Bio data

Name Muhammad Luban

Age 27 years

Gender Male

Family Size 5

No. of siblings 3

Birth Order 1st

Family Type Nuclear

Father’s Occupation Factory worker

Mother’s Occupation Teacher

Father’s Education Matric

Mother’s Education Graduation

Language Urdu/Punjabi

Socioeconomic Status Middle

Residence Khurrianwala, Faisalabad

Presenting Complaints

According to reports from parents, he struggles with grasping academic content at his grade
level. He finds it particularly hard to follow instructions that require higher level reasoning and
problem solving. He experiences difficulty in managing tasks independently and unable to plan,
prioritize and complete his work without constant supervision and support. He seems to be
lagging behind his peers in all cases.
History of Present Problem

Parents have noticed delays in activities like rolling over, holding their head up. Delays in
forming words, and building a basic vocabulary were evident. After that he displayed a low level
of responsiveness to sounds, faces, and toys. He struggled with basic literacy and numeracy,
falling behind peers in reading, writing, and arithmetic. Similarly, he showed difficulties in
managing daily activities and needed help with organizing his schoolwork, on time. Basic tasks
like dressing, eating, or personal hygiene also required assistance and supervision from
caregivers. All of these symptoms indicated that there must be a problem with child. Over the
years, they consulted different doctors, including a pediatrician and a neurologist. In addition to
medical consultations, the family also pursued spiritual help, seeking guidance from local
religious or spiritual leaders. Believing that the child's condition might have a spiritual or
supernatural component.

Prenatal History

At the time of birth, his mother was 26 years old, and throughout the nine months, she reported
feeling well both physically and emotionally. There were no complications during the pregnancy,
and all routine check-ups indicated normal fetal development. The pregnancy reached full term,
and the client was born weighing 6 pounds. However, complications arose during delivery. His
first cry was delayed like 5 to 10 minutes which is a critical sign of potential respiratory distress.
Following this delay, it was noted that the child experienced hypoxia. This lack of oxygen at
birth likely contributed to subsequent developmental issues, impacting his cognitive and
intellectual growth as he aged. Overall the client’s prenatal history indicates that his mother had
a healthy and uneventful pregnancy.

Birth and Milestones

Milestones Age of Achievement

1st Cry 10 Minutes delayed

Neck holding No hold

Sat alone After 2 years

 Babbling 6 months

Crawling 18 months

Cooing 3 months

Walking No

Fed self 10 years

First word 15 months

Toilet training 10 years

Self dressed 12 years

Medical History

Over the years, they consulted different doctors. The pediatrician initially identified signs of
delayed cognitive development during early childhood. The neurologist evaluated birth-related
complications like hypoxia that might have contributed to his condition then they went to Lahore
and Islamabad for MRI as per doctor’s instructions, then diagnosed with Cerebral Palsy. Parents
continued many Muscle relaxers and Anticonvulsants. The combined intellectual and physical
disabilities prompted the family to pursue specialized therapies, including physical to help
improve his motor skills and overall physical functioning.

Family History

The client is a 27-year-old male, lives in a supportive family environment. He is the eldest of
three siblings and shares a friendly and positive relationship with his parents and younger
brothers. His father, who is 48 years old, works in a factory.He plays an important role in
ensuring that the client is involved in family activities and feels included in daily life. His mother
aged 46, is a teacher, which has influenced her active involvement in her children’s education
and development. Her background in teaching has been particularly beneficial in supporting the
client with his learning needs.The client has two younger brothers, who share a strong bond with
him. This pattern of learning challenges was not isolated to the client alone; both of his younger
brothers, aged 23 and 18, exhibited similar issues. Overall, the family exhibits a strong sense of
unity and support. They have created a positive home environment where the client feels secure
and valued.

Educational History

The child’s educational journey began in a mainstream school, where he was first admitted at the
typical age of enrollment. He initially seemed to adapt well, attending kindergarten and
progressing to the 2nd grade. However, during these early years, teachers began to notice
significant delays in his learning compared to his peers. He struggled with basic academic tasks,
such as reading, writing, and simple arithmetic, and required much more time and repetition to
grasp new concepts. His difficulty in understanding abstract ideas and following multi-step
instructions became more evident as the curriculum advanced. Following this assessment, his
parents decided to transfer him to Tanzeem-ul-Lisan, a school specifically designed for such
children who helped him make gradual progress in areas such as communication, social
interaction, and basic academics.

Social History

His social history is characterized by friendly relationships and active participation in community
activities. He enjoys playing cricket with his friends in his colony. In school, he maintains good
relationships with his classmates, who appreciate his friendly nature. He is on friendly terms with
his peers. Additionally, the client feels a sense of joy and excitement when his cousins visit him.
His interactions with family members and friends reflect a supportive and positive social
environment, contributing to his overall well-being and happiness. The client's social history is
marked by meaningful relationships and a sense of belonging within both his community and
family.

General Characteristics

Temperament

He is friendly and enjoys interacting with others. However, he can be sensitive and gets easily
offended by small remarks or situations. When this happens, his mood can shift suddenly; he
may become withdrawn or visibly upset, and it affects his willingness to engage in activities. He
has a natural tendency to cool down on his own and usually resumes his activities once he has
calmed down. His ability to recover quickly from these emotional episodes shows a positive
overall temperament, even though he may have occasional struggles with regulating his
emotions.

Adaptability

The client demonstrates a generally adaptive nature, especially when he has the support of
familiar people around him. Although he tries his best to cooperate and adjust, changes in his
environment can affect him significantly. He is sensitive to even small changes in his
surroundings, such as a different setting, new faces, or alterations in daily routines, which may
cause him to feel unsettled. Despite this, he puts in effort to adapt and to process the changes.

Character Traits

The client is a disciplined individual who understands the importance of completing tasks on
time. His respectful nature is evident in the way he treats everyone around him, whether it's his
family, friends, or teachers. However, there are moments when he struggles with confidence,
especially when faced with tasks that highlight his intellectual challenges. This can make him
feel inferior or hesitant, particularly in social or academic settings.

Levels of Functioning

Personal Domain

The client exhibits a mix of independence and the need for support in his daily self-care
activities. While he can wear clothes and put on his shoes independently, he faces difficulties
tying his shoelaces and often requires a little assistance to complete them. Feeding himself is a
challenge, and he is unable to do this on his own, needing help during mealtimes and on the other
hand he can use the washroom by himself.
Cognitive Domain

He is capable of counting money accurately and informing you of the remaining amount.
However, his attention span is quite short, and he tends to rush through tasks, eager to finish
quickly and move on to something else. Additionally, he has a short-term memory issue,
frequently forgetting recent instructions or tasks. For example, if his mother asks him to switch
off the TV, he might forget the request soon after and start a conversation or move on to a
different activity.

Social Domain

He has a large circle of friends both at school and in the neighborhood, and they often gather to
play cricket that he thoroughly enjoys it. He is good at maintaining friendships. His excitement
reaches a whole new level when his cousins visit but he takes some time to get comfortable to
strangers and yes he has a fear of them. Despite his social nature, he experiences attachment
issues. For instance, even when one of his friends blocked him for some reason, he continues to
talk about her showing a strong emotional attachment to the people he cares about.

Assessment

Medical Assessment

His parents took him to Dr. Iram Javed who diagnosed him with Cerebral Palsy (CP). The
diagnosis confirmed their concerns about his delayed motor skills and developmental challenges.
Dr. Iram explained that cerebral palsy is a neurological disorder that affects movement, posture
often caused by damage to the developing brain. Parents felt a sense of relief in finally
understanding the cause of his symptoms.Parents continued many Muscle relaxers and
Anticonvulsants. The combined intellectual and physical disabilities prompted the family to
pursue specialized therapies, including physical to help improve his motor skills and overall
physical functioning.

Psychological Assessment
Psychological assessment is conducted to gain a deeper understanding of an individual's
cognitive, emotional, behavioral, and social functioning. It involves standardized tests,
interviews, and observations to identify strengths, challenges, and potential mental health
conditions. Psychological assessment ensures more effective support and better outcomes in
therapy, education, and personal development.

Mental Status Examination

The mental status examination of the child reveals a generally untidy overall appearance. His
behavior is consistently appropriate, demonstrating respect and positive interactions with elders
and teachers. The child's mood is typically good but occasionally exhibits agitation. Their
thought process is notably slow, suggesting cognitive delays. Despite these challenges, the
child's demeanor reflects a cooperative and well-mannered attitude, highlighting their strengths
in social behavior and emotional regulation.

Psychological Testing

A Psychological test is a systematic procedure or observing person’s behaviour or performing,

describing it with the aid of a numerical scale or category system. Mostly tests are used as a way
of measuring differences between people or differences in the same person over time. The
following tests were administered to the child in this case.

 Slosson Drawing Coordination Test SDCT

 Standard Progressive Matrices SPM
 Portage Guide to Early Education PGEE
 Human Figure Drawing HFD

Slosson Drawing Coordination Test (SDCT)

The Slosson Drawing and Coordination Test (SDCT) is an assessment tool designed to evaluate
fine motor coordination, visual-motor integration, and basic drawing skills in children. It is
primarily used in educational and developmental contexts to identify potential delays or
difficulties in motor and coordination skills that might affect academic performance or daily
activities.
Quantitative Analysis

Total Score Obtained Score Errors Percentage Indication

36 20 16 56% Not Intact

Qualitative Analysis

Slosson Drawing Coordination Test, a neuropsychological test reveals that child’s eye hand
coordination is not intact. His performance on the Slosson Drawing Coordination Test suggests
deficits in fine motor skills, coordination, and attention control. The number of errors and the
relatively low obtained score 20 indicates that he’s not accurately reproducing geometric shapes
and following instructions within the specified time frame. As the cut off score for SDCT is 85%
and his score is 56% that falls in the category of not intact which indicates that he has not good
eye hand coordination.

Standard Progressive Matrices (SPM)

Standard Progressive Matrices (SPM) is a non-verbal assessment tool designed to measure an

individual's abstract reasoning and fluid intelligence, which is the capacity to think logically and
solve problems without relying on acquired knowledge or language skills. Developed by John C.
Raven in 1938, the test evaluates an individual's ability to recognize patterns, understand
complex relationships, and complete visual puzzles. The test consists of visual matrices with one
missing element, and the test-taker must identify the correct piece from a set of options to
complete the matrix logically.

Quantitative Analysis

Client’s Age 27 years

Total Score 22

Discrepancies 1, -1, -1, 0, 1

Percentile Less than 5

Grade V
 Intellectual Level Defective

Qualitative Analysis
The client’s total score is 22 and percentile is 5th and the grade is given V. This indicates that
client is Intellectually defective.

Portage Guide to Early Education (PGEE)

The Portage Guide to Early Education (PGEE) is a comprehensive developmental tool designed
to assess, monitor, and enhance the growth and learning of children from birth to six years of
age, with a particular focus on those who have developmental delays, disabilities, or are at risk of
falling behind in their milestones.

Quantitative Analysis

Domains Concluded Age

Self-help 5 years 3 months

Motor 2 years 7 months

Cognition 8 years 8 months

Language 5 years 3 months

Social 7 years 4 months

Qualitative Analysis

Based on the PGEE assessment, the estimated developmental ages in various domains for the
child who is actually 27 years old are as follows: In the self-help domain the child’s skills are at
the level of a 5-year-3-month-old. In the motor domain his skills are at 2 years and 7 months,
indicating a delay in physical coordination and movement skills. For the cognitive domain, the
child demonstrates abilities equivalent to an 8-year-8-month-old. In the language domain, the
estimated age is 5 years and 3 months, aligning with the self-help sector and suggesting moderate
development in verbal and communication skills. Finally, in the social sector, the child’s abilities
correspond to those of a 7-year-4-month-old, indicating a higher level of social interaction and
understanding.

Human Figure Drawing (HFD)

The Human Figure Drawing Test (HFD) is a psychological assessment tool used to evaluate
cognitive, emotional, and personality functioning in children and adults. It involves asking the
individual to draw a person, with the resulting drawing analyzed for various features, such as
detail, proportions, and overall representation.

Quantitative Analysis

Indicators Interpretation

Shading of hands Anxiety over real or imagined activities

involving the use of hands.
Gross asymmetry of limbs Neurological impairment, physical
awkwardness, physical inadequacy.
Shading of limbs Guilt over aggressive impulses.

Qualitative Analysis

Human Figure Drawing (HFD), a projective test, revealed that the child has anxiety over real or
imagined activities involving the use of hands and has neurological impairment & regression due
to severe emotional disturbance that indicates struggles with coordination and spatial awareness,
coupled with a tendency to revert to earlier developmental stages under stress. Physical
awkwardness and physical inadequacy is evident which may contribute to low self-esteem and
avoidance of physically demanding tasks. He also faces guilt over aggressive impulses.

Diagnosis

The child has Cerebral Palsy (CP) and according to DSM-5 he is diagnosed with Intellectual
Disability (315.10 / F71) with Moderate level severity.
Management Plan

Objective Goals Interventions

Foster daily life and self-care -Brush teeth with assistance. -Use clothing with easy
skills -Dress with little assistance. fasteners (large buttons) and
-Drink from a cup without practiced in a step-by-step
spilling. manner.
-Button up a shirt. -Make a chart for brushing
teeth with reminders.
-Use small cups gradually
shifted to larger.

Enhance Motor Skills -Improve grip strength for -Practice coloring and
holding pencil. drawing.
-String beads. -Engage in activities like bead
-Hand strength by playing with stringing for hand movements.
balloons. -Play games that involved ball,
-Improve eye-hand strength throwing & catching.
and coordination by catching a -Cutting increases his hand
ball. coordination.
-Use of scissors to cut shapes.
Behavioral Regulation -Use words or gestures to -Teach simple phrases like “I
express frustration. need a break”.
-Reduce tantrums. -Gave warnings before
-Identify calming strategies transitioning to new tasks.
(deep breathing, counting till -Teach deep breathing
5). exercise.
-Use a schedule to reduce -Teach a hand signal for
anxiety in changes. requesting for a break.
Social Awareness and Safety -Learn safe behaviors, not -Teach through stories safe
talking to strangers. and unsafe scenarios.
 -Learn to ask for help when -Teach the child to raise his
needed. hand or say help.
Social Skills -Learn to greet others. -Encourage eye contact.
-Practice sharing stuff. -Use polite expressions and
-Learn to make eye contact. modeling.
-Basic phrases thank you and
sorry.

Sessional Detail

Session 1

In the first session, the main goal was to build rapport and gather detailed background
information. I started the session in a friendly and relaxed way, asking him about his daily
activities, interests, and familiar routines to make him feel at ease. I used simple questions and
open-ended prompts to encourage him to express himself while closely observing his verbal and
non-verbal behaviors, including eye contact, attention span, and responses. I also collected a
comprehensive history from his teacher and mother using the child case history form. This initial
session was crucial for building trust and provided key insights into his baseline behavior,
ensuring he felt safe, understood and valued.

Session 2

In the second session, the focus was on introducing Luban to basic self-care tasks, specifically
brushing his teeth and buttoning up his shirt, with the goal of helping him build a routine. I began
by engaging him in a casual conversation about his day to make him feel comfortable and then
transitioned into discussing the importance of self-care. To make it interactive, I asked him to
practice the brushing motions with an empty toothbrush then focused on buttoning a shirt. At
first, I guided his hands through the process, and then encouraged him to try it independently.
After that HFD was administered. The client was seated comfortably, I asked
her to draw a complete human, it could be whether male or female and there
should be no sketchy lines or cartoonic figure. He took the page and I asked
him just feel relax and do it. He then completed and I took that page back.
Session 3

In the third session, we aimed to assess Luban's motor skills using (SDCT) and engaged him in
activities to enhance hand-eye coordination. Luban made 16 errors during the SDCT, indicating
challenges in fine motor control. We then focused on bead stringing to improve his finger
dexterity. Initially, he struggled but showed progress with guidance, successfully stringing beads
with less assistance. Next, we played catching and throwing games to enhance gross motor skills.
Although Luban had difficulty tracking the ball at first, he improved noticeably, catching it 7 out
of 10 times by the end. Overall, Luban demonstrated active participation and gradual
improvement, with recommendations for continued practice to boost his coordination skills.

Session 4

In the fourth session, the focus was on teaching Luban coping strategies for managing anger and
seeking help when needed. We began by introducing breathing techniques and encouraging him
to count from 1 to 10 when he feels anger building up, helping him to calm down and regain
control. Additionally, we practiced the phrase "I need help" to empower him to ask for assistance
when he finds himself in difficult situations. The session also included the start of the PGEE test,
during which we covered two domains. Luban engaged well with the activities, and the session
aimed to equip him with emotional regulation tools and assess his skills across the specified
domains.

Session 5

In the fifth session, we continued with the PGEE test, covering the next three domains. After
completing these assessments, I engaged Luban by encouraging him to draw and color, which
helped maintain his interest and focus. We then worked on social awareness, teaching Luban the
difference between good and bad people, helping him understand safe and unsafe behaviors. I
also discussed safety measures, emphasizing how to stay safe in different situations.

Session 6
In the sixth session, the main focus was on teaching Luban how to greet people politely and
maintain eye contact during interactions. We practiced various greetings and discussed the
importance of looking at others when speaking to show respect and engagement. After this, we
moved on to administering the SPM where we completed the first three parts: A, B, and C. The
session provided valuable insights into his social behavior while reinforcing important
communication skills.

Session 7

In the seventh session, we completed the remaining parts of the SPM, covering sections D and E.
After finishing the assessment, we analyzed Luban's overall progress across the various domains.
He demonstrated noticeable improvement, particularly in the social, behavioral, and self-help
areas. Luban’s social interactions showed greater awareness and confidence, and he exhibited
better control over his behavior. His self-help skills also improved, indicating progress in
managing daily tasks independently. Overall, the session highlighted significant strides in his
development, with a positive outlook for continued growth in these key areas.

Long Term Goals / Suggestions

1. Provide Individualized Education Programs (IEPs) that focus on practical academic skills
like basic literacy, numeracy, and problem-solving. Emphasize vocational training for
future employment opportunities in supportive environments.
2. Teach self-care routines, such as personal hygiene, cooking, and cleaning, to encourage
independence. Use step-by-step instructions and repetition to ensure mastery of these
skills.
3. Implement strategies to manage agitation or frustration, such as teaching coping skills,
providing a predictable routine, and using positive reinforcement.
4. Gradually introduce the child to community settings to develop confidence in navigating
social environments, such as public transportation or local activities.
5. Provide training for family members to create a supportive home environment and
encourage the family to participate in the child’s learning and development process.