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Attention Deficit/ Hyperactivity Disorder

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Table of content
Content Page No

Bio data………………………………………………………………………………. 1

Identifying information……………………………………………………………... 2

Presenting problems………………………………………………………………… 3

History of present illness……………………………………………………………. 4

Personal history……………………………………………………………………... 4

Family history……………………………………………………………………….. 4

Social history…………………………………………………………………………4

Educational history………………………………………………………………….. 5

Psychological assessment…………………………………………………………….5

Informal assessment……………………………………………………………….....6

Formal assessment…………………………………………………………………. .7

Administration of psychological tests………………………………………………. 9

Diagnosis …………………………………………………………………………… 9

Prognosis …………………………………………………………………………….9

Management plan ……………………………………………………………………9

Short term goals ……………………………………………………………………. 9

Long term goals …………………………………………………………………… 10

Appendixes …………………………………………………………………………12
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Bio data
Name MA

Father Name MH

Age 18 years

No. Of Sibling 4

Birth Order first

Education MCC (In special education school)

Religion Islam

Socioeconomic Status Lower Middle Class

Address 164 RB MAHESH. FSD

Identifying Information
The subject was a male of 18 years old. He has 4 siblings including 4 brothers. He
lives in joint family system. In home punjabi language used. He belongs to the lower middle
class family and his religion is islam. He has good relationship with his family members. His
family gives him proper attention and care.
Presenting problems
He has developmental delays. He cannot read a sentence of two to three words consist
on English or Urdu. In class, he behaves normal with peers. His behaviour often becomes
impulsive. He becomes hyperactive after a few minutes. He has some speaking problems
such as he cannot speak fluently or a complete sentence of three to four words. His listening
ability is good. He follows all verbal instructions for any task. He has problems such as
reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and
learning from experience. He has difficulities with spelling, written expressions, mastering
number sense, mathematical reasoning.
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History of present illness

Neck holding 6 months Sat alone Yes Crawling 1.5 years

Standing 2 years Walked 4 years
unaided
Fed self 5 years Self dressed 8 years Toilet 8 years
training
Cooing 1 year Babbling 2 years First word 3 years

Personal History
He is 18 years old. He belongs to the lower middle class family. He has some
problems from birth such as low milestone level, developmental delays and physical
problems like speak fluently. However, he has the ability of labeling the pictures about which
he has any understanding and knowledge. He can follow the simple directions like right, left,
upward and downward. He displays temper tantrums, overly active, short attention span,
aggressive towards self and agressive towards others.
Family history
His parents are alive. He has three brothers. He lives in a jont family system.
Furthermore, his mother did not face any type of home problems and suffered from tension
before his birth. However, his birth was normal delivery after nine months. His mother’s
brother has these problems like speech,language, learning problems. He is aware of his
problems and speciality. He recieves this problem geneticaly.

Social history

From the observation in the class of the child, it observed that he behaves familiar and
friendly with his peers. In home, his behavior was good to his all-family members. He likes
to play with toys. In the presence of his family members he feels comfort and remain relax.
However, after facing the neglecting behaviors of anyone in his social circle his behaviors
becomes impulsive and aggressive. In the beigning of the school he was attention deficit and
hyperactive. He cannot stayed in the classroom for 1 hour. And in the classroom he was
squirmy and showed restlessness.
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Educational history

According to his mother, he was not able to go to school at the age of 6 or 7 years old.
He was unable to go to any institute for education. Because of his developmental delays, he
was unable to match the progress of his class fellows. After checking or practicing the normal
education institutions his family decides to send him in special education school. Now he is
in the special education school. He is in the class of MCC. In his class, he learns about the
simple things that can help him in living his life.

Psychological Assessment

Informal Assessment

Formal Assessment

Informal Assessment

 Behavioral observation
 Mental state examination
 Clinical interview

Behavioral Observation

In first session, when subject came his behavior was fine towards me. He shows good
behavior but not familiar. He gave answers of questions according to his ability. He talks in a
good way but not mature. His behavior was often impulsive. His attention was short span. He
repeated some words in his conversation. He shows some restlessness for still sitting of 10-15
minutes.

Mental state examination

For measuring, the mental state (MMSE) test applied. The need of this test was
measuring the ability of orientation, reasoning and attention of the subject. In this test, he
gains 18 scores. The cut off score of this test is 24. Less than 24 show abnormalities. This test
gives information and checks the ability of orientation, registration, attention and calculation,
recall and language and praxis. He does not have the information of his surroundings. He
only has the information of Friday.
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Clinical interview

In the start of the interview the child was bit anxious and withdrawn, he was not much
co-operative but later on, he became open and co-operative towards the interview. He gives
answers of asked questions according to his ability. He tells about his favorite toys and
activity and the person, which he likes after developing a good report.

Formal Assessment

 Tests
 Scoring
 Interpretation

Tests

MMSE (Mini Mental State Examination)

SIT (Slooson Intelligence Test)

SDCT (Slooson Drawing Coordination Test)

HFD (Human Figure Design) emotional scale

Conners’ Teacher Rating Scale – Revised (S)

Scoring

Quantitative analysis

1. MMSE(Mini Mental State Examination)

Age Total score Obtained score

18 years 30 18

2. SIT(Slooson Intelligence Test)

Chronological age Mental age Intelligence Quotient

222(months) 98(months) 44(percent)
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3. SDCT (Slooson Drawing Coordination Test)

Age Score Accuracy

18 years 14/36 38(percent)

4. Conners’teacher Rating Scale – Revised (S)

Age Score
18 Oppositional Cognitive Hyperactivity ADHD
years 8 problems 14 index
Gende 11 19
r
Male
Column score

Oppositional Cognitive Hyperactivity ADHD Index

89 problems 89 73
89

Qualitative analysis

5. HFD(Human Figure Drawing)

His drawing shows the poor integration of figures, which represent the impulsivity,
emotional disturbance, immaturity, impairment in emotional regulation. No nose shows
social withdrawn, as he does not like to participate or indulge in activities or with other peers.
Nobody in the drawing shows mental retardation as this proved by his SIT results, and theses
scores shows intellectual disability. Gross asymmetry of limbs indicate the impulsivity as his
behavior was impulsive in all his sessions after 5 or 10 minutes he shows restlessness and
want to go to home. Slanting figure shows imbalance as his behavior shows, movement of
head and eyes movement and not focus behavior.

Administration of Psychological Tests

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According to the observation of the symptoms, which tests applied, are as follows,
MMSE, SIT, SDCT, HFD and Conners’ Teacher Rating Scale – Revised (S).

Diagnosis

Unspecified Attention-Deficit/Hyperactiity Disorder

Prognosis

According to his symptoms and his severity, there is less possibility of recovery or
there are fewer chances for the betterment. He shows impulsivity and emotional disturbance.
He has imbalance in his physical appearance. He has poor coordination of muscle and the
movement of the body. He has immaturity in all his behaviors like still sitting, conversation,
mastering in number sense.

Management Plan

1) Short terms goals

 Rapport building

As a psychologist, for the intervention of the disorder rapport building is essential tool.
By receiving good expressions and sympathy persons shows concern to the interview. After
building trust person feel security and he describes his situation. All information received
from the child and tests applied to the child were the result of the good rapport building.

 Painting and coloring

For good rapport, coloring method used to engage the one in the assessment
process. Firstly, a draw pictured page gave to him. Moreover, said to him for coloring
in the drawing. By engaging in the drawing activities, he shows some familiarity
towards me. According to his symptoms, familiarity gave the possibility to apply the
assessment test on him.
 Psycho-education (parents)

After getting the case history of the subject and observing his behavior. Moreover, by
applying the test and receiving the assessment the information of the disorder described to the
mother of the child. It has been told the mother that your child has neurological problems and
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these problems are not curable but manageable. Changes would make after giving proper care
and instruction for a good behavior.

2) Long-term goals
Behavioral modification
a) Shaping
b) Shaping is tool, which used to develop targeted behavior that a person or animal does
not currently show or exhibit. Shaping defined as the differential reinforcement of
successive approximation of targeted behavior.
c) Differential reinforcement
d) Its means that which behavior will reinforce or which behavior will ignored.
According to the current case when subject show impulsivity and try to go off his this
behavior will not reinforce. When he shows interest in coloring or joining the dots
this behavior will reinforce by saying good or you are a good child. This is soo nice
and good which you are doing. Because targeted behavior will reinforcement.
e) Successive reinforcement
f) It means that the behavior which is close to our targeted behavior will
reinforce. According to the present case when the subject hold the paper in his hand or
choose color top do his this behavior will reinforce. This reinforcement was verbal
reinforcement like good do this with good effort and with concertration. When he
shows response to our verbal instruction his this behavior will reinforce because his
behavior will close to our targeted behavior.

Art therapy

All our reinforced instructions and his good behavior will make the possibilities of
getting the targeted behavior. Art used to manage the anger and developing his interest
towards the assessment of the subject. By seeing the colors and different shapes, he was
engage in this process. There was some dots consisted shapes on the page and instruction
was join the presented dots by joining one by one. By doing this, he engaged for some
time and his attention diverted from the impulsivity. After doing this instruction given to
the subject that match these shapes by focusing which shapes are similar or familiar.
 Anger management

Anger is frequently a result of frustration, or of feeling blocked or thwarted from

something the subject feels is important. According to his mother, he shows impulsivity and
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aggression towards other. For the management of the anger some suggestions given to mother
of the child. When he expects something extra, try to obey him or distract his attention
toward another thing. Keep him in the observation as you can make it possible. Make the
surrounding of the child comfortable for him.

g) Prompting
Prompting involves the strategies to encourage correct responses.

Response prompt

In this prompt when subject show his attention and become engage in the activities
some prompts used for his betterment. In response prompts verbal, gestural, modeling and
physical prompts are use. When the subject started the coloring of shapes, joining of dots, and
matching the shapes verbal and gestural prompts used and when he gets difficulty to
understand what to do first then modeling and physical promptes used for the targeted
behavior.

Stimulate prompts

In stimulus prompts temporary changes made to physical stimuli that help a learner to
engage in a target behavior. When the subject show tired some behavior towards the coloring
of the pictures then this activity changed compare to the assessment tests. Like SDCT test, in
this test subject divert his attention towards the drawing of pictures of the SDCT.
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Appendixes