CASE STUDY -

AUTISM
 CASE STUDY -3

AUTISM

DEMOGRAPHIC DATA (CHILD)

NAME Raj
AGE /DOB 2 years 7 months, 3 January 2020
SEX male
EDUCATION Special Education
OCCUPATION Student
CAST/RELIGION Hindu
DATE 05/08/22
REGN. NO.
INFORMANT Mother
REF. BY Relative
LANGUAGE Hindi

DEMOGRAPHIC DATA (Parents/ Guardians)

FATHER'S NAME MR. MS
FATHER'SEDUCATION Graduation
FATHER'S OCCUPATION Business in Finance
MOTHER'S NAME MRS. SS
MOTHER'S EDUCATION Graduation + B.ed
MOTHER'S OCCUPATION House maker
PRESENT ADDRESS Pooth kala , Kavita colony
Mobile no. 95821XXX
PRESENTING COMPLAINTS / PRE-ASSESSMENT CONCERN.
Hefnds difficulty in maintaining eye contact. He finds difficulty in following instruction
cometimes. He is less attentive. He needs help in basic daily life activities. He does hand
clapping very frequently. He takes hand in the mouth frequently. He shows excessive emotions
like excessively crying or laughing.
[as per mother]

PERSONALHISTORY / CHILDHOODHISTORY
PRENATAL HISTORY

His mother had a regular health check-ups as per schedule during pregnancy. er pregnancy
was wanted. Mother's physical health was not good at all as she was having excessive back
pain during 7h to 9h months of pregnancy. Due to disc pain mother has taken injections for 1.5
months/ from 7th to 8h month of pregnancy. Mother used to take healthy diet during pregnancy.
NATAL HISTORY:

He was born at hospital with full term delivery. It was normal delivery. The mother of the
child experienced normal labor duration. His body presentation was normal but cord was
rounded his neck. His birth cry was present and was normal on time. The infants color was
pink at the time of birth. His birth weight was 2.8kgs. He had respiratory distress and kept on
Oxygen for short time.

POST NATAL HISTORY:

The infant was kept on Breast Feeding after birth as per schedule. Bowel movement of infant
was normal. There was no physical illness. The child was taken primary dose of immunization
as per schedule.

FAMILY HISTORY

The child is having a joint family headed by his grandfather. There was no consanguineous
marriage in the family. He has a good relationship with his mother and father. His mother is
Sometimes authoritarian and his father is permissive. His family have a good atmosphere at
home, attitude of all family member towards the child is good. He is more attached with his
2rand father and mother. All the pcrsonal needs of child like educational, financial, play
.emotional etc., are taken care by his parents &other family members. Child has good
welationship with other family members and neighbours. The child has one elder sister. There is
family history of any disability/mental illness/epilepsy.
PEDIGREE CHART

DEVELOPMENT HISTORY

His neck holding, sitting, walking etc. was delayed. He is able to speak one word at a time and
finds difficulty to speak two word phrases sometimes. He lacks in toilet control. Child is able to
avoid simple hazards. Child faces difficulty in doing monetary transaction and has average
scholastic performance. He had clove foot.
SCHOOL HISTORY

Child was admitted to special school named Ignited Minds Special School & Learning Centre
at the age of 2years. His attendance is regular. Time duration at school is 11:30 AM to l PM.
He is less attentive in hisclassroom and relationship adjustmentwith peer groups and teachers
is good.

PLAY HISTORY
The child enjoys outdoor games more and prefers to play with peer group. When he plays in a
SOP, he takes part as an active player in a group plays. His motor activity like running
jumping is delayed. He tinds difficulty in balancing himself, play with clay, sand plastics etc.
He finds difficulty in making and building houses, modelling, painting, drawing. He finds
difficulty in understanding games governed by rules. In leisure time he likes to play with toys.
LIKING & DISLIKING

He likes ball and moving objects (running tap, moving fan etc.)
PERSONAL HISTORY

His diet is vegetarian. Hehas allergy from lactose and wheat. He likes to eat banana.
OBSERVATION(MSE)

APPEARANCE: His appearance was good. He was neatly dressed. He was wearing t-shirt and
pants as per summer season. His shoes were clean, Overall, he was well-maintained.

MOVEMENT AND BEHAVIOR: When he entered the room he was looking here and there
and he did not maintained eye can contact in starting after few minutes as one of us gave high
five to him, he replied high-five and gave 2 to 3 seconds eye contact. He roamed in the room
observing things around him.

AFFECT: While sitting in the room, there was less facial expression and he was facing
difficulty in eye contact.

MOOD: Subject was seemed to be in neutral mood while entering the room. He was looking
upwards and noticing and enjoying the movement of fan.
SPEECH: Speech was not clear. Child was facing difficulty in speaking clear words or full
sentences. It seemed like he is communicating with himself.

THOUGHT CONTENT:
Subject was not answering the questions as well as not giving attention towards question asked.
He was not aware of things around him and was finding difficulty in comprehending what is
going around him.
PURPOSEOF TESTING
clinical
objcctive assessment tool for persons with autisn which uses observation,
SAAis an
subject and also information
evaluation of behaviour, testing by interaction with the
autism.
suDplemented by parents or caretakers in order to diagnose
DIAGNOSED:

Autism
TEST ADMINISTERED:

Indian Scale for Assessment of Autism (ISAA)

The ISAA is a 40 item scale divided into six domains

(5 questions);
Social Relationship and Reciprocity (9 questions); Emotional Responsiveness
questions);
Speech Language and Communication (9 questions); Behavior Patterns (7
Sensory Aspects (6 questions) and Cognitive Component (4 questions).
frequency
The scores for the each item of ISAA range from 1-5, depending on the intensity,

and duration ofa particular behavior.

BEHA VIOR OBSERVATION DURING ASSESSMENT:

Child aged 2 years 7 mnonths , neatly dressed. Roaming in a room noticing different objects and
enjoying movement of fan. He didn't maintain eye contact in starting after few minutes as one
of us gave high f)ve to him,he replied andgave 2-3 seconds eye contact. He was talking to
himself and not responding to question that was asked to him.
TEST RESULTS

Domain-I Social Relationship and Reciprocity

Subject has poor a contact, lacks social smile , he wants to remain alone , finds difficulty in
reaching out to others , find difficulty relating to people , finds difficulty in responding to social
and environmental cues , Frequently he engages in solitary and repetitive play activities, finds
difficulty in taking turns in social interaction and finds difficulty in maintaining peer
relationships.
Domain-II Emotional Responsiveness
Subject shows inappropriate emotional response, shows exaggerated enotions and get excited
or agitated for no apparent reason mostly. He frequently engages in self stimulating emotions.
He lacks fear of danger.

Domain-IIISpeech - Language and Communication

Subject has difficulty in using non-verbal language and gestures to communicate and he mostly
engages in stereotyped and repetitive use of language. He is unable to initiate or sustain
conversation with others. He always produces unusual noises.

He uses meaningless words and pronoun reversals. He finds difficulty in grasping pragmatics
of communication.

Domain-IV Behavior Patterns

He frequently engages in stereotyped and repetitive motor mannerisms, he shows attachment to

inanimate objects and he exhibits aggressive behavior. He sometimes shows hyperactivity and
restlessness, throws temper tantrums. He rarely engages in self injurious behaviour. He rarely
insists on sameness.

Domain-V Sensory Aspects

Subject frequently stares into space for a long period of time, he has difficulty in tracking
objects, he has unusual vision and he responds to objects and people usually by smelling,
touching or tasting. He is rarely sensitive to sensory stimuli and insensitive to pain.
Domain-VI Cognitive Component
He has inconsistent attention and concentration, he shows delay in responding, he has unusual
memory of somne kind and he has `savant' ability.
 INTERVIEW 1

(Taken interview from CLIENT'S MOTHER as CLIENT was not responding.)

COUNSELLOR:- Hello ma`anm, How are you?
CLIENTS MOTHER:- Iam fine. What about you ?
COUNSELLOR:- Iam good, what's your name ?
CLIENT'S MOTHER:- My name is Sarita.

COUNSELLOR:- What do you do ?

CLIENT'SMOTHER:- Iam house maker.
COUNSELLOR:- OK! How can Ihelp you?
CLIENTS MOTHER:- Actually, my child's behaves different as compare to other children.

COUNSELLOR:- Can you tell me what all incidence happened when you noticed these
changes in your child?

CLIENT'SMOTHER:- Actually he doesn't maintain eye contact and doesn't respond to any of
our commands and restrictions.

COUNSELLOR:- What's the age of your child.

CLIENT'S MOTHER:- His age is 2 years 5 months.
COUNSELLOR:- When did you get to know about this ?
CLIENT'S MOTHER:- We noticed it few months back.

COUNSELLOR:- Are you living in joint family or nuclear family ?

CLIENT'S MOTHER:- Joint Family.

COUNSELLOR:- How many members are there in your family ?

CLIENT'S MOTHER:-8 members.

COUNSELLOR:- Which family member does he attached more or express lhimself easily ?
CILIENT'SMOTHER:- He is morc comfortable with his grandfather.
COUNSELLOR:- Does he has any siblings ?

CLIENTSMOTHER:- Yes, I have 1daughter also.

COUNSELLOR:- How the child's interaction with his sister ?
sister.
CLUENTS MOTHER:- He has caring behaviour towards his
members ?
COUNSELLOR:- How the child's interaction with other family
family member also.
CLIENT'S MOTHER:- He has good relationship with other
behaviour ?
COUNSELLOR:- Can youtell me something more about his
and takes hand in the mouth
CLIENT'S MOTHER:- He does hand clapping very frequently,
frequently.
COUNSELLOR:- Where do you live ?

CLIENT'S MOTHER:- We live in Pooth kalan.

COUNSELLOR:- Which type of planning you are doing for him?

CLIENT'S MOTHER:- We are looking for ways by which he can improve his social
behaviour.

COUNSELLOR:- Is he persuing his education ?

CLIENT'SMOTHER:- Yes, He is student in Ignited nminds, special school.

COUNSELLOR:-By religion , you are ?

CLIENT:S MOTHER:- By religion, we are Hindu.
COUNSELLOR:- OK ma'am ! you can go now. I will call you again tomorrow. Take Care.

CLIENT'S MOTHER:- OK MA'AM. (left the room with smile)

 INTERVIEW 2

(with client's mother)

cOUNSELLOR:-Hello Mrs Sarita, How are you?

CIIENT'S MOTHER:- Hello ma'am. I am fine.
cOUNSELLOR:- Ok dear. Tell me, did you have regular check-ups during the time of
pregnancy ?

CLIENT'S MOTHER:-Yes, I had regular check-ups as per schedule ?

COUNSELLOR:- What was your age at the time of pregnancy?

CLIENT'S MOTHER:- My age was 31.

COUNSELLOR:- Was your physical health good during pregnancy ?

CLIENT'SMOTHER:- No, My health was not good during pregnancy, actually Iwas having
excessive back pain, during 7th to 9th months of pregnancy. Due to disc pain I had taken
injections for 1.5 1months/ from 7h to 8h month of pregnancy.
COUNSELLOR:- How was you nutritional status ?

CLIENT'S MOTHER:- My nutritional status was good,as iused to take healthy diet during
pregnancy.
COUNSELLOR:- Was foetal movement of baby normal ?

CLIENT'S MOTHER:- Yes , it was normal.

COUNSELLOR:- Was the delivery of child normal at hospital ?

CLIENT'S MOTHER:- Yes, the delivery was normal at hospital.
COUNSELLOR:- What was colour of your baby at the time of birth?

CLIENTSMOTHER:- He was pink in colour.

COUNSELLOR:- Was presentation of your baby normal ?
CLIENT'S MOTHER:- No, the cord was rounded his neck.

COUNSELLOR:- Was birth cry present at the time of birth or it was delayed ?
 CLIENTS MOTHER:- I was on time.

cOUNSELLOR:- What was the weight of the baby at the time of birth ?
CUENTS MOTHER:- He was 2.8 kgs.

COUNSELLOR:- Is there , any other infornmation you want to tell ?

CLIENTS MOTHER:- Yes. After birth the baby had respiratory distress so he had kept on
Oxygen for few minutes.

COUNSELLOR:-Your child was breast fed or bottle fed ?

CLIENT'SMOTHER:- He was breast fed as per schedule.

COUNSELLOR:- Is there any physical illness, he faced ?
CLIENTS MOTHER:- No, there is no specific physical illness he was faced.
COUNSELLOR:- Allthe immunization were taken or not ?

CLIENT'SMOTHER:- Primary dose of immunization was taken as per schedule.

COUNSELLOR:- Doyour family supports you in caring personal, educational ,play, financial
and emotional needs of the child ?

CLIENT'SMOTHER:- Yes, they supports me in taking care of the child, but not in educational
activities. (only I teach him at home)

COUNSELLOR:-Does he enjoy to play in a group or alone ?

CLIENT'SMOTHER:- He enjoy to play in a group.
COUNSELLOR:- What kind of play he used to prefer,indoor or outdoor ?

CLIENT'SMOTHER:- He prefers to play outdoor games.

COUNSELLOR:- Does his motor skills are good ?

CLIENT'S MOTHER:- Yes,He can jump, run but finds difficulty to balance himself
unassisted.
COUNSELLOR:- Doeshe likes to inake thingsto destroy them knocking down ?
CLIENT'SMOTHER:- Yes,he likes to do sO.
COUNSELLOR:- There is any leisure tine activity he likes to do ?
CLIENTS MOTHER:- He likes to see moving object (running tap, moving fan etc).
COUNSELLOR:- Is there any specific likes or dislikes of child.
CIUENTSMOTHER:- He prefers to play with his pet dog.

COUNSELLOR:- Ok , for now you can leave dear , We will meet again.
CLIENT'SMOTHER:- Ok ma' am.

INTERVIEW 3

(With Client's Mother)

COUNSELLOR:-Hello Dear, How are you ?

CLIENT'S MOTHER:- Hello mna' am. Iam good.

COUNSELLOR:- Does he pays attention towards you ,when you call his name ?
CLIENT'S MOTHER:- He finds difficulty in paying attention towards a person who calls his
name.

COUNSELLOR:- Ok dear. Tell me, something more about your child behaviour at home ?
CLIENT'SMOTHER:- Sometimes, He shows excessive emotions like excessive crying,
excessive laughing etc.
COUNSELLOR:- Does his neck holding ,sitting, walking etc were age appropriate ?
CLIENT'S MOTHER:- No. They were delayed.
COUNSELLOR:-Is he able to speak first word or two word phrases ?
CLIENT'SMOTHER:- He is able to speak first word but faces difficulty in speaking two word
phrases.
COUNSELLOR:- Does he face difficulty in using non-verbal language or gestures to
communicate?
CLIENT'S MOTHER:- Yes, he faces difficulty in it.
COUNSELLOR:- Does he engages in stereotyped and repetitive use of language?
CUENTS MOTHER:- Yes, frequently he do so.
COUNSELLOR:- Does he produce unusual sounds / noises?
CLIENT'S MOTHER:- Yes, always.
COUNSELLOR:- Is there any physical deformity child had ?
CLIENT'S MOTHER:- Yes, the child had cloved foot.
cOUNSELLOR:- OK. Is there toilet control or he tells you about it?
CLIENT'S MOTHER:- No. he doesn't have toilet control.
COUNSELLOR:- Does he know about monetary transactions ?
CLIENT'S MOTHER:- He is poor at monetary transactions.
COUNSELLOR:- What was the age of your child, when he joined the school ?
CLIENT'S MOTHER:- He was 2 years old 1month, when he joined the school.
COUNSELLOR:- Does his attendance regular at school ?
CLIENT'S MOTHER:- Yes

COUNSELLOR:- What is you child's behaviour in classroom ?

CLIENT'S MOTHER:- He is less finds difficulty in paying attentive and listening to the
instructions of teachers at school

COUNSELLOR:- What type of relationship your child have with his peer group and
teachers ?
CLIENT'S MOTHER:- He has good relationship with his friends and teachers.
COUNSELLOR:- Does a child have any other specific allergy ?
CLIENT'S MOTHER:- Yes, child have allergy from lactose and wheat.
COUNSELLOR:- Is he taking precautions regarding this ?
CLIENT'SMOTHER:- Yes, he is taking precautions.
COUNSELLOR:- Is there any preferences regarding food ?
CLIENT'S MOTHER:- Yes. He likes to eat banana.
 0UNSELLOR:- Does he able to discriminate edible substance fron non edible ?
C IJENT'S MOTHER:- He is poor at discriminating edible from non-edibles.
cOUNSELLOR:- Does he finds difficulty in tracking objects?
CLIENT"SMOTHER:- Yes, frequently.
cOUNSELLOR:- OK dear, Now you can go.
CLIENT'S MOTHER:- OK ma' am, Thank you so much.

INTERVIEVW4
(With Client's Mother)
COUNSELLOR:-Hello Dear, How are you ?
CLIENT'SMOTHER:- Hello ma' am. Iam good.

COUNSELLOR:- Can you tell me, Have you ever taken any religious help, regarding his
symptomns?

CLIENT'S MOTHER:- No, religious help was not taken.

COUNSELLOR:- What other things you are doing now ?

CLIENT'S MOTHER:- He is taking Special Education at special school only.
COUNSELLOR:- OK! It's good. It will help your child a lot.
CLIENT'S MOTHER:- yes ma' am.
COUNSELLOR:-Do you have any questions for me ?

CLIENT'S MOTHER:- What do you think, when will he able to speak properly ?
COUNSELLOR:- You have to keep patience , it willtake time.
CLIENT'S MOTHER:- Willhe able to speak fluently like other children?
COUNSELLOR:- No, He won't be able to speak fluently like other children, but surely he will
improve.
CLIENT'S MOTHER:- Ijust want my child to understand thingsthat are going around him,
and do his little daily life chores (eating with own hands) unassisted.
COUNSELLOR;- You don'tworry, you just providehim with therapies and sessions as much
as possible.

CLIENTs MOTHER:- Isthere any chance of improvement?

COUNSELLOR:- Yes he can improve till the age of 6-6.5 years.
CLIENTS MOTHER:- OK ma'am,we are having a patience and hope he will improve.
COUNSELLOR:- Sure, This was our last session. Good Luck to your child for Future (with
smile).

CLIENT'S MOTHER:- Thank You ma'am. (She left the room with smile).
CASE SUMMARY

The subject was having mild autism due to this he faces difficulty in his daily routine activities
and academic performance. His score in ISAA was 30 that falls under mild autism category.
His parents were very concerned and taking all the precautions at home, providing him
therapies and sessions at special school, also helps him to rehearse it at home as much as
possible. As a result, he was improving day by day.
PLAN OFACTION

Thesubject should be provided with special education. He should be given therapies as per
needs. He should be encouraged to participate in different activities. Parents should take
precautions at home. Parents should help him to rehearse his learnings at home.
 IGNITED MINDS
Special Schools und arnig Cenr

CASE RECORD

1. Demographic Data (Child)

Name
Ray Date 5/3/ 2. 2
Age/DOB: - Regn. No
Sex: - Male Informant

Education: dseeaton Ref.by- Rlelans

Occupatbon. stadint Language
CasUReligion Hend
2. Demographic Data (Parents/Guardians)
Father's Name- MA
Father s Educatbor - Canadunm
Father's Occupation - B s s finane
Mother's Name SS

Mother's Education.
Mother's Occupation - Mah
Present Address Poo t kala, kamta cotony

Mobile. No. q5321X XX Telephone No.

Permanent Address -

Mobile No. Telephone No

 InconeADt!: SoMce of tncome

3. Chiefl Presenting Complaints

Contal at.

freguLly .

4. Childhood History
Prenatal History:
Antenatal Checkups:- 1 e luf
Pregnancy - Wanted! Unwanted
Aborion: Attempted ! Threatened/Ni
Age of parents at concepion:
Mother Age:- I
Father Age:- 3
Mother's Physical Healt: - fain 2
Physical Built camlete bedwt}
RH Incompatibility [D to dsc a mathe

Diabetes has daken iytien

to
Jaundice
menth
STD
HIV
fegnayJ
Infection No
Drugs (during 13 trimester, 2 trimester, 314 trinester)
Alcohol
Accident
Hypertension
Convulsion
Exposed to Rad1abon No
Nutr1tional status of mother fi tal
Foetal movenent Notmal Sugg1sh fxcessve
Mother's Menlal healtth Nornai

Natal History:;
Deivery place Home ! Hosp1tai: Other
Full Pre -atur ePost maBure
Term
Labour Draton Nomal ProBonged
Types of Delivery. - Normal iInstumental Caesarean Nanmal
round the neck/ Other
Abnormal presentation: - Prolapsed cord'Breech FeetvCord
Excessive Bleeding:
Birth Cry. - Immediate Delay
Pink Yelbw Blue Pale
Colour of baby
Birth Weight Normal High Low Known
lncubated No
Respiratory D:sttess Oxygen given Resuscitated
APGAR SCore:

Congental Anomalies:
Any other information
Post Natal Historyi
Breast Fed Bottle Fed
Feeding history: feeding
Dermand Feeding Schedule
Feeding Time - NormaVFrequent Constipated
Bowel moverment

Physical illness
Diarrhoea
Measles
Chickenpox No
Mumps
Polio
Meningitis
 Encephaitus
Hrgh Fever
Head nury
Accdent
N
its Sezure

Nutitonal Deficiency
Jaundice
Infection

Any Others
InnanHzation history: - Primary Booster
BCG: Yes /No Yes/ No
Pol:o Yes No Yes/ No
Measles: - Yes/No Yes/ No

Triple Antigen (DPT): Yes/No Yes/ No

Hepaitis B Yes/No Yes! No
Menarche

5. Family History
Types of family NucleariJointvExtended/Broken others.
Consanguinity: - Presentt absent, if yes
I Cousin/ Cousin / Other
Interpretational relationship of famity members with child
(a) Father Good/FairPoor/Not known
(b) Mother Good/FairPoor/Not known

(c) Siblings: Vgood

(d) Grandparents: nandfhe attachmnt
(e) Significant others: ’ lay
Child rearing practice al home by:
(a) Mother Permissivel Authoritarianlover protective/Negligent
(b) Father Permissivel Authoritarian/over protective/Negligent
Gener al atnosphere at hame Neral
Serene/Ourrelsometitrstabie/Over ankiousEasy going
Relationship among va ious fauly uenbers
Family involvement .
Personal need of the chld Yes No

Educational activities
Yes/ N
Yes' No
Play and leisure Actvies

Support of extended Family -

Yes / No /Not known
Financial:
Yes/ No Not known
Emotonal:

Other (Specity):
Attitude toward the Child:

Parents

Family Member s

Neighbourhood vemy jor

Siblings
Retardation/ Mental illness. .Ne.
Family history of any disabiity /Mental
6. Pedigree Chart

client ’
7. Developmental history
Age at whichulfained
(a) Neck hoktu (2.6 month)

(b) Stting

(c) Wakng
(5- 10month)
(9-14 month}
Dolagid
(d) Fst word (7-12 month) Y.
(e) Two word phrases (16-30 month)
No
() Sentences (3-4 Years).
(g) Toilet Conttol. (3-4 Year s)
(h) Monetary Transaction Yes No

(i) Avord Simple Hazards Yes No

ü)Problem in schooliScholastic backwardness Yes/ No

(k)Physical deformity Yes/ No claw feat

()Sensory inpairment Yes! No

(m)Fits Yes No

8. School History
Whether admitted in school or not

If admitted:
Name of the School 1gmidid indds
Attended/dropped/discontinued
Age of joining 2 yes
Medium of Instuction Hund
Nature of School: Normal /Special /Integrated /Others
Attendance: - Regular/ Irregular
Time Dur ation Alschool: to
If reqular teason

Does not gT WnderS, Tenul:oncial poblemíothers

chanqe
Change in school. Dul aon of schocl Nresons (ou
Roasons
Name of schooi Dur aton

Les
atuneam
attentiveObedient/Defiant
Class Room Behaviour Attentive Not
Relation adjustnent wath
Favourable/Unfavourablesnot known
Peer Groups.
Favourable:Unfavourable/not knowm
Teachers yes
Liking and disiking of any pa11culars sbjects:

Good Fait /poor / Not known

Scholastic performance
Any other information.

9. Play History
interested in play/ others
Play behaviour: - Enjoy play/Not pet dog
alone/Older/YoungerPeer grouplAnimalother
Play preference. - Play
indoor /Outdoor
Types of preference:
( (ien nys)
Leader IActive Passive
Behaviour at Play in ground s1tuaion. - Follower
Kind of play:
Free muscular play Running. Jumping. Climbing
(a)
balance, trying out scissors, using
(b) Experimental and Manipulative:- Trying to
 Clay. snd plasic elc
ic) Desttuctive Makng thnys to destoy them knock1ng dovun
Building us1ngscIssors lo danage nater1al damaging toys
(d) Censtt ucive Mak1ng and Building house. modelling. Pant1ng. drawng
Knowledge of gannes governed by rules: Yes /No Not known
Lersure time activity Interest Hobbies
a yah.. (Runrung. ta fan
Special likes and dislikes of child

I poor play behaviour, reasons for the same:

No commpanion.
Sibl1ngs not interested irn playing with chid
Over-potection
Poor play facilities
Quarrelsome

Unwilling to share his possession

Unwilling to take turns
Inability to assert his own night

10. Personal History:

Diet - Vegetarian Non Vegetarian/Mixed ( iks4 to eat
Gunana)
Habits: Tobacco chewing/Drugs/ Alcohol No
Bowels: - Regular /lregular
Micturalion: - Normal frequency / Irregular/ Nocturnal enuresis
Physical work: Donel not done
Lactae and eluat
History of allergy:.
 INTELLECTUAL IPSYCHOLOGICAL ASSESSMENT:
1 General Behaviour during Assessment

2. Attention & Concentration

3. Comprehension

4. Emotions & Behaviour

5. Relation ship with in /out side family.

Psychological Tests Used (Please Tick)

DST, VSMS, GDS, GDT, SFB, PAT, BSB, MISIC, BKT
Any other (Specifiy)
Test Results
DA .SA.. .MA

DQ SQ

Any other information

Further testing (If required):
11. Provisional Diagnoses

12. Recommendations/ Suggestion

Date:
Signature of Psychologist