Identifying Data

Name Adeena
Sex Female
Education Noeducation
Marital status unmarried
Family status Nuclear
Siblings 02
Birth order Last child
Parents Alive
Economic status Middle class
No. Of dependent 03
Age 10

Reasons and Source of Referral

The client was referred to the clinical psychologist in MH by her mother for the
purpose of assessment and management for her presenting complaints of being
stubborn, deficits in verbal and non-verbal communication, social interaction,
inadequate eye contact, self-stimulating and self-harming behavior of self hitting.
Presenting Complaints
‫ بلک)ل بلک)ل بھی س)وتی‬،‫ اگر بات نہیں مانو ت))و دوس)روں ک))و م))ارتی ہے‬،‫ بات نہیں مانتی‬،‫یہ بہت ضیدی ہے‬
‫ گ))انے بہت س))نتی ہے‬،‫ ہر کام میں اس کا کھود کرتی ہ))وں‬،‫ خود کچھ نہیں کر سکتی‬،‫ تین سال سے‬،‫نہیں ہے‬
‫ کسی س))ے ب))ات نہیں ک))ر‬،‫ یہ گھر میں سب کو مارنے لگ جاتی ہے‬،‫اور اگر بند کروں تو چیخیں مارتی ہے‬
‫ ہاتھوں سے ہر وقت کچھ نہ کچھ کرتی رہتی ہے۔‬،‫ آئی کانٹیکٹ بالکل نہیں ہے‬،‫سکتی‬
History of Present Illness
Client’s father and mother had a cousin marriage. Client was born after 5 years of
marriage through normal delivery. All the developmental milestones, babbling,
sitting, crawling, walking, were also [Link] the age 2 of years,According to
client's mother, she used to harm herself by hitting her chin, didn’t use to speak and
play like other children. Due to these concerns Client’s family took her to a
psychiatrist where she was treated for 8 to 9 months. Under the influence of
medications prescribed by psychiatrist, she used to remain drowsy and lethargic.
Treatment was discontinued by parents after 9 [Link] this tie she also used
medications, but the medications cant
Treat her condition and her condition was not stable at [Link] all this period her
speech was not properly developed at all, she only used to babble and make sounds.
Background Information

Family History
In the beginning of marriage the client parent’s belonged to a joint family of middle-
class status. There were 7 family members in their house including her mother father
and [Link]’s parents were related by blood and both were first cousins.
As reported by client’s mother .Initially, they had a conflicted married relationship
and their interest always clashed with each other and their in laws was engaged in
these relationship clashes. Her in-laws’ family environment was very chaotic and
strict. Client’ was born after 5 years of her parent’s [Link]’s father was 36-
year-old man with good physical health. He has an educational historyof graduation.
He was a officer in pak army. According to client’s mother her husband has a calm
personality and showed warmth towards his children. Client has a closed relationship
with her father. Her mother is a 30 year old housewife with an educational history of
[Link] spend most of his time with mother and is more attached to her than
[Link] had 2 siblings. General home environment was reported to be healthy
and [Link] when in laws make more clashes between the client parents then
they shift from in laws house to the army quarters and live with their children.
Personal History
According to the client’s mother, she was born through normal delivery, there were
no complications during pregnancy and birth [Link] reported by the mother
client’s milestones were [Link] couldn’t hold her head and there was no
frequent eye movement till 50 days after [Link] learned to hold her head at the age
of 2 months. She could sit at 11 months and started crawling after 1 ½ years of age.
She just used to babble make sounds till 6 years of age. She achieved her one-word
speech at the age of 6 after frequently visiting the speech therapist. Reaching at the
age of 7 years she still can’t hold a spoon or glass. For all the daily activities including
eating, drinking using toilet and changing clothes she needs constant assistance and
help of others. She had no comprehension of self-help and [Link] takes
medication also but not effective at all and she cant sleep for more than 3 years.
Psychological Assessment
Client’s formal and informal assessment were conducted by using different measures,
to assess the level of severity devise a management plan for her problems.
Informal Assessment
Informal assessment included clinical interview, general observation , and
subjective ratings of the presenting complaints.
Clinical Interview
A semi-structured interview was conducted with the mother to get a detailed insight
about client’s presenting complaints, background information which included his
family, personal and educational history, and also about his strengths, interests, and
home environment. Client’s mother showed her full support during the interview. She
shared possibly all the details that provided a deep understanding of client’s problem
and helped in diagnosis.
Behavioral Observation
The client was a physically healthy 10 year-old girl. She was attired in neat and clean
clothes with a shirt, trouser, and hairs can’t [Link] was restless, continuously
throwing tantrums and was not ready to sit on chair. Eye contact was not maintained
at all, throughout the session. She was easily bored and had a short attention span
towards therapist and people around her. Because of poor fine motor functioning,She
had an evident speech issues and she makes a sound“eeeeeeeeeeeeee”
Or“yeayeyeaye….when she is excited, angry or feels any emotion. She made high
pitch sounds which could be heard from another [Link] was not able to say mama
or papa. She understood what her mother was saying such as “do you want to drink
water?”In next sessions, it was observed that she is hyperactive and did not imitate
behavior and follow command. But it wasobserved that she imitated behavior and
obeyed command such as giving ‘high five’ when she was reinforced.
Mental Status Examination
Mental status examination (MSE) was used as a tool to describe appearance,
behavior,cognition, speech and mood of a client. MSE indicated that the child was
well-groomed and well-dressed girl with suitable weight according to her age.
Impairment in the some areas were noted which were; behavior, speech, mood,
orientation, attention and concentration.
•Behavior
Repetitive behaviors, which included using gestures (finger pointing) with mother
only and stereotypical behavior (hand flapping and body rocking) were
[Link] activity in the form of hyperactivity was observed.
•Speech
Her speech was limited to making sounds only which were loud and high pitched.
Echolalia was noted when her sister randomly said “Peek-a- boo” and she started
repeating it as“pee, pee,….” as she cannot say the whole word due to impaired
speech.
•Mood and affect
Agitated mood and irritability was detected during examination. The client also threw
things on others and slap others when she is hyperactive.
•Concentration
The client was easily distracted by any stimulus and by the presence of others but
didnot directly see another as well as did not gave eye contact.
•Attention
The child gave selective attention to activities in which she was interested. She didnot
respond to a colorful toys with sound rather she paid attention to only listening
songs . No delusions and hallucination were present or reported by the parents. Her m
emory was [Link] overall behavior was in accordance with her symptoms and
problem.
Formal assessment
Formal assessment was done through the use of subjective tests such as autism
spectrum screening questionaire(ASSQ)filled by her mother in order to understand
her severity level.
Interpretation of score of ASSQ
The child’s score was.
Tentative Diagnosis
Autism Spectrum Disorder
Case formulation
The client A was 10 years old girl who came with the presenting complaints of being
stubborn, deficits in verbal and non-verbal communication, impaired social
interaction, inadequate eye contact, self-stimulating and self-harming behavior.
Further problems reported by the mother include developmental delays in all areas,
absence of self-help skills, deficits in fine motor functioning as well as speech delay.
The client belongs to a middle-class family, born through normal
[Link] assessment of client was carried out through behavioral
observation, clinical interviewing from mother, subjective ratings of problematic
behavior. For formal assessment
Management plan
 Psycho education
 Cognitive Behavioral Therapy(CBT)
 Behavior modification techniques
 Individualized educational plan
 Play therapy
 Developmental and Individual Differences Relationship (DIR) Therapy
 Applied Behavioral Therapy
 Verbal Behavior Therapy (VBT)
Tentative Diagnosis
Autism Spectrum Disorder
Case formulation
The client A was 10 years old girl who came with the presenting complaints of being
stubborn, deficits in verbal and non-verbal communication, impaired social
interaction, inadequate eye contact, self-stimulating and self-harming behavior.
Further problems reported by the mother include developmental delays in all areas,
absence of self-help skills, deficits in fine motor functioning as well as speech delay.
The client belongs to a middle-class family, born through normal
[Link] assessment of client was carried out through behavioral
observation, clinical interviewing from mother, subjective ratings of problematic
behavior. For formal assessment Childhood Autism Rating Scale (CARS) were
applied. The client was diagnosed with Autism spectrum Disorder as her scores on
CARS were 39 which falls into the range of severely autistic.
Management plan
 Psycho education
 Cognitive Behavioral Therapy(CBT)
 Behavior modification techniques
 Individualized educational plan
 Play therapy
 Developmental and Individual Differences Relationship (DIR) Therapy
 Applied Behavioral Therapy
 Verbal Behavior Therapy (VBT)