INTERNSHIP REPORT

EDUCATIONAL PSYCHOLOGY

Submitted to
Dr. Nazia Iqbal
Submitted by
Anoshia Shakil
Registration no
359-FSS/MSEP/F23

Department of psychology
Faculty of Social Sciences
International Islamic University, Islamabad
 CASE NO. 1

314.01(F90.0) Attention Deficits/Hyperactivity Disorder

Identifying Data
Name: Raina
Age: 5 years old
Gender: Female
Education: Montessori
Number of Siblings: 04
Birth Order: Last Born
Family setup: Nuclear
Father’s Occupation: Government Job
Mother’s Occupation: Housewife
City: Islamabad
Informant: Client and Father
Reason for Referral:
The client was brought to Transition special care center by her father on the recommendation of her
teachers because she had writing problems and attention issues.

Presenting complaints:
According to the client's father, she struggles with writing, is inattentive, and has
aggressive and vindictive tendencies, which negatively impact her relationship with her siblings.
Her academic performance is also poor, and she talks excessively and does not listen to what
others are saying or asking from her.

Target symptoms:
 Writing issues
 Inattentiveness
 Aggression
 Conflicts with peers and siblings
 Talking excessively
History of presenting complaints:
The Client is a 5-year-old girl. Currently, she has been brought to transition special care center on the
recommendation of her teachers for her writing difficulties. She is unable to write without
prompt and instead draws circles instead of writing alphabets. Her teachers complain about her
inattention and aggressive behavior towards peers, accompanied by her inability to stay seated.
She enjoys going to school but talks excessively without listening to the questions being asked.
She displays extremely vindictive and spiteful behavior and tends to physically harm other
children, resulting in fewer friendships. She is reluctant to share her belongings with anyone.

Family History:
The client has been living in a nuclear family system. Her father is a graduate and serves
For the government, while her mother is a housewife. She has 3 brothers and no sisters. As the only
daughter, she has a healthy relationship with her parents. She used to sleep with her father and
loved him dearly, waiting until he fell asleep before sleeping herself. She loves her siblings but
often engages in fights with them and their friends.

Early Developmental History:

Prenatal:
The client was a planned child. There were no family stressors like marital discord or
problems with in-laws present during the pregnancy. The mother's physical health was good
overall, as no illnesses or injuries were reported. No medications or drugs were used during
pregnancy. There were no previous miscarriages, and her physical and psychological health was
satisfactory.
Perinatal:
During the birth of the child, everything was normal. No perinatal complications were
encountered, and the child was completely normal and in fully functioning condition.
Postnatal:
The client's developmental history was complicated. She started crawling and walking at
the age normal children does. She even started talking normally, but then she fell ill. After
recovering, she developed a fear of something, which caused her to regress and become mute.
She received therapy for her mutism and eventually started talking properly again.

Past Medical/Surgical History:

When the client was about 10 to 11 months old, she fell ill and experienced asthma
attacks accompanied by seizures. After that, when she was 1 and a half years old, she developed
fear while sleeping and fell ill again. Following this incident, she became mute and experienced
a speech delay. She received therapy for this and was then admitted to school at the age of 4
years.

School History:
The client was admitted to school at the age of 4 years and had to repeat her nursery class
due to writing difficulties. Her teachers complain about her inattention and aggressive behavior
toward peers, accompanied by her inability to sit in her place. She enjoys going to school. She
talks excessively without listening to the questions being asked. She shows extremely vindictive
and spiteful behavior, and she physically harms other children, resulting in fewer friendships.
She does not share her belongings with anyone.

Forensic History:
The client has no forensic history

Past Psychiatric History:

The client has no past psychiatric history

Pre-morbid Personality:
The client had some speech issues before the onset of present problems. She became
mute for which she received speech therapy.
Psychological Assessment:
Assessment of client was done at informal and formal level to understand the client’s
problem.
Informal Level:

Case History Interview:

During the clinical interview, the client's father reported that the client is 5 years old and she has been
brought to transition special care center based on her teachers' recommendation due to writing
difficulties. The client was admitted to school at the age of 4 years and had to repeat her nursery class
due to these problems. She struggles to write without prompt and instead prefers to draw circles
rather than forming alphabets. The teachers have expressed concerns about her inattention and
aggressive behavior towards peers, as well as her difficulty in staying seated. While she enjoys
attending school, she tends to engage in excessive talking without actively listening to the questions
asked. Furthermore, she exhibits extremely vindictive and spiteful behavior, leading to fewer
friendships due to her tendency to physically harm other children. Sharing belongings is also a
challenge for her. The client's father has also noticed her aggressive and vindictive tendencies, which
adversely affect her relationship with her siblings. Additionally, her academic performance is poor,
and she continues to struggle with excessive talking and a lack of attentive listening to others' words
or inquiries.

Behavioral Observation:
During the session held with the client, she was observed to be neatly and cleanly
dressed. The client was overall healthy but did not maintain eye contact. Rapport building was
easy. She was a bit shy when she entered for the session, but later she responded. She did not
answer the questions properly and did not carefully listen to what was asked. She responded with
whatever she wanted to say, regardless of the relevance to the question. She did not sit firmly,
stood up, and ran here and there and even jumped on the sofa during the interview.

Formal Assessment:

Following tools were used as Formal Assessment

1. ADHD Rating Scale

Interpretation of Assessment Tools:

ADHD Rating Scale:
There were 9 questions each for both inattention and hyperactivity. From which 6 for
each were required to be fulfilled to meet the criteria for Attention Deficit Hyperactivity
Disorder. According to the father's report, the client fulfilled 7 statements of inattention and all 9
of hyperactivity, as all of them were marked with 'very often' or 'always'. These problems were
present in both the school and home settings.

Tentative Diagnosis:
The client has been tentatively diagnosed with Attention-Deficit/Hyperactivity Disorder
(F90.2) combined subtype according to assessment of psychological tests and her symptoms,
which are consistent with the criteria in DSM-5TR.

Prognosis:
The client's prognosis seems to be hopeful because her parents are educated and well
aware of the client's problems, and they want to bring change in their daughter.

Therapeutic recommendations:
Keeping in view the client's history and the information gathered from her father,
following recommendations are advised for the client.
 Provide the client's parents with information about Attention-Deficit/Hyperactivity
Disorder (ADHD), its symptoms, and management strategies. Help them understand the
importance of consistent and structured routines at home.
 Offer parent training sessions to teach effective behavioral management techniques,
including setting clear expectations, implementing rewards and consequences, and improving
communication skills with the client.
 Engage the client in individual therapy sessions to address her writing difficulties,
inattentiveness, aggression, and poor impulse control. Use behavioral interventions, cognitive-
behavioral techniques, and play therapy to improve her emotional regulation, problem-solving
skills, and coping strategies.
 To conduct group therapy sessions to help the client develop appropriate social skills,
such as turn-taking, sharing, conflict resolution, and empathy. Role-playing and modeling can
be used to enhance her interpersonal interactions with peers.
 To continue speech therapy to address any remaining speech and language difficulties
that may contribute to the client's communication challenges.
 Coordination with the client's teachers to implement classroom accommodations, such as
preferential seating, clear instructions, and a structured learning environment. Provide
strategies to manage her inattention and impulsivity in the classroom.
 Consider a medication evaluation by a qualified healthcare professional to determine if
medication could be beneficial in managing the client's ADHD symptoms. Collaborate with
the family and a medical provider to explore appropriate medication options.
 Schedule regular follow-up sessions to monitor the client's progress, assess the
effectiveness of interventions, and make necessary adjustments to the treatment plan.

Case Formulation:
The client was brought to transition special care center by her father on recommendation of her
teachers. According to her father, she struggles with writing, is inattentive, and has aggressive and
vindictive tendencies, which negatively impact her relationship with her siblings. Her academic
performance is also poor, and she talks excessively and does not listen to what others are saying or
asking from her. The client was admitted to school at the age of 4 years and had to repeat her nursery
class due to writing difficulties. Her teachers complain about her inattention and aggressive behavior
toward peers, accompanied by her inability to sit in her place. She enjoys going to school. She talks
excessively without listening to the questions being asked. She shows extremely vindictive and
spiteful behavior, and she physically harms other children, resulting in fewer friendships. She does
not share her belongings with anyone. The client’s father reported also that when the client was about
10 to 11 months old, she fell ill and experienced asthma attacks accompanied by seizures. After that,
when she was 1 and a half years old, she developed fear while sleeping and fell ill again. Following
this incident, she became mute and experienced a speech delay. She received therapy for this and was
then admitted to school. The client is currently residing in a nuclear family setup. Her father holds a
graduate degree and serves for the government, whereas her mother fulfills the role of a housewife.
The client has three brothers and no sisters. As the sole daughter in the family, she shares a healthy
and affectionate bond with her parents. She used to sleep in the same bed as her father and held a
deep affection for him, even waiting until he fell asleep before drifting off herself. Although she
loves her siblings, it is common for her to get involved in conflicts and arguments with them and
their friends. Therefore, the client has been tentatively diagnosed with Attention-
Deficit/Hyperactivity Disorder (F90.2) according to assessment of psychological tests and her
symptoms, which are consistent with the criteria in DSM-5TR. The diagnosis considers the presence
of a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning
or development. The diagnosis also takes into account the specific symptoms and their impact on
social and academic/occupational activities.

Sessions:

Session 1

Aims or Goals of Session  To build rapport with the client

 To take history from the client’s father

Psychotherapeutic  The client was engaged using sensory toys and age-
technique/tools appropriate activities to establish rapport.
implemented  Conducted a clinical interview with the father to gather
background information and understand the presenting
issues.
 Observed the client’s behavior, noting her reluctance to
sit still and her tendency to run around or jump on
furniture.
 Allowed the client the freedom to explore the room while
gently encouraging her to interact.

Outcomes  A significant rapport was established with the client,

although she shy, and moving around here and there.
 Session 2

Aims or Goals of Session  To conduct Mental Status Examination

 To take detail history from the client’s father
 To administer assessment on the client

Psychotherapeutic  Used observation and structured questions to assess the

technique/toolsimplemented client’s attention span, behavior, and social responses
during the MSE.
 Ensured the client felt at ease by integrating play into the
session, using soft toys and coloring materials.
 Administered ADHD assessment tools to gather formal
data.
 The father provided additional developmental history
during the session, allowing for a comprehensive
understanding.
Outcomes  ADHD was administered and detail history was taken

 MSE revealed notable signs of inattention and impulsivity.

 Session 3

Aims or Goals of Session  To introduce behavioral intervention techniques using

ABA (Applied Behavior Analysis).
 To improve the client’s ability to follow simple
instructions and engage in structured tasks.
Psychotherapeutic  Introduced basic instructions like "sit down," "give me,"
technique/tools and "look here," using prompts and reinforcers such as
implemented stickers and small toys.
 Used positive reinforcement (e.g., verbal praise and
immediate rewards) to encourage compliance with
instructions.
 Implemented task analysis, breaking down complex
activities (e.g., putting toys in a box) into smaller,
manageable steps.
 Introduced visual aids, such as flashcards with simple
images, to help the child associate actions with verbal
cues.
 Encouraged eye contact during activities by holding
objects of interest close to the therapist's face and
rewarding moments of eye contact.
Outcomes  The child began responding to prompts and completed
simple instructions with guidance.
 Eye contact increased slightly during reinforced
activities.
 The child showed initial signs of understanding task
sequences.
 Session 4

Aims or Goals of Session To engage the client in sensory and developmental activities.
To address repetitive behaviors and improve attention span.

Psychotherapeutic Occupational Therapy Techniques:

technique/tools
implemented  Engaged the child in sensory activities like squeezing
therapy putty, stacking blocks, and using textured objects
to improve tactile processing.
 Introduced gross motor exercises, such as jumping on a
trampoline and crawling through a tunnel, to enhance
coordination and reduce hyperactivity.

Behavioral Redirection:

 Managed repetitive behaviors by redirecting the child to

structured play activities, using prompts and rewards to
maintain focus.
 Encouraged creative expression by asking the child to
color simple drawings, with periodic prompts to sustain
attention.
 Used a timer to introduce the concept of task duration,
reinforcing the child’s ability to stay engaged in an
activity until the timer buzzed.,
Outcomes  The client engaged more actively in sensory activities,
showing improved focus for short periods.
 Repetitive behaviors decreased during structured play
though they recurred when the child was left
unprompted.
 The client completed the coloring activity with
assistance, staying engaged until the timer buzzed.
 CASE NO.2

299.00(F84.0) Autism Spectrum Disorder

Identifying Data

Name: Zaraar

Age: 4.5 years old

Gender: Male

Education: (never attended school)

Number of Siblings: 2 brothers, 2 sisters

Birth Order: LAST BORN

Family Setup: Nuclear

Father’s Occupation: Businessman

Mother’s Occupation: Housewife

City: Islamabad

Informant: Parents

Reason for Referral:

The client was brought to the special care center by his parents due to developmental delays,
minimal speech, repetitive behaviors, and symptoms consistent with autism.

Presenting Complaints

Zaraar’s parents brought him to the special care center due to concerns about his developmental
delays and behavior. The parents reported that Zaraar has minimal speech, avoids eye contact,
and engages in repetitive behaviors such as spinning objects and lining up toys. He struggles to
respond to his name consistently and has difficulty following instructions, often requiring
repeated prompts. His limited social interaction, minimal communication, and difficulty adapting
to new situations have raised significant concerns for his parents, prompting them to seek
assessment and intervention.
Target Symptoms:

 Delayed speech development (very minimal speech)

 Poor eye contact
 Repetitive behaviors (e.g., hand-flapping, lining up objects)
 Lack of social interaction
 Difficulty following instructions
 Resistance to changes in routine

History of Presenting Complaints

Zaraar’s parents started noticing developmental delays when he was around two years old. He
began walking at 20 months but did not develop speech milestones on time. Currently, he only
uses single words or sounds to express himself and relies heavily on gestures to communicate.
He avoids interaction with others, even with his siblings, preferring to play alone. When
interrupted during his repetitive play activities, he becomes distressed and cries excessively. His
parents also report that he is highly sensitive to certain textures and sounds, often covering his
ears or refusing to wear specific clothes.

Family History

Zaraar lives in a nuclear family with two brothers and two sisters. His father is a businessman,
and his mother is a housewife. There is no family history of psychological or developmental
disorders. His parents describe him as a reserved child who prefers isolation.

Early Developmental History

Prenatal:
The client was a planned child. There were no family stressors like marital discord or problems
with in-laws present during the pregnancy. The mother's physical health was good overall, as no
illnesses or injuries were reported. No medications or drugs were used during pregnancy. There
were no previous miscarriages, and her physical and psychological health was satisfactory.
Perinatal:
During the birth of the child, everything was normal. No perinatal complications were
encountered, and the child was completely normal and in fully functioning condition.

Postnatal:

Zaraar achieved motor milestones later than expected. He started walking at 20 months and has
minimal verbal communication to date.
Past Medical/Surgical History

No significant medical or surgical history reported.

School History

Zaraar has not attended school yet. His parents decided to seek assessment and therapy before
enrolling him in a formal education system due to his developmental delays

Psychological Assessment

The assessment of Zaraar was conducted at both informal and formal levels to gain a
comprehensive understanding of his developmental challenges and behavioral patterns.

Informal Level

Case History Interview:

The clinical interview with Zaraar's parents provided key insights into his developmental history
and behavioral concerns:

Speech and Communication: Zaraar has very minimal speech, using only single words or
sounds to communicate his needs. He primarily relies on gestures or pulling on his parents to
express desires.

Repetitive Behaviors: He engages in stereotypical behaviors such as hand-flapping, lining up

toys, and spinning objects for extended periods. Attempts to interrupt these activities often result
in distress or tantrums.

Social Engagement: Zaraar avoids interaction with unfamiliar people, including the therapist.
He does not initiate or respond to social overtures, such as waving or smiling.

Sensory Sensitivities: He demonstrates strong aversions to certain textures and sounds, such as
loud noises and rough fabrics, often covering his ears or refusing contact.

Response to Routine Changes: Transitions, such as moving from one activity to another, trigger
significant distress, often expressed through crying or withdrawal.

Parental Concerns: His parents expressed concern over his inability to form meaningful
interactions with siblings or peers. They also noted his lack of response when his name is called
and his preference for solitary play.

Behavioral Observation:
During the session, Zaraar’s behavior reflected core symptoms of Autism Spectrum Disorder:
Eye Contact: Zaraar maintained minimal eye contact, looking away when directly addressed.

Interaction with the Environment: He spent most of the session fixated on spinning a toy car’s
wheels, displaying a lack of interest in other toys presented by the therapist.

Response to Instructions: Zaraar required repeated prompts to follow basic instructions, such as
handing over a toy or looking in the therapist’s direction.

Social Behavior: He avoided physical proximity to the therapist and retreated closer to his
mother when approached.

Emotional Reactivity: Zaraar exhibited frustration when the spinning toy was briefly taken
away, showing irritability and a repetitive hand-flapping behavior in response.

Formal Level

Child Autism Rating Scale (CARS):

The CARS was administered to evaluate the severity of autism-related symptoms across various
domains. Zaraar’s scores indicated severe symptoms of Autism Spectrum Disorder, reflecting
significant challenges in the following areas:

Social Interaction: Profound difficulty engaging with others, including family members.

Communication: Markedly limited verbal communication and reliance on non-verbal methods.

Repetitive Behaviors: High frequency and intensity of stereotyped behaviors, such as lining up
objects and spinning toys.

Emotional Responses: Strong negative reactions to changes in routine or the removal of

preferred items.

Sensory Sensitivities: Noticeable discomfort with certain sounds and textures.

Interpretation of Scores:
Zaraar's score exceeded the threshold for severe autism, confirming the need for immediate and
intensive intervention.

Tentative Diagnosis

The client has been tentatively diagnosed with Autism Spectrum Disorder (ASD) (F84.0) with
severe symptoms according to the assessment of psychological tests and his observed behaviors,
which are consistent with the criteria outlined in the DSM-5TR.
Prognosis:
The client's prognosis seems to be hopeful because his parents are educated and well aware of
the client's problems, and they want to bring change in their son

Therapeutic Recommendations

Speech Therapy

To improve verbal communication and foster expressive and receptive language skills.

 Picture Exchange Communication System (PECS): Introduce a visual communication

system to help Zaraar convey his needs, starting with basic pictures of common objects
and gradually expanding his vocabulary.
 Modeling Techniques: Use simple, repetitive language during play to model appropriate
speech patterns.
 Prompting and Reinforcement: Provide verbal and physical prompts to encourage
vocalizations and reward communication attempts.
 Progression to Phrases: Encourage the use of short phrases once Zaraar is comfortable
with single words.

Applied Behavior Analysis (ABA)

To reduce problematic behaviors, promote eye contact, and enhance compliance with
instructions.

 Structured Sessions: Focus on basic skills like sitting still, making eye contact, and
following one-step commands.
 Positive Reinforcement: Reinforce desired behaviors with Zaraar’s preferred rewards.
 Behavioral Redirection: Address repetitive behaviors by redirecting Zaraar to functional
activities.
 Task Analysis: Teach complex behaviors by breaking tasks into smaller steps.

Occupational Therapy

To address sensory sensitivities and enhance motor skills.

 Fine Motor Skills: Practice tasks such as drawing, threading beads, or stacking blocks to
improve hand strength and coordination.
 Gross Motor Skills: Include activities like climbing or jumping on a trampoline to
enhance balance and body awareness.

Parent Training

To empower Zaraar’s parents with tools to support his development.

  Understanding Autism: Explain how Zaraar’s condition affects behavior and learning.
 Behavior Management: Train parents in the use of visual schedules, reward systems, and
consistent routines.
 Crisis Management: Provide guidance on managing meltdowns and using calming
techniques.

Follow-Up and Monitoring

To evaluate progress and adjust interventions as needed.

 Plan bi-weekly sessions to track improvements.

 Use standardized assessments (e.g., CARS) every six months to refine goals.
 Ensure regular communication with parents and educators for consistency across
environments.

Case formulation

Zaraar, a 4.5-year-old boy, was brought to the special care center by his parents due to
significant developmental concerns. His symptoms, observed both at home and in the assessment
environment, indicate pervasive challenges across multiple domains, aligning with severe
Autism Spectrum Disorder (ASD) as per DSM-5 criteria. From an early age, Zaraar exhibited
delays in developmental milestones. He began walking at 20 months and has yet to achieve
typical speech development, using only single words or gestures to communicate. Despite efforts
by his parents to encourage interaction, Zaraar does not respond to his name consistently and
avoids eye contact. His preference for solitary play, coupled with limited interest in engaging
with siblings or adults, highlights significant deficits in social reciprocity. Repetitive behaviors
are a prominent feature of Zaraar’s presentation. He often engages in stereotypical actions, such
as spinning objects and lining up toys, becoming distressed if these activities are interrupted.
This rigidity extends to his daily routines; even minor changes elicit strong emotional reactions,
including crying or withdrawal. Sensory sensitivities further complicate his behavior, with
aversions to certain sounds and textures contributing to increased distress in unfamiliar
environments. During the clinical session, Zaraar exhibited a lack of spontaneous interaction
with the therapist, requiring repeated prompts to participate in activities. His engagement was
limited, and he showed persistent fixation on spinning a toy car’s wheels. Although he could
follow simple instructions with significant guidance, his responses were inconsistent,
underscoring deficits in both attention and comprehension. The results of the Child Autism
Rating Scale (CARS) reinforced the severity of his symptoms, with scores reflecting profound
challenges in communication, social interaction, and behavioral flexibility. These issues
significantly impact his ability to adapt to new situations, build relationships, or achieve
developmental milestones typical for his age. Despite these challenges, Zaraar’s prognosis
remains hopeful. His parents are highly involved and proactive in seeking help, which is a
critical protective factor. Early and consistent intervention, including speech therapy, ABA,
occupational therapy, and parent training, can create opportunities for Zaraar to develop essential
skills. Structured routines, targeted behavioral strategies, and specialized education programs
will be pivotal in supporting his progress and preparing him for greater independence

Sessions:

Session 1

Aims or Goals of Session  To build rapport with the client

 To take history from the client’s father

Psychotherapeutic  The session began with the introduction of sensory toys

technique/tools (e.g., textured balls, spinning toys) to create a welcoming
implemented and stimulating environment.
 Zaraar was allowed to explore the room freely to reduce
anxiety and encourage comfort in the therapeutic setting.
 A clinical interview was conducted with the parents to
gather a detailed history of Zaraar’s developmental
milestones, behaviors, and routines.
 Observations of Zaraar’s behavior during the session
included:
 Minimal eye contact with the therapist.
 Repetitive spinning of a toy car’s wheels.
 Resistance to interaction when verbally addressed.
 Gentle encouragement was provided to Zaraar to engage
with new toys and interact with the therapist, though he
often returned to preferred repetitive activities.
Outcomes  Rapport was established, with Zaraar displaying initial
signs of familiarity with the therapist by occasionally
looking at them.
 A comprehensive developmental history was obtained
from the parents, highlighting areas of concern such as
speech delays, repetitive behaviors, and sensory
sensitivities.
 Session 2

Aims or Goals of Session  To conduct a Mental Status Examination (MSE).

 To gather additional developmental history.
 To assess Zaraar formally using the Child Autism
Rating Scale (CARS).
Psychotherapeutic The MSE was conducted using structured questions and
technique/tools behavioral observation:
implemented
 Assessed Zaraar’s attention span, noting his difficulty
staying focused on a single task for more than a minute.
 Observed his emotional reactivity when a toy was briefly
removed, which included crying and hand-flapping.
 Integrated play into the session, using textured blocks and
soft toys to reduce Zaraar’s anxiety and encourage
participation.
 Administered the CARS to quantify the severity of autism
symptoms, focusing on areas such as social interaction,
communication, and behavioral patterns.
 The parents provided additional information about
Zaraar’s sensitivities to sounds and his resistance to
changes in routine..

Outcomes  The CARS results confirmed severe symptoms of Autism

Spectrum Disorder.
 The MSE highlighted significant deficits in attention,
communication, and social responsiveness.
 Zaraar became slightly more comfortable in the
therapy setting, though he continued to rely on
repetitive behaviors.
 Session 3

Aims or Goals of Session  To introduce behavioral intervention techniques using

Applied Behavior Analysis (ABA).
 To improve compliance with simple instructions and
promote engagement in structured activities.
Psychotherapeutic  Behavioral Instructions:
technique/tools
implemented  Taught basic commands such as “sit,” “give me,” and
“look here” using clear verbal prompts and
demonstrations.
 Reinforced compliance with stickers and verbal praise
(“Good job, Zaraar!”).

 Task Analysis:

 Broke down complex tasks into manageable steps, such as

putting toys in a box. Each step was demonstrated and
reinforced upon completion.

 Visual Aids:

 Introduced flashcards depicting actions (e.g., sitting,

clapping) to help Zaraar associate verbal commands with
visual cues.

 Encouraging Eye Contact:

 Held toys close to the therapist’s face to gently prompt eye

contact, rewarding each instance with immediate
reinforcement.

Outcomes  Zaraar followed simple instructions with guidance and

began responding more consistently to prompts.
 He showed slight improvement in eye contact during
reinforced activities.
 Demonstrated an emerging understanding of task
sequences, such as putting toys away in the correct
order.
 Session 4

Aims or Goals of Session  To engage Zaraar in sensory and developmental activities.

 To address repetitive behaviors and improve his attention
span.
Psychotherapeutic  Occupational Therapy Techniques:
technique/tools
implemented  Engaged Zaraar in sensory activities, including squeezing
therapy putty and exploring textured objects, to address
tactile sensitivities.
 Introduced gross motor activities, such as jumping on a
trampoline and crawling through a tunnel, to enhance
coordination and reduce hyperactivity.

 Behavioral Redirection:

 Redirected repetitive behaviors (e.g., spinning objects) to

more structured play, such as stacking blocks.
 Used verbal and physical prompts to sustain his focus
during these activities.

 Creative Expression:

 Encouraged Zaraar to color simple drawings, providing

guidance and intermittent praise to maintain his
engagement.

 Introducing Task Duration:

 Used a timer to set a clear endpoint for activities,

reinforcing his ability to remain focused until the timer
buzzed.

Outcomes  Zaraar engaged actively in sensory activities, showing

improved tactile exploration and short periods of focus.
 Repetitive behaviors decreased during structured play,
though they recurred when he was left unprompted.
 He completed a coloring activity with assistance and
stayed engaged until the timer buzzed, demonstrating
improved task endurance.