Name

CHILD PLACEMENT PORTFOLIO 1
Case Reports
——————————————————————————————————
Submitted by Rabia Imran
19101090015
Submitted to Mam Habiba
Mam Nafeesa
Bs Clinical Psychology (Fall 2019-2023)
PSY-314-Clinical Internship II
Humanities and Social Sciences

GIFT UNIVERSITY, GUJRANWALA
PORTFOLIO COMPLETION CERTIFICATE

It is certified that child placement portfolio by Ms. Rabia Imran, 19101090015,
session (2019-2023) has been completed under the supervisor according to the set
patterns of the GIFT University, Gujranwala, and also been approved for submission
in its present form, as to satisfy the partial fulfillment of the course requirement for
the degree of BS Clinical Psychology.
Supervisor I Supervisor II External
Examiner
(Internal Examiner) (Internal Examiner)
Name: ________________ Name: ________________ Name: ________
Date: _________________ Date: _________________ Date: _________
Signature: _____________ Signature: _____________ Signature: _____
Institute’s Head Chairperson
(HOD)
Name: _________________ Name: _______
Date: __________________ Date: ________
Signature: ______________ Signature: _____

Acknowledgement
First of all, I would like to express my gratitude to Almighty Allah for enabling me to
complete this Clinical Internship with lots of new experiences and learning.
Presentation inspiration and motivation have always played a key role in success of
any venture.
I express my sincere thanks to Mr. L.P. Senior teacher, Govt. SPL. Education
Centre, Civil line, Gujranwala and Head of Model children homes. Without their
facilitation, this would not be possible.
I would like to acknowledge and give my special thanks to my supervisors who made
this work possible. I am also very grateful and obliged to our supervisor Mam
Habiba and Mam Nafeesa. Without their kind direction and proper guidance on
teaching and training us for the client’s adequate history-taking elements, this
internship wouldn’t have been successful.
Throughout the internship, I have also learnt many things about the mental health
problems. This help me to develop myself both professionally and socially. I am all
beholden to the clients, parents, and teachers for their cooperation, acknowledging my
efforts, trust, and recognition. I also thank their families for the assistance, support,
and coordination, which enabled me to accomplish my case reports.
Rabia Imran
19101090015
Table of Contents
Serial No
Page.
No
Case 1- Cerebral palsy (5-17)

disorder
Case 2- Motor skill and C.P (18-
29)
Case 3- Depressive disorder (30-

42)
Case 4- Emotional (43-

disturbance 54)
Case 5- Generalized Anxiety (55-

65)
References ( 66)
Appendix
(67-
70)
Case 1- Cerebral Palsy Disorder

Summary
S was a 24 years old girl. She had muscle weakness and speech problem which were
the symptoms of cerebral palsy. She was a shy personality and does not communicate
with others. She was aggressive in nature. The finding was going through behavioral
observation or clinical interview. For the formal assessment we took bender gestalt
test. In informal assessment we observe the behavior of client through clinical
interview.
Identifying data
Name S.A.
Age 24
Gender Female
Education Govt. Special education Centre
Number of sibling 4
Birth order 1
Religion Islam
Marital status None
Informant Teacher
Source and Reason for referral

The special education institute referred the child for the observation under the
supervisor. Reason for refer was that S had cerebral palsy and muscle weakness
issues. She had difficulty in communication. She needs physical exercise and special
teaching method.
Presenting complaints
Complaints Duration
Hit others Sometimes like 5 to 10 min
Aggressive From early years
Self talking From early years
Can’t read well From early years
Can’t talk well From early years
Shy All time
Self conscious According to situation
Initial observation
S was a 24 year old. She was a patient of cerebral palsy with delayed milestones,
muscle weakness, stuttering and speech issues. S was having a shy personality. When
she was asked to perform any task she loses her control and shows a confused
behavior. Her hygiene was normal.
Development milestones
Developmental milestone Normal age of achievement Clients of achievement

Weight 3 kg 2 kg
Start smiling 6-12 weeks 6 month
Head control 4 months 1 year
Start recognizing things 3 months 1.5 year
Teeth development 4 years 1 year
Start sitting 6 months 1.5 year
Start walking by own 1.5 years 3.5 year
First speech 2 years 1 year
Feed 2-3 years 3 year
Urine control Under age of 3 years 4 year
Background history
Personal history
S was born through normal delivery Her mother had no difficulty during her
delivery. But she suffered from depression due to her financial condition. She
had high grade fever at the time of birth.
Milestone of development
S was having delayed physical milestone. She started to walk after 2 years. She
started to control at age of 2.5 years. Head control after 1 year, smiling or sitting or
recognising other after 1 year.
Premorbid personality
S lived in a lower class family. Her both father or mother are doing job. S had Cp
issue from birth because her mother had high grade fever or her right hand does not
work. She can’t communicate with others. She was aggressive in nature.
History of present illness

Before our observation, she was not going for a treatment. In her family, nobody had
this issue.
Educational history
S started her schooling from the age of 14 years at M.Z.A.K special education centre.
In start, she does not know anything. Her teachers gave her training and motivate her
to participate in activities .After this, she became a good student. She started to
participate in activities.
Social history
S was having introvert personality. She mostly spend her time alone. She was shy. She
likes to talk with herself. She had few friends and was not interested in playing.
Sexual history
No sexual history was reported.
Family history
S father name was A.D. He worked as a mechanic in a company. His qualification was
up-to primary. Her father gets angry when she did not eat her food by herself. She
shared good relation with her father.
S mother name was K.P. She worked house to house to fullfil her house needs. She
was very attentive or conscious towards her daughter. Saba had close relationship
with her mother.
She had 4 siblings. 3 sisters and 1 brother. She was the third one. She was closed with
her siblings. She was very attached to her eldest married sister.

General home enviornment
S lived in a small house. Her house was not hygienic. Her home environment was
peaceful.
Monthly income
Both parents were the breadwinner of the family with total 10,000 monthly income.
History of psychiatry/Medical illness

Her family has a history of tuberculosis. Her sister s was having the same issue.
Provisional Formulation
Cerebral palsy or aggression is a major problem. Institute referred the client. She had
cerebral palsy due to weakness of muscle strength. Because of Cerebral palsy she also
had aggressive behaviour. Through observation or by conducting interview we got
information about her problem.
Assessment
Assessment was completed with the help of following assessment modalities.
Informal assessment
 Behavioural Observation
 Clinical Interview
 Identification of Reinforcement
 Subjective Rating Scale (Rating by care giver, rating by therapist)
Formal assessment
Bender gestalt test
Quantitative interpretation
Signs 4 Points
Preservation 4
Rotation or Reversal 4
Concretism
Signs 3 Points
Add Angles
Separation of Lines 3
Overlap
Distortion 3
Signs 2 Points
Embellishments
Partial Rotation 2
Signs 1 Points
Omission 1
Abbreviation 1 or 2
Separation
Absence of Erasure 1
Closure
Point of Contact on Card A

The Bender Visual-Motor Gestalt Test(abbreviated as Bender-Gestalt test) is a

psychological test used by mental health practitioners that assesses visual-motor
functioning, developmental disorders, and neurological impairments in children.
Qualitative Interpretation
According to this test, client was not stable physically or mentally. Her motor skills
not working properly or indicate neural problem.
Informal assessment
Behavioral observation
Behavior observation is a used to observe the data of client, this method is used to
collect quantitative and objective data which is used to make an intervention plan for
the betterment of behavior.
Client was 24 years old child. Her behavior was not cheerful and friendly. Her
behavior was aggressive. She was looking tensed. She was not happy. She answered
all the questions very comfortably. She was unable to recall her father, mother and
sibling’s name. Her speech was not much clear. She has fine motor skills problem.
Mini-mental state examination is a method of organizing clinical evaluation
observation pertaining to the mental status or mental condition. The primary purpose
of the mental state examination is to evaluate current cognitive processes.
Appearance & Behavior. The child was wearing neat and clean clothes. She was
very energetic and sometime shows anger towards other people.
Speech. The client’s speech was not clear.
Mood. The client had a good mood.
Memory. Memory was sharp.
Orientation. Orientation was present
Abstract thinking. The abstract thinking was absent.

General knowledge. The general knowledge of the child was satisfactory.
Attention & concentration. The attention span of the child was deficient especially
when she was studying. Otherwise her focus and attention was satisfactory.
Clinical interview
S had a very shy personality. She spent almost 10 years in her school. She was not an
active learner in the start as she had speech issues and weak muscles but now, She had
good participation in class. According to her parents, S sometimes showed mood
swings. And loses her tamper. Her right hand doesn’t work properly. Her hygiene was
normal. Her parents were cooperative.
Subjective Rating scale

In S case, Subjective rating was done by teacher or interview and by psychologist.
Symptoms Rating by teacher (0-10) Rating by therapist (0-10)

Muscle weakness 9 9
Attention 6 6
Aggressive 7 8
Speech 8 8
Shivering 6 6
Identification of Reinforcement
Reinforcer Identifying source by

therapist
Coloring  She told us she likes to
color in her free time.
Case Formulation
S experienced these issues after 2 years of her birth. Her right hand does not work
properly. In S case, she was having thoughts that she cannot work from her right hand
or even she cannot use pen instead of pencil.
“Scientists and researchers are continuously working on a cure for cerebral palsy.
Much of the current research focuses on developing a better understanding of the
disorder, identifying risk factors and causes, and finding and creating advanced
treatment options.
The National Institutes of Health (NIH) and its counterpart, the National Institute of
Neurological Disorders and Stroke (NINDS), lead the majority of cerebral palsy
research in the U.S.
The Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD) is also actively researching this disorder.
In some instances, genetic defects are responsible for a child developing cerebral
palsy. Scientists are attempting to identify how genetic factors may do this by
collecting DNA samples from those who currently have the condition, along with
samples from their family members.
Sophisticated screening techniques are used to evaluate the collected samples.
Scientists can then search for links that might explain the way cerebral palsy develops
in individuals with certain specific genetic abnormalities.
Cerebral palsy is most commonly caused by damage to the white matter in the brain,
specifically in the area surrounding the ventricles. This is the part of the brain most
commonly affected in cerebral palsy. Researchers are working to develop effective
strategies to prevent white matter brain damage. They are currently using mouse
models and cell-based therapies in an attempt to prevent the perinatal white matter
damage that causes cerebral palsy.
Botulinum toxin, more commonly known as Botox, is frequently used to treat children
with cerebral palsy who suffer from severe spastic movements. Scientists continue to
research the benefits of Botox, particularly its effectiveness in helping with daily
vibration treatments and improving the bone structure of the lower leg.
Constraint-induced therapy (CIT) is a promising new form of therapy for cerebral
palsy. It involves putting the child’s stronger limb in a cast, which forces the weaker
limb to work more during routine activities and exercises.
NICHD-backed research on CIT is helping physicians determine the most effective

methods to help children, as well as the various levels of training the child’s weak
limbs should undergo to achieve the best results.
Other treatment options for cerebral palsy that NIH is currently researching include:
 Systemic hypothermia
 Functional electrical stimulation (FES)
 Non-Government Research on Cerebral Palsy
In addition to in-depth research provided by the NIH, non-governmental agencies also
conduct research in an attempt to help children with cerebral palsy live better lives.
The Cerebral Palsy Research Foundation, also a non-profit organization, assists in
funding studies and white brain matter research. This will enhance current
understanding of the causes of cerebral palsy, formulate better treatment options and
ultimately find a cure for the disorder. If your child has cerebral palsy, it’s important
to keep up with the latest research. Talk to your medical team about any studies that
could help your child and any available clinical trials.”
"Cerebral Palsy: Hope Through Research", NINDS, Publication date July 2013.
Case Conceptualisation
● Hit others
● Aggression
● Can’t talk
Assessment: Two types Informal assessment (Clinical
interview, Behavioral observation, Subjective rating)
Formal assessment (Tool)
Maintaining
Protective
factor
Predisposing factor
Precipitating factor Over protective
factor Motivational
Development delays genetic style of
Genetic factor level
teacher or
Diagnosis
According to DSM-V, client was diagnosed with cerebral palsy along with intellectual
disability.
According to DSM-5
Motor disability: Moderate (F71)
Diagnostic Criteria for Intellectual disability
Intellectual disability (intellectual developmental disorder) is a disorder with onset

during the developmental period that includes both intellectual and adaptive
functioning deficits in conceptual, social, and practical domains. The following three
criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem solving, planning,

abstract thinking, judgement, academic learning, and learning from experience,
confirmed by both clinical assessment and individualized, standardized
intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and
socio-cultural standards for personal independence and social responsibility.
Without ongoing support, the adaptive deficits limit functioning in one or more
activities of daily life, such as communication, social participation and
independent living, across multiple environments, such as home, school, work,
and community.
C. Onset of intellectual and adaptive deficits during the developmental period.
Severity level: Moderate (F71)
Conceptual domain
All through development, the individual’s conceptual skills lag markedly

behind those of peers. For preschoolers, language and pre-academic skills develop
slowly. For school-age children, progress in reading writing, mathematics, and

understanding of time and money occurs slowly across the school years and is
markedly limited compared with that peer. For adults, academic skill development is
typically of an elementary level, and support is required for all use of academic skills
in work and personal life. Ongoing assistance on a daily basis is needed to complete
conceptual tasks of day-to-day life, and others may take over these responsibilities
fully for the individual.
Social domain
The individual shows marked differences from peers in social and

communication behavior across development. Spoken language is typically a primary
tool for social communication but is much less complex than that od peers. Capacity
for relationships is evident in ties to family and friends, and the individual may have
successful friendships across life and sometimes romantic relations in adulthood.
However, individuals may not perceive or interpret social cues accurately. Social
judgement and decision-making abilities are limited, and caretakers must assist the
person with life decisions. Friendships with typically developing peers are often
affected by communication or social limitation. Significant social and communicative
support is needed in work setting for success.
Practical domain
The individual can care for personal needs involving eating, dressing,
elimination, and hygiene as an adult, although an extended period of teaching and
time is needed for the individual become independent in these areas, and reminders
may be needed. Similarly, participation in all household tasks can be achieved by
adulthood, although an extended period of teaching is needed, and ongoing supports
will typically occur for adult-level performance. Independent employment in jobs that
require limited conceptual and communication skills can be achieved, but
considerable support from co-workers, supervisors, and others is needed to manage
social expectations, job complexities, and ancillary responsibilities such as
scheduling, transportation, health benefits, and money management. A variety of
recreational skills can be developed. These typically require additional supports and
learning opportunities over an extended period of time. Maladaptive behavior is
present in a significant minority and causes social problems.
Prognosis
After the observation, client was suffering from cerebral palsy but she can managed
by different techniques.
Proposed Management plan

Short term goal
• Built a healthy rapport with client.
• Try to improve cognitive skills.
• Try to improve academic skills
• Working on relaxation method
• Use muscle training method
• Education plan
Long term goal

 Continued short term goal for the maintenance of behavior.
 Conduct creative activities
Summary of Therapeutic Interventions
Positive Reinforcement
Positive reinforcement involves the addition of a reinforcing stimulus

following a behavior that makes it more likely that the behaviors will occur again in
the future. When a favorable outcome, event, or reward occurs after an action,
particular responses or behaviors will be strengthened. This technique was used with
the client to enhance her attention span.
Modeling
A method used in particular cognitive-behavioral psychotherapy techniques
whereby the client learns by imitation alone, without any specific verbal direction by
the therapist. It is also a general process in which persons serve as models for others,
exhibiting the behaviors to be imitated by the other. The modeling technique was used
with the client. The client has modeled the learning readiness skill, such as onset
behaviors. The client was taught how to sit in his place and do activities in the
session. Every step was introduced to the client and was modeled by the trainee to
understand and learn the steps of sitting on the chair for some time while doing tasks.
Prompting and Fading

Prompts are used to increase the likelihood that a child will provide the
desired response. Fading is gradually reducing the prompt. The prompts used with the
client were verbal prompt, physical prompts, and it was constantly used in the
management session to achieve the goals like learning readiness skills such as non-
compliance behaviors of the client. When the child was able to discover the desired
behaviors like showing compliance towards the teacher and listening to the
instructions given by the trainee or teacher, slowly and gradually, the prompts were
decreased (faded out). The client was able to show small compliance with the
instructions and commands given to him.
Daily Activity Scheduling

An activity schedule is used to plan a child's daily activities. Following a
predictable schedule and staying consistent on life skills could be a part of a child's
daily routine. This helps build confidence and reduce stress in performing new or
challenging skills. Tracing (Dot-to-Dot)
Draw a complete figure and then outline the exact figure using dots. Ask the
student to make the figure by connecting the dots (Learner, 1988). This procedure was
used to teach her to write the shapes of alphabets like a vertical line, horizontal line,
diagonal line, etc. Drawing Between the Lines
Student’s practice making "roads: between double lines in various widths and
shapes. Then asked the students to write letters by going between the double lines of
outlined letters. Use arrows to show the direction and sequence of the line (Learner,
1988). The client used this technique to write the shapes of alphabets like a vertical
line, horizontal line, diagonal
line, etc.
Individualized Intervention Plan

An individualized intervention plan was developed based on the strengths and

weaknesses of the child based on observation, history, and functional assessment of
the client. The selected tasks were taught in simple steps using different behavior
modifications. The child was able to learn new tasks through the assistance and
support of the therapist.
Picture Communication System

Some children benefit from using pictures to communicate. This makes
communication much more concrete for them. You can start by using a simple
communication board and having the child point to what he wants.
Limitation
 Session with client was limited
 Also her parents does not come for the interview.
Recommendation
 Give her a special training for improving her motor skills
 Do different physical therapies with her.

Case 2- Motor skill and Cerebral palsy

Summary
I was a 13 years old boy who was have stuttering or motor skills issue which was a
symptom of cerebral palsy. He had extrovert personality and like to explore things.
For the assessment I was going through behavioral or clinical observation. For the
informal assessment, we observed the behavior of client. In formal assessment, we
took House tree person test.
Identifying data
Name I.A.
Age 13
Gender Male
Education Govt. Special edu.centre
Number of sibling 4
Birth order 1
Religion Christian
Marital status None
Informant Teacher
Reason for referral

The special education institute referred a child I for the observation or assessment of
his behavior under the supervisor. I was a 13 yrs old boy having cerebral palsy or
motor skills problem. He needs special training or special education.
Duration Complaints
Aggressive From early years
Low attention span From early years
Do not listen parents From early years
Dress is not proper During school
Stubborn According to the time
Hit others From early years
Can’t talk properly During the session
Initial observation
I was a 13 years old boy. He was patient of motor skills problems and cerebral palsy.
I participated very actively in class and had a good memory. Showed a expressive
behavior but he can’t stick to a thing or any task for more than an hour.He was very
aggressive in nature.
Development history of problem
Developmental milestone Normal age of achievement Clients of achievement

Weight 3 kg 2 kg
Start smiling 6-12 weeks 6 month
Head control 4 months 1 year
Start recognizing things 3 months 1.5 year
Teeth development 4 years 1 year
Start sitting 6 months 1.5 year
Start walking by own 1.5 years 3.5 year
First speech 2 years 1 year
Feed 2-3 years 3 year
Urine control Under age of 3 years 4 year
Background history
Personal history
I was born through normal delivery.His mother condition during delivery or before
delivery was normal. Proper oxygen was not provided to child.
I development was weak. He started to smile at 6 month, Head control or bubbling
after one year, recognising or sitting after 1.5 year urine control after 4 years.
Premorbid personality
He belonged to a normal family. His father was the only earner of their family.He had
Cp issue by birth.Different physiotherapies was also done on him.He had aggressive
behavior from his childhood.

I was 13 years old boy who was suffering from Cp .He had motor skills issue.He
can’t write from his hand properly. His speech ability was also not normal.He also had
stubborn behavior.He usually get aggressive on little things.He was not having any
treatment.
Educational history
He started his schooling at the age of 8 years. He was not a regular student. He can’t
pay attention to any activity more than 1 hour. He had a short attention span problem.
But he was a active performer.
Social history
I was a social boy. He was very extrovert.He wanted to explore different things.He
had good relation with his friends.
Family history
His father name was S.A. He was a labour or a metric qualified. His relation with
child was normal. He also took I with him on work.
His mother name was N.B. She was housewife. His mother was matric qualified. His
relation with his mother was very closed.
He has 3 sibling. 2 sister and 1 brother. He is the eldest one. Relationship with sibling
is normal. He used to beat his younger brother

I lived in a small house. His house was hygienic or according to the requirement. His
house enviornment and parents lived peacefully.
Monthly income
His father was the only earner of family with 20,000 income.

No disease was reported in the family.
Provisional formulation
Cerebral palsy or motor skills was a major neurological issue.Because of major issue
he can’t control himself or become aggressive. He had stuttering or his muscle does
not work properly.
Assessment
Informal assessment
Formal assessment
House Tree person test
The house-tree-person test (HTP) is a projective personality test, a type of exam in
which the test taker responds to or provides ambiguous, abstract, or unstructured
stimuli (often in the form of pictures or drawings). In the HTP, the test taker is asked
to draw houses, trees, and persons, and these drawings provide a measure of self-
perceptions and attitudes. As with other projective tests, it has flexible and subjective
administration and interpretation.
HOUSe
1. It is a single story house.
2. It's my house
3. a) I would take the room with the windows.
b) My family, because I can't live without them.
4. Not specifically represented.
TREE
1.A tree
2. Old enough to produce fruit.
3. It is alive and producing food.
4. It looks strong .
5. It gives good vibes.
6. No weather is mentioned specifically.
7. The faces of the branches are on the right, so the wind is blowing in the right
direction.
8. It needs water and sunlight to produce better and more apples.
PERSON
1. It is a boy.
2. He is about 11 years old.
3. A friend.
4. Nothing
5. Nothing
6. He is a good and calm person.
7. Not mentioned
8. Nothing
9. Gense and T shirt
Hence, the test was conducted on a boy of age 13 years. According to the whole
test the child was intellectually not stable. He had a very flexible personality and
was very dependent on his parents and want them around himself
Informal assessment
Behavior observation is a used to observe the data of client, this method is used to
collect quantitative and objective data which is used to make an intervention plan for
the betterment of behavior
Client was a 16 years old child. His behavior was normal. His behavior was
not aggressive. He was using his hands while talking. He answered all the questions
comfortably. He was not walking properly. He forgets spellings. He used to forget
words during conversation. He was picking the things with only 4 fingers without
using his thumb. He has fine motor and gross motor skills problem. His fingers were
stiffed.
Appearance & Behavior. The child was wearing neat and clean clothes. He was
very energetic and sometime shows anger towards other people.
Speech. The client’s speech was not clear.
Mood. The client had a good mood.
Memory. Memory was sharp.
Orientation. Orientation was present
Abstract thinking. The abstract thinking was absent.

General knowledge. The general knowledge of the child was satisfactory.
Attention & concentration. The attention span of the child was deficient especially
when she was studying. Otherwise her focus and attention was satisfactory.
Clinical interview
I had motor skill problems but he was very active learner in class according to his
teacher. He participated in every activity. And was very expressive. I was having good
relation with his mother, his delivery was premature and delayed milestone.
In I case, we got this data by teachers and by psychologist in interactive session.

Symptoms Rating by teacher (0-10) Rating by therapist
(0-10)
Motor skills 8 10
Attention 4 5
Aggressive 6 6
Memory 2 3
Reinforcer Identifying source by therapist

Eatables  He told us that he like
jellies
 Biscuits
Case formulation
I experienced these issues by birth. He had motor skills issue and many physical
therapies was done on him before the admission in special school.
“Government, non-government organisations, community-based organisations and
industry organisations (disability and Cerebral Palsy) perform and sponsor research
on Cerebral Palsy, disabilities and impairments which can greatly benefit individuals
with Cerebral Palsy.Studies help to understand the condition and the cause, form a
basis for improved treatment options, and are used to develop prevention measures.
Some research allows government agencies to calculate how many individuals have
the condition and predict the type and amount of assistance required.Research is also
performed on treatment and therapy options. For instance, stem cell research is being
performed to ascertain whether damaged brain cells can be fixed or replaced. In an
experiment conducted by neurologist Evan Snyder at Harvard Medical School, mice
were injected with stem cell implants. The results of the study indicated that missing
cells were spontaneously replaced.While it is too early to know for certain if Snyder’s
results can be replicated in children with Cerebral Palsy, scientists are hopeful. If they
can find a surefire way to manipulate damaged brain cells to heal or replenish
themselves, then conditions like Cerebral Palsy could be treated, or perhaps
reversed.International agencies based outside of the United States promoting Cerebral
Palsy research, include:United Nations, or UN, is an international organization of over
192 member states, organized for the purpose of furthering worldwide economic
development, human rights, international law, international security, social progress,
and world peace. WHO is a branch of the UN charged with directing and coordinating
health initiatives within the UN. United Nations Enable is the UN website for all UN
activities which further the rights and dignity of those with disabilities.World Health
Organization, or WHO, is the United Nations’ coordinating authority for health and
leadership on global health initiatives. They shape research agendas, set norms and
standards, and articulate evidence-based policy options while monitoring and
assessing health trends.Surveillance of Cerebral Palsy in Europe, or SCPE, is a
collaborative network in 14 centres in 8 countries across Europe developing a central
database of children with Cerebral Palsy. SCPE monitors trends, disseminates
information, and provides a collaborative framework.The U.S. Department of Health

and Human Resources, or HHR, is the leading national agency dedicated to protecting
the health of all Americans, while providing essential human services. HHR maintains
several divisions that focus on research, prevention, safety, health, and welfare
including:The Centre’s for Disease Control and Prevention, or CDC, is a division of
the U.S. Department of Health and Human Services, an organization dedicated to
marketing communications for the protection of health and disease control, injury and
disability. The CDC has conducted surveillance of birth defects, including the
following three initiatives:Metropolitan Atlanta Development Disabilities
Surveillance Program, or MADDSP monitors five developmental disabilities,
including Cerebral Palsy, in Atlanta. It is the model for many other programs in U.S.
Autism and Developmental Disabilities Monitoring Network, or ADDM tracks
children with autism spectrum disorders and Cerebral Palsy”
"Cerebral Palsy: Hope Through Research", NINDS, Publication date July 2013.
Case conceptualisation
● Low attention span

● Aggression
● Stubborn
Assessment: Two types
Informal assessment (Clinical interview,
Behavioral observation, Subjective rating)
Maintaining Protective
factor factor
Predisposing factor Precipitating factor
Over protective Motivational
Genetic factor Development delays
genetic style of level
teacher or
parents.
Diagnosis
According to DSM-5, the client was diagnosed with cerebral palsy along with muscle
stuttering problem.
According to DSM-5
Motor disability: Mild 315.4(F28)
Diagnostic Criteria for Intellectual disability
Intellectual disability (intellectual developmental disorder) is a disorder with onset

during the developmental period that includes both intellectual and adaptive
functioning deficits in conceptual, social, and practical domains. The following three
criteria must be met:
D. Deficits in intellectual functions, such as reasoning, problem solving, planning,

abstract thinking, judgement, academic learning, and learning from experience,
confirmed by both clinical assessment and individualized, standardized
intelligence testing.
E. Deficits in adaptive functioning that result in failure to meet developmental and
socio-cultural standards for personal independence and social responsibility.
Without ongoing support, the adaptive deficits limit functioning in one or more
activities of daily life, such as communication, social participation and
independent living, across multiple environments, such as home, school, work,
and community.
F. Onset of intellectual and adaptive deficits during the developmental period.
Severity level: Mild 315.4(F28)
Conceptual domain
For preschool children, there may be no obvious conceptual differences. For

school-age children and adults, there are difficulties in learning academic skills
involving reading writing, arithmetic, time, or money, with support needed in one or
more areas to meet age-related expectations. In adults, abstract thinking, executive
function (i-e., planning, strategizing, priority setting, and cognitive flexibility), and
short-term memory, as well as functional use of academic skills (i.e., reading, money,
management), are impaired. There is a somewhat concrete approach to problems and
solutions compared with age-mates.
Social domain
Compared with typically developing age-mates, the individual is immature in social

interactions. For example, there may be difficulty in accurately perceiving peers,
social cues. Communication, conversation, and language are more concrete or
immature than expected for age. There may be difficulties regulating emotion and
behavior in age-appropriate fashion; these difficulties are noticed by peers in social
situations. There is limited understanding of risk in social situations; social judgement
is immature for age, and the person is at risk of being manipulated by others
(gullibility).
Practical domain
The individual may function age-appropriately in personal care. Individuals need

support with complex daily living tasks in comparison to peers. In adulthood, supports
typically involve grocery shopping, transportation, home and child-care organizing,
nutritious food preparation, and banking and money-management. Recreational skills
resemble those of age-mates, although judgement related to well-being and
organization around recreation requires support. In adulthood, competitive
employment is often seemed in jobs that do not emphasize conceptual skills.
Individuals generally need support to make health care decisions and legal decisions,
and to learn to perform a skilled vocation competently. Support is typically needed to
raise a family.
Prognosis
Child’s parent was cooperative and willing that their child become better.
After observation, child was suffering from muscle but he can improve from physical
therapies and treatments

Short term goal
• Built a healthy rapport with client.
• Try to improve intellectual skills.

• Improve academic skills
• Working on interactive session
• Use self control training
• Education plan
Long term goal

 Continued short term goal for the maintenance of behavior.
 Conduct creative activities or group therapy
Summary of Therapeutic Interventions

Positive Reinforcement
Positive reinforcement involves the addition of a reinforcing stimulus

following a behavior that makes it more likely that the behaviors will occur again in
the future. When a favorable outcome, event, or reward occurs after an action,
particular responses or behaviors will be strengthened. This technique was used with
the client to enhance her attention span.
Modeling
A method used in particular cognitive-behavioral psychotherapy techniques
whereby the client learns by imitation alone, without any specific verbal direction by
the therapist. It is also a general process in which persons serve as models for others,
exhibiting the behaviors to be imitated by the other. The modeling technique was used
with the client. The client has modeled the learning readiness skill, such as onset
behaviors. The client was taught how to sit in his place and do activities in the
session. Every step was introduced to the client and was modeled by the trainee to
understand and learn the steps of sitting on the chair for some time while doing tasks.
Prompting and Fading

Prompts are used to increase the likelihood that a child will provide the
desired response. Fading is gradually reducing the prompt. The prompts used with the
client were verbal prompt, physical prompts, and it was constantly used in the
management session to achieve the goals like learning readiness skills such as non-
compliance behaviors of the client. When the child was able to discover the desired
behaviors like showing compliance towards the teacher and listening to the
instructions given by the trainee or teacher, slowly and gradually, the prompts were
decreased (faded out). The client was able to show small compliance with the
instructions and commands given to him.
Daily Activity Scheduling

An activity schedule is used to plan a child's daily activities. Following a
predictable schedule and staying consistent on life skills could be a part of a child's
daily routine. This helps build confidence and reduce stress in performing new or
challenging skills. Tracing (Dot-to-Dot)
Draw a complete figure and then outline the exact figure using dots. Ask the
student to make the figure by connecting the dots (Learner, 1988). This procedure was
used to teach her to write the shapes of alphabets like a vertical line, horizontal line,
diagonal line, etc. Drawing Between the Lines
Student’s practice making "roads: between double lines in various widths and
shapes. Then asked the students to write letters by going between the double lines of
outlined letters. Use arrows to show the direction and sequence of the line (Learner,
1988). The client used this technique to write the shapes of alphabets like a vertical
line, horizontal line, diagonal
line, etc.
Individualized Intervention Plan

An individualized intervention plan was developed based on the strengths and
weaknesses of the child based on observation, history, and functional assessment of
the client. The selected tasks were taught in simple steps using different behavior
modifications. The child was able to learn new tasks through the assistance and
support of the therapist.
Picture Communication System

Some children benefit from using pictures to communicate. This makes

communication much more concrete for them. You can start by using a simple
communication board and having the child point to what he wants.
Limitations
 Client does not come for the interview
 He was not a regular student
Recommendation
 Provide him proper motor skills training
 Provide him physiotherapist for the betterment or involve him in different
creative activities
Case 3- Depressive disorder

Summary
H was a 12 years old girl. She was suffering from mild depression and emotional
disturbance. She was living in “Model Children homes” from last four years. The
assessment was done by observation. Clinical interview was also conducted on her.
She took psychological test like HTP, BDI and Beck suicidal thoughts. The
intervention plan was self controlling or self cognition control training was curable.
Identifying data
Name H.T.
Age 12
Gender Female
Education Model children homes
Number of sibling 6
Birth order 1
Religion Islam
Marital status None
No of sessions 4
Source and Reason for referral

Orphanage institute referred the client under the supervisor control for the observation
and assessment with presenting complaints.
Client behave aggressively when her parents did not come to meet her.
She has jealousy and complex factor when someone showed her their
things.
She also does not have interest in studies.
Initial observation
H was a 12 years old girl. She referred to us for the assessment. When her name
called, she came to us. In start, she was little bit shy. But after sometime, she started to
talk. Her body language was normal. She continuously shakes her feet. She gave all
answer to the question which we asked from her.
Development history of problem

The client belonged to a ordinary family. Her parents was separated at her birth time.
She lived in her grandmother house. After some years, her grandmother took her to a
orphanage centre for a admission due to financial issues. She was living in a
orphanage for last four years. Her mother and father was married to another spouse
and started their life separately. When her family did not come to meet her, she felt
bad or these things affect her thoughts.
Background history
Personal history
The client’s parent did not come for the interview. So, we got all information from the
client.
Her milestone was developed on time.

Before our observation, she was not going for a treatment.
Educational history
Client was in class four. Before admission in this institute, she got position. But now,
She has no interest in her studies.
Social history
She had no friends. She mostly spent her time alone. She had no interest in others.
Sexual history
No sexual history was reported.
Family history
According to client, her parents was separated at the time of her birth. Now her father
married to another women and has three child.
After divorce, her mother was also married to another men or has two child
She had five siblings, three brother or 3 sister and she had good relation with all of her
family.

According to client, whenever she was going to her home, she felt happy and enjoy at
her home very well.

Client was not have psychiatry and medical illness in her family.
Provisional Formulation
The client had anger issues and suicidal thoughts which indicated that she was having
mild depression.
Assessment
Informal assessment
Formal assessment
Beck Depression Inventory
Sr. no Items Scores

1 Sadness 2
2 Pessimism 1
3 Past failure 1
4 Loss of pleasure 1
5 Guilt feeling 1
6 Punishment feelings 2
7 Self Dislikes 0
8 Self-Criticalness 1
9 Suicidal Thoughts 1
10 Crying 1
11 Agitation 1
12 Loss of interest 1
13 Indecisiveness 0
14 Worthlessness 1
15 Loss of energy 0
16 Changes in Sleeping pattern 0
17 Irritability 1
18 Changes in Appetite 0
19 Concentration difficulty 0
20 Tiredness or fatigue 1
Sr. no Items Scores

21 Loss of interest in sex 0
TOTAL= 16
Age Raw score Normal range Results

25 43 0-13 minimal depression
14-19 minimal depression Severe depression
20-28 moderate
29-63 severe depression
The Beck Depression Inventory (BDI, BDI-II), created by Dr. Aaron T. Beck, is a 21-
question multiple-choice self-report inventory, one of the most widely used
instruments for measuring the severity of depression. Its development marked a shift
among health care professionals, who had until then viewed depression from a
psychodynamic perspective, instead of it being rooted in the patient’s own thoughts.
Quantitative scoring
First page Second page Total page

12 4 16
According to this test, she had mild depression. She was not in a severe stage but had
emotional disturbance.
House Tree person test

The house-tree-person test (HTP) is a projective personality test, a type of exam in
which the test taker responds to or provides ambiguous, abstract, or unstructured
stimuli (often in the form of pictures or drawings). In the HTP, the test taker is asked
to draw houses, trees, and persons, and these drawings provide a measure of self-
perceptions and attitudes. As with other projective tests, it has flexible and subjective
administration and interpretation.
Qualitative interpretation
House
According to house drawing, client was rigid and insecure. She was in need of
support. She had low self esteem and anxiety and poor adjustment. She was having
shy personality. She had weak ego boundary. She was not socially connected and does
not have feeling for others.
Tree
In this, she draw a fruit tree. According to this, tree showed dependency and
immaturity in her nature. She had OCD and anxiety. She also had split ego. She had
no self concept. She was dependent on other and needed a proper care.
Person
The picture draw by client showed that she had anxiety and not able to take her
decisions properly. She mostly depend on others and sometimes showed immaturity.
She also felt discouragement. She had ego problem, assertiveness and melancholia.
Beck Suicidal Thought
First page Second page Total page

13 12 25
Beck Scale for Suicide Ideation is an evaluation of suicidal thinking that helps
identify individuals at risk. It also helps measure a broad spectrum of attitudes and
behaviors.
According to scoring, she had moderate suicidal thoughts. She needed a proper self
control training.
Informal assessment
Clinical interview
Interactive session with client in which we collected detail about her. Firstly, rapport
built with her and she started to tell about her problem and family detail. She had
aggression issues.

In H case, Subjective rating was done by teacher and interview and by psychologist.
Symptoms Rating by client(0-

10)
Aggression 6
Hit herself 5
Jealousy 7
Complexes 8
Reinforcement increases the person's probability to respond. Reinforcement is a
behavior that will increase and strengthen responses. Reinforcements are anything.
like, compliments, appreciations, clapping on doing good.
Case Formulation
H experienced these issues after the admission in orphanage. She had aggressive
behavior with herself when her parents did not come to meet her.
“According to the DSM-5, depressive disorders all have one common feature, namely
the presence of sad, empty or irritable mood, accompanied by somatic and cognitive
changes that significantly affect the individual's capacity to function (DSM-5). They
may become a serious health problem if allowed to persist for long periods of time
and occur with a moderate-to-severe degree of intensity. One important consequence
of depression is the risk of suicide, which is, according the World Health Organization
(WHO) (2017), the second most common cause of death among young people aged
between 15 and 29.
The main novelty offered by the DSM-5 in its section on depressive disorders is the
introduction to Disruptive mood dysregulation disorder (which should not be
diagnosed before the age of 6 or after the age of 18). This disorder is characterised by
severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or
behaviourally (e.g., physical aggression toward people or property). These outbursts
often occur as the result of frustration and in order to be considered a diagnostic
criterion must be inconsistent with the individual's developmental level, occur three or
more times per week for at least a year in a number of different settings (at home, at
school, etc.) and be severe in at least one of these. This disorder was added to the
DSM-5 due to doubts arising in relation to how to classify and treat children
presenting with chronic persistent irritability as opposed to other related disorders,
specifically paediatric bipolar disorder. The prevalence of this disorder has been
estimated at between 2 and 5%, with male children and teenage boys being more
likely to suffer from it than their female counterparts.
Depressive disorders cannot be explained by any single theory, since many different
variables are involved in their onset and persistence. The principal biological and
psychological theories were therefore taken as the main references for this section.
Subsequently, the contributions made by each of these theories regarding depression
were studied by conducting searches in PubMed, Web of Science, Science direct, and
Google Scholar. With the constant key words being depression, child depression and
adolescent depression, the search for information cross-referenced a series of other
key words also in accordance with the specific theory in question. Due to the
importance of some seminal works in relation to the development of psychological
theories of depression, certain authors have remained key references for decades. A
total of 64 bibliographical references were used. The following is a summary of the
various explanations for the onset of depression, according to the different theoretical
frameworks.
Biological Theories
If a mood disorder cannot be explained by family history or stressful life events, then
it may be that the child or adolescent in question is suffering from a neurological
disease. In such a case, depressive symptoms may manifest early in children and
adolescents as epileptic syndromes, sleep disorders, chronic recurrent cephalalgias,
several neurometabolic diseases, and intracranial tumours (Narbona, 2014).
Noradrenalin Deficit
Serotonin is a monoamine linked to adrenaline, norepinephrine, and dopamine which
plays a key role, particularly in the brain, since it is involved in important life
regulation functions (appetite, sleep, memory, learning, temperature regulation, and
social behaviors, etc.), as well as many psychiatric pathologies (Nique et al., 2014).
Serotonin modulates neuroplasticity, particularly during the early years of life, and
dysfunctions in both systems contribute to the physiopathology of depression (Kraus
et al., 2017). MRI tests in animals have revealed that a reduction in neuron density
and size, as well as a reduction in hippocampal volume among depressive patients
may be due to serotonergic neuroplasticity changes. Branchi (2011), however, argues
that improving serotonin levels may increase the likelihood of both developing and
recovering from the psychopathology, and underscores the role played by the social
environment in this process. In this sense, Curley et al. (2011) point out that the
quality of the social environment may influence the development and activity of
neural systems, which in turn have an impact on behavioral, physiological, and
emotional responses.
The review of current child and adolescent depression prevention programs revealed
that the vast majority coincide in adopting a cognitive-behavioral approach, with
contents including social skills and problem solving training, emotional education,
cognitive restructuring, and strategies for coping with anxiety. These contents are
probably included because they are important elements in the treatment of depression,
as shown in this review. But if their inclusion is important and effective in the
treatment of depression, why do they not seem to be so effective in preventing this
pathology? There are probably many factors linked to prevention programs which, in
one way or another, influence their efficacy: who implements the program and what
prior training they receive; the characteristics of the target group; group dynamics;
how sessions are run; how the program is evaluated; and if the proposed goals are
really attained (e.g., training in social skills may be key, but perhaps we are not
training students correctly). Moreover, in universal prevention programs carried out in
schools, the intervention focuses on students themselves rather than adopting a more
holistic approach, as recommended by certain authors such as Greenberg et al. (2001).
But, if we accept that depression is multifactorial and that risk and protection factors
may be found not only in the school environment but also in the family and social
contexts, should prevention not also be multifactorial?
There is therefore still much work to be done in order to fully understand child and
adolescent depression and its causes, and so design more effective evaluation
instruments and prevention and treatment programs. Given the important social and
health implications of this disorder, we need to make a concerted effort to further our
research in this field.”
Abramson, L. Y., Seligman, M. E. P., and Teasdale, J. D. (1978). Learned helplessness
in humans: critique and reformulation. J. Abnorm. Psychol. 87, 49–74. doi:
10.1037/0021-843X.87.1.49
Case Conceptualisation
● Hit others
● Aggression
● Can’t talk
Maintaining
Protective
factor
Predisposing factor Precipitating factor factor
Traumatic
By birth Mental impairment Insight is good
experience
Diagnosis
According to DSM-5 criteria, all her symptoms indicated that she had mild
depression. In this, suicidal thoughts occurred.
Prognosis
Motivate her to take interest in her studies. Recovery can begin within 3 months
Management plan
Goals Therapeutic techniques
Short term goal

 Built a strong rapport with client.  Working on relaxation
 Try to improve self control skills. method
 Use cognition training
method
Long term goal
Continued short term goal for the Conduct creative activities
maintenance of behavior.
Limitation
 Session with client was limited
 Institute does not provide information about the client
 Institute was unhygienic.
Recommendation
 Give her a special training for self control.
 Involve her in different activities.
Case 4- Emotional Disturbance

Summary
H was a 19 years old girl living in “Govt. model children home”. At the initial
observation the client had an aggression issue and minor appearance of jealousy. The
findings or assessments was going through behavioral observation, then conducted a
clinical interview with her. For the formal assessment we took HTP and baseline tests
for aggression and got the proposed assessment for the relevant test. The diagnosis of
the client was aggression, mild level depression and emotional imbalance.The
intervention plan according to the client condition was group therapy, self control
training for anger control and cognition control training this was curable. These
different techniques, strategies and treatment plans that help to maintain the life and
behavior.
Identifying Data
Client’s name: H.T.
Age: 19
Gender: female
Education: Model children homes
Number of siblings: 4
Birth order: 1st
Marital status: None
No of sessions: 4
Date seen: 19\10\22
Last date seen: 27\10\22
Reason for referral

The client was referred to a clinical psychologist by the orphanage administration
with presenting complaints , anger issues and other behavioral issues.
Presenting Complaints
She behaves aggressively with their friends.

also aggravates a minute jealousy factor when her friend is with other fellows.
she has no interest in curricular activities.
Initial Observation
When her name was called she came into the room and she was a little bit depressed
because she fought with her fellow but gently calmed after a minute. and then built a
rapport with her. Initially she was hesitant. Her body language is normal while
attending the session. and gave all the answers to the concerning questions.then she
walked out from the room.
Developmental History of the Problem

She belongs to a mediocre family. Her father did not support their family and violated
their family member. After that her mother got divorced with her husband. and left the
country and worked at a salon in Dubai. All the behavior shown by her father affects
their children. She and her sisters have been living in an orphanage for the last 6
years. her behavior may be established during these tragic childhood experiences.
These incidents affect her behavior along with other factors of her personality. Also
the environment of the orphanage plays a role in the modification of their behavior.
Background Information
Personal history
Due to unavailability of the data from parents we could got the personal history of the
child.
according to the client. She really enjoyed her childhood but when teenage started she
had troubled family issues that lead to this current situation.

Educational history
The client was studying at level 10. According to her, she was not interested in her
education.
Social History
The client had a friendly nature but she showed aggression during the arguments and
others.
Family History
The client's father was an illiterate person. He did not run his family. He was involved
in bad deeds. He had abusive behavior with his family member, he was also violent
with his wife. The relationship of the client with her father was not good. She didn't
love him.
The client's mother was a literate lady. When she divorced from her husband she ran
her family. She moved to Dubai for her job at a salon. The client's relationship with
her mother is good.
The client had 3 younger sisters. all were living in an orphanage. The relationship
with her siblings was normal.
General home environment

The client had an aggressive and violent home environment.
Orphanage History
The general environment of the orphanage was good; they have a clean environment.
At 8:00 am children go to school in the orphanage bus and return at 2:30 pm then
change their clothes and the lunch was given to all children in the dining room. After
that they offer prayers and learn the Quran and siparas. Then the young girls prepared
the dinner and served them. At night they have some time for television serials. then
go to sleep.
History of Psychiatry/ Medical Illness

The client had no history of psychiatric illness in their family. And had no medical
history reported in their family.
Assessment
The assessment was completed with the help of following assessment modalities:
Informal Assessment
• Behavioral Observation
• Clinical Interview
• Identification of Reinforcement
• Subjective Rating Scale
Formal Assessment
HTP (House, Tree, Person)
HTP is a projective technique that measures and examines the different aspects like
social , emotional, cognitive and mental state of the person. client asked to perform
the activity.
Tool
Psychological assessment can include numerous components such as norm-referenced
psychological tests, informal tests and surveys, interview information, school or
medical records, medical evaluation, and observational data.
Test administration
For the test administration, I give them instructions according to relevant tests and
task complete time. For this purpose I gave them an assessment sheet and pencil for
drawing. and note the time.
The client coordinated and cooperated with us and follows all the instructions.
Qualitative interpretations
House:central placement; shows rigidity
low placement on page; shows insecurity, depression and insecurity
door; shows social openness no window; usually feeling of withdrawn abusive child
irrelevant detail; shows that sense of insecurity and wants to get power over her
environment.
Tree: Tree placement refers to that person's sense of growth & development and also
represents her father.
abstract tree; shows that avoid direct confrontation
fruits; represent that dependency and immaturity
excessive detail; in the tree shows obsessive compulsive anxiety.
no roots; shows sense of insecurity
The crown ;shows fantasy like imagination.
apple fruit; shows that dependence and nurturance.
Person:back view head; escape character and escape from reality, schizophrenia,
paranoid type
pocket; affectional deprivation and maternal dependency.
finger grape like and more than five; aggression and immaturity infantile triat
arm extended from body; shows hat external aggression
middle placement; aggression
circular stocks; shows that dependency
clothing carefully; shows egocentric , over concern
Projective analysis shows that she was aggressive and feeling of insecurity and also
had dependency and immaturity She looked for emotional insecurities. She withdrew
from the relationship and had trust issues as well. projective analysis reflects the
obvious aspects of situations. The responses reflect depression and maladjustment.

Some cores show she had self worth. finding had some evidence of depression.
Analysis indicates that depression was interlinked with aggression.
Informal Assessment
Behavioral Observation
For better understanding and assessments the Client was observed in natural room
settings. To understand the behavior, academics and their personality. For the
assessment the test was given to the client she actively participated. and coordinated.
Clinical Interview
Clinical interview was conducted with the client’s teacher for more information and to
make best interventions according to them. I also took a clinical interview with a
client and during the session, performed some activities to build a good rapport
between the client and the psychologist.
Subjective Ratings
Showing Problem and Rating of those Problems by the Client

Symptoms Ratings by Client
(0-10)
she has aggression 9
she has a jealousy factor 6

face difficulty mingling with 7
her fellows .
Case Formulation
H was a 19 years old girl. She was the eldest or 1st born child of her parents. She
had good hygiene measures. She behaved aggressively with their friends, also
aggravates a minute jealousy factor when her friend was with other fellows.The
for aggression. The developmental causes of the client was aggressive and violent
home environments. Her behavior may be established during these tragic childhood
experiences. These incidents affected her behavior along with other factors of her
personality. Also the environment of the orphanage played a role in the modification
of their behavior. “Predisposing factors are those that put a child at risk of developing
a problem.genetic factor causes intellectual disability .genetic factors play a very
important role in the causation of autistic traits in children with intellectual disability.
The prevalence of ID is highly variable depending on the country studied, the age of
the subjects and the method of determination [Kaufman et al., 2010]. Precipitating
factors refer to a specific event or trigger to the onset of the current problem
CBT have been well studied in randomized controlled trials in children with
disruptive behavior disorders, and studies of transdiagnostic approaches to CBT for
anger and aggression are currently underway. More work is needed to develop
treatments for other types of aggressive behavior
Sukhodolsky DG, Smith SD, McCauley SA, Ibrahim K, Piasecka JB. Behavioral
Interventions for Anger, Irritability, and Aggression in Children and Adolescents. J
Child Adolesc Psychopharmacol. 2016 Feb;26(1):58-64. doi: 10.1089/cap.2015.0120.
Epub 2016 Jan 8. PMID: 26745682; PMCID: PMC4808268.
Predisposing factors: Maintaining Factors:
• Genetics. Poor coping strategies
• Chromosomal abnormality. Therapies not applying
• by birth
Precipitating factors: Protective Factors:
• poor anger management . Her insight
• Intellectual disability. Physical skills”
MG designed the study and wrote the protocol. EB and JJ conducted literature review
and provided summaries of previous research studies, and wrote the first draft of the
manuscript.
Case Conceptualization
● Hit others
● Aggression
● Has no interest in activities
Precipitating Maintaini Protective

Predisposing factor
factor ng factor factor
Genetic factor
Poor anger Coping Insight is good
management strategies
Diagnosis
According to all the observations and data the client was diagnosed with a behavioral
problem but if not managed then her proposed diagnosis is ODD.
Client’s prognosis
After the observations, the diagnosis of the client was that she was suffering from
aggression. But can be managed through the different therapeutic techniques, the
client at least able to manage herself with good living, healthy diet and psychological
help.

Short term goal:
● Establish a healthy rapport building with clients.
● Try to improve cognitive skills.
● Psychoeducation for institute management.
● establish clear behavioral expectation.
● Working on social functioning.
● use progressive muscle relaxation.
● new skill development technique.
Long term:
 Continued the short term goal for maintenance of behavior and routine
task.
 Create awareness activities
Intervention Strategies
Reinforcement

behavior that will increase and strengthen responses. Reinforcements are anything
like things like toys, colors etc. , appreciations (clapping) on doing good.
Limitations
● Sessions with the client are very limited.
● parents were not actively concerned about him.
● There is a need to change the company of a client in order to reduce the

negative behavior of a client
● Aggressive behavior of father affect the child so family counseling session is
needed to overcome his aggressiveness in the client because she learn from
his father
Recommendations
● Child should given one on one attention
● Concept formulation
● Parent child bonding
● Rapport building
Case 5- Generalized Anxiety Disorder

Summary
E was a 10 years old girl living in “Govt. model children home”. At the initial
observation the client had an aggression issue and more conscious about her health.
The findings or assessments was going through behavioral observation, then
conducted a clinical interview with her. For the formal assessment we took HTP and
baseline tests for aggression and got the proposed assessment for the relevant test. The
diagnosis of the client was aggression, General anxiety disorder and emotional
imbalance.The intervention plan according to the client condition was group therapy,
self control training for anger control and cognition control training this was curable.
These different techniques, strategies and treatment plans that help to maintain the life
and behavior.
Identifying Data
Client’s name: E.N
Age: 10
Gender: female
Education: Model children homes
Number of siblings: 3
Birth order: 2nd
Marital status: None
No of sessions: 4
Date seen: 24\11\22
Last date seen: 26\11\22
Reason for referral

The client was referred to a clinical psychologist by the orphanage administration
with presenting complaints , anger issues and other behavioral issues. She was more
conscious about her health because she had a heart problem.
Presenting Complaints
She sometimes destroy other people things

She had a aggressive behavior
Emotionally unstable due to her poor health
She had a stubborn behavior
Poor sleep
Initial Observation
When her name was called she came into the room and she was anxious because she
had a anxiety issue. and then built a rapport with her. Initially, she was hesitant. Her
body language is normal while attending the session. and gave all the answers to the
concerning questions. She was self conscious and had poor socialization.
Developmental History of the Problem

She belongs to a poor family. Her brother abused her younger sister and also abused
her one time. She informed her mother. But there was no response from her parents.
Her mother killed her father because she loves another men. She hates her
mother.After the admission in orphanage, she abuse a girl and involved in these
activities. When she cane to know about her heart problem she left all these activities
and thought that this was a punishment for her. She was more conscious about her
health.
Background Information
Personal history
Due to unavailability of the data from parents we could got the personal history from
the child.
According to the client, she was 8 years old girl. She had a anxiety problem due to her
health problem.

Educational history
The client was studying at prep class. She was suspended from the school because of
her immoral activities.
Social History
The client had a shy nature but she showed aggression when she was anxious about
her health problem. She had no friends. She was attached with her younger sister.
Family History
The client's father was an illiterate person. He was a car mechanic. He was killed by
clients mother because she was interested in another men. The client had good
relation with her father.
The client's mother was a illiterate lady.She had no interest in her husband and
family. She was in love with someone else. With her lover, she killed her husband and
left her children. The client relation with her mother was not good, she hate her
mother.
The client had 3 siblings. Two sister and one brother. She was middle child. Her elder
brother involved in immoral activities and started to live his life with her mother. The
client and her sister was living their life in orphanage.
General home environment

The client had a poor family. Her home environment was not peaceful.
Orphanage History
The general environment of the orphanage was good; they have a clean environment.
At 8:00 am children go to school in the orphanage bus and return at 2:30 pm then
change their clothes and the lunch was given to all children in the dining room. After
that they offer prayers and learn the Quran and siparas. Then the young girls prepared
the dinner and served them. At night they have some time for television serials. then
go to sleep.
History of Psychiatry/ Medical Illness

The client had no history of psychiatric illness in their family. And had no medical
history reported in their family. But she had a heart problem. After her admission in
orphanage, she get to know about her problem.
Assessment
The assessment was completed with the help of following assessment modalities:
Informal Assessment
• Behavioral Observation
• Clinical Interview
• Identification of Reinforcement
• Subjective Rating Scale
Formal Assessment
HTP (House, Tree, Person)
HTP is a projective technique that measures and examines the different aspects like
social , emotional, cognitive and mental state of the person. client asked to perform
the activity.
Tool
Psychological assessment can include numerous components such as norm-referenced
psychological tests, informal tests and surveys, interview information, school or
medical records, medical evaluation, and observational data.
Test administration
For the test administration, I give them instructions according to relevant tests and
task complete time. For this purpose I gave them an assessment sheet and pencil for
drawing. and note the time.
The client coordinated and cooperated with us and follows all the instructions.
Projective analysis shows that she was aggressive and feeling of insecurity and also
had dependency and immaturity She looked for emotional insecurities. She withdrew
from the relationship and had trust issues as well. projective analysis reflects the
obvious aspects of situations. The responses reflect depression and maladjustment.
Some cores show she had self worth. finding had some evidence of depression.
Analysis indicates that depression was interlinked with aggression.
Informal Assessment
Behavioral Observation
For better understanding and assessments the Client was observed in natural room
settings. Her appearance was unhygienic. She was not dressed properly. For the
assessment the test was given to the client she participated. and coordinated.
Clinical Interview
Clinical interview was conducted with the client for the information about her
problems to make best interventions according to them. Performed some activities to
build a good rapport between the client and the psychologist. In interview, we got to
know about her problem, that she was an extreme conscious about her health and she
had fear of separation from the loved ones.
Subjective Ratings
Showing Problem and Rating of those Problems by the Client

Symptoms Ratings by CareTaker
(0-10)
she had aggression 9
Poor sleep 6
Poor health 7
Poor hygienic 9
Case Formulation
E was a 10 years old girl. She was the middle or 2nd born child of her parents. She
had bad hygiene measures. She behaved aggressively with their fellows, also
aggravates a minute jealousy factor when her friend was with other fellows.The
for aggression. The developmental causes of the client was aggressive and violent
home environments. Her behavior may be established during these tragic childhood
experiences. These incidents affected her behavior along with other factors of her
personality. Also the environment of the orphanage played a role in the modification
of their behavior.
“Generalized anxiety disorder is a syndrome of ongoing anxiety and worry about

many events or thoughts that the patient generally recognizes as excessive and
inappropriate. However, the nature of “generalized worry” has been hard to describe
in a categorical manner. The criteria required for making a diagnosis are evolving:
these criteria clearly increase or decrease markedly the threshold for diagnosis.
About 1%-5% of the general population report having generalized anxiety disorder.
Many of these people also have other disorders, and those with generalized anxiety
disorder report a considerable level of disability. Long term follow-up studies suggest
that generalized anxiety disorder is a condition that worsens the prognosis for any
other condition, and that people who have only generalized anxiety disorder are likely
to develop further conditions. The availability of and evidence for efficacious
treatments has increased in the past five years.
We used the Clinical Evidence database then searched for community surveys,
randomized controlled trials, and systematic reviews—using the term “generalized
anxiety disorder”—in Medline, Embers, and the Cochrane Library up to June 2006.
Most of the recent literature uses DSM-IV criteria for generalized anxiety disorder;
the ICD-10 criteria place greater weight on somatic symptoms and explicitly limit
comorbidity (box). Anyone presenting with a mood or anxiety disorder may have
generalised anxiety disorder. Most screening questionnaires for the condition ask if
the person is a worrier, if they worry overmuch about many things, and then ask if
they have somatic symptoms of anxiety. As people with generalised anxiety disorder
may develop other mood and anxiety syndromes over time, it is important to screen
for these too, particularly depressive disorder. Both cognitive therapy and anxiety
management therapy are efficacious, and cognitive behavior therapy may be more
efficacious than anxiety management therapy alone.
Anxiety management therapy is a structured therapy involving education, relaxation
training, and exposure but does not include cognitive restructuring; cognitive behavior
therapy adds to this a cognitive restructuring element. Relaxation involves practicing
techniques that lead to muscular or bodily relaxation. Exposure entails (over a period
of time) graded, repeated confrontation (through visualization, image, or the stimulus)
with a stimulus that causes anxiety. Cognitive restructuring involves challenging the
dysfunctional thought processes and the underlying assumptions that may be related
to the symptoms.
Systematic reviews and subsequent randomized trials found that cognitive behavior
therapy significantly improved anxiety and depression over four to 12 weeks
compared with the waiting list control group, anxiety management alone, relaxation
alone, or non-directive psychotherapy. 16 17w9 w10 w11 Patients randomized to
anxiety management therapy also fare better than waiting list controls, and the
efficacy of this treatment may equal that of cognitive therapy”.
Christopher Gale, senior lecturer and consultant psychiatrist and Oliver Davidson,
associate professor and clinical psychologist
Case Conceptualization
● Poor Hygienic
● Poor health
● Aggression
● Poor sleep
Precipitating Maintaining Protective

Predisposing factor factor
factor factor
Long life emotionally unstable Cognition
Poor health Insight is good
consciousness strategies
Diagnosis
According to all the observations and data the client was diagnosed with a generalized
anxiety disorder problem if not managed then, person experience excessive worry.
Client’s prognosis
After the observations, the diagnosis of the client was that she was suffering from
aggression and generalized anxiety disorder.. But can be managed through the
different therapeutic techniques, the client at least able to manage herself with good
living, healthy diet and psychological help.
Management plan
Goals Therapeutic techniques

Short term goal:
● Establish a healthy rapport building ● Work on social management.
with clients. ● use muscle relaxation.
● Try to coping cognitive skills. ● CBT should applied
Long term:
Continued the short term goal for ● Create awareness activities
maintenance of behavior and routine task. and coping strategies.
Intervention Strategies
Reinforcement
behavior that will increase and strengthen responses. Reinforcements are anything
like things like toys, colors etc. , appreciations (clapping) on doing good.
Limitations
● Sessions with the client are very limited.
● Cannot communicate with the family.

● There was not a proper treatment for heart problem
● Proper hygienic.
Recommendations
● Child should give hygienic training.
● Proper treatment
● Involve in different activities
● Rapport building
References
Anderson, C. A and Bushman, B.J.(2002). Human aggression. Annu. Rev.Psychol.53,
27-51
Anderson,C.A.,and Bushman,B.J.(1997). External validity of "trivial"
experiments:the case of laboratory aggression. Rev.Gen.Psychol.1,19- 41.
Appendix

Name

Uploaded by

Copyright:

Available Formats

Name

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Name

Uploaded by

Copyright:

Available Formats

CHILD PLACEMENT PORTFOLIO 1

Humanities and Social Sciences

PORTFOLIO COMPLETION CERTIFICATE

Supervisor I Supervisor II External

(Internal Examiner) (Internal Examiner)

Name: ________________ Name: ________________ Name: ________

Date: _________________ Date: _________________ Date: _________

Signature: _____________ Signature: _____________ Signature: _____

Institute’s Head Chairperson

Name: _________________ Name: _______

Date: __________________ Date: ________

Signature: ______________ Signature: _____

Case 1- Cerebral palsy (5-17)

Case 3- Depressive disorder (30-

Case 4- Emotional (43-

Case 5- Generalized Anxiety (55-

Case 1- Cerebral Palsy Disorder

Source and Reason for referral

Hit others Sometimes like 5 to 10 min

Aggressive From early years

Self talking From early years

Can’t read well From early years

Can’t talk well From early years

Shy All time

Self conscious According to situation

Developmental milestone Normal age of achievement Clients of achievement

Start smiling 6-12 weeks 6 month

Head control 4 months 1 year

Start recognizing things 3 months 1.5 year

Teeth development 4 years 1 year

Start sitting 6 months 1.5 year

Start walking by own 1.5 years 3.5 year

First speech 2 years 1 year

Feed 2-3 years 3 year

Urine control Under age of 3 years 4 year

History of present illness

History of psychiatry/Medical illness

Point of Contact on Card A

The Bender Visual-Motor Gestalt Test(abbreviated as Bender-Gestalt test) is a

Speech. The client’s speech was not clear.

Mood. The client had a good mood.

Memory. Memory was sharp.

Orientation. Orientation was present

Abstract thinking. The abstract thinking was absent.

General knowledge. The general knowledge of the child was satisfactory.

Subjective Rating scale

Symptoms Rating by teacher (0-10) Rating by therapist (0-10)

Reinforcer Identifying source by

NICHD-backed research on CIT is helping physicians determine the most effective

Assessment: Two types Informal assessment (Clinical

interview, Behavioral observation, Subjective rating)

Formal assessment (Tool)

Motor disability: Moderate (F71)

Diagnostic Criteria for Intellectual disability

Intellectual disability (intellectual developmental disorder) is a disorder with onset

A. Deficits in intellectual functions, such as reasoning, problem solving, planning,

All through development, the individual’s conceptual skills lag markedly

slowly. For school-age children, progress in reading writing, mathematics, and

The individual shows marked differences from peers in social and

Name: ________ Name: Name:

Date: _________ Date: _ Date: _

Signature: _____ Signature: _ Signature: _

Name: ___________ Name: _

Date: __________ Date:

Signature: __________ Signature: _