portage program was used to calculate
MK’s mental age. His mental age was estimated to be 2.5 years.

As far as his development in different domains was concerned, his cognition and self-
help domains are matters of great concern.

His IQ was 25 which is an indication of mental retardation or intellectual disorder but

it would require further testing for confirmation.

Human Figure Drawing (HFD):

Time Taken: HFD was completed in 10 minutes.

The HFD test revealed that the client has extremely low IQ (below 69 i.e. 66).

Tentative Diagnosis:
314.01 (F90.2) Attention-Deficit/Hyperactivity Disorder with Combined presentation

The client was showing the symptoms of squirming and fidgeting a lot, can’t quietly
engage in leisure activities, often interrupt others, make careless mistakes, and does
not seem to listen when spoken directly. All these symptoms indicates the presence of
combined subtype of ADHD.

Recommended therapy:
After the diagnostic phase of ADHD, the treatment plan has been made. The
medication and Eclectic Approach is recommended for MK. These treatments can
bring relief from the symptoms and make ADHD manageable for MK.

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There is a no. of medicines that are used to control hyperactive and impulsive
behaviors of patients along with the improvement of attention span. Among these
medicines Methylphenidate is the most commonly used medicine for ADHD. It
belongs to a group of medicines called stimulants, which work by increasing activity
in the brain, particularly in areas that play a part in controlling attention and behavior.

As far as therapy is concerned, our main focus was on changing behavior. In this
regard Special Education centers play an important role. In order to change MK’s
behavior, an Eclectic Approach will be used.

The behavioral therapy’s principles would be used to change the bad behaviors of MK
in to the desirable ones. Like he will be taught through behavioral therapy that
whenever he would wait for his turn in school canteen, he will be allowed to have his
favorite cookies.

Art therapy and Play Therapy in combination would be used for several purposes. Art
and role-playing will help MK to channelize his energy into some productive work. It
would also improve MK’s communication and interpersonal skills as he would
explain his artwork to others. It would also help him in social interactions and maybe
he could excel in art in the future and make a career (as he is very good in drawing
objects). Both of these therapies could help in learning, proving reassurances, calming
anxiety and improving self-esteem.

Social skills training could also be helpful.

Furthermore, family counseling will also be helpful in which MK’s family will be
taught on how to deal with ADHD patients, The do’s and don’ts of ADHD clients.

Case Formulation:

MK case was supported by the Biological Perspective. The biological perspective

views psychological disorder with biological phenomenon. And MK case was a
biological phenomenon as he had a fever during infancy which prevailed for 3
months. This fever might cause some biochemical changes in his brain which could
cause ADHD in him. In addition, other developmental disorder was found in his first
cousins as well as his siblings so there might be some genes that are contributing in
the prevalence of developmental disorder among his family.

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CASE 2:
Background Information/ History:
ISA was a female child admitted to Govt. Special Education Centre, Rawalpindi on 27-
09-2021. She was 10 years old at the time of assessment and her date of birth was
12-10-2013. She was the eldest of her three siblings. She was studying in MCC (Mentally
Challenged Children Classroom). Her parents observed her abnormal behavior and
admitted her at this institute.

Main reasons for referral:

ISA was referred by the Psychologist Dr. Aasma Munir and being assessed as an
academic course requirement and for the partial fulfillment of the degree of
PSYI619 from the Virtual University of Pakistan.

Presenting complaints:
 Child’s verbatim:

Presenting Complaints Duration (in weeks/months/years)

Sara din parh kr bhi sabaq yaad nahi hota 4 years
Mery number baqi bachon se km aty hn. 4 years
who to prhty bhi nahi hn
Mujh se naye logon se baat nahi hoti N/A (She didn’t tell anything
about it)

Informant’s verbatim:

Presenting Complaints Duration (in

weeks/months/years)
Teacher Prhai mn kamzor h 1.5 years

Easy baat bhi nahi samajh pati 1 year

Baqi bachon k sath ghulti milti nahi 2 years

h
Parents Bohat der se bolna aur chalna shuru N/A
kiya
Batein aur cheezyn bhool jata h 5 years

Ghussa jldi a jata h 5 years

Psychological History:

1. Predisposing factors:

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ISA was a premature child. Her first cry was very late and also had a
breathing problem. Her mother was not taking any multivitamins or any food
supplements during pregnancy which may cause malnutrition in ISA. And she
has some cardiac and diabetic problems too. All of these factors may cause the
development of Intellectual Developmental Disorder in ISA.
2. Precipitating factors:
ISA was a developmentally delayed child. She had started late walking, crawling and
talking. When ISA was admitted to normal school, she could not perform well
in that school. Her parents had changed many schools but she could not work
in them. So after seeing her delayed responses in school, her teachers had
advised ISA’s parents to admit her in special school.

3. Maintaining factors:
ISA’s father’s personality could be the cause in the worsening of her symptoms. As
he had some anger issues which could affect her self-esteem which turn would be the
reason of her social isolation and reluctance to talk to others.

Family History:
Father:
ISA’s father was alive and a driver. He was SSC passed male of 40 years old and
completely healthy in terms of physical health. His relationship with ISA and her
siblings was normal. As far as his relationship with ISA’s mother was concerned, it
was satisfactory. Aggression and rigidness were his personality traits.

Mother:
ISA’s mother was 39 years housewife and a matriculation pass alive female. She was
mentally and physically healthy. Optimism, cooperativeness and flexibility were her
personality traits. Her relationship with ISA and her siblings was helping and
nurturing. ISA mother’s relationship with her father was satisfactory.

Siblings:
ISA was first born of her parents and she had two brothers and one sister. The
physical and mental health of her siblings was normal except ISA and her sister. Her
sister was also a mentally disturbed person. Her relationship with her other brothers
was friendly. But her relationship with her sister was strained.
The overall friendly environment of MK’s family was expressive and nurturing.
Medical, Psychiatric and Drug History:
Her parents were 2nd cousins and her family has a history of Down’s syndrome or
other disorders that are caused by inheritance.
Her father was a chain smoker and not any other drug abuse was found in the family.

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Personal History
1. Prenatal History:
ISA was a premature child. Her mother had not taken any food supplements during her
pregnancy. Her mother was healthy during her pregnancy. The gestation period was 7
months. ISA mother’s diet was good during her pregnancy.

2. Natal History:
Her mode of delivery was C-section which occurred in hospital. At first she had breathing
problem. Otherwise the baby was healthy at the time of birth.

3. Postnatal History:
She had a late first cry and was kept in incubator for a fortnight. ISA had got cardiac
problems during her initial stages of development.

4. Vaccination and reactions:

MK got all of his vaccination and did not get any infection due to these vaccinations.

5. Developmental History:
Sr. Developmental Average age of Achieved Delayed time
no. Milestones age
achievement duration

1. Neck holding 1-2 months 6 months 4 months

2. Support 5-8 months 10 months 2 months

3. Sitting 5-6 months 1.5 year 1 year

4. Standing 9-12 months 1 year and 9 months

9 months

5. Walking 9-10 months 2.5 years 1 year and 8 months

6. Speech 1 year 4 year 3 year

7. Babbling 9-13 months Don’t N/A

remember

8. Two words 14 months Don’t N/A

remember

9. Toilet training 4 years 6 years 2 years

6. Schooling and social relationship:

When ISA got registered in a normal school, her teachers said that ISA could not
remember, and memorize her lessons even if she tried hard to learn it. She also had
troubles with initiating relationship with her peers.

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Psychological assessment:
The assessment was done on two levels i.e. informal and formal assessment.

Informal assessment:
Classroom observation:
The child was observed for a week for one hour by the internee under the supervision
of Dr. Aasma Munir. She was having difficulty in remembering, and was irresponsive
towards commands. She could not even build a simple block design like a tower even
when demonstrated several times. She could not follow the verbal instructions of
doing a task which was very apparent while I’ve given her HFD.

Clinical interview:
An interview is conducted with ISA’s parents in order to understand the problem of
ISA. They told us that ISA had delayed milestones. She was afraid of going into the
gatherings. For which we thought that she might have some trauma or Agoraphobia.
But upon history taking, it was observed that she neither had any trauma nor having
any panic attacks. So we then prompted them further, then they told us that she has
changed many schools and she has failed in her classes. They further said that ISA is
not responsive. She had troubles to remember something. She had difficulty of
carrying certain self-help skills like changing clothes, washing hands after using
toilet, etc. When we interviewed ISA, she told us that she had troubles of initiating
relationship and she had problems of learning her lessons. So after seeing all these
things we gave her parents some psychological tests related to intellectual
developmental disorder.

Reinforcer Identification:
Primary reinforcement:

ISA’s primary reinforcements are as following:

Tangible:

Whenever ISA memorized something, the teacher gave her a candy.

Intangible:

When ISA took care of herself like washing hands at lunchtime without the assistance
of maid, her teacher pointed her out in front of class as a role model.

Secondary Reinforcement:

Tangible:

When ISA tried to color without creating mess, she got a star from her teacher.

Intangible:

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Whenever ISA talked to her peers, she was appreciated by her teacher.

Problem identification:

All of these symptoms and observations have revealed that ISA has some disorder.
Her symptoms like speaking difficulty, delayed walking, temper tantrums and
difficulty in following instructions indicate that ISA might have IDD which could
further be confirmed by psychological testing.

Formal assessment:
 Raven’s Colored Progressive Matrices (CPM) was used for measuring IQ.
 Portage Guide for Early Education (PGEE) was used to study the
developmental delays of child.
 Additionally, Human Figure Drawing (HFD) was used for the IQ of the child.

Analysis and Results of the Psychological Tests:

Raven’s Colored Progressive Matrices (CPM):

Time Taken: CPM was completed in 35 minutes.

ISA’s score on CPM was 6 with the discrepancies of -2,-1.-1. She was classified in 4 th
percentile which is grade V.

So, According to CPM scoring, ISA fall in the fifth Grade which indicates that the
client is intellectually defective. Furthermore, it also shows the presence of
intellectual disability.

Portage Guide for Early Education (PGEE):

PGEE commonly known as portage guide or portage program was used to calculate
ISA’s mental age. Her mental age was estimated to be 2.1 years.

As far as her development in different domains was concerned, his cognition and
language domains are matters of great concern.

Her IQ was 25 which is an indication of mental retardation or intellectual disorder.

Human Figure Drawing (HFD):

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Time Taken: HFD was completed in 5 minutes.

The HFD test revealed that the client has extremely low IQ (below 69 i.e. 39).

Tentative Diagnosis:
319 (F72) Severe Intellectual disabilities (intellectual developmental disorder)

The client was showing the symptoms of language difficulties with limited
vocabulary, having difficulty in self-help skills like changing clothes and bathing as
well as having difficulty in decision-making.

Recommended therapy:
The treatment of IDD comes in the form of help, care and support to improve the
daily life conditions of the patients suffering from intellectual disability. With no cure
for IDD, the primary function of therapies is usually to improve the daily life
functioning of the patients.

Psychopharmacologic interventions may play a significant role in treating behavioral

abnormalities associated with intellectual disorder and co-morbid conditions.
Risperidone and Aripiprazoleare antipsychotic medicines used to manage aggression.

Among the psychotherapies eclectic approach is recommended in which ISA will be

treated in less restricted environment as in case of Special Schools. Educational
support will help ISA in various ways as it would promote self-efficacy, help ISA to
seek assistance, improve social interaction and language of ISA.

In the eclectic approach, behavioral therapy is the most significant one. It would be
used to promote positive behavior and stop the bad behaviors of ISA. Positive
reinforcements and benign punishments like time-out techniques are effective
teaching ISA behaving in a desirable manner. Using behavioral training and cognitive
therapy in combination could help ISA to address her emotional issues and negative
thoughts which would then be converted into the positive ones.

In addition, to these therapies, family counseling and education about psychological

disorders would be beneficial. The family must be educated about the cause,
prognosis and management of IDD. The family must be taught to respect, care and
encourage ISA and don’t hate her or discourage her. Furthermore, the realization that
ISA is an abnormal/special child could cause frustration, anxiety, depression and
stress in the family. So, the psychologist should conduct some group therapy in order
to help the family to manage these problems.

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Case Formulation:
ISA’s case was best described by Diathesis Stress Model. The model say that
although genetics is important, this perspective also emphasizes the importance of
learning, stress, faulty and self-defeating thinking patterns, and environmental factors.

So, this model illustrates the importance of having food supplements during
pregnancy and intake of a complete diet to avoid malnutrition in ISA. Her premature
birth could also be explained by the biological factors. Her siblings having anomalies
described the presence of some abnormal genes causing these disorders. So the key
assumption of the diathesis-stress model is that both factors, diathesis and stress, are
necessary in the development of a disorder. And it is the model that explain ISA’s
development of IDD. In which her mother’s diet, her father’s aggression and her
family genes interact with each other in her development of IDD.

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 APPENDICES
Case 1
Appendix 1

NICHQ Vanderbilt Assessment Scale for Parent:

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 Appendix 2

NICHQ Vanderbilt Assessment Scale for teacher:

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 Appendix 3

Portage Guide for Early Education (PGEE):

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 Appendix 4

Human Figure Drawing (HFD):

Human Figure Drawing (HFD) scoring for MK:

HFD SCORING SHEET

NAME _MK AGE __8 years__________________________

1 1 Head present

1 2 Legs present

1 3 Arms present

1 4a Trunk present

4b Length of trunk greater than breadth

4c Shoulders definitely indicated

1 5a Attachment of legs and arms

1 5b Legs attached to the trunk. Arms attached to the trunk at the correct point

1 6a Neck present

1 6b Outline of neck continuous with that of the head, of the trunk, both

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1 7a Eyes present

7b Nose present

1 7c Mouth present

7d Both nose and mouth shown in two dimension; two lips are shown

7e Nostrils shown

8a Hair shown

8b Hair present on more than the circumstance of the head. Better than a scribble. Non-
transparent; that is, outline of head not showing through hair.

9a Clothing present

9b At least two articles of clothing (as the hat and trousers) non-transparent; that is,
concealing the parts of body which they are supposed to cover.

9c Entire drawing free from transparencies of any sort. Both sleeves and trousers must
be shown

9d Atleast four articles of clothing must be indicated

9e Costume complete without incongruities

10a Fingers present

10b Correct number of fingers shown

10c Detail of fingers correct

10d Opposition of thumb shown

10e Hand shown as distinct from

11a Arms joint shown, either elbow, shoulder or both

11b Leg joint shown, either knee, hip or both

12a Proportion head

12b Proportion arms

12c Proportion legs

12d Proportion feet

12e Proportion two dimension

13 Heel shown

14a Motor coordination lines A

14b Motor coordination lines B

14c Motor coordination lines head outline

14d Motor coordination lines trunk outline

14e Motor coordination lines arms and legs

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 14f Motor coordination features

15a Ear present

15b Ear present in correct proportion and position

16a Eye detail, brow, lashes, or both shown

16b Eye detail pupil shown

16c Eye detail proportion

16d Eye detail glance

17a Both chin and forehead shown

17b Projection of chin shown, chin clearly differentiated from lower lip

18a Profile A

18b Profile B

TOTAL ______________10 MA 5.3 CA: 8 years

MA ÷CA×100 = 5.3/8*100 =66

MK has extremely low IQ because it is below 69.

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 Case 2
Appendix 5

RAVEN’S COLORED PROGRESSIVE MATRICES

Name: ISA Age: 10 years

Gender: Female School: Govt. Special Education Center, RWP

Test started: 9:05am Test ended: 9:40am Total time: 35 minutes

Sr. A AB B
no. Item Respons  or Ite Respons  or Ite Respon  or
no. e × m e × m se ×
no. no.
1 A1 2 × AB1 4  B1 2 
2 A2 5  AB2 4 × B2 2 ×
3 A3 1  AB3 2 × B3 5 ×
4 A4 2  AB4 1 × B4 1 ×
5 A5 5 × AB5 1 × B5 2 ×
6 A6 1 × AB6 5 × B6 1 ×
7 A7 4 × AB7 5 × B7 1 ×
8 A8 1 × AB8 4  B8 9 ×
9 A9 2 × AB9 5 × B9 1 ×
10 A10 1 × AB10 4 × B10 1 ×

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 11 A11 1 × AB11 1 × B11 1 ×
12 A12 1 × AB12 4 × B12 2 ×
∑ 3 2 1
Discre =3-5 =2-3 =1-2
pancy =-2 =-1 =-1

Discrepancy=-2,-1,-1 Total Scores=6 Percentile=5th Grade=V

Level of Intelligence=Intellectually Defective

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 Appendix 6

Portage Guide for Early Education (PGEE):

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 Appendix 7

Human Figure Drawing (HFD):

Human Figure Drawing (HFD) scoring for ISA:

HFD SCORING SHEET

NAME _ISA AGE __10 years__________________________

1 1 Head present

1 2 Legs present

3 Arms present

4a Trunk present

4b Length of trunk greater than breadth

4c Shoulders definitely indicated

5a Attachment of legs and arms

5b Legs attached to the trunk. Arms attached to the trunk at the correct point

6a Neck present

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 6b Outline of neck continuous with that of the head, of the trunk, both

1 7a Eyes present

7b Nose present

7c Mouth present

7d Both nose and mouth shown in two dimension; two lips are shown

7e Nostrils shown

8a Hair shown

8b Hair present on more than the circumstance of the head. Better than a scribble. Non-
transparent; that is, outline of head not showing through hair.

9a Clothing present

9b At least two articles of clothing (as the hat and trousers) non-transparent; that is,
concealing the parts of body which they are supposed to cover.

9c Entire drawing free from transparencies of any sort. Both sleeves and trousers must
be shown

9d Atleast four articles of clothing must be indicated

9e Costume complete without incongruities

10a Fingers present

10b Correct number of fingers shown

10c Detail of fingers correct

10d Opposition of thumb shown

10e Hand shown as distinct from

11a Arms joint shown, either elbow, shoulder or both

11b Leg joint shown, either knee, hip or both

12a Proportion head

12b Proportion arms

12c Proportion legs

1 12d Proportion feet

12e Proportion two dimension

13 Heel shown

14a Motor coordination lines A

14b Motor coordination lines B

14c Motor coordination lines head outline

14d Motor coordination lines trunk outline

14e Motor coordination lines arms and legs

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 14f Motor coordination features

15a Ear present

15b Ear present in correct proportion and position

16a Eye detail, brow, lashes, or both shown

16b Eye detail pupil shown

16c Eye detail proportion

16d Eye detail glance

17a Both chin and forehead shown

17b Projection of chin shown, chin clearly differentiated from lower lip

18a Profile A

18b Profile B

TOTAL ______________4 MA 3.9 CA: 10 years

MA ÷CA×100 = 3.9/10*100 =39

ISA has extremely low IQ because it is below 69.

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