Case Summary

W.K. is a 13-year-old girl with a height and weight appropriate for her age. She was
referred to the clinical psychologist by her teacher due to difficulties in learning, speech delay,
stubborn behavior, grip problems, and frequent crying over minor issues. A total of nine
structured therapy sessions were conducted with W.K. Initially, rapport was established with the
client through play-based and engaging activities. The client's preferred reinforcers were
identified using the Multiple Stimulus Preference Assessment, which revealed that she enjoyed
coloring and music. Behavioral observations were conducted across different settings, including
the classroom and playground, to evaluate her motor, cognitive, attention, and social skills. A
brief interview with the teacher was also carried out to gather additional information regarding
her academic performance and classroom behavior. Furthermore, W.K. was assessed using the
Quick Neurological Screening Test (QNST 3-R), which highlighted significant deficits in
language, cognitive skills, and adaptive functioning. Based on the assessment results and
presenting problems, specific intervention goals were established for W.K. These included
teaching her to ask for permission without repeated reminders, recognizing and naming three
basic colors, and improving her attention span. The interventions applied throughout the sessions
included modeling, prompting, chaining, and positive reinforcement, all tailored to her
developmental needs and learning style. These strategies aimed to enhance her cognitive,
adaptive, and social-emotional skills while providing consistent reinforcement and support.
Demographic Information

Name W.K.

Age 13

Gender Female

Family system Joint

Siblings 4

Parents Alive

Birth order 3rd

Religion Islam

Residence Okara

Past psychiatric history of the family None

Past psychiatric history of the client Yes

Source and Reason for Referral

The client was referred by the teacher to the clinical psychologist with the complaints of
being slow learner, speech problem, crying behavior and grip problem.
Presenting Complaints
Table 1
Duration and Symptoms of the client about the presenting problems

Duration Symptoms Presenting Complaints

3 year Below average in ‫پڑھائی میں دوسرے بچوں کی نسبت بہت پیچھے‬
studies ‫ہے‬

3 year Excessive ‫ضد بہت کرتی ہے بات بات پر رونے لگ جاتی‬

stubbornness,
 Frequent crying ‫ہے‬

3 year Slow understanding ‫چیزوں کو دیر سے سمجھتی ہے‬

‫غصہ بہت کرتی ہے‬

3 year Anger outbursts

3 year Needs help in daily ‫اپنے کام کرنے کے لیے اسے دوسروں کی ضرورت‬
tasks ‫پڑتی ہے‬

Initial Observation
The girl was observed in different setting through non participant observation. She
appeared to be with normal looking facial features was wearing neat and clean uniform
according to season with combed hair and polished shoes. She seated on the chair with straight
and comfortable posture. Teacher called her name she maintained the eye contact properly
however she seemed to communicate either nonverbally or with two word speech. She was
following the commands of her teacher about the class work. She was observed to be writing
using left hand her pencil grip was appropriate but the pencil only used the tares’ things. She was
doing coloring in different shapes with 90% fill but she was not coloring name concept. Her
attention span was found to be appropriate during coloring. The problem in gross motor skill.
She was observed to have problem in his right foot. She was very friendly and helpful girl. When
the teacher was scolding her she was showing the tantrum and crying behavior. The girl is
variances of puberty problem. She was interested in music. She was enjoying the music class.
She was following the ethics of classroom and playground. When the teacher say going
to the playground. She got so excited and happy. During the playground the child was observed
to be playing with her friends. She was playing football and running. She was very happy when
the kick the football. Then after 30 minutes she back to classroom.
Past Personal History
The client was born full-term via a normal delivery, with no prenatal or perinatal complications,
and was generally healthy at birth. Her first cry was immediate, and she exhibited normal early
motor milestones, including head holding and sitting by six months. However, parents observed
atypical behavior by the age of two, noting that she did not behave like other children of her age.
She was described as a stubborn child, possibly influenced by being the youngest in the family.
She developed an interest in music and had normal eating habits, enjoying foods such as
macaronis. Her sleep pattern was regular, and there were no physical deformities or chronic
health issues reported.

History of Present Illness

The client's developmental problems were evident from early childhood. Speech delay was
prominent, with the child speaking her first single words at three years, which has persisted.
Cognitive delays were also noted, as her mental age was reportedly three years at the
chronological age of six. Early behavioral difficulties included aggression, irritability, frequent
crying, and stubbornness, although aggression has improved over time. She had poor attention
and concentration in school and required constant supervision to complete tasks. A history of
high-grade fever at age three and epilepsy treated during the first five years of life was reported.
Despite these challenges, she demonstrates friendliness toward peers, compliance with rules, and
an interest in music.

Medical History

The client was treated for epilepsy during the first five years of life. She experienced a high-
grade fever at age three. Currently, her general health is normal, and there are no ongoing
medical issues. She has no history of chronic illness, hospitalizations, or physical deformities.
Early neurological events, including epilepsy and delayed motor and speech milestones, are
significant factors in her medical history.

Developmental History

Motor milestones were delayed, with walking occurring at two years, although sitting and head
control were achieved on time. Speech development was significantly delayed, with single words
emerging at three years, repeated frequently, and continuing to present language challenges.
Cognitive development is below age level, as reflected in poor understanding of letters, shapes,
and colors, and the inability to copy simple figures. Toilet training occurred on time. Socially
and emotionally, she initially showed stubbornness, frequent crying, and irritability, but
presently she exhibits cooperative behavior, friendliness, and interest in music. Attention and
learning difficulties persist, requiring structured guidance and supervision for tasks.
Family Psychiatric History

There is no reported history of psychiatric illness in the family. Both parents are mentally and
physically healthy, and siblings do not exhibit psychiatric or developmental problems. The client
herself shows crying behavior and speech delay, but no other family members display similar
issues.

General Home Atmosphere

The client resides in a nuclear family with four members: her parents and one sibling. The home
environment is peaceful, supportive, and emotionally stable. The parents maintain a congenial
relationship and are attentive and proactive regarding the client's developmental difficulties. The
family provides a protective environment, ensuring access to medical and psychological
consultation, and maintains consistent emotional support.

Presenting the complaints diagram

Family History

The father, aged 52, holds a [Link] degree and works as an engineer. He is described as friendly,
loving, and supportive. The mother, aged 45, holds an [Link] in psychology, is affectionate,
cooperative, and actively involved in managing the client's developmental needs. The client has
one younger brother who is pursuing higher education. The parents are relatives, indicating
consanguinity, which may increase the risk of genetic predispositions. No psychiatric illnesses
are reported in the family, and the family is generally supportive and concerned about the client's
health and development.

Genogram

Key
Assessment
 Behavioral Observation
 Clinical Interview
 Mini Mental Status Examination
 Quick Neurological Screening Test

Behavioral Observation

Non participant behavioral observation of the client was conducted. Non-participant

Observation involves observing participants without actively participating. This option is used to
understand a phenomenon by entering the community or social system involved, while staying
separate from the activities being observed (Liu & Maitlis, 2010).
Behavioral observation of the client intended to assess her current functioning level and
problematic behaviors in order to formulate a comprehensive and effective management plan for
her (Cowen, Harrision & Burns 2006). The behavioral observation of the client was non
participative in first session whereas in subsequent session it was participative. The client was a
healthy young girl who seemed equal to her stated age i.e. 15 years. She appeared to be with
normal-looking facial features. She used to wear clean and shoes and her hair were neatly tied.
Client used to wash her hand regularly after using toilet and eating her food. The client’s
attention was also seemed to be appropriate as she followed instructions or commands given by
the teacher. The client was established and maintains the eyes contact. She was playing football.
She was very happy when the kick the football. Fine motor skills of the client were appropriate.
Gross motor skills were also noted to have balance with coordination. The development
milestones were seemed to be delayed with language and cognitive areas to be most affected.
The assessment was done using Quick Neurological Screening Test (QNST 3-R).
Clinical Interview

A clinical interview is basically a conversation with a purpose and is defined as dialogue

between psychologist and client that is designed to help the psychologist diagnose and plan
treatment for the client. When a psychologist speaks to a client about his or her concerns and
history, they're able to observe how the client thinks, reasons and interacts with others.
Assessments may also include interviewing other people who are close to the client, such as
teachers, coworkers or family members (Kalat, 2011).
 A brief clinical interview was conducted with the teacher of the client in order to gain
knowledge regarding the client’s problems in classroom and other relevant settings. Teacher
reported attention problem of the client.

Mini Mental Status Examination

Mini MSE is a useful diagnostic tool in psychiatric practice. It is a semi structured
method for describing the client’s mental state and behaviors at a given moment. Diagnostic
and therapeutic decisions about client are based on the findings of MSE (Trzepacz& Baker,
1993).
The client was 13 years female child with normal weight and height wearing neat and
clean dress and overall hygiene condition was satisfactory. Client was responded to her name
when her teacher called and maintains eye contact.
Appearance
She has a healthy body. She was in neat and clean dress.
Behavior
Her behavior was stubborn and rigid. Her eye contact was good.
Attitude
She was cooperative and has attention on questions that were being asked. She was
communicated with two words and nonverbally.
Level of Consciousness
She was in conscious and concentrate to things. She colors the objects but show problem
in gross motor skills.
Speech and Language
She was less talkative and answered the asked questions. Her words were limited and
couldn’t convey her message properly. Her voice was normal.
Memory
Her short-term and long-term memory was not normal.
Quick Neurological Screening Test (QNST) 3-R
Quick Neurological Screening Test is a standardized tool used by clinicians,
psychologists, and educators to screen individuals for subtle neurological soft signs that may
indicate developmental, neurological, or learning difficulties. The QNST 3-R is typically
administered to individuals aged 5 years and older, including children, adolescents, and adults.
The test usually takes 20–30 minutes to administer. The total score is interpreted based on
normative data and is categorized into three ranges.
Range and Scoring

Range Score Obtained Score

Normal Range 0-24

Mild Range 25-49

Severe Range 50-75 72

Interpretation
The test has been administered on the basis of observation of the clinician and brief
interview of the teacher. The child was 15 years old and was functionally 13-12 years behind his
chronological age. The coordinated movements of large and small body muscles of the child
were comparatively better as she was many complex tasks like jumping, running and walking
backwards. She was able to do catching and throwing the ball. However, the child could not
draw straight line or trace objects. The client faced hurdle in performing tasks involving snipping
or cutting.
The better motor skills also facilitated the child to be independent in performing many
self help tasks without aid. The child showed discrepancy of 3-4 years as compared to his
chronological age in the area of self help. She was self sufficient in maintaining hygiene as she
was toilet trained and could wash her hands and face without any physical aid. She was able to
button up his shirt, zip or unzip clothes. The child was well aware of personal safety as he knew
to stay away from poisons or threatening objects. However, child felt slight difficulty in
performing tasks like buckling unbuckling her belt. The child could not judge or select weather
appropriate clothing.
Child also perceives the emotions of others like anger but does not know how to
respond. Child depicted great deal of imitation and could easily copy tasks taught by the teacher
or therapist. As she could count 1-3 numbers in imitation and could point to body parts through
imitation. However, child showed hurdle in communicating with the peers.
Though the child had comparatively self-help skills and socialization but she had some
difficulty in performing cognitive and language tasks according to his chronological age. She
showed the discrepancy of 13-12 years in this area. She could perform simple tasks like putting
objects into container, putting pegs and pointing to body parts through imitation. She could not
detect some likeliness and difference in objects like she could not tell heaviness and lightness of
objects. She could also not match objects. She had no sense of color identification (even basics
red yellow and blue). The language of the child was not developed according to his age. The
client score is lies in severe range.

Intellectual Disability (Intellectual Developmental Disorder) DSM-5-TR Code: F70–F79

Diagnostic Criteria

Criterion A: Deficits in Intellectual Functioning

 Deficits in general mental abilities such as reasoning, problem-solving, planning, abstract

thinking, judgment, academic learning, and learning from experience.
 These deficits must be confirmed by both clinical assessment and standardized
intelligence testing (e.g., IQ tests).

Criterion B: Deficits in Adaptive Functioning

 Intellectual deficits are associated with failure to meet developmental and sociocultural
standards for personal independence and social responsibility.
 Adaptive functioning deficits occur in one or more areas, including:

1. Communication - Difficulty understanding or expressing language.

2. Social participation - Difficulty forming relationships, understanding social norms, or
engaging appropriately in peer/family interactions.
3. Independent living - Difficulty managing self-care, safety, money, transportation, or
occupational tasks.

These deficits limit functioning across multiple environments (home, school, work, or
community).
Criterion C: Onset during Developmental Period

 Intellectual and adaptive deficits must begin during childhood or adolescence, not
acquired later in life.

Approximate IQ
Severity Description (Adaptive Functioning)
Range

Can achieve social and vocational skills; may need support under
Mild 50–70
stress; academic skills roughly up to 6th grade

Requires support in daily living; can communicate and perform

Moderate 35–49
some self-care; academic skills roughly up to 2nd grade

Limited communication; needs extensive support for self-care and

Severe 20–34
safety; minimal academic skills

Fully dependent for all self-care; may have physical or sensory

Profound <20
impairments; very limited communication

Case Formulation
The client was 15 years old girl with height appropriate of her age. The client was referred
to trainee clinical psychologist by her teacher with presenting problems of being slow learning,
speech problem and grip problem. The informal and formal assessment of the client was based
on her teacher’s interview, behavioral observation of the client administration of QNST 3-R. The
results of the QNST 3-R revealed that the overall discrepancy in client’s functional age and her
chronological age was 13-11 years with language and cognitive are most affected. The
behavioral observation and assessment of the client reflected that there might be likelihood of
presence of symptoms in client as are in with speech and learning problem. Predisposing Factors
that may have contributed to client condition could include genetic influences, early childhood
developmental delays, or a family history of intellectual disabilities. In addition, any prenatal or
birth complications could have affected her cognitive and motor development, contributing to
her current challenges. Precipitating factors recent academic pressures or social situations at
school may have triggered or exacerbated her emotional reactions (e.g., crying over minor
issues). Stressful events, like difficulties in communication and fine motor tasks (e.g., grip
problems), may also have contributed to her behavioral symptoms and emotional distress.
Perpetuating factors client stubborn behavior and speech problems may continue to impede her
progress unless appropriate interventions are in place. Lack of effective coping strategies and
possible limited support from caregivers or educators could perpetuate her emotional reactivity
(e.g., crying). Additionally, peer exclusion or academic difficulties may reinforce her avoidance
behaviors and emotional outbursts. Protective factors may include the fact that W.K. was
referred for professional help, which indicates a supportive school environment and potential
family involvement in addressing her challenges. W.K.'s outlook of body weight to height
according to age suggests that her physical health is on track, and she might benefit from
targeted support in speech and motor development, as well as behavioral strategies.

Predisposing Factors

Several factors likely contributed to W.K.'s current condition. Biologically, she was born to
consanguineous parents, which may increase the risk of genetic vulnerabilities. Early childhood
neurological events, including epilepsy and a high-grade fever at age three, likely impacted her
brain development. Her motor and speech milestones were delayed, with walking occurring at
two years and first words emerging at three years. From a young age, she demonstrated a
temperament characterized by stubbornness and emotional sensitivity, which may have further
influenced her cognitive and behavioral development. Collectively, these factors created a
foundation for her intellectual and adaptive difficulties.

Precipitating Factors

Recent academic and social pressures appear to have intensified W.K.'s difficulties. She
struggles to keep up with her peers in school, which likely increases frustration and feelings of
inadequacy. Socially, she experiences challenges in communicating with peers due to her limited
language skills, which may contribute to emotional outbursts and crying over minor problems.
Frustration with tasks that she cannot complete independently also serves as a trigger for her
emotional reactions. Additionally, pubertal changes may have heightened her emotional
sensitivity, exacerbating her responses to daily challenges.

Maintaining Factors
Several factors contribute to the persistence of W.K.'s difficulties. Her stubborn behavior and
resistance to instructions can reinforce delays in learning and adaptive skills. Her limited
language and communication abilities impede her capacity to express needs effectively, which in
turn increases frustration and crying behaviors. A lack of structured coping strategies allows
these emotional reactions to continue, and in some cases, attention and support from adults in
response to her tantrums may unintentionally reinforce these behaviors. Without consistent
intervention, these patterns are likely to perpetuate her difficulties.

Protective Factors

Despite these challenges, W.K. has several protective factors that support her development. She
resides in a supportive family environment where her parents are attentive, emotionally
nurturing, and proactive in seeking professional help. Her school environment is also positive,
with teachers engaging her in structured activities and recognizing her needs. Physically, W.K. is
healthy with weight and height appropriate for her age, and she demonstrates independence in
basic self-care skills such as hygiene and dressing. She shows motivation and interest in
activities she enjoys, such as music, and is socially friendly and cooperative in structured
settings, which provides a foundation for positive intervention outcomes.

Interventions Implemented

Over nine sessions, W.K. received structured behavioral and developmental support. The
therapist conducted detailed behavioral observations and assessments, including the Quick
Neurological Screening Test (QNST 3-R), which revealed severe deficits in language and
cognitive areas. Multiple Stimulus Preference Assessment was used to identify reinforcers to
motivate learning. Information from teacher interviews informed goal-setting and intervention
planning. Targeted teaching focused on functional skills, such as responding to permission
without reminders, identifying three basic colors, and enhancing attention span. Rapport-building
sessions were also prioritized to establish trust and engagement, providing a foundation for
effective learning and therapy.

Outcome

Following the intervention, W.K. demonstrated several positive changes. She became more
engaged in structured tasks and showed improvements in attention span during classroom and
therapy activities. She successfully followed simple instructions and was able to imitate tasks
modeled by the therapist or teacher. Socially and emotionally, she expressed enjoyment in
classroom and playground activities, indicating increased engagement and motivation. Despite
these gains, challenges remain in her language development, cognitive functioning, and
emotional regulation. She continues to require support to complete academic and adaptive tasks
beyond basic imitation, and her tendency toward stubbornness and emotional reactivity still
needs consistent management.

Prognosis

With continued structured intervention, W.K. is expected to make meaningful progress in her
adaptive, cognitive, and language skills. Her social participation and emotional regulation are
likely to improve in the context of supportive family and school environments. While she may
not fully reach the functional level of her chronological age due to moderate-to-severe
intellectual disability, she can achieve greater independence and improved academic
performance through targeted, consistent therapy and behavioral support. The presence of strong
protective factors, including family involvement, school support, and motivation, enhances the
likelihood of a favorable long-term outcome.

Case conceptualization
Therapies

Modeling

During my sessions with W.K., I applied modeling to help her acquire new skills, particularly
color identification. Modeling involved demonstrating the desired behavior clearly for her to
observe and imitate. For example, I would hold a red block, clearly point to it, and say "Red,"
encouraging her to do the same. Initially, she observed and imitated small aspects of my actions,
such as pointing to the object, before she could verbalize the color label. This technique was
effective because W.K.'s language skills were delayed, and she responded well to visual
demonstration. Over repeated sessions, she gradually improved in recognizing and naming basic
colors. Modeling also helped her understand classroom routines and simple instructions by
showing her step-by-step how to perform tasks, which reduced her frustration and crying during
activities.

Prompting

I used prompting to increase the likelihood that W.K. would correctly perform desired behaviors.
I applied prompts in a structured way, using verbal, visual, and physical prompts depending on
the task. For example, to encourage her to ask for permission before taking objects, I verbally
reminded her, "Ask first before taking," while pointing to a permission card. When teaching
color recognition, I used verbal prompts like "Point to blue" or "Say yellow," and when she
struggled, I gently guided her hand to the correct object as a physical prompt. Visual prompts,
such as picture cards or color charts, were also provided to reinforce learning. Over time, I
gradually faded the prompts as she began performing tasks independently. Prompting was
essential in helping W.K. gain confidence and reduce reliance on constant adult guidance.

Chaining

To teach more complex tasks, I applied chaining, breaking each task into smaller, manageable
steps and teaching them sequentially. For color recognition, I divided the task into three steps:
first, pointing to the colored object; second, naming the color; and third, matching it to the
corresponding color card. I reinforced her performance at each step before moving on to the
next, following a forward chaining approach. This ensured that W.K. could master each step
without feeling overwhelmed. Chaining was also applied to daily classroom routines and
attention-based tasks. For instance, in coloring exercises, she was taught to pick the crayon, color
inside a shape, and then identify the color, step by step. This method helped her improve
attention span, sequencing, and task completion while reducing her frustration.

Positive Reinforcement

I used positive reinforcement throughout the sessions to encourage and maintain desired
behaviors. Whenever W.K. completed a task successfully, followed instructions, or imitated a
modeled behavior, I immediately provided reinforcement. This included verbal praise ("Good
job!"), high-fives, tokens, or access to preferred activities such as listening to music, which was
identified through the Multiple Stimulus Preference Assessment. Reinforcement was applied
consistently to strengthen attention, compliance, and participation. Over time, this approach
increased her motivation, reduced crying and tantrums, and helped her engage more actively in
tasks. Positive reinforcement also facilitated the generalization of skills to classroom and
playground settings, ensuring that learned behaviors were more sustainable outside therapy
sessions.

Outcomes

After applying the interventions over nine structured sessions, W.K. demonstrated noticeable
progress in several areas. She became more engaged and attentive during classroom and therapy
activities, showing an increased ability to follow instructions and imitate modeled tasks.
Specifically, she began to recognize and name basic colors, respond to permission requests
without repeated reminders, and complete small chained tasks such as coloring within shapes.
Her social and emotional participation improved, as observed during playground activities and
cooperative play with peers. W.K. showed increased motivation when reinforcements were
provided, and her frequency of tantrums and crying decreased during structured tasks. However,
despite these gains, she continued to face challenges in complex cognitive tasks, language
expression, and adaptive problem-solving, which require ongoing support and intervention.

Limitations

Several limitations were noted during the intervention process. First, W.K.'s language delay and
cognitive deficits sometimes slowed the pace of learning, making it challenging to teach multi-
step or abstract concepts within limited session time. Second, her stubbornness and emotional
sensitivity occasionally interfered with task completion, requiring repeated prompting and
reinforcement. Third, the intervention was limited to nine sessions, which is a relatively short
period for a child with moderate-to-severe intellectual disability; longer-term interventions may
be necessary to achieve more substantial gains. Additionally, assessments such as the Quick
Neurological Screening Test and teacher interviews provided limited insight into underlying
cognitive functioning and learning potential, as formal IQ testing was not conducted. Lastly,
generalization of skills outside the therapy and classroom setting, such as home routines, could
not be fully monitored.

Suggestions

Based on my observations and interventions with W.K., several recommendations can be made
to support her ongoing development:

Continued Behavioral Intervention: Structured behavioral strategies, including modeling,

prompting, chaining, and positive reinforcement, should be continued regularly to reinforce
learned skills and teach new functional behaviors.

Language and Communication Support: Speech therapy should be provided to improve

expressive and receptive language skills, which will enhance her ability to communicate needs
and interact socially.

Academic Support: Individualized education plans (IEPs) or modified classroom instruction

should be implemented to accommodate her learning pace and cognitive level, focusing on basic
concepts such as colors, shapes, numbers, and simple academic tasks.

Parental and Teacher Collaboration: Continuous involvement of her parents and teachers is
essential to ensure consistency of reinforcement strategies, prompt fading, and generalization of
skills across environments.

Adaptive Skills Training: Emphasis on daily living skills, personal safety, and self-help tasks
should continue, with chaining and reinforcement used to gradually improve independence.

Social and Emotional Development: Structured social skills training and guided peer interactions
may help W.K. improve emotional regulation, reduce tantrums, and increase cooperative
behavior.
Long-Term Monitoring: Regular assessment of progress should be conducted to adapt
intervention goals and strategies based on her evolving strengths and challenges.

Session Report

Session 1

Objective:

To observe W.K.'s baseline behavior, attention, speech, and motor skills in natural classroom and
playground settings.

Activities / Techniques Used:

Non-participant behavioral observation was conducted in both classroom and playground. Fine
motor skills were noted to be appropriate, while gross motor skills demonstrated good balance
and coordination. Visual-motor integration was well-developed, but sensory processing was
inconsistent. Learning readiness was assessed by observing sitting behavior, eye contact, and
compliance with simple instructions. Attention span was very low, and expressive and reflective
speech was limited to two-word phrases. During playground observation, W.K. engaged in
running and peer play but required frequent verbal prompts to stay focused.

Session 2

Objective:

To build rapport with W.K. and assess her engagement and attention in play-based and creative
activities.

Activities / Techniques Used:

Structured rapport-building activities were conducted, including outdoor ball play and coloring
with visually interesting pictures. W.K. was encouraged to follow instructions while coloring
within shapes and attempt simple pattern replication. Verbal prompts were occasionally used to
redirect attention. Engagement, motivation, and distractibility were carefully observed
throughout the session.

Session 3

Objective:
To identify W.K.'s preferred reinforcers and assess gross motor and cognitive skills.

Activities / Techniques Used:

Multiple Stimulus Preference Assessment was administered, identifying coloring and music as
preferred reinforcers. Gross motor skills were assessed through jumping, skipping, and balance
exercises. Cognitive skills were evaluated via structured block play, where W.K. sorted blocks
by size and color and built simple patterns. Imitation and problem-solving behaviors were
observed. Verbal praise and access to reinforcers were used to maintain motivation.

Session 4

Objective:

To enhance attention, fine motor skills, and imitation of structured tasks.

Activities / Techniques Used:

W.K. participated in coloring and alphabet tracing tasks. A "catch the ball" game was conducted
to integrate gross motor activity with attention and compliance training. Verbal prompts guided
task completion, while verbal reinforcement encouraged engagement. Multi-step instructions
were modeled and followed to assess imitation and attention.

Session 5

Objective:

To develop self-help/adaptive skills while continuing fine motor and attention training.

Activities / Techniques Used:

Chaining techniques were used to teach tasks such as zipping/unzipping a bag and washing
hands independently. Coloring exercises continued to maintain engagement. The Quick
Neurological Screening Test (QNST 3-R) was administered to assess neurological soft signs and
cognitive delays. Verbal and visual prompts guided her during adaptive tasks, and reinforcement
was provided for successful completion.

Session 6

Objective:

To improve verbal imitation, counting skills, and gross motor abilities.

Activities / Techniques Used:

Therapist modeled counting from 1-10 in a rhythmic tone and letters (A, B, D...G) for W.K. to
verbally imitate. Backward walking and running exercises assessed gross motor coordination.
Physical prompts were used when necessary, and verbal praise or access to preferred activities
reinforced correct performance. Engagement and attention were closely observed throughout.

Session 7

Objective:

To develop object recognition, fine motor coordination, and imitation of structured tasks.

Activities / Techniques Used:

W.K. was asked to paste objects on paper following instructions, combining fine motor
coordination with sequential task imitation. Tasks were modeled, and verbal prompts were used
as needed. Performance on imitation tasks was observed, noting her ability to complete
sequences and maintain focus.

Session 8

Objective:

To teach recognition and naming of basic colors.

Activities / Techniques Used:

Structured activities focused on one color at a time. Therapist modeled the color name,
encouraged W.K. to point to and match objects of that color, and used chaining to break the task
into small steps: pointing - naming - matching. Verbal praise and access to reinforcers were
provided after correct responses. Observations focused on her ability to recognize and name the
color and maintain attention.