INTERNSHIP REPORT

Submitted by

SAITHUAMPUII SAILO

23/CPSY/028

III Semester

M.Sc. Clinical Psychology

Department of Clinical Psychology

Mizoram University

Supervised by

Dr. Lalhmingmawii

Assistant Professor

Department of Clinical Psychology

Mizoram University

2024
 CERTIFICATE

This is to certify that Saithuampuii Sailo, a student of M.Sc. Clinical Psychology, Mizoram
University has successfully completed her internship report under the supervision and guidance
of Dr. Lalhmingmawii. She has taken proper care and shown utmost sincerity in the completion
of this report.

No part of this report has ever been published by any other university or institution for any
purpose whatsoever.

Date: .11.2024

Place: Mizoram University, Tanhril

(Dr. Lalhmingmawii)

Assistant Professor

Department of Clinical Psychology

Mizoram University
 DECLARATION

I, Saithuampuii Sailo, hereby declare that the presented report of internship is uniquely prepared
by me after the completion of ten day work at Child Development Centre, Aizawl, Mizoram.

l also confirm that, the report is only prepared for my academic requirement not for any other
purpose. It might not be used with the interest of opposite party of the corporation.

This is being submitted to Mizoram University for the Post Graduate Degree in Clinical
Psychology.

(SAITHUAMPUII SAILO)

23/CPSY/028

III Semester

M.Sc. Clinical Psychology

Department of Clinical Psychology

Mizoram University
 ACKNOWLEDGEMENT

First of all, I would like to express my heartfelt gratitude to God for blessing me with health and
good grace to complete my report.

Successful completion of any type of project requires help from a number of people. I have also
taken help from different people for the preparation of this report.

I would like to express my sincere appreciation and gratitude to Dr. Laxmi Narayan Rathore,
Head of the Department, Department of Clinical Psychology, for creating this invaluable
opportunity, and my supervisor Dr. Lalhmingmawii, Assistant Professor, for her guidance.

I also convey my sincere gratitude to Miss Esther Zaihmingthangi Varte, the Principal of Child
Development Centre for giving me the opportunity to have my internship at their centre.

I am also truly grateful to my family and friends who had helped me during my internship and all
the people who allowed to make my humble work a success.

(SAITHUAMPUII SAILO)

23/CPSY/028

2ndSemester

M.Sc. Clinical Psychology

Department of Clinical Psychology

Mizoram University
 CONTENTS

1. INTRODUCTION

2. ACTIVITIES UNDERTAKEN

3. CASE REPORT

4. EXPERIENCES/LEARNINGS
 INTRODUCTION

The Child Development Centre (CDC) is a pioneering, inclusive educational and

therapeutic facility located in Aizawl, Mizoram. Established on February 6, 2021, and initially
situated in Jail Veng, Aizawl, the Centre relocated to Ramhlun South, Aizawl, on May 9, 2023,
to better accommodate its growing needs. Child Development Centre is the first of its kind in
Mizoram, offering a comprehensive and multidisciplinary approach to support children and
adolescents with developmental and behavioral challenges. Under the leadership of Principal
Esther Zaihmingthangi Varte, the Centre has quickly become a beacon of inclusive education
and specialized care in Mizoram. The Centre provides services not only in the academic domain
but also strives to help children reach their full potential across all aspects of their development,
including cognitive, social, emotional, and physical growth. Through a combination of
educational and therapeutic interventions, Child Development Centre aims to create an
environment where each child is supported in their unique journey towards independence and
personal success.

At the core of Child Development Centre’s mission is its commitment to inclusivity. The
Centre brings together a team of highly trained professionals who work collaboratively to
address the unique needs of each child. This includes a diverse range of specialists such as
trained teachers, clinical psychologists, occupational therapists, audiologists, speech-language
pathologists, and physiotherapists, pediatricians. With a focus on individualized care, Child
Development Centre provides therapeutic services alongside its educational programs, ensuring
that children receive holistic support that nurtures both their academic and developmental
progress.

School Section

The school section of the Child Development Centre is designed to cater to the varied
learning needs of children with developmental and behavioral challenges. The medium of
instruction is both Mizo and English, ensuring that children receive an education that is
culturally relevant while also equipping them with the skills necessary for communication in a
globalized world. The educational approach at Child Development Centre is highly
individualized, with teachers and therapists working closely to adapt lessons and interventions
based on the specific needs of each student.

Classes at the Child Development Centre are organized according to developmental

needs, and children are grouped into various class sections. The current classes include:
Watermelon Class, Strawberry Class, Peach Class, Kiwi Class, Blueberry Class, and Cherry
Class. These classes are structured to cater to children of different age groups and developmental
stages. Watermelon and Peach classes are located on the upper floor and other classes are on the
lower floors of the building.

Each class is staffed with a team of two or three class teachers, who are not only
educators but also play an active role in the therapeutic process. They collaborate closely with
clinical staff, including psychologists, speech therapists, and occupational therapists, to ensure
that the children’s learning experiences are supportive of their individual developmental needs.
This integrated approach helps foster a nurturing environment where children feel understood,
supported, and empowered to learn.

Therapy Section

The therapy section of the Child Development Centre operates alongside the school to
provide a range of specialized services tailored to the individual needs of each child. The therapy
ensures that therapeutic support is seamlessly integrated with the educational program, allowing
children to receive both academic and developmental assistance in one comprehensive setting.
There are 5 clinical assistants who provide therapy to the students and clients and provide
services such as occupational therapy, behavioral modification, special education, and speech
therapy.

Children receive therapy during school hours, ensuring minimal disruption to their
academic progress. Sessions are scheduled on a one-on-one basis, allowing therapists to address
the specific needs of each child in a focused manner. These personalized therapy sessions are
carefully planned to support the child’s overall development while maintaining their involvement
in the classroom activities.
 The therapy section's multidisciplinary team works closely with the school educators to
ensure that children receive a holistic approach to their development. Whether through therapy
for motor skills, communication challenges, behavior management, or learning difficulties, the
therapy section is designed to provide targeted interventions that help children thrive both in and
out of the classroom. This integrated approach promotes the child’s academic growth, personal
independence, and emotional well-being, offering them the support they need to reach their full
potential.

After-School Care and Therapy

The Centre also provides after-school care for children who require additional support
beyond regular school hours. After-school care allows children to continue receiving therapeutic
services or engage in structured activities that promote socialization, skill-building, and personal
growth. Students attending after-school care typically stay at the centre until around 3:30 to 4:00
pm, after which they return home.

In addition to the school section, the centre’s clinic remains operational in the afternoon,
offering therapy services to clients who are not enrolled in the school program. These clients—
who may be younger children or adolescents—receive targeted therapy sessions based on their
individual needs, with many receiving therapies such as speech-language pathology,
occupational therapy, and behavioral modification.

Services Provided

The Child Development Centre (CDC) offers a comprehensive range of services designed
to support the holistic development of children and adolescents facing developmental,
behavioral, and learning challenges. The centre is committed to providing multidisciplinary care
through a team of trained professionals, ensuring that each child receives personalized
interventions based on their individual needs. The services offered are structured to enhance
cognitive, emotional, social, and physical growth, and are available through a combination of
assessments, therapies, and educational interventions.

Occupational Therapy Services

 The occupational therapy (OT) team at the Child Development Centre focuses on
supporting children with difficulties in sensory processing, fine motor skills, self-care, and
functional abilities necessary for daily living.

a) Occupational & Sensory Assessment: Comprehensive evaluations to assess how a child

processes and responds to sensory stimuli, as well as their overall ability to engage in functional
tasks.

b) Sensory Integration Processing Therapy: Therapeutic interventions aimed at helping children

manage sensory sensitivities and improve their ability to interact with their environment.

c) Self-Care Training: Focused interventions to help children develop independence in essential

life skills, including eating, dressing, and toilet training.

d) Fine Motor Skills Training: Activities and exercises designed to improve a child's hand-eye
coordination, grasp, and control over small movements.

e) Locomotion Therapy: Physical therapy techniques to improve walking, balance, and

coordination, helping children achieve greater mobility and independence.

f) Communication Skills Development: Support in enhancing verbal and non-verbal

communication abilities, helping children to better interact with peers and adults.

Psychological Services

The psychological services provided at the Child Development Centre aim to support
children's emotional, social, and cognitive development. This includes a range of therapeutic
modalities, counseling, and behavioral interventions.

a) Assessment & Diagnostic Services: Psychological evaluations to assess the cognitive,

emotional, and behavioral functioning of children, with an emphasis on early diagnosis and
intervention.

b) Behavior Modification Therapy: Evidence-based interventions focused on helping children

develop positive behaviors and reduce challenging or maladaptive behaviors.
c) Cognitive Retraining: Cognitive exercises designed to enhance a child's attention, memory,
problem-solving, and other cognitive skills.

d) Cognitive Behavioral Therapy (CBT): A therapeutic approach that helps children recognize
and manage negative thoughts and behaviors, fostering healthier coping mechanisms.

e) Play Therapy: Therapeutic interventions that use play as a medium to help children express
their emotions, resolve conflicts, and develop social skills.

f) Art Therapy: A creative form of therapy that encourages self-expression through art, helping
children explore their feelings and enhance their emotional well-being.

g) Family Therapy: Counseling services designed to support families in understanding and

addressing the challenges faced by their children, fostering stronger family relationships and
improving communication.

h) Individual Counseling: One-on-one sessions to support children in managing emotional

difficulties, anxiety, depression, or trauma.

Special Education Services

The special education services at Child Development Centre are designed to cater to
children with learning disabilities, developmental delays, and other special needs. The focus is
on creating personalized learning plans that help children succeed in both academic and life
skills.

a) Assessment: In-depth evaluations to identify specific learning challenges and needs, providing
the foundation for tailored educational strategies.

b) Individualized Education Program (IEP): Each child is supported by an Individualized

Education Program, a customized learning plan that outlines specific academic goals, strategies,
and interventions based on their unique needs.

c) Multisensory and Cost-Effective Instructional Materials: Development of teaching tools that

engage multiple senses, making learning more accessible and effective for children with various
learning styles.
d) Enhancing Functional Skills: Special educators focus on improving both academic
performance and functional life skills, including social, self-help, and organizational skills.

e) Co-curricular Activities: Emphasis is placed on integrating functional and life skills with
academic learning, ensuring children participate in a variety of activities to enhance their holistic
development.

Pediatric Services

Pediatric services at the Child Development Centre focus on the overall health and well-
being of children. The team of pediatricians is dedicated to managing growth and development
concerns, as well as providing ongoing care for various pediatric conditions.

a) Growth and Development Monitoring: Regular assessments to track physical and

developmental milestones in children, ensuring early identification and management of any
growth-related concerns.

b) Nutrition Counseling: Guidance on proper nutrition to support healthy growth and

development, including managing dietary needs for children with special requirements.

c) Outpatient Management of Pediatric Illnesses: Medical care and treatment for common
pediatric illnesses, as well as specialized management for chronic conditions.

Speech and Language Services

The speech and language therapy services provided at Child Development Centre are
designed to address a wide range of speech, language, and communication challenges.

a) Assessment & Diagnosis: Detailed evaluations to identify speech and language disorders,
including articulation, fluency, language comprehension, and expressive communication
difficulties.

b) Speech and Language Therapy: Targeted interventions aimed at improving articulation,

pronunciation, language understanding, and social communication skills.

c) Voice Therapy: Therapeutic techniques to improve vocal quality, pitch, and resonance,
particularly for children with speech disorders affecting their voice.
Audiology Services

Audiology services at the Child Development Centre are dedicated to supporting children
with hearing impairments or difficulties in processing auditory information.

a) Hearing Screening & Evaluation: Comprehensive hearing assessments to identify hearing

impairments, ranging from mild to profound, and to recommend appropriate interventions.

b) Auditory Verbal Therapy: Therapy focused on developing listening and spoken language
skills for children with hearing impairments, helping them integrate auditory input for
communication.

Referral Assistance

In addition to its in-house services, Child Development Centre provides referral

assistance to other allied specialties. If a child requires further medical or therapeutic
interventions outside the scope of Child Development Centre’s services, they are referred to
appropriate specialists for comprehensive care.

Psychiatry: For children who may require psychiatric evaluations or medication management for
conditions such as anxiety, depression, or ADHD.

Medicine: Referral for general medical concerns or ongoing health management that requires a
more specialized approach.

Physical Medicine and Rehabilitation (PMR): For children needing rehabilitation services,
particularly related to physical disabilities or recovery from injury.

Orthopedics: Referral for musculoskeletal issues or orthopedic conditions that may require
specialized care.

Obstetrics and Gynecology (OBG): For female children and adolescents requiring gynecological
care or reproductive health services.

The Child Development Centre provides a comprehensive suite of services designed to

address the diverse needs of children and adolescents with developmental and behavioral
challenges. With a multidisciplinary team of experts in various fields, Child Development Centre
ensures that each child receives individualized care, support, and interventions that promote their
well-being and enable them to achieve their fullest potential. Whether through pediatric care,
therapy, special education, or family support, Child Development Centre is committed to making
a positive impact on the lives of children and their families.
 ACTIVITIES UNDERTAKEN

Duration of posting: 09.08.2024 to 11.10.2024

Day 1 (09.08.24)

I arrived at the Child Development Centre (CDC) at 9:25 AM on Friday, 9th August.
Upon arrival. For the day, I was assigned to Strawberry Class, where I assisted the teachers with
any tasks they needed help with. The teachers in charge of Strawberry Class were Miss Tluangi
and Miss Zuali. The class consisted of approximately 15 students. Since it was my first day, I
mainly helped with classroom activities and did not participate in any therapy sessions. I was
helping the teachers with whatever necessary and assisting with basic tasks under their guidance.
At 12:30 PM, the students were dismissed for the day, and I took a break for lunch. After lunch, I
was instructed to stay in the after school care, where children who did not go home after the
morning session were supervised. These children remained in the aftercare until they were
picked up by their parents, which typically occurred between 3:30 and 4:00 PM. After the
children were picked up, I concluded my day at the centre and returned home. Overall, my first
day was spent getting acquainted with the centre, observing the daily routines, and assisting in
the classroom environment. It was a relatively quiet start, as I focused on understanding the
layout, the staff, and the general structure of the school day.

Day 2 (16.08.24)

I arrived at the centre at 9:35 AM on my second day. In the morning, I was assigned to
observe occupational therapy session with Miss Dingi, the clinical assistant conducting the
therapy. During the session, three clients attended. The first client was a 5-year-old child with
autism, who also has hearing impairments, a poor attention span, and sensory processing issues.
The child is sensitive to loud noises and exhibits self-harming behaviors and tantrums when Miss
Dingi performs self-brushing exercises. Despite these challenges, the child is able to follow basic
commands. Another client was a 6-year-old boy who has difficulty in numerical learning. In
addition to numbers, he also has confusion with alphabets. He also has difficulty sleeping; he
sleeps very late at night and wakes up early in the morning. He likes to isolate himself and even
though he can speak properly, he speaks at a very low tone. Miss Dingi practices brain gym
exercises on him. The third client, with an intellectual disability, faced challenges with motor
coordination, communication, and social interaction. The client struggled to engage in activities
that required fine motor skills, such as object manipulation and tasks involving hand-eye
coordination. In the afternoon, I assisted Miss Mami, the special educator, with another group of
three clients. The first was a 6-year-old with speech and behavioral issues; the second was a 6-
year-old with Specific Learning Disorder and the third was an 8-year-old child with social and
emotional challenges.

Day 3 (23.08.24)

On Day 3 of my internship, I arrived at 9:20 AM and assisted with occupational therapy

in the morning, working with four clients: one girl and three boys. The activities focused on
improving fine motor skills, cognitive development, and sensory integration. For example, one
child practiced transferring objects between containers to improve hand-eye coordination, while
another worked on arranging numbers and letters in sequence to strengthen cognitive abilities.
One boy with sensory processing difficulties engaged in tactile activities, transferring textured
objects, and another child worked on number sequencing and grip strength by using tongs to
transfer small objects. In the afternoon, I assisted with speech therapy, where I observed four
clients, ranging from 4 to 7 years old, each addressing different speech and language challenges.
One child with a speech delay worked on sound articulation, while another focused on creating
simple sentences using picture cards to build vocabulary. A third child worked on following
multi-step directions to enhance language comprehension, and a fourth child with a stutter
practiced slow, deliberate speech and breathing techniques to improve fluency. I finished my day
and went home at 4:00 PM.

Day 4 (30.08.24)

On Day 4 of my internship, I arrived at 9:30 AM and assisted the special educator in the
morning, working with three clients. The first client was a 6-year-old boy diagnosed with
ADHD, who struggled with attention and impulse control. During the session, we engaged him
in structured activities like sorting objects by color and shape, which helped him practice focus
and organization while promoting self-regulation. The second client was a 5-year-old girl with a
mild intellectual disability. She worked on basic academic skills, such as recognizing numbers
and letters, and practiced simple math problems to improve her cognitive abilities and early
numeracy skills. The third client was a 7-year-old boy with a language delay. He participated in
an activity where he matched pictures to words, which helped expand his vocabulary and
improve his ability to understand and express himself verbally. In the afternoon, we the interns
attended a class with the clinical psychologist, where he had a lecture on neurodevelopmental
disorders. The lecture covered a range of topics, including autism spectrum disorder (ASD),
ADHD, intellectual disabilities, etc with a focus on their diagnostic criteria and therapeutic
interventions. After the lecture, we had the opportunity to interact with the clinical psychologist,
asking questions about the management of neurodevelopmental disorders and gaining valuable
insights into assessment techniques and treatment approaches used in therapy. After the class, we
were done for the day, and went home at 4:00 PM.

Day 5 (06.09.24)

I arrived at the centre in the morning and assisted with speech therapy, working with four
clients. The first client, a 4-year-old girl with a speech delay, practiced articulation by repeating
simple words and phrases while looking at pictures. This helped her improve her ability to form
clear sounds and enhance her verbal communication. The second client, a 6-year-old boy with a
mild expressive language disorder, worked on building his vocabulary. He participated in an
activity where he matched words to corresponding images and practiced using those words in
simple sentences. The third client, a 5-year-old boy with a stutter, engaged in breathing and
relaxation exercises to help reduce his speech anxiety. He also practiced slow, deliberate speech
while reading short sentences aloud. The fourth client, a 7-year-old girl with autism spectrum
disorder, focused on improving her social communication skills. She participated in turn-taking
games, which helped her practice appropriate conversational exchanges and improve her social
interaction. In the afternoon, I was assigned to stay at the after-school care, where some students
stayed on after school hours. I helped manage the group by cleaning up the space and ensuring
everything was in order. I also played with the children, engaging in simple games and activities
to keep them entertained. Later, I assisted with distributing food to the students and making sure
everyone had their snacks. Parents arrived to pick up their children between 3:30 and 4:00 PM,
and once all the children were picked up, I finished my duties and headed home for the day.

Day 6 (13.09.24)

On Day 6 of my internship, I assisted the clinical assistant with behavioral modification

therapy in the morning, working with five clients. The first client, a 6-year-old girl, had difficulty
following instructions and stayed focused better using a token reward system for completing
tasks. The second client, a 7-year-old boy, struggled with task completion and practiced a first-
then approach, where he completed a less-preferred task before moving on to something more
enjoyable. The third client, a 5-year-old boy, needed help with turn-taking and patience, which
he worked on through role-playing games. The fourth client, a 6-year-old girl, practiced calming
techniques like deep breathing to manage her emotions during group activities. The fifth client, a
7-year-old boy, used visual cues and social scripts to improve his social interactions and reduce
repetitive behaviors. In the afternoon, I assisted another clinical assistant with four clients. The
first client, a 6-year-old boy, worked on staying seated during activities and earned rewards for
participating. The second client, a 7-year-old girl, practiced speaking in small groups to build
confidence and improve communication. The third client, a 5-year-old boy, focused on
transitions between tasks, using redirection techniques to help him stay calm. The fourth client, a
6-year-old girl, improved her focus in distracting environments by completing tasks while
managing background noise. After assisting with both sessions, I finished my day and went
home.

Day 7 (20.09.24)

On Day 7, I assisted with behavioral modification therapy in the morning with five
clients. The first client, a 6-year-old girl, worked on improving her attention span by sorting
objects by color and shape, earning small rewards for each completed task. The second client, a
7-year-old boy, worked on impulse control by playing a game where he had to wait for a signal
before responding, helping him practice patience. The third client, a 5-year-old girl, practiced
improving her attention span by completing a matching activity, where she matched pictures to
their corresponding words, which helped her stay engaged and focused. The fourth client, a 5-
year-old boy, worked on following instructions by participating in a scavenger hunt, where he
had to follow a series of simple directions like "find the red ball" and "bring me the toy car."
The fifth client, a 7-year-old boy, worked on regulating his energy levels by participating in a
movement-based activity, such as stretching or jumping jacks, to help him calm down and focus
during the session. In the afternoon, I stayed at the after-school care, where I helped supervised a
group of children, cleaned up after the kids, and helped serve snacks. With all the children
picked up by their parents between 3:30 and 4:00 PM, I finished my shift and made my way
home.

Day 8 (27.09.24)

On Day 8, I assisted with occupational therapy in the morning, working with four clients.
The first client, a 7-year-old girl with an intellectual disability, worked on transferring objects
into matching containers, focusing on shape and size since she had difficulty with color
differentiation. The second client, a 6-year-old boy with cerebral palsy, practiced transferring
small objects between containers to improve his hand-eye coordination. The third client, a 5-
year-old boy, worked on arranging alphabet and number cards in order to improve letter
recognition and sequencing skills. The fourth client, a 6-year-old girl, participated in sensory
integration activities, like squeezing stress balls and using a texture board, to improve tactile
sensitivity. In the afternoon, I was assigned to assist the special educator. However, she only had
one client that day, a 9-year-old boy with learning difficulties. He arrived at 3:00 PM. We
focused on reading and writing, where he read short sentences aloud, matched words to pictures,
and practiced writing simple words to improve his skills. After the session, I waited for my
fellow interns to finish their activities and then went home.

Day 9 (04.10.24)

On Day 9 of my internship, I assisted with speech therapy in the morning, working with 7
clients. One client struggled with articulation, specifically with the "s" and "r" sounds. We used
flashcards and repetition drills, and while progress was made with the "s" sound, the "r" sound
still posed a challenge. Another client, who has a mild stutter, worked on speech fluency through
controlled speech and breathing exercises, showing some improvement in overall fluency. A
third client focused on building more complex sentences, successfully completing an activity that
involved sentence formation. Another client had difficulty with auditory discrimination and
practiced distinguishing various sounds through listening games, showing gradual improvement.
A fifth client had difficulty following directions and understanding simple instructions. We
worked on a sequencing activity where the client had to follow step-by-step instructions, which
they improved with some guidance. The last two clients were in the room at the same time, but I
worked with one while the other was attended by Miss. Both clients had individual therapy
sessions: one focused on improving vocabulary skills through flashcards and word association
games, while the other worked on enhancing pragmatic language skills, such as taking turns in
conversation and using appropriate greetings. In the afternoon, I assisted with after-school care,
providing support as needed and helping with the children’s activities.

Day 10 (18.10.24)

On my last day, I was originally scheduled to assist the special educator in the morning,
but I was asked to stay in the Watermelon class instead, as one of the class teachers was absent
and needed help. The classroom was noticeably cleaner compared to the others, and the students
were well-behaved, which made the day run smoothly. The students worked on memorizing a
Bible verse, and each was asked to recite it one by one. However, most of them, except for one,
struggled to say it on their own. We also worked on alphabet recognition. The students were
given picture cards with different objects, people, food items, etc., and I would call out an item,
such as "ice cream," and they were asked to pick the correct picture. The students were divided
into groups based on their levels. Those with fewer difficulties worked with a broader range of
cards, including objects, people, and food, while the students with more significant challenges,
such as those with intellectual disabilities, struggled to differentiate between letters and had more
difficulty with the tasks. After completing the activities with the students, we gave them lunch.
The children who were not staying for after-school care went home, while those remaining
stayed in the after-school program. After we too had lunch, we take case histories for five clients
each, which we would include in our internship reports. Once this task was completed, we
wrapped up for the day and headed home.
CASE REPORT
 Case No. 1
Socio demographic details

Name : XY

Age : 3 years 10 months

Sex : Female

Date of birth : 21.12.20

Father’s name : XX

Father’s occupation : Journalist

Mother’s name : YY

Education : Pre school

Socio economic status : High socio economic status

Family : Extended family

Religion : Christian

Residence : Chaltlang

Mother tongue : Mizo

Informant’s Report

Name: YY

Relationship with the client: Mother

Known to client since: Birth

Reliability: Reliable

Adequacy: Adequate
Presenting Complaints

1. Doesn’t follow commands (1 year - present)

2. No eye contact (2 years - present)
3. Poor social skills (2 years - present)
4. Limited verbal communication (2 years - present)

History of Present illness

The patient's current condition began approximately two years ago with reports of
difficulty following commands, initially observed sporadically but gradually becoming more
consistent over the past year. Concurrently, they noted a complete absence of eye contact during
social interactions, which has persisted. This lack of eye contact has been accompanied by a
progressive decline in social skills, manifesting as difficulty in understanding social cues,
maintaining conversations, and engaging in reciprocal interactions with peers and caregiver
alike.

Furthermore, there has been a noticeable limitation in verbal communication, with the
patient displaying minimal speech and often resorting to nonverbal gestures or expressions to
convey their needs or thoughts. This pattern of limited verbal communication has been persistent
over the same two-year period.

The symptoms described have had a profound impact on the patient's daily functioning,
significantly impairing their ability to participate in age-appropriate tasks or responsibilities, both
at home and in educational or social settings, engage in social relationships, and fulfill expected
roles within their family and community.

Total duration of present illness: 2 years

Predisposing factors: None

Precipitating factors: None

Perpetuating factors: Social (social isolation, lack of social skills)

Mode of onset: Insidious

Course of illness: Continuous

Progress of illness: Improving

Negative history: None

FAMILY HISTORY

Type of family: Extended family

Family size: 7 (Father, mother, grandparents, aunt, older brother, younger brother)

Head of the family: Grandfather

Socio economic status: High socio economic status

Consanguinity: None

History of psychiatric illness in family: No history suggestive of any psychiatric illness in

family

Intrafamilial relationship:

Social support system: The client does not interact much with her families.

Home atmosphere during childhood: No bad atmosphere is present

Parental lack: Present to some extent since her parents are both busy with their jobs

Consanguinity: None
Family genogram

Personal History

Source : Mother

Adequacy : Adequate

Delivery : Natural Birth

Birth cry : Yes

Birth weight : 2.8 kg

Prenatal complication : No complication

Maternal Complication : No complication

Mother’s age of pregnancy : 29 years

Developmental History:

Motor Milestone

1. Head control : Yes

2. Sit with support : Yes

3. Sit without support : Yes

4. Walk without support : Yes

5. Climb upstairs : No

6. Runs well : Yes

Speech and Language

1. Babbling : Yes

2. Can speak two words : No

3. Two words phrases : No

4. Word sentences : No

Adaptive

1. Visual tracking : No

2. Reaches for objects : No

3. Pincer grasp : Yes

4. Know two body parts : No

5. Scribbles/copy line or circle: Yes

6. Make believe play : No

7. Can write few alphabets : No

Personal and social

1. Social smile : No

2. Recognizes mother : Yes

3. Imitates : No

4. Drinking from glass : No

5. Feed self without help : No

6. Indicates toilet needs : No

7. Dress self without help : No

8. Fully toilet trained : No

Temperament

Activity level : High

Distractibility : High

Temper tantrums : Present

Attention Span : Low

Energy level : Normal

Threshold of responsiveness : Normal

(sensitive to heat, noise, etc)

Quality of mood : Calm

Rhythmicity : Normal

Approach or Withdrawal : Withdrawn

Educational History

The patient attended Anganwadi at the age of 2 years and even then she lack social skills
and does not communicate with her peers. She started attending preschool from this year. She
never interacts with her classmates and prefers to play alone. She does not listen or obey when
teachers ask her to do some tasks. She ignores everyone and will sometimes just lay on the floor
or desks. The teacher therefore does not include her in their activities and just let her be and do
anything she wants during school hours. But the teacher reported that there is some improvement
in the way she behaves as compared to the beginning of the year.

Psychological Assessment Report

As per assessment done with Vineland Social Maturity Scale and Indian Scale for
Assessment of Autism, the following are the findings

Vineland Social Maturity Scale (VSMS):

Social Age: 2 years 6 months

Social Quotient: 74

Indian Scale for Assessment of Autism (ISAA):

112

Moderate Autism
Diagnostic Formulation

Provisional Diagnosis:

Childhood autism (F84.0)

Criteria met:

 Inability of reciprocal social behavior

 Communication impairment
 Avoid or does not keep eye contact
 Repetitive behaviors

Differential Diagnosis:

Receptive language disorder (F80.2)

Criteria met:

 Failure to respond to familiar names by 1 year

 Failure to follow simple, routine instructions by the age of 2 years
 Difficulty in understanding and producing speech and language
 Lack of understanding of more subtle aspects of language (tone of voice, gestures, etc.)

Treatment Plan/ Recommendations:

1. Parent education and support: Provision of psychoeducation and support services for parents
to enhance understanding of autism, develop coping strategies, and facilitate positive parent-
child interactions and communication. This will introduce parents to effective therapeutic
approaches, as well as improves symptoms, educational aspects and social aspects and create a
home safety zone.

2. Speech and language therapy: Initiation of speech and language therapy to address expressive
and receptive language deficits, augmentative and alternative communication strategies, and
promote functional communication skills.
3. Educational approach: Refer to special educator for needful and achieve important learning
milestones by using various teaching methods, tailored to the specific needs of the patient.

4. Behavioral approach: Behavioral approach like Applied Behavior Analysis (ABA) can be
used. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful
or effect learning such as using positive reinforcement.

5. Occupational Therapy: Teaches skills that help the patient live as independently as possible
and may address sensory processing difficulties, fine motor delays, sensory integration
challenges self-care skills like dressing, eating, bathing, etc.

6. Collaborate with school when needed – This will help parents in understanding client’s
accurate academic and social state in school and will help in keeping track of client’s
improvement.
 Case No. 2
Socio demographic details

Name :B

Age : 4 years 9 months

Sex : Male

Date of birth : 26.01.20

Father’s name :A

Father’s occupation : Police

Mother’s name :L

Education : Pre school

Socio economic status : Middle

Family : Nuclear family

Religion : Christian

Residence : Chanmari

Mother tongue : Mizo

Informant’s Report

Name: L

Relationship with the client: Mother

Known to client since: Birth

Reliability: Reliable

Adequacy: Adequate
Presenting Complaints

1. Constantly on the move, difficulty staying seated. (2 years– present)

2. Easily distracted, struggles to focus on tasks. (2 years– present)
3. Acts without thinking, interrupts frequently. (2 years– present)
4. Tantrums and mood swings. (2 years– present)

History of Present illness

According to the informant, when their child was 2 years old, they first noticed his
restlessness and difficulty remaining seated for prolonged periods. This marked the onset of the
illness, characterized by an incessant need for movement and a notable inability to stay still.
Such behaviors were initially attributed to typical childhood energy levels but soon escalated,
becoming more pronounced and concerning.

They also observed that he is easily distracted. Despite attempts to engage the child in
activities, maintaining focus became increasingly challenging. This difficulty manifested across
various settings, from home to school, and others.

Concurrently, the child began exhibiting impulsive behaviors, acting without apparent
forethought and frequently interrupting others. These impulsive actions often led to disruptions
in social interactions and challenges in adhering to structured routines. As these behaviors
persisted, concerns regarding the child's ability to regulate impulses and exercise self-control
became more prominent.

Furthermore, over the same period, the child began displaying emotional dysregulation,
marked by tantrums, mood swings, and difficulty transitioning between activities. These
emotional outbursts were often triggered by seemingly minor stimuli or changes in routine,
making daily life increasingly challenging for both the child and the families

Total duration of present illness: 2 years

Predisposing factors: None

Precipitating factors: None

Perpetuating factors: The patient’s symptoms intensified after he started attending preschool. The
structured environment and demands of classroom routines seem to exacerbate his challenges,
particularly in terms of sitting still and following instructions.

Mode of onset: Insidious

Course of illness: Continuous

Progress of illness: Static

Negative history: None

FAMILY HISTORY

Type of family: Nuclear family

Family size: 3 (Father, Mother)

Head of the family: Father

Socio economic status: Middle

Consanguinity: None

History of psychiatric illness in family: No history suggestive of any psychiatric illness in

family.

Intrafamilial relationship:

Social support system: While the patient’s parents are supportive, they experience increased
tension and strain in their relationship due to the challenges of managing his symptoms and their
differing approaches to discipline. The constant challenges of managing his symptoms have left
his parents feeling overwhelmed and unsure of how to help him. The parents often experience a
sense of helplessness and exhaustion, which can affect their attitudes and interactions with their
child.

Home atmosphere during childhood: No bad atmosphere is present

Parental lack: Absent

Family genogram

Personal History

Source : Mother

Adequacy : Adequate

Delivery : Natural Birth

Birth cry : Yes

Birth weight : 3.5 kg

Prenatal complication : No complication

Maternal Complication : No complication

Mother’s age of pregnancy : 27 years

Developmental History

Motor Milestone

1. Head control : Yes

2. Sit with support : Yes

3. Sit without support : Yes

4. Walk without support : Yes

5. Climb upstairs : Yes

6. Runs well : Yes

Speech and Language

1. Babbling : Yes

2. Can speak two words : Yes

3. Two words phrases : Yes

4. Word sentences : Yes

Adaptive

1. Visual tracking : Yes

2. Reaches for objects : Yes

3. Pincer grasp : Yes

4. Know two body parts : Yes

5. Scribbles/copy line or circle: Yes

6. Make believe play : Yes

7. Can write few alphabets : Yes

Personal and social

1. Social smile : Yes

2. Recognizes mother : Yes

3. Imitates : Yes

4. Drinking from glass : Yes

5. Feed self without help : Yes

6. Indicates toilet needs : Yes

7. Dress self without help : No

8. Fully toilet trained : No

Temperament

Activity level : High

Distractibility : High

Temper tantrums : Present

Attention Span : Low

Energy level : High

Threshold of responsiveness : Normal

(sensitive to heat, noise, etc)

Quality of mood : High

Rhythmicity : High

Approah or Withdrawal : Approach

Educational History

The patient started attending preschool from last year at 3 years where his teachers have
expressed concerns about his behavior and its impact on his ability to participate in classroom
activities and social interactions. He often finds it hard to follow instructions. When the teacher
asks the children to line up, he gets distracted and wanders off or has trouble waiting his turn. He
struggles to sit still, constantly fidgeting or getting up from his seat. He blurts out answers
without raising his hand or interrupts other children during group activities. His hyperactivity
makes it hard for him to engage in quiet activities or focus on tasks that require sustained
attention. He darts around the classroom or play area, making it challenging for him to engage in
structured activities.

Psychological Assessment Report:

Child Behavior Checklist

T score – 65, Borderline range

Diagnostic Formulation

Provisional Diagnosis:

Hyperkinetic disorder (F90)

Criteria met:
  Impaired attention
 Hyperactivity
 Impulsivity

Differential Diagnosis:

Oppositional defiant disorder (F91.0)

Criteria met:

 Easily angered or having frequent temper outbursts

 Deliberately annoying others or being easily annoyed
 Impact social interactions and relationships

Treatment Plan/ Recommendations:

1. Parent Training - Provide parents with training in behavioral management techniques such as
positive reinforcement, setting clear and consistent expectations, and implementing structured
routines at home. Parental involvement is crucial in managing ADHD symptoms in young
children.

2. Early Intervention Programs - Enroll the child in early intervention programs that focus on
behavior management, social skills development, and academic readiness. These programs often
incorporate strategies tailored to the child's age and developmental stage.

3. Environmental Modifications - Create a structured and organized environment at home and in

other settings to minimize distractions and promote focus. This may include reducing clutter,
establishing predictable routines, and providing clear instructions.

4. Behavioral Therapy - Engage the child in behavioral therapy sessions with a qualified
therapist who specializes in working with young children with ADHD. This can help the child
learn self-regulation skills, impulse control, and social skills through play-based activities and
behavior modification techniques.
5. Physical Activity -Encourage regular physical activity and outdoor play, which can help
channel excess energy and improve attention and focus. Activities such as running, jumping, and
climbing can be particularly beneficial.

6. Regular Follow-Up and Monitoring - Schedule regular follow-up appointments with

healthcare professionals to monitor the child's progress, adjust interventions as needed, and
provide ongoing support to the family. Open communication between parents, teachers,
therapists, and healthcare providers is essential for effective management.
 Case No. 3
Socio demographic details

Name : YZ

Age : 4 years 4 months

Sex : Female

Date of birth : 09.07.20

Father’s name : XX

Father’s occupation : Businessman

Mother’s name : YY

Education : Pre school

Socio economic status : Middle

Family : Nuclear family

Religion : Christian

Residence : Ramhlun North

Mother tongue : Mizo

Informant’s Report

Name: YY

Relationship with the client: Mother

Known to client since: Birth

Reliability: Reliable

Adequacy: Adequate
Presenting Complaints

1. Unclear speech (2 years – present)

2. Unusual behavior (2 years – present)
3. Difficulty in learning (2 years – present)
4. Very sensitive (2 years – present)
5. Lack social skills (2 years – present)

History of Present illness

According to the informant, by the time client was 2 years old, there were subtle signs of
unclear speech noted by family members and teachers, which were attributed to developmental
factors. However, over time, these speech difficulties persisted and became more pronounced,
leading to concerns regarding the patient's communication abilities.

Approximately one year ago, alongside the persisting speech issues, there emerged
reports of unusual behavior exhibited by the patient. This included repetitive movements,
fixation on certain objects or topics, and difficulty in adapting to changes in routine. These
behaviors were initially perceived as quirks but have since escalated in frequency and severity,
significantly impacting the patient's daily functioning.

Concurrently, over the past two years, there has been a noticeable decline in the patient's
learning abilities. Despite efforts from educators and families, the patient struggles to grasp new
concepts and retain information. This difficulty in learning has led to academic challenges and
frustration, further exacerbating the patient's behavioral issues.

Moreover, there has been a marked increase in the patient's sensitivity to environmental
stimuli, such as loud noises, bright lights, or tactile sensations. This heightened sensitivity often
triggers distressing reactions, including agitation or withdrawal.

Additionally, over the same period, there has been a noticeable lack of development in
the patient's social skills. They struggle to engage in age-appropriate interactions, demonstrate
limited understanding of social cues, and exhibit difficulties in forming and maintaining
relationships with peers.
Total duration of present illness: 2 years

Predisposing factors: None

Precipitating factors: None

Perpetuating factors: Psychological (low self esteem, insecurity)

Social (lack of social skills)

Mode of onset: Insidious

Course of illness: Continuous

Progress of illness: Static

Negative history: None

FAMILY HISTORY

Type of family: Nuclear family

Family size: 4 (Father, Mother, Elder sister)

Head of the family: Father

Socio economic status: Middle

Consanguinity: None

History of psychiatric illness in family: No history suggestive of any psychiatric illness in

family.

Intrafamilial relationship:

Social support system: Good

Home atmosphere during childhood: No unusual and unhealthy atmosphere are present
Parental lack: Absent

Family genogram

Personal History

Source : Mother

Adequacy : Adequate

Delivery : Natural Birth

Birth cry : Yes

Birth weight : 3.3 kg

Prenatal complication : No complication

Maternal Complication : No complication

Mother’s age of pregnancy : 31 years

Developmental History

Motor Milestone:

1. Head control : Yes

2. Sit with support : Yes

3. Sit without support : Yes

4. Walk without support : Yes

5. Climb upstairs : No

6. Runs well : No

Speech and Language:

1. Babbling : Yes

2. Can speak two words : Yes

3. Two words phrases : No

4. Word sentences : No

Adaptive:

1. Visual tracking : No
2. Reaches for objects : Yes

3. Pincer grasp : Yes

4. Know two body parts : No

5. Scribbles/copy line or circle: No

6. Make believe play : No

7. Can write few alphabets : No

Personal and social

1. Social smile : No

2. Recognizes mother : Yes

3. Imitates : No

4. Drinking from glass : No

5. Feed self without help : Yes

6. Indicates toilet needs : No

7. Dress self without help : No

8. Fully toilet trained : No

Temperament

Activity level : Low

Distractibility : High

Temper tantrums : Present

Attention Span : Low

Energy level : Low

Threshold of responsiveness : Present

(sensitive to heat, noise, etc)

Quality of mood : Low

Rhythmicity : Normal

Approach or Withdrawal : Withdrawn

Educational History

The patient encountered speech delays and communication difficulties in preschool,

leading to frustration and isolation. She exhibited repetitive behaviors and struggled with routine
changes, impacting her classroom engagement. Learning challenges hindered her academic
progress, while social difficulties impeded peer interactions. Despite educators' efforts, her
development faced significant obstacles, requiring tailored support for improvement.

Psychological Assessment Report

As per assessment done with Vineland Social Maturity Scale and Indian Scale for
Assessment of Autism, the following are the findings:

Vineland Social Maturity Scale (VSMS):

Social Age: 2 years 8 months

Social Quotient: 76

Indian Scale for Assessment of Autism (ISAA):

110

Moderate Autism

Diagnostic Formulation
Provisional Diagnosis:

Childhood autism (F84.0)

Criteria met:

 Impairment in communication skills

 Repetitive behaviors
 Lack of social interest
 Not understanding and use of language in social contexts
 Sensitive

Differential diagnosis:

Specific developmental disorder of speech and language (F80)

Criteria met:

 Difficulty in understanding and producing speech and language

 Difficulty in reading and spelling
 Abnormalities in interpersonal relationships

Treatment Plan/ Recommendations:

1. Parent education and support: Provision of psychoeducation and support services for parents
to enhance understanding of autism, develop coping strategies, and facilitate positive parent-
child interactions and communication. This will introduces parents to effective therapeutic
approaches, as well as improves symptoms, educational aspects and social aspects and create a
home safety zone.

2. Speech and language therapy: Initiation of speech and language therapy to address expressive
and receptive language deficits, augmentative and alternative communication strategies, and
promote functional communication skills.

3. Educational approach - Refer to special educator for needful and achieve important learning
milestones by using various teaching methods, tailored to the specific needs of the patient.
4. Behavioral approach - Behavioral approach like Applied Behavior Analysis (ABA) can be
used. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful
or effect learning such as using positive reinforcement.

5. Occupational Therapy - Teaches skills that help the patient live as independently as possible
and may address sensory processing difficulties, fine motor delays, sensory integration
challenges self-care skills like dressing, eating, bathing, etc.

6. Collaborate with school when needed – This will help parents in understanding client’s
accurate academic and social state in school and will help in keeping track of client’s
improvement.
 Case No. 4
Socio demographic details

Name : SS

Age : 9 years 1 month

Sex : Male

Date of birth : 23.09.2015

Father’s name : CD

Father’s occupation : Driver

Mother’s name : AB

Education : Class III

Socio economic status : Middle

Family : Extended Family

Religion : Christian

Residence : Saitual

Mother tongue : Mizo

Informant’s Report

Name: AB

Relationship with the client: Mother

Known to client since: Birth

Reliability: Reliable

Adequacy: Adequate
Presenting Complaints

1. Difficulty with reading and writing (4 years – present)

2. Struggles with math and numbers (4 years – present)
3. Difficulty following more than one instructions (5 years – present)
4. Trouble making friends (5 years – present)
5. Inability to stay focused for long periods (7 years – present)

History of Present illness

From the age of 4, the child has had persistent difficulty with reading and writing.
He has struggled to recognize letters, form words, and spell correctly. Even simple tasks such as
writing his name or reading basic words have proven challenging, despite consistent efforts and
educational support. The child’s struggles in this area have continued over time, with little
improvement, affecting both their academic performance and daily functioning.

Alongside reading and writing difficulties, the child has also faced significant challenges
in math. He has struggled to grasp basic mathematical concepts, including recognizing numbers,
counting, and performing basic arithmetic tasks such as addition and subtraction. These
difficulties have not improved with instruction, making it hard for the child to keep up with
math-related tasks in school.

By the age of 5, the child began having trouble following multi-step instructions. Tasks
requiring more than one step, such as "Put on your shoes and get your backpack," were often
confusing, and the child would either forget the instructions or become overwhelmed. This
difficulty in processing and following directions has persisted, requiring frequent reminders and
guidance at both home and school.

Social challenges also became apparent by the age of 5. The child has had trouble making
friends and interacting with peers, often preferring solitary play. He struggle with understanding
social cues and the give-and-take of group interactions, which has led to difficulty forming
friendships. The child’s lack of social interaction has been a consistent concern in both school
and recreational settings, and often appears frustrated or withdrawn during group activities.
 In addition to these academic and social difficulties, the child has had trouble maintaining
focus on tasks since the age of 7. Whether in class or at home, he become easily distracted and
have difficulty completing tasks that require sustained attention, such as finishing homework or
focusing on a game. This difficulty in concentrating has hindered their ability to engage with
more complex tasks and led to incomplete work and frustration.

Total duration of present illness: 5 years

Predisposing factors: None

Precipitating factors: Psychological (low intelligence)

Perpetuating factors: Social (social isolation)

Mode of onset: Insidious

Course of illness: Continuous

Progress of illness: Static

Negative history: None

FAMILY HISTORY

Type of family: Extended family

Family size: 6 (Grandmother, Father, Mother, Uncle, Older sister)

Head of the family: Father

Socio economic status: Middle

Consanguinity: None

History of psychiatric illness in family: No history suggestive of any psychiatric illness in

family.

Intrafamilial relationship:
Social support system: Good

Home atmosphere during childhood: No unusual and unhealthy atmosphere are present

Parental lack: Absent

Family genogram
Personal History

Source : Mother

Adequacy : Adequate

Delivery : Natural Birth

Birth cry : Yes

Birth weight : 3.7 kg

Prenatal complication : No complication

Maternal Complication : No complication

Mother’s age of pregnancy : 33 years

Developmental History

Motor Milestone

1. Head control : Yes

2. Sit with support : Yes

3. Sit without support : Yes

4. Walk without support : Yes

5. Climb upstairs : Yes

6. Runs well : Yes

Speech and Language

1. Babbling : Yes

2. Can speak two words : No

3. Two words phrases : No

4. Word sentences : No

Adaptive

1. Visual tracking : No

2. Reaches for objects : Yes

3. Pincer grasp : Yes

4. Know two body parts : Yes

5. Scribbles/copy line or circle : Yes

6. Make believe play : No

7. Can write few alphabets : Yes

Personal and social

1. Social smile : No

2. Recognizes mother : Yes

3. Imitates : Yes

4. Drinking from glass : Yes

5. Feed self without help : No

6. Indicates toilet needs : Yes

7. Dress self without help : No

8. Fully toilet trained : Yes

Temperament
Activity level : Low

Distractibility : High

Temper tantrums : Normal

Attention Span : Low

Energy level : Normal

Threshold of responsiveness : Normal

(sensitive to heat, noise, etc)

Quality of mood : Calm

Rhythmicity : Normal

Approach or Withdrawal : Withdrawn

Educational History

The child began his education at the age of 3 in Anganwadi. At age 4, he joined St.
Francis Assisi School and attended there from KG-I to class III but struggled with reading,
writing, and math from the start. By age 5, he had difficulty following multiple instructions and
making friends. He would sometimes hide behind pillars or under desks during class as he is
unable to focus for long periods. His academic struggles led to him getting teased by his peers or
classmates. Due to these ongoing challenges, his mother decided to switch him to Willow Mount
School where he is currently attending now, a smaller and less crowded school, in the hope that
he would receive more help and understanding from his teachers.

Psychological Assessment Report

Vineland Social Maturity Scale (VSMS)

Social Age: 7 years 3 months

Social Quotient: 63.4

Binet Kamat Test of Intelligence

Mental age: 6.2

Intelligence Quotient: 66

Diagnostic Formulation

Provisional Diagnosis:

Mild Intellectual Disability (F70)

Criteria met:

 IQ lies between 50 - 69
 Difficulty understanding more complex language or ideas.
 Struggles with learning and using basic academic skills.
 Difficulty with social interactions or understanding social cues.
 Needs help with everyday tasks

Differential diagnosis:

Mixed disorder of scholastic skills (F81.3)

Criteria met:

 Persistent difficulty in reading, writing, and math

 Below expected level for age
 Interferes with academic or daily activities

Treatment Plan/ Recommendations:

1. Psychoeducation: Parents and caregivers should receive guidance on recognizing early signs
of developmental delays and understanding how these may impact the child’s behavior and
communication. This education will include strategies for fostering the child’s social skills and
language development, with an emphasis on patience, consistency, and the use of visual or
alternative communication methods.

2. Speech and language therapy: Initiation of speech and language therapy to address expressive
and receptive language deficits, augmentative and alternative communication strategies, and
promote functional communication skills.

3. Educational approach: Refer to special educator for needful and achieve important learning
milestones by using various teaching methods, tailored to the specific needs of the patient.

4. Occupational Therapy: Provide focused Occupational Therapy to improve fine motor skills,
sensory processing, and functional daily skills. OT will work on strengthening hand muscles,
enhancing handwriting, supporting self-care tasks like dressing and grooming, and developing
strategies to help [Child's Name] regulate sensory input and attention.

5. Academic Support: Provide multisensory techniques for reading, writing, and math, using
visual aids, hands-on activities, and assistive technology. Offer extra time for tasks and clear,
simplified instructions.
 Case No. 5
Socio demographic details

Name : LS

Age : 5 years 9 months

Sex : Male

Date of birth : 06.02.19

Father’s name : XX

Father’s occupation : Teacher

Mother’s name : LT

Education : Kindergarten

Socio economic status : Middle

Family : Nuclear family

Religion : Christian

Residence : Zarkawt

Mother tongue : Mizo

Informant’s Report

Name: LT

Relationship with the client: Mother

Known to client since: Birth

Reliability: Reliable

Adequacy: Adequate
Presenting Complaints

1. Poor eye contact and attention ( 1 year – present)

2. Speech production ( 1.5 years – present)
3. Poor appetite ( 3 years – present)
4. Play alone and remains aloof (3 years – present)

History of Present illness

At around 1 year of age, the child’s caregivers first noticed that he was having
difficulty maintaining eye contact and struggled to focus attention during interactions. Over time,
this issue persisted, and his avoidance of eye contact remained a consistent feature of his
behavior. His attention span appeared limited, especially in social situations, and he seemed
disengaged from the people around him. This lack of social attention and eye contact has
continued to the present day.

By the time the patient was 1 year and 5 months old, concerns about his speech
production became more apparent. He was initially able to say a few simple words, but his
vocabulary development stagnated. Although he was able to say “Ma” at 10 months of age, this
word was no longer used after his first year, and his ability to express himself verbally remained
extremely limited. He now mostly says single words that are often nonsensical or unclear,
making communication challenging. His speech has not progressed in a meaningful way, and he
does not use language functionally, either to express needs or to engage in typical conversations.

Around the age of 3 years, the child began showing signs of poor appetite. His informant
reported that he became increasingly disinterested in food, and his eating habits became
irregular. Despite efforts to encourage eating, the child’s appetite remained poor, and he showed
little interest in trying new foods. While there have been no significant reports of weight loss, his
lack of interest in food is concerning, as it might affect his growth and nutritional intake.

Additionally, by the age of 3 years, the child began displaying marked social withdrawal.
He prefers to play alone and remains aloof, showing little to no interest in interacting with other
children. He does not reach out to engage with peers or attempt to initiate play with them. The
child does not point to objects or use gestures to communicate his interests, which are typical
behaviors in children at this stage of development. When he wants something, he tends to take
the caregiver’s hand and guide it to the desired object, rather than pointing or asking for it
verbally. This behavior suggests a significant delay in his social communication skills and his
ability to engage in joint attention with others.

Total duration of present illness: 3 years

Predisposing factors: None

Precipitating factors: None

Perpetuating factors: Social (Social withdrawal)

Mode of onset: Insidious

Course of illness: Continuous

Progress of illness: Improving

Negative history: None

FAMILY HISTORY

Type of family: Nuclear family

Family size: 5 (Father, mother, older sister and brother)

Head of the family: Father

Socio economic status: Middle

Consanguinity: None

History of psychiatric illness in family: No history suggestive of any psychiatric illness in

family.

Intrafamilial relationship:
Social support system: Good

Home atmosphere during childhood: No unusual and unhealthy atmosphere is present

Parental lack: Absent

Family genogram
Personal History

Source : Mother

Adequacy : Adequate

Delivery : Natural Birth

Birth cry : Yes

Birth weight : 3.3 kg

Prenatal complication : No complication

Maternal Complication : No complication

Mother’s age of pregnancy : 35 years

Developmental History

Motor Milestone

1. Head control : Yes

2. Sit with support : Yes

3. Sit without support : Yes

4. Walk without support : Yes

5. Climb upstairs : Yes

6. Runs well : No

Speech and Language

1. Babbling : Yes

2. Can speak two words : No

3. Two words phrases : No

4. Word sentences : No

Adaptive

1. Visual tracking : No

2. Reaches for objects : Yes

3. Pincer grasp : Yes

4. Know two body parts : Yes

5. Scribbles/copy line or circle : Yes

6. Make believe play : No

7. Can write few alphabets : No

Personal and social

1. Social smile : No

2. Recognizes mother : Yes

3. Imitates : No

4. Drinking from glass : Yes

5. Feed self without help : No

6. Indicates toilet needs : No

7. Dress self without help : No

8. Fully toilet trained : No

Temperament
Activity level : Low

Distractibility : High

Temper tantrums : Present

Attention Span : Low

Energy level : Low

Threshold of responsiveness : Present

(sensitive to heat, noise, etc)

Quality of mood : Normal

Rhythmicity : Normal

Approach or Withdrawal : Withdrawn

Educational History

The child displayed difficulty with eye contact and maintaining attention, often appearing
disengaged during group activities. His speech production was delayed, and he struggled to
communicate effectively, relying on gestures or repeating phrases. He tended to play alone and
showed little interest in interacting with peers, remaining aloof during playtime. His challenges
with social cues and communication led to social isolation, and he had trouble joining group
activities. Despite these difficulties, he showed focus in certain areas, requiring individualized
support to improve communication and social engagement.

Psychological Assessment Report

Vineland Social Maturity Scale (VSMS)

Social Age: 2 years 4 months

Social Quotient: 71
ISAA

83

Mild Autism

Diagnostic Formulation

Provisional Diagnosis:

Childhood autism (F84.0)

Criteria met:

 Social Interaction Impairment

 Communication Impairment
 Restricted Behaviors

Differential diagnosis:

Mild Intellectual Disability (F70)

Criteria met:

 Difficulty in comprehension of complex language concept

 Poor conceptual, social and practical skills
 Require appropriate support for practical activities

Treatment Plan/ Recommendations:

1. Psychoeducation: Parents and caregivers should receive guidance on recognizing early signs
of developmental delays and understanding how these may impact the child’s behavior and
communication. This education will include strategies for fostering the child’s social skills and
language development, with an emphasis on patience, consistency, and the use of visual or
alternative communication methods.
2. Behavior therapy: The patient should engage in structured interventions to encourage positive
social behaviors, such as initiating eye contact and using gestures to communicate. Techniques
will focus on reinforcing functional communication and improving eating habits by gradually
introducing new foods and rewarding attempts to try them, helping to reduce feeding difficulties.

3. Cognitive Therapy: Cognitive stimulation activities will be introduced to enhance attention,

memory, and problem-solving skills. As the child grows, modified cognitive-behavioral
techniques may be used to address emotional regulation and any emerging cognitive concerns.

4. Reduce Screen Exposure: Reducing screen time will encourage more social interactions and
engagement with caregivers, fostering communication and play. This will help limit distractions
and promote healthier development of social and language skills.
 EXPERIENCES/LEARNINGS

During my internship at the Child Development Centre, I had the opportunity to work
closely with children facing a range of developmental challenges, such as speech delays, autism
spectrum disorders, learning difficulties, intellectual disabilities, etc. This experience gave me a
deep understanding of the importance of personalized and tailored approaches to child
development. I worked alongside a dedicated team of therapists, educators, and psychologists,
which helped me see how different specialists collaborate to provide holistic support for each
child.

A significant part of my internship involved direct interaction with the children. I assisted
therapists in conducting speech, occupational, behavioral therapy sessions, observing how
children responded to different interventions. I saw firsthand how important it is to adjust
strategies to meet the unique needs of each child. The experience also highlighted the crucial role
of family involvement in a child's development. I learned that the most successful progress
happens when therapy and support are carried over into the child’s home and daily routines,
rather than being limited to the centre.

Working in such a dynamic and diverse setting taught me a lot about the power of
patience and empathy. I had to learn how to adapt my communication style, whether by using
simpler language, visual cues, or gestures, to make sure the children felt understood. It was also
evident that building trust with the children was essential for their growth, as it encouraged them
to engage in activities and feel comfortable with the therapeutic process.

I truly believe that all the work that they have done there is very admirable and deserve
respect. I've come to realize that their work is definitely not easy and I have seen their dedication
and also learn that it requires a lot of patience and endurance to deal with the children.

Overall, my time at the Child Development Centre was invaluable. I gained a better
understanding of the complexities involved in child development and how individualized care
can make a significant difference in a child’s life. The experience taught me the importance of
early intervention, collaboration, and tailored learning approaches, all of which are essential in
supporting children to reach their full potential.