mpce-15-7xadhi-it-has-10-cases-of-patients-with-clinical-psychological-disorders-and-its-treatment.pdf

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MPCE-15-7xadhi - It has 10 cases of patients with clinical
psychological disorders and it's treatment
masters in psychology (Indira Gandhi National Open University)
Studocu is not sponsored or endorsed by any college or university
MPCE-15-7xadhi - It has 10 cases of patients with clinical
psychological disorders and it's treatment
masters in psychology (Indira Gandhi National Open University)
Downloaded by ANSHU MAURYA (anshumaurya1986@gmail.com)
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CASE STUDY-A
SOCIO DEMOGRAPHIC DATA
Name: A
Age: 24 years
Gender: Male
Marital Status: Unmarried
Religion: Islam
SES: Middle Class
Occupation: Driver
Domicile: Rural
Informants: Patients, Mother
Reliability: Reliable
PRESENTING COMPLAINTS
1. Tension
2. Feeling dirty
3. Difficulty in swallowing the food
4. Palpitation of the chest
5. Irresistible desire to wash hands with soap, whenever he washes
6. Feels discomfort after eating porotta
HISTORY OF PRESENTING COMPLAINTS
The patient was absolutely normal till last year. He was working as a driver in Qatar.
He could not cope with the situations at Qatar. He said that he became tensed there. So he left
Qatar after 45 days. On the way back, he got down at Oman and there he felt that he will miss
his flight to India. This incident made him more tensed.
When he came home, he started to bath only with water from a house. He could not
bath without using the water from house and soap. Also he started to wash his hands with
soap whenever he washes hands due to an unhygienic feeling. A difficulty while swallowing
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developed with him, and became tensed and restless after eating portals. He developed
palpitation of chest. All these symptoms started after stopping bathing with the house.
HISTORY OF PAST ILLNESESS
1. History of seizures after a fright while bathing in pond water.
2. No significant medical illnesses were reported.
TREATMENT HISTORY
One month before he consults a psychiatrist for tension. He took medicine and after
two week he stopped medication. There is no other significant treatment history.
PERSONAL HISTORY
Normal institutional delivery. Normal birth weight. No maternal emergencies during
birth. Mile stones were normal.
Separation anxiety reported in the primary classes. Co-operative with the peer group.
Studied up to the X standard, but failed in the final exam. He had also failed in the VIIth
standard for once.
Started smoking at the age of 16 years with friends. Friends offered him cigarettes.
The habit of alcoholic drinking started at the age of 22nd
. But the drinking habit is occasional.
He had also an occasional habit if betel chewing using pan parag.
He had got a first prize in a short story writing competition conducted by
Mathrubhumi weekly. He had also worked as an associate director for a tele film in a local
channel. He had the habit of reading books.
EDUCATIONAL HISTORY
He studied up to the Xth
standard, but he failed in the final exam. He had failed in the
VIIth standard for once.
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OCCUPATIONAL HISTORY
He is a driver. He went to Qatar for the same job. But he could not able to cope with
the situations there. He said that the vehicles were having so speed and he was afraid to drive
in such a speed.
SEXUAL HISTORY
Primary and secondary sexual characters were normal. He had positive attitudes
towards sex. He used to masturbate and once he had a sexual relation with a lady, 2 years
back.
PRE-MORBID PERSONALITY.
Pre morbidly he was well adjusted and sociable, he actively participated all family and
function He was energetic and religious.
FAMILY HISTORY
60 years 52 years, H/o psychiatric illness
Still birth 30 years 24 years
Index patient id the youngest child in family, His father died 5 years before. His
mother has History of psychiatric illnesses with(since last 15 years). No other history of
mental retardation, epilepsy, substance abuse were reported among family members.
MENTAL STAUTS EXAMINATION
GENERAL APPEARANCE
Dressed properly.
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Combed hair.
Co-operative.
Eye to eye contact is maintained.
Rapport was established.
Psychomotor activity is normal.
SPEECH
Audible, Normal , Productive and coherent speech. Reactive Time- Normal.
MOOD
Subjective- ‘Pleasant’
Objective- Anxious affect.
THOUGHT PROCESS
Feels that body is not clean.( obsession thoughts- contamination)
PERCEPTION
No perceptual disturbances were found.
STATE OF CONSCIOUSNESS
Conscious
ATTENTION AND CONCENTRATION
Attention and concentration were aroused and maintained.(In digit span test)
MEMORY
Immediate- Present. (digit forward test, )
Recent- Present. ( recollecting recent event)
Remote- Present.( recollecting past event )
INTELLEGENCE
Average (in general-arithmetic )
General knowledge- Average.
Abstract Thinking- Present.( proverb testing)
INSIGHT
Personal- Present
Social- Present.
True emotional insight ( grade – 6)
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SUMMARY AND DIAGNOSTIC FORMULATION
The presenting complaints of the patient were tension, irresistible desire to bathe with
water from the hose, difficulty in swallowing and palpitation in the chest. He was found
anxious. His family and personal history all are normal and there is one significant
psychiatric history in family, mother has mental illness , pre morbidly well adjusted and
sociable. Science one year he became very anxious about hygiene. he started to wash his
hands with soap . He frequently washing his hands due to an unhygienic feeling. And
became tensed and restless after eating portals. He developed palpitation of chest. All these
symptoms started after stopping bathing with the house.
On MSE, he is having disturbances in the thought process such a feeling of
contamination(obsession ) and a compulsion to bathe with water from a hose and tendency to
wash hands with soap whenever he washes. Rest of the mental functions are normal. He was
found to be anxious and restless.
DIAGNOSIS
Clinical feathers of patent meeting the DSM-IV-TR and ICD- 10 Diagnostic
Criteria for Obsessive-Compulsive Disorder. (A- Either obsessions or compulsions (-
Obsession -Contamination, compulsion- reaped washing of hand ); B- At some point during
the course of the disorder, the person has recognized that the obsessions or compulsions are
excessive or unreasonable. C- The obsessions or compulsions cause marked distress, are
time-consuming (take more than 1 hour a day), or significantly interfere with the person's
normal routine, occupational (or academic) functioning, or usual social activities or
relationships. D- The disturbance is not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition. E- no other axis -1
disorders). No other co-morbid disorders.
MANAGEMENT
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Well-controlled studies have found that pharmacotherapy, cognitive behavior therapy, or a
combination of both is effective in significantly reducing the symptoms of patients with OCD. The
decision about which therapy to use is based on the clinician's judgment and experience and the
patient's acceptance of the various modalities. In this case Prognosis is good due to following factors
Insight present, 24 years., Good family support., Acute onset and Patient’s age.
1. PHARMACOLOGICAL some medicines were prescribed.
2. PSYCHOTHERAPY.
Cognitive behavioral therapy and behavior therapy is as effective as
pharmacotherapies in OCD, and some data indicate that the beneficial effects are longer
lasting with CBT and behavior therapy. There is particular CBT modal for treatment of OCD
called Exposure and Response Prevention Therapy (ERP), and other CBT and behavioral
method also very effective in treatment of OCD.
EXPOSURE AND RESPONSE PREVENTION THERAPY (ERP)
ERP is widely used to treat many anxiety-based neurotic conditions. It has proven to
be especially effective at treating obsessive-compulsive disorder. In ERP, the patient is
repeatedly exposed to his fears, while being denied the opportunity to engage in any safety
behaviors (compulsions) that normally would alleviate the patient's anxiety regarding
exposure to those fears. This is a safe therapy that can normally be done through phone
contact with a therapist (the nature of the treatment makes face-to-face contact unnecessary).
If you would like to treat obsessive compulsive disorder (OCD) with ERP, there are a few
simple steps you should learn.
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CASE STUDY-B
Name : B
Age : 29 yr
Gender : Male
Religion : Hindu
Domocile : Rural
Occupation : Teacher
Marital Status : Un married
Informants : Patient, Brother, and Father
PRESENTING COMPLAINTS
1. Mood off
2. swelling in the abdomen
3. pain in the abdomen
4. Irritability
5. Suicidal thoughts
6. Desperate Mood
HISTORY OF PRESENTING COMPLAINTS
Complaints started 4 years back. He had a swelling in the abdomen and pain in the
abdomen. He underwent endoscopy. He had difficulty in breathing while sleeping in the
night. He became irritable and restless while taking classes in the college. He consulted a
neurologist and he prescribed some medicines. He used to make conflicts with other family
members and abuses them. He became irritable with the partners of his institution and
withdrawn his share. When he had stopped the medicines advised by the neurologist, he
became weak. He became so careless with money matters. He went to NIMHANS and
consulted the doctors there. He was admitted there, but he could not cope with conditions
there then he stopped medication. So he returned home and consulted another psychiatrist at
Calicut. He started the habit of drinking alcoholic stimulants. Once he had made fights with
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somebody in a Pooram. Again he had been taken to NIMHANS and returned without
completing the course of the treatment. His restlessness and other complaints did not subside.
Then he had admitted for further treatment.
HISTORY OF PAST ILLNESS
No history of psychiatric illness, epilepsy, and mental retardation.
FAMILY HISTORY
65 years 55 years
Psychiatric illness
32 years 29 years
Index patent is youngest one in his family , History of psychiatric illness reported
with Mother Maternal grandmother (episodic illness - mania) No history of mental
retardation, epilepsy, suicide among other family members.
PERSONAL HISTORY
Normal home delivery. No prenatal complaints were reported. After the delivery, the
mother has been admitted with some psychiatric illness (puerperal mania?)
EDUCATIONAL HISTORY
He studied up to BA Economics degree. He was co-operative with peer group.
OCCUPATIONAL HISTORY
He was a parallel college teacher. He had his own institution.
SEXUAL HISTORY
Primary and secondary sexual characters were normal. He had positive attitudes
towards sex.
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PRE- MORBID PERSONALITY
Well adjusted and sociable. He was energetic.
MEDICAL HISTORY
No history of medical illnesses.
MENTAL STATUS EXAMINATION
GENERAL APPEARANCE
Dressed properly.
Combed hair.
Co-operative.
Eye to eye contact is maintained.
Rapport was established.
Psychomotor activity is normal.
SPEECH
Audible, Normal , Productive and coherent speech. Reactive Time- Normal Reactive
Time- Normal.
THOUGHT PROCESS
Suicidal thoughts
No other thought disturbances.
PERCEPTION
No perceptual disturbances were found.
MOOD
Subjective- “Anxious”
Objective- Anxious affect.
STATE OF CONSCIOUSNESS
Conscious
Attention and concentration were aroused and maintained.(In digit span test)
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MEMORY
Immediate- Present. (Digit forward test,)
Recent- Present. (Recollecting recent event)
Remote- Present. (Recollecting past event)
INTELLEGENCE
Average
General knowledge- Average.
Abstract Thinking- Intact (proverb test)
INSIGHT
Awareness of illness-present
Awareness of mentally ill- present
Willingness to take treatment-present
JUDGEMENT
Personal- Present
Social- Present.
True emotional insight (grade – 6)
VOLITION
Present
PSYCHOLOGICAL ASSESSMENT
Beck Depression Inventory- score is 18(moderate depression)
SUMMARY AND DIAGNOSTIC FORMULATION
The patient is 29 years old year, unmarried male. The presenting complaints were
swelling in the abdomen , pain in the abdomen mood off, suicidal thoughts, and irritability.
The complaints started 4 ½ years back. He had a swelling in the abdomen and pain in the
abdomen. He underwent endoscopy. He had difficulty in breathing while sleeping in the
night. He became irritable and restless while taking classes in the college. His personal
history all are normal and there is two significant psychiatric history in family, mother and
Maternal grandmother mental illness (Mania) , pre morbidly well-adjusted and sociable.
Mental statues examination showing presence of suicidal thought and anxious mood, rest of
all mental function are normal. The Beck Depression Inventory has a score showing
moderate depression (score -18) .
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DIAGNOSIS
Clinical feathers of patent meeting the DSM-IV-TR and ICD- 10 Diagnostic Criteria
for Somatization Disorder with Psychiatric Symptoms. ( A history of many physical complaints
beginning before age 30 years that occur over a period of several years and result in treatment being
sought or significant impairment in social, occupational, or other important areas of functioning, and
The symptoms are not intentionally produced or feigned (as in factitious disorder or
malingering).
MANAGEMENT
Psychotherapy and Pharmacotherapy
Somatization disorder is best treated when the patient has a single identified physician
as primary caretaker. When more than one clinician is involved, patients have increased
opportunities to express somatic complaints. Primary physicians should see patients during
regularly scheduled visits, usually at monthly intervals. The visits should be relatively brief,
although a partial physical examination should be conducted to respond to each new somatic
complaint. Additional laboratory and diagnostic procedures should generally be avoided.
Once somatization disorder has been diagnosed, the treating physician should listen to the
somatic complaints as emotional expressions rather than as medical complaints. In
psychotherapy settings, patients are helped to cope with their symptoms, to express
underlying emotions, and to develop alternative strategies for expressing their feelings is very
effective for somatization disorder, Pharmacological treatment is effective in patients without
coexisting mental disorders, anti-depressant and benzodiazepines can be given on a short
term basis for associated depression and anxiety. It mainly consists of; psychotherapy of
somatization disorder mainly consisting
 Supportive psychotherapy
 Behavioral modification
 Relaxation therapy
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Case study: c
Name : C
Age : 42 yrs
Sex : Male
Marital status : Married
Education : 10th
Standard
Religion : Muslim
Socio economic Status : Middle class
Occupation : Driver
Residential Area : Urban
Family type : Nuclear
Informant: Informant was patient Wife, information was reliable and adequacies
CHIEF COMPLAINTS:
Lack of sleep.
Irritability.
Violent and destructive behaviour.
Excessive talk.
Aggressive
Poor appetite.
Over importance to religious activity.
(Duration Since two week)
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MADE OF ONSET : acute
CAUSE OF ILLNESS : Episodic (3rd
)
DURATION OF ILLNESS : Since 6 yrs old.
HISTORY OF PRESENT ILLNESS
The first episodic was started after death of his father. He was very much attached to
father. Then onwards he has been showing some abnormal behaviours. Since that period
onwards he was under psychiatric treatment. His illness is found as episodic. This is third
episode. Before one week he was experiencing lack of sleep and poor apparition. He started
to speak more. Whenever he talks over, stress violent behaviour will start. This time he is
aggressive and destructive and abusive to family members. His was in asymptomatic in last
one year, and one month before he stopped his medication.
NEGATIVE HISTORY:
No history suggestive of head injury, substance abuse and mental retardation.
TREATMENT HISTORY
2003 onwards the patient is under psychiatric treatment. He was taking mood
stabilizers and other psychotic drugs. He was regular in medications till last one month, one
month before he stopped medication.
PERSONAL HISTORY
BIRTH ANDE ARLY DEVELOPMENT:
Prenatal, per natal and postnatal developments are reported as normal.
PRESENCE OF CHILDHOOD DISORDERS: Nil
EDUCATIONAL HISTORY: Patient started his formal education when he was five year
old and he stopped his studies after 10th
standard. He had lots of friends.
OCCUPATIONAL HISTORY: He is working in company as a driver at Dubai.
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PRE-MOBILE PERSONALIT : Patient was sociable. He had very good interpersonal
relationships.
FAMILY HISTORY:
68 years 60 years,
47 years 40 yr 37yr 33yr
Index patent is eldest one his family ,there is no History of psychiatric illness
reported in family and no history of mental retardation, epilepsy, suicide among other family
members.
HOME ATMOSPHERE IN CHILDHOOD AND ADOLESCENCE:
He had good home atmosphere. He was very attached to his father.
PRESENT LIVING CONDITION:
The patient is with his family. They are well in financially.
ATTITUDE OF FAMILY:
Family members are loving, caring and cooperative to the patient.
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GENERAL APPEARANCE:
Well dressed, eye contact is maintained. Report is easily established. PMA is
accelerated. Interpersonal and attitude towards Examiner is co-operative.
SPEECH AND SOUND:
Speech is Spontaneous, Pressure of speech, Output is Increased and quick reaction
time.
MOOD AND EFFECT:
Subjective mood : “I feel happy”
Objective effect : Euphoric
THOUGHT:
Stream : An accelerated flight of ideas.
Content : Grandiose ideas, ideas of religiosity.
Possession : Normal
Form : Normal
PERCEPTUAL DISTURBANCE: Nil
ATTENTION AND CONCENTRATION:
Digit forward test score is 5 and Digit back ward test scoe is 4. Attention is raised
and sustained.
MEMORY:
Immediate- Present. (digit forward test, )
Recent- Present. ( recollecting recent event)
Remote- Present.( recollecting past event )
INTELLIGENCE:
GK : Average
Arithmetic : Average
Comprehensive : Average
ABSTRACT THINKING: Conceptual
ORIENTATION: Oriented to time, place and person.
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JUDGMENT:
Test : satisfactory
Social : Satisfactory
Personal : Satisfactory
INSIGHT : Absent( complete denial- grade -1)
DIAGNOSTIC FORMULATION:
The patient is brought to the OPD with the complaints of lack of sleep, poor appetite,
irritability, over activity, talkativeness and over religious activity. His MSE also shows that he
was accelerated psychomotor activity, grandiose ideas, religiosity and flight of ideas. The
illness is found as episodic. Base on ICD-10 criteria F31.1 the above mentioned symptoms
show that the patient is affected by bipolar affective disorder, current episodic mania. ( DSM-
IV TR:- A-Currently (or most recently) in a manic episode. B-There has previously been at
least one major depressive episode, manic episode, or mixed episode. C-The mood episodes
in Criteria A and B are not better accounted for by schizoaffective disorder and are not
superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic
disorder not otherwise specified)
TREATMENT PLAN
Treatment of patients with mood disorders should be directed toward several goals.
First, the patient's safety must be guaranteed. Second, a complete diagnostic evaluation of the
patient is necessary. Third, a treatment plan that addresses not only the immediate symptoms
but also the patient's prospective well-being should be initiated. Although current treatment
emphasizes pharmacotherapy and psychotherapy addressed to the individual patient, stressful
life events are also associated with increases in relapse rates. Thus, treatment should address
the number and severity of stressors in patients' lives.
Overall, the treatment of mood disorders is rewarding for psychiatrists.. Because the
prognosis for each episode is good, optimism is always warranted and is welcomed by both
the patient and the patient's family. Mood disorders are chronic, however, and the psychiatrist
and psychologist must educate the patient and the family about future treatment strategies.
The primary method of treatment for bipolar disorder is pharmacological intervention -
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medications. The prescriptions for treatment are usually specific to mania or depression.
Mood stabilizers are one of the most important groups of medications for bipolar disorder.
Lithium was the first medication used to treat bipolar disorder, and it also can be used as an
add-on treatment for clinical depression. in addition with lithium other druge such as
Olanzapine (Zyprexa)Risperidone (Risperdal)Clozapine (Clozaril) also using the treatment of
bipolar disorder.
Psychotherapy is often recommended for people taking mood-stabilizing drugs,
mostly to help them take their treatment as directed. Group therapy often helps people and
their partners or relatives understand bipolar disorder and its effects. Individual
psychotherapy may help people learn how to better cope with problems of daily living.
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Case study : D
Name : D
Age : 44 yrs
Sex : M
Marital status : Married
Education : 10th
Standard
Religion : Muslim
Socio ecom Status : Lower class
Occupation : Business
Residential Area : Rural
Family type : Joint family
Informant: Informant was patient’s wife and Brother. Information was reliable and
adequacies
CHIEF COMPLAINTS:
Sleeplessness.
Irritability.
No interest in work.
Poor social relationship.
Complaints about having voices of two persons.
Restlessness.
Wandering.
Lack of concentration
MADE OF ONSET : Insidious
CAUSE OF ILLNESS : Continuous
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DURATION OF ILLNESS : 29years.
HISTORY OF PRESENT ILLNESS
Patient had the problems in sleep. Increased talk, restlessness, aggressive behaviour,
excessive substance abuse, irritability etc. He also complaint about hearing voices which is
like people talking about him.
Since 15 years of age, the patient was very disturbed and showed many abnormal
behaviours. He had sleep problems, increased amount of talk and that too about unrelated
things. He behave aggressively and destroyed many things. He was very stressed and lonely
of the time and he extorted the area of substance abuse. He complained of having voices of
people talking about him, There is no negative history( head injury, substance epilepsy or
MR). He had the history of substance abuse. Since 16th
age onwards the patient was in
psychiatric treatment. The patient had consulted many psychiatrists..
TREATMENT HISTORY:
Since 16th
age onwards the patient was psychiatric treatment. The patient had consulted
many psychiatrists. And he irregular in medication and drug complaint
PERSONAL HISTORY:
Patent’s Birth and early development are normal
EDUCATIONAL HISTORY:
Formal education started in his 5th
age. He was poor was be. He stopped studies in 10th
standard and started business.
OCCUPATIONAL HISTORY;
The patient is working since his 15th
age. He was helping his father in business.
PRE-MORBID PERSONALITY:
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The patient was poor in social relations. He had the history of substance abuse.
FAMILY HISTORY:
Family Tree:
68 years 60 years,
46 years 44 yr 39yr 35yr
Index patent is second child in his family and belongs to financially lower class
family, He living with family members, .They are cooperative and loving. There is no
History of psychiatric illness reported in family and no history of mental retardation,
epilepsy, suicide among other family members.
MENTAL SATUS EXAMINATION.
GENERAL APPEARANCE:
Well dressed, personal cleanliness is good. Body posture is appropriate, eye contact is
sustained. Attitude towards examiner is cooperative. Report is established. PMA is normal.
SPEECH AND SOUND : Audible, normal reaction time but not good oriented.
MOOD AND AFFECT:
Subjective mood : “ I feel happy”.
Objective mood : Restricted.
PERCEPTUAL DISTURBANCES:
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Auditory hallucinations : Third person hallucination.
THOUGHT:
Stream : Poverty of thought content circumstantially.
Content : Delusion of references, delusion of control.
Possession : Thought broadcasting.
Form : Normal.
MOOD : Incongruent
Digit forward test score is 5 and Digit back ward test score is 3 . It means attention is
aroused but not sustained.
MEMORY:
Immediate : Intact
Recent : Intact
Remote : Intact
INTELLIGENCE:
General Knowledge : Below average
Arithmetic : Below average
Comprehension : Below average
ABSTRACT THINKING : Conceptual
ORIENTATION : Oriented to time ,place and person.
JUDGMENT :
Test : Satisfactory
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Personal : satisfactory
INSIGHT : partially present ( grade – 3)
The index patient was brought with the chief complaints of sleep disturbances,
irritability, talking to self and his MSE shows that the patient has delusion of reference,
delusion of control, thought broadcasting etc. He has perceptual disturbances and third
person. Based on the ICD-10 criteria, f.20 the index patient meeting diagnosed criteria of
schizophrenia.
TREATMENT PLAN:
Antipsychotic medications are the mainstay of the treatment for schizophrenia, and
also clinical research has found that psychosocial interventions, including psychotherapy,
can augment the clinical improvement. Just as pharmacological agents are used to treat
presumed chemical imbalances, nonpharmacological strategies must treat non-biological
issues. The complexity of schizophrenia usually renders any single therapeutic approach
inadequate to deal with the multifaceted disorder. Psychosocial modalities should be
integrated into the drug treatment regimen and should support it. Patients with schizophrenia
benefit more from the combined use of antipsychotic drugs and psychosocial treatment than
from either treatment used alone. By adding behavioral treatments for schizophrenia to a
medical treatment regimen, the rate of relapse is further reduced, to only 25%. A variety of
types of psychotherapy are available to schizophrenics. Cognitive therapy, psycho education,
and family therapy can all help schizophrenics deal with their symptoms and learn to operate
in society. Social skills training is of great importance, in order to teach the patient specific
ways to manage themselves in social situations.
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CASE study- E
SOCIO DEMOGRAPHIC DATA.
Name : E
Sex : Female
Age : 21 years
Marital Status : Single
Religion : Christian
Education : 1st
year BBA student
Socioeconomic Status : Middle class
Residential Area : Rural
Family type : Nuclear family
Informant: Informant was patient Wife, information was reliable and adequacies
CHIEF COMPLAINTS:
- Decreased appetite.
- Crying.
- Decreased self care.
- Decreased talk.
- Decreased psychomotor activity.
- Decreased socialization.
- Increased sleep.
Mode of onset : Acute
Course of illness : continuous
Duration of illness : One year
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HISTORY OF PRESENT ILLNESS.
Childhood onwards she was very calm and quite character. She has limited no
friends. One and a half year before her father underwent a minor surgery and since she was
very much attached to her father this was very shocking for her. On the day of operation she
was very upset and complaint of chest pain and she too was admitted at the hospital for two
hours. From there onwards she started showing abnormal behaviours like sitting alone and
crying, getting up in sleep in the midnight and screams out abusive words. Now the problem
is increased in the sleeping hours and always in the depressed mood. In her classroom there is
no good atmosphere and she had no friends there. No negative history of head injury,
epilepsy or M.R. In childhood she had taken treatment for Asthma.
PAST PSYCHIATRIC HISTORY:
Treatment was started before one year. First she took medicine from general
medicine. Then she consulted a psychiatrist at Mysore, and start medication. Six month
before she consult a clinical psychologist at Kannur for psychotherapy. She took two
psychotherapy session and discontied the psychotherapy.
PERSONAL HISTORY
BRITH AND EARLY DEVELOPMENTS:
Patent’s Birth and early development are normal . no significant event reported in
child hood.
EDUCATIONAL HISTORY:
She is above average student . In plus two she scored good mark. Then she joined
the BBM course. The patient’s report that in the classroom she felt loneliness. Most of the
time she was alone in class.
PRE MORBID PERSONALITY:
She was having good interpersonal relationship with her family. She was
religious and basically she was deserved, socially less active and lonely type.
HOME ATMOSPHERE IN CHILDHOOD AND ADOLESCENCE:
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The patient understood her condition. Her family relations was good. She was
more attached to her father.
FAMILY HISTORY
Family tree
48 years 45 years
21years 16 years
Index patient is the first child in family. No family history of psychiatric illness and no other
history of mental retardation, epilepsy, substance abuse were reported among family
members.
GENERAL APPEARANCE
Looks comfortable but sad face. Self care is good and eye contact is average. poor
Psychomotor activity She is cooperative and support is established.
SPEECH AND SOUND : Volume is low. Speech output is slow.
MOOD AND AFFECT:
Subjective mood : “I am not happy”
Objective affect : Depressed
PERCEPTUAL DISTURBANCES : Auditory hallucination.
THOUGHTS:
Stream : Retarded
Content : Hopelessness, suicidal ideas .somatic ideas
Possession : Nil
Form : normal
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Digit forward test score 4 and Digit back ward test score is 3. It shows the attention
and the concentration is poor.
MEMORY:
Immediate : Impaired
Recent : Intact
Remote : Intact
INTELLIGENCE:
GK : Average
Arithmetic : Average
Comprehensive : Average
ABSTRACT ABILITY : Conceptual
ORIENTATION : Oriented to person, place, time.
JUDGEMENT:
Test : Satisfactory
Personal : Satisfactory
INSIGHT : Partially present( grade-5)
PSYCHOLOGICAL ASSESSMENT – Beck Depression Inventory (BDI)
Beck Depression Inventory score is 33 (scores of 30 to 63 indicate severe
depression.)
Patent’s case history shows that she has reported Decreased appetite, Crying
.Decreased self care. Decreased talk. Decreased psychomotor activity. Decreased
socialization. Increased sleep. Thre is no past personal and family history of psychiric. Her
MSE reported thought disterbenses( suicidal ideation - Hopelessness, suicidal ideas .somatic
ideas) and digressive mood also. BDI score also showing sever depression (33)
According to ICD-10 F31.3, the index patient is diagnosed as affected by depression
with psychotic features, ( ICD-10- Depressed mood, loss of interest and enjoyment, and
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increased fatiguability are usually regarded as the most typical symptoms of depression, and
at least two of these, plus at least two of the other symptoms described above should usually
be present for a definite diagnosis. None of the symptoms should be present to an intense
degree. Minimum duration of the whole episode is about 2 weeks. An individual with a mild
depressive episode is usually distressed by the symptoms and has some difficulty in
continuing with ordinary work and social activities, but will probably not cease to function
completely.)
TREATMENT PLAN
Treatment plan of this patient is combination of psychotherapy and
pharmacotherapy .There are a number of different psychotherapies for depression, which may
be provided to individuals or groups. Psychological treatment of depression (psychotherapy)
assists the depressed individual in several ways. First, supportive counseling helps ease the
pain of depression, and addresses the feelings of hopelessness that accompany depression.
Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly
critical self-evaluations that create depression and sustain it. Cognitive therapy helps the
depressed person recognize which life problems are critical, and which are minor. It also
helps him/her to develop positive life goals, and a more positive self-assessment. Third,
problem solving therapy changes the areas of the person's life that are creating significant
stress, and contributing to the depression. This may require behavioral therapy to develop
better coping skills, or Interpersonal therapy, to assist in solving relationship problems.
Studies have shown that cognitive therapy is an effective treatment for depression and is
comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy.
In depression case Cognitive therapy using different techniques like Dysfunction thought
record form, activity schedule, imagery, role play act. The combination of cognitive therapy
and antidepressants has been shown to effectively manage severe or chronic depression.
Cognitive therapy also has proved beneficial in treating patients who have only a partial
response to adequate antidepressant therapy. Good evidence has shown that cognitive therapy
reduces relapse rates in patients with depression, and some evidence has shown that cognitive
therapy is effective for adolescents with depression.
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Case Study :F
Sociodemographic Information
Name Rita No. of Sessions One
Age 18 Years Date of Testing 28-12-12
Class XII School Navy Children School, Chanakyapuri
Father’s Name Mr.Jagdish
Chander
Address 14/4, Railway Colony, Sarojini Nagar,
New Delhi 110023
Informant
Child’s mother and child herself
Reason of Referral
The child’s mother came in with the chief complaints of poor academic performance, poor spellings,
inability to frame answers adequately in her own language, tendency to forget easily, inability to form
grammatically correct sentences and seems to lack interest in studies.
A semi-structured interview was conducted with the father to screen for the presence of Specific
learning Disability (Dyslexia) as per the ICD-10 Guidelines. The interaction with the mother revealed
that the child experiences difficulties in spellings, comprehension and expressive writing.
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An interaction with the child revealed that she has an easy go lucky attitude and enjoys shopping and
watching Television more than studying. Therefore, an assessment for Specific learning Disability
was done to assess her current level of functioning.
Test administered
To assess the child’s current functioning, the following test was administered:
 Wechsler Adult Performance Intelligence Scale (WAPIS)
 NIMHANS Battery of Specific Learning Disability
Behavioral Observation
She was attentive, cooperative and communicative. She was able to comprehend the instructions
adequately. She was motivated and performed the test with interest. Rapport could be established and
maintained with ease.
Test findings
I WAPIS
Summary
SUBTESTS Raw Score Scaled Score
Picture Completion 19 14
Digit Symbol 45 11
Block Design 42 15
Picture Arrangement 16 10
Object Assembly 24 10
TOTAL 60
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On WAPIS she obtained a total scaled score of 60 with the corresponding IQ being 109 suggestive of
Average Level of Current Intellectual Functioning.
II NIMHANS Battery of Specific Learning Disability
ATTENTION
a) Digit cancellation test for single and double digits
On Digit cancellation test for single and double digits, it was seen that the child was able to
cut all the digits correctly in a sequence suggesting that her attention span was adequate.
LANGUAGE
a) Oral Reading (English)
It was adequate to her grade level except that the prosody was lacking.
b) Copying (English)
It was not adequate to her grade level. She was seen to omit letters while copying the text.
Her pencil holding was incorrect but the posture was correct.
c) Spellings (English)
It was not adequate to her grade level. She was clear with the concept of phonetics, blends
and double letters; but lacked the concept of silent words and tended to make errors in words
involving rules of spellings.
d) Comprehension (English)
Her level in comprehension was II grade level below her current level. She was able to
comprehend the meaning of the text and the question on her own. She was also able to answer
direct and inferential questions but needed assistance in framing them in her own language.
Her critical and creative abilities were poor.
e) Expressive Writing (English)
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Her level in expressive writing was II grade level below her current level. She wrote very
simple sentences and they were grammatically incorrect. Complexity of ideas and sentences
as expected of her grade was absent. The passage written by her lacked organization. Her
vocabulary and divergent thinking was limited.
MEMORY
a) Auditory Memory for Sentences
It was below II grade level. She could remember up to 2 commands only in English
Language. She was seen to engage in word substitution and omission as the length of the
sentence increased and when it contained words unfamiliar to the child.
b) Visual Memory
On Bender Visual Retention Test (BVRT), she drew 9 out of 10 figures correctly. Significant
impairment was not seen in her visual memory.
PERCEPTUAL MOTOR FUNCTIONING
a) Test of Visuo-Motor Integration (TVMI)
On TVMI, the child was able to draw all the shapes correctly. Significant deficits were not
seen on it.
b) Bender Gestalt test (BGT)
The child was able to draw all the shapes correctly. Significant deficits were not seen on it.
Impression
The test findings on WAPIS suggest that the child has an IQ of 109 suggestive of Average Level of
Current Intellectual Functioning. On NIMHANS Battery of Specific Learning Disability, the child
was found to have specific learning disability (Dyslexia) in the area of comprehension and expressive
writing in English Language. Deficits were also seen in her auditory memory.
Recommendations
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 She needs to be made clear with the concept of silent letters and rules of spelling.
 To enhance her comprehension skills, she needs to practice several unseen passage with
emphasis on inferential, creative and critical abilities and she should be encourage to frame
answers in her own language.
 To help build her expressive writing skill, she should be encouraged to write more complex
sentences beginning from her current level by gradually adding difficult words and more
complex ideas. Her grammatical concepts need to be revised.
 She should be taught exercises to enhance her auditory memory.
 As per the CBSE guidelines, the child should be given extra-time in exams to help her
perform to her optimum level.
 Her marks for spellings should be ignored, unless they are grossly wrong or are those of
technical terms.
 It is essential to praise her for her achievement, no matter how small they may be, as this is
likely to improve her self-concept and confidence level.
 Focus should be on assessing her, based on her conceptual knowledge.
 She needs to continue going to a regular school. She needs to be taught effective study skills
and compensatory strategies to deal with the difficulties experienced by her in the above
mentioned areas.
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Case Study: G
Name Roshini No. of Sessions Two
Age 10 Years Date of Testing 02-09-12 and 03-09-12
Class V School Amity International School. Pushp Vihar
Father’s Name Mr. Vikas Seth Address H-17, Maharani Bagh, First Floor, New
Delhi
Informant
Child’s parents
Reason of Referral
The child came with her parents with the chief complaints of poor academic performance, poor
spellings, difficulty comprehending languages, tendency to forget easily, tendency to make several
calculation and sign errors in mathematics, inability to adequately comprehend reasoning sums and
poor grammatical concepts.
The parents further reported that the child had a full term cesarean delivery. The birth cry was
immediate and all her developmental milestones were on time. However, the mother had thyroid
during her pregnancy and it went undiagnosed. At the age of 2 years, the child developed allergy
towards dust and had asthmatic attacks. She was given steroids for the same. For the same, she had
been admitted nearly 4 times from the time of 2 years till 5 years of age. Since, last 5 years she has
not had any attack and has been reportedly doing well.
An interaction with the child revealed that she is a pleasant child who enjoys drawing. In order to gain
a better understanding of the difficulties she is facing in her academics, an assessment for Specific
learning Disability was done.
Test administered
 Malin’s Intelligence Scale for Indian Children (MISIC)
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 Grade Level Assessment device for Children with Learning Problems in Schools
She was attentive, communicative and cooperative. She was able to comprehend the instructions
adequately. She was motivated to perform the tests. Rapport was established and maintained with
ease.
Test findings
I MISIC
On MISIC, the child obtained a VQ of 110, a PQ of 105 and a Global IQ of 108 suggestive of Average
Level of Current Intellectual Functioning. The test profile of the child on MISIC is as follow:
Verbal Subtests IQ Performance Subtests IQ
Information 115 Picture Completion 71
Comprehension 134 Block Design 120
Arithmetic 92 Object Assembly 106
Similarities 123 Coding 111
Vocabulary 103 Mazes 115
Digit Span 92
The subtest analysis of her performance on MISIC shows that on the subtest assessing the Ability for
sorting missing details in visually presented material, the child’s score suggest below Average
performance. The child’s scores on subtest assessing the Ability for Arithmetic, Vocabulary, Attention
and New Learning Ability, and Ability for Visual Integration and Perceptual Organization, suggest
average performance. Her Ability for Factual Information, Comprehension, Ability to Reason by
Analogy, Visuo-spatial Ability, Problem Solving Ability and Abstraction Ability, is at an Above
Average Level.
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ATTENTION
b) Digit cancellation test for single and double digits
cut all the digits adequately on her own suggesting that her attention span and concentration
level is adequate.
LANGUAGE
f) Oral Reading (English)
It is below II grade level. Finger tracing; letter substitution and addition and mispronunciation
was present. Her reading was hesitant and laborious. Posture was inadequate and the prosody
was absent.
g) Copying (English)
It was below II grade level. She was seen to copy letter by letter and took long to copy the
text. She was unable to maintain adequate spacing between the lines. Her pencil holding was
incorrect and she was seen to use lot of pressure while writing. Her posture was inadequate.
h) Spellings (English)
It was adequate to her grade level.
i) Comprehension (English)
It was below II grade level. She was seen to comprehend the meaning of the question and the
text on her own. She was able to answer simple direct questions. But, in questions, where she
had to infer the answer, she tended to look for key words while answering them and tended to
copy the exact line containing those key words as an answer. Her inferential, creative and
critical abilities were poor.
j) Expressive Writing (English)
It was below II grade level. She wrote simple sentences and they were grammatically
incorrect. She was unable to generate ideas as expected of her grade level.
MEMORY
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c) Auditory Memory for familiar and unfamiliar words
d) Auditory Memory for Sentences
It was adequate to her grade level. She could remember up to 2 commands in English
Language.
e) Visual Memory
On Bender Visual Retention Test (BVRT), she drew 9 figures out of 9 correctly. Her
performance is not suggestive of any impairment in her visual memory.
c) Test of Visuo-Motor Integration (TVMI)
On TVMI, the child was able to draw all the shapes correctly. No deficits were seen.
d) Bender Gestalt test (BGT)
She was able to draw all the figures correctly. No deficits were seen.
III Grade Level Assessment Device for Children with Learning Problems in Schools
LANGUAGE
a) Oral Reading (Hindi)
It is below II grade level. Finger tracing; matra omission and addition; word substitution and
mispronunciation was present. Her reading was hesitant and laborious.
b) Copying (Hindi)
It was below II grade level. She was seen to copy letter by letter and took long to copy the
text. She was unable to maintain adequate spacing between the lines. Her pencil holding was
incorrect and she was seen to use lot of pressure while writing. Her posture was inadequate.
c) Spellings (Hindi)
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It was below II grade level. She was not clear with the concept of matras and half-letters,
blends and concept of bindu and chandrama bindu.
d) Comprehension (Hindi)
It was below II grade level. She was able to comprehend the meaning of the question on her
own and was able to answer simple direct questions. In questions, where she had to infer the
answer, she tended to look for key words and thereby copying the exact line containing those
key words as an answer to the question. Her inferential, creative and critical abilities were
poor.
k) Expressive Writing (Hindi)
ARITHMETIC
a) Arithmetic Computation
It was adequate to her grade level except that she was not clear with the concept of fractions.
She was also seen to make several careless mistakes.
b) Arithmetic Reasoning
It was below II grade level. She was unable to comprehend the meaning of the reasoning
sums and was unable to elicit the computations involved.
Impression
The test findings on MISIC suggest that the child has an IQ of 108 suggestive of Average Level of
was found to have specific learning disability (Dyslexia) in the area of reading, copying,
comprehension and expressive writing in English Language. On Grade Level Assessment Device for
Children with Learning Problems in Schools, the child was found to have specific learning
disability (Dyslexia) in the area of reading, copying, spelling, comprehension and expressive writing
in Hindi Language and in Arithmetic reasoning.
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Recommendations
 She should be encouraged to do analysis of error. She needs to be given practice in dictation
of Hindi language while giving emphasis on the concept of matras, half-letters, bindu,
chandrama bindu and blends. She needs to practice reading in English and Hindi Language
using word attack skills.
 To help build her comprehension skill, she should be explained the meaning of the text word
by word. She should be encouraged to learn the meaning of the word not known to her and to
make use of these words in her day to day language so that they become part of her
vocabulary.
 She needs to made clear with the concept of fractions and she needs to practice reasoning
sums.
technical terms.
 He should not be pressurized to do lot of writing work as her pencil holding is incorrect which
significantly affects her speed and letter formation.
 Since the child is already aware of her shortcomings, hence try do not scold her to much
especially in front of others. Also avoid comparisons with other children.
mentioned areas. The child is likely to benefit from special education.
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Case Study:H
Name Ms. Savita Husband’s Name Rajender Singh
Age Years No. of Sessions One
Sex Female Date of Testing 23-03-13
Occupation Journalism Address 53, Samrat Enclave, Pritampura
Informant
Self
Reason of Referral
Psycho-diagnostics
Test administered
The following tests were administered:
 Sac’s Sentence Completion Test (SSCT)
 Thematic Apperception Test (TAT)
 Rorschach Ink Blot Test
She was attentive, cooperative and communicative. She was able to comprehend the instructions
adequately. She was motivated and performed the test with interest. Rapport could be established and
maintained with ease.
Test findings
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I SSCT
Her responses on SSCT reveal that although she shares a loving relationship with her mother and is
very attached to her. But unlike, mother she appears to have ambivalent feelings towards her father ,
where she wishes him to be more wise and to believes that he had taught her the basic coping skills,
then her life would have been far more better than what it presently is. She further appears to think
that her family is a bit different from other in general and from last few months she thinks that her
family members have begun to consider her as an irresponsible person.
According to her, most females should be independent, self-reliant and having a mind of their own.
However she thinks that most women are basically shallow and too dependent on men. She revealed
that this aspect of women is the one she dislikes the most. She feel guilty for ruining her marital
relationship because of lack of adequate understanding about interpersonal skills. However, she
strongly desires a stable and a healthy relationship with her husband.
She does not seem to like people who are dominating and thinks that her friends do not probably miss
her, when she is not there. Although she appears to enjoy freedom at work place but seems to find it
difficult to trust her colleagues as she feels that they may take credit for her work.
Her greatest fear appears to be the fear of being left alone or abandoned by others, where she feels
that her husband may leave her alone forever. She believes that her true potential has been untapped.
When faced with difficulties she is likely to feel anxious and tends to sulk and becomes passive. She
seems perplexed and uncertain about her future.
II TAT
The client’s responses on TAT suggested that she is an individual with average intelligence (presence
of internal consistency and logical development of stories; average vocabulary) whose emotional
maturity level seems to be adequate (identified with the same age but opposite gender; stories are in
logical harmony with the facts of the stories).
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Her personal and family adjustment seems to be poor. Her stories were filled with more negative
emotions (like guilt, rejection, frustration, sadness etc) as compared to positive emotions (like
happiness). In her stories she saw illness of her father and presence of significant difficulties in
marital relationships where in most of the cases either the husband left the wife or through wishful
thinking all of a sudden things between the two became fine and normal. Most of her stories were
marked by presence of shallow, superficial but extreme emotions. When faced with difficulties the
hero in most of the stories was seen to become passive and to wait for and depend on others to solve
problems of her life and to bring about the desired change.
Her dominant needs appeared the need for passivity, affiliation, nurturance, abasement and love. In
all her stories, the press was largely supportive except in stories on marital relationships where the
husband rejects the wife. Her major conflicts seem to be the approach vs avoidance and id vs
superego. Her major defense mechanisms seemed to be magical thinking, escape and wishful
thinking.
Her ego functioning seems to be inadequate (inability to resolve conflicts adequately, varied
outcomes). She is likely to be in touch with reality (inclusion of all the central dominant parts of the
pictures).
III Rorschach Psychodiagnostics
Her responses on Rorschach suggest that she is an individual with average intelligence who seems to
be aware of and accepting of her affectional needs experienced in terms of desire for approval,
belongingness and response from others retaining a passive recipient flavor (Fc responses). She may
be trying to handle her affectional anxiety by introspective efforts; trying to objectifying her problem
by gaining perspective on it, by putting it at some distance from herself (FK Responses). But the
tensions appear to be too strong to permit her from utilizing her inner resources for the constructive
solutions of her everyday problems of living (FM+m> M).
She appears to be an impulsive person whose impulsive life seems to subordinate her value system.
She also appears to possess self-acceptance and the capacity to defer gratification without undue
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frustration, conflict or inhibition (FM is not less than one-half of M). she seems capable of
subordinating her impulse life to either long-term goals or to reality situation or both resulting in
favorable occupational adjustment (Presence of one or two m responses). Her ability to view her
world in an impersonal matter of fact way mat further serve as an aid to controlled adjustment (F%=
20% to 50%).
There seems to be too little responsiveness to influences from the environment (SumC<3), where she
may be either inhibited in her productiveness under conditions of strong environmental impacts or
basically lacking in responsiveness to such impact (% of responses to card VIII, IX and X, less than
30 %).
She seems to have a rich fantasy life and appears to have a creative potential for which she may have
not found an adequate outlet (W<2M). she appears to be an anxious person who may fear to go into
anything too deeply with a tendency to skirt the fringe of a situation without coming to grips with it
(de Responses). She may also be obsessional, meticulous in nature, which may in reality be a defense
against insecurity. As a result she appears to cling to limited areas for a fear of losing one’s grip and
being carried away into confusion. Therefore, she seems too hesitant in drawing general conclusions
from fine detailed observations. (dd Responses and Dd+S>10%, increase at the expense of W
Responses).
Her socialized responses tend to be superficial as she appears to be unwilling to allow herself a strong
emotional reaction even when the situation demands a deep emotional response (FC >CF + C, if
CF+C is absent or nearly so). Her interpersonal relationships are likely to be poor ((H) responses).
She may be an evasive (Seeing maps), impulsive (FM responses), person who seems to be pre-
occupied with pre-genital sexuality and an inability to effectively carry out heterosexual relationships
(Seeing Sexual content) and is likely to be concerned about her social self (Seeing Mask). She may
harbor feelings of inferiority within herself (Presence of FC’ responses).
Impression
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The above test findings suggest that the patient is likely to be an impulsive individual with average
intelligence whose personal, and family adjustment seems to be poor. She appears to be emotionally
less stable, engaging in superficial but extreme emotions. Her dominant needs seem to be the need for
passivity, succourance, affiliation, nurturance, abasement and love. Her major defense mechanisms
seemed to be magical thinking, wishful thinking and escape mechanisms. Her socialized responses
tend to be superficial. Her ego-functioning seems to be inadequate. She appears to be too insecure to
delve deeply into things and prefers to be at the surface and hence may avoid drawing general
conclusions from fine details. She seems to be in adequate touch with reality.
Recommendations
 Cognitive behavior therapy is recommended to help deal with her conflicts.
 Her coping mechanism need to be strengthened.
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Case Study: I
Name Baby Simran No. of Sessions Two
Age 10 Years Date of Testing 02-09-12 and 04-09-12
Class V School Amity International School. Pushp Vihar
Father’s Name Mr. Arun Khanna Address E-129, First Floor, Lajpat Nagar-I, New
Delhi
Informant
Child’s parents
Reason of Referral
The child came with her parents with the chief complaints of poor academic performance, poor
spellings, difficulty comprehending languages, tendency to forget easily, poor tables and poor
grammatical concepts.
The parents further reported that the child had a full term normal delivery. The birth cry was
immediate and all her developmental milestones were on time. But, throughout pregnancy, the mother
was very stressed due to some family conflict. During her 4th
month of pregnancy she tended to have
frequent vomiting and fever.
An interaction with the child revealed that she is a pleasant child who is quite sensitive and
hardworking. She wishes to improve herself in academics and enjoys co-curricular activities. In order
to gain a better understanding of the difficulties she is facing in her academics, an assessment for
Specific learning Disability was done.
Test administered
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ease.
Test findings
I MISIC
Digit Span 92
The subtest analysis of her performance on MISIC shows that on the subtest assessing the Ability for
Factual Information, Arithmetic, Ability for sorting missing details in visually presented material,
Visuo-spatial Ability, Ability for Visual Integration and Perceptual Organization, the child’s score
suggest below Average performance. The child’s scores on subtest assessing the Ability for
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Comprehension, Vocabulary, Attention and New Learning Ability, Problem Solving Ability and
Abstraction Ability, suggest average performance. Her Ability to Reason by Analogy, is at an Above
Average Level.
ATTENTION
c) Digit cancellation test for single and double digits
cut all the digits adequately on her own suggesting that her attention span and concentration
level is adequate.
LANGUAGE
l) Oral Reading (English)
It is adequate to her grade level.
m) Copying (English)
It was below II grade level. She was seen to add, omit and substitute letters at inappropriate
places. Her pencil holding was incorrect and she was seen to use lot of pressure while writing.
n) Spellings (English)
o) Comprehension (English)
It was below II grade level. She was seen to comprehend the meaning of the question and the
text by looking at some key words. She was able to answer simple direct questions. But, in
questions, where she had to infer the answer, she tended to look for key words while
answering them and tended to copy the exact line containing those key words as an answer.
Her inferential, creative and critical abilities were poor.
p) Expressive Writing (English)
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MEMORY
f) Auditory Memory for familiar and unfamiliar words
g) Auditory Memory for Sentences
It was adequate to her grade level. She could remember up to 2 commands in English
Language.
h) Visual Memory
On Bender Visual Retention Test (BVRT), she drew 8 figures out of 9 correctly. Her
performance is not suggestive of any impairment in her visual memory.
e) Test of Visuo-Motor Integration (TVMI)
On TVMI, the child was able to draw all the shapes correctly. No deficits were seen.
f) Bender Gestalt test (BGT)
She was able to draw all the figures correctly. No deficits were seen.
LANGUAGE
e) Oral Reading (Hindi)
It was below II grade level. She was seen to engage in substitution of matras at inappropriate
places. Finger tracing and mispronunciation was present. She tended to guess the words by
looking at the first few syllables and was seen to have significant difficulty reading words
containing half-letters.
f) Copying (Hindi)
It was adequate to her grade level except that her pencil holding was incorrect.
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g) Spellings (Hindi)
It was below II grade level. She was not clear with the concept of matras and half-letters.
h) Comprehension (Hindi)
It was below II grade level. She was able to comprehend the meaning of the question on her
own and was able to answer simple direct questions. In questions, where she had to infer the
answer, she tended to either answer them based on common sense and general awareness or
tended to look for key words and thereby copying the exact line containing those key words
as an answer to the question. Her inferential, creative and critical abilities were poor.
q) Expressive Writing (Hindi)
ARITHMETIC
c) Arithmetic Computation
d) Arithmetic Reasoning
It was adequate to her grade level. She needed assistance in understanding the meaning of the
question and was able to compute reasoning sums adequately.
Impression
was found to have specific learning disability (Dyslexia) in the area of copying, comprehension and
expressive writing in English Language. On Grade Level Assessment Device for Children with
Learning Problems in Schools, the child was found to have specific learning disability (Dyslexia) in
the area of reading, spelling, comprehension and expressive writing in Hindi Language.
Recommendations
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of Hindi and English language while giving emphasis on the phonetic sounds and concept of
matras and half-letters.
 She needs to practice reading in Hindi Language based on the phonetic scheme.
vocabulary.
 She needs to practice reasoning sums.
technical terms.
 He should not be pressurized to do lot of writing work as her pencil holding is incorrect which
significantly affects her speed and letter formation.
 Since the child is already aware of her shortcomings, hence try do not scold her to much
especially in front of others. Also avoid comparisons with other children.
mentioned areas.
 The child is likely to benefit from special education.
lOMoARcPSD|9054700

Case Study: J
Name Baby Vanshika No. of Sessions One
Age 6 Years Date of Testing 05-03-13
Class I School Tagore International School, East Of
Kailash
Father’s Name Mr. Brij Gopal Address 98D, Hari Nagar, Asharam, New Delhi-
10014
Informant
Child’s father
Reason of Referral
The child came with her father with the chief complaints of poor academic performance, poor
spellings, poor social skills, poor mathematical concepts, inadequate reading, tends to forget her
answers, has poor comprehension and low confidence level.
The parents further reported that the child had a full term cesarean delivery. Her birth cry was
immediate and her birth weight was normal. Reportedly, she attained all her developmental milestones
on time.
An interaction with the child revealed that she is a pleasant child who is shy and takes time to open
up. She seemed to lack self-confidence and her social skills seemed poor. In order to gain a better
understanding of the difficulties she is facing in her academics, an assessment for Specific learning
Disability was done.
Test administered
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ease.
Test findings
I MISIC
Digit Span 85
The subtest analysis of her performance on MISIC shows that on the subtest assessing the
Ability for Arithmetic, Attention and New Learning Ability, Ability for sorting missing details in
visually presented material and Ability for Visual Integration and Perceptual Organization, the child’s
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score suggest below Average performance. The child’s scores on subtest assessing the ability for
Factual Information, Ability to Reason by Analogy, Vocabulary, Visuo-spatial Ability, and Abstraction
Ability, suggest average performance. Her Ability for Comprehension and Problem Solving Ability, is
at an above average level.
ATTENTION
d) Digit cancellation test for single and double digits
cut all the digits adequately on his own suggesting that her attention span and concentration
level is adequate.
LANGUAGE
r) Reading (English)
Her reading skills were II grade below her current level. She was seen to read the letter aloud
and was unable to join them to form words. Finger tracing was present. Her reading was
hesitant and laborious. She lacked recognition of most of the sight words. Her word attack
skills were poor. Her posture was adequate but the prosody was lacking.
s) Copying (English)
Her copying skills are II grade below her current Level. She was seen to copy letter by letter
and took long to copy the text. She tended to avoid writing work and had to be persuaded a lot
to write. She was unable to maintain adequate spacing between the words and the lines and
was seen to ignore punctuation marks while writing. Her pencil holding was inadequate.
t) Spellings (English)
Her spellings were II grade below her current level. She was not clear with the concept of
phonetics and tended to write words that involved vowel combination, rules of spelling and
blended sounds incorrectly.
u) Comprehension (English)
Her comprehension skills were II grade below her current level. She was unable to
comprehend the meaning of the text and the question on her own. When a question was asked,
she was seen to stay mum. Her direct, inferential, creative and critical abilities were poor.
lOMoARcPSD|9054700

v) Expressive Writing (English)
Her expressive writing skills were II grade below her current level. She was unable to
describe objects in her own words. She was seen to give monosyllabic responses even when
lot of assistance was given to her.
MEMORY
i) Auditory Memory for familiar and unfamiliar words
j) Auditory Memory for Sentences
It was below II grade level. She could remember only up to 1 command (not more than 3 to 4
words) in English Language. She was seen to engage in word omission and substitution as the
length of the sentence increased or it contained words unfamiliar to her.
k) Visual Memory
On Bender Visual Retention Test (BVRT), she drew only 3 figures out of 10 correctly.
Substitution, rotation, misplacements and size errors were seen. Her performance is
suggestive of significant impairment in her visual memory.
g) Test of Visuo-Motor Integration (TVMI)
On TVMI, the child was unable to draw all the shapes correctly. Significant deficits were
seen.
h) Bender Gestalt test (BGT)
She was unable to draw all the figures correctly. Significnat deficits were seen.
LANGUAGE
lOMoARcPSD|9054700

i) Reading (Hindi)
Her reading was II grade below her current level. She was seen to read the letters aloud but
was unable to join them to from words. She lacked recognition of matras. Finger tracing was
present. Her reading was hesitant and laborious. Her word attack skills were poor. Her posture
was adequate but the prosody was lacking.
j) Copying (Hindi)
Her copying skills are II grade below her current Level. She was seen to copy letter by letter
and took long to copy the text. She tended to avoid writing work and had to be persuaded a lot
to write. She was unable to maintain adequate spacing between the words and the lines and
was seen to ignore punctuation marks while writing. Her pencil holding was inadequate.
k) Spellings (Hindi)
Her spellings were II grade below her current level. She was not clear with the concept of
matras, half-letters, blends, bindu and chandrama-bindu.
l) Comprehension (Hindi)
Her comprehension skills were II grade below her current level. She was unable to
comprehend the meaning of the text and the question on her own. But when the passage was
read out to her, she was able to answer simple direct questions with little assistance. Her
inferential, critical and creative abilities were poor.
w) Expressive Writing (Hindi)
Her expressive writing skills were II grade below her current level. She was unable to
describe objects in her own words. She was seen to give monosyllabic responses even when
lot of assistance was given to her.
ARITHMETIC
e) Arithmetic Computation
Her arithmetic skills were II grade below her current level. She lacked the concept of greater
than and less than; before and after; ascending and descending order; and was not very clear
with the concept of addition and subtraction.
f) Arithmetic Reasoning
lOMoARcPSD|9054700

Her arithmetic reasoning was II grade below her current level. She was unable to comprehend
the meaning of the questions. Even when the meaning of the question was explained to her,
she was unable to compute the reasoning sums adequately.
Impression
was found to have specific learning disability (Dyslexia) in the area of reading, copying, spelling,
comprehension and expressive writing in English Language. Significant difficulties were seen in her
auditory and visual memory and in her visuo-motor co-ordination skills. On Grade Level Assessment
Device for Children with Learning Problems in Schools, the child was found to have specific
learning disability (Dyslexia) in the area of reading, copying, spelling, comprehension and expressive
writing in Hindi Language and in Arithmetic computation and reasoning.
Recommendations
of Hindi and English language while giving emphasis on the phonetic sounds. She needs to be
made clear with the sounds of vowels, vowel combination, diagraphs, rules of spelling and
blended sounds in English and with the concept of matras, half-letters, blends, bindu and
chandrama bindu.
 She needs to practice reading in English and Hindi Language based on the phonetic scheme.
vocabulary.
 She needs to be made clear with the concept of of greater than and less than; before and after;
ascending and descending order; and was not very clear with the concept of addition and
subtraction.
 She needs to practice reasoning sums.
lOMoARcPSD|9054700

 She should be taught exercises to enhance her auditory and visual memory and in her visuo-
motor co-ordination skills.
 As per the CBSE guidelines extra-time (20 minutes per hour) needs to be given to her during
exams to help her perform to her optimum level.
 Her marks for spellings can be ignored, unless they are grossly wrong or are those of
technical terms.
 Keeping in view her current level of functioning, a simplified objective type of paper based
on a limited syllabus, is likely to help the child to perform to her optimum level.
mentioned areas.
 She is likely to benefit from special education inputs.
lOMoARcPSD|9054700

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