Bio Data Name Age Gender Sibling Birth order Socioeconomic Status: Religion Informant Reason for Referral

The client was referred to CWC with the complains of academic problem, short attention span, speech problems major because of the problem of cerebral palsy and also problems of motor movements and poor coordination Presenting complains X.y 9Years 11month Male 3 Ist born Middle. Islam Mother

Background Information Family History The clients father was 38 years old. He by profession was an accountant officer in a government institute. He was reported to be an introvert person and short tempered. Although he was fulfilling clients all needs but the complete acceptance of client problem was not yet as it should. Although he was providing all necessary things but his more attachment with the other twin of client showed that he had great love for him as compare to client. It was reported by mother if both sons are demanding for some thing father will pay more attention to normal son as compare o client .if both want a toy father will prefer normal son for this. Client was not much attached to his father. Satisfactory relations were reported by mother. The father had satisfactory relationship with family members. No physical or psychiatric illnesses were reported by the mother. The clients mother was 42 years old educate up to Msc in psychology from Punjab University.She was reported to be a house wife. She had calm temperament. She was not concerned about the client problems as client medical history revealed that there were no frequent medical checkups as it should be needed according to clients problem. She was not an active lady in terms of clients demands or needs. She use to give a pack of slanty or lays chips to him even he didnt open the pack .Client had preferred home made things but mother was not ready to prepare for him. Although the clients class teacher and therapist had been asking her to give him home made chips or any other thing that client prefer to eat. Client had congenial relations with mother. Mother had satisfactory relation with the client. Mother had an affectionate relation with all her children. No physical or psychiatric illnesses were reported by the mother. Parental relationships were reported to be satisfactory. Mother reported that they have taken every step after mutual consultation. Client had 3 siblings all were brothers. First born was client himself Second born brother was 9 years old .He was a student of class three. He was reported to be loving, caring .He was confident and had warm relationship with the client. Client shared quality time at home when they were together. There was no physical or psychological problem was reported by the mother in twin brother of client. The first and second born were twins. Third born sibling was 3 years old. He was yet not admitted to school. Client had healthy relations with him. He was reported to understand clients problem and deals client according to his abilities. When ever client needed some thing and, he was unable to approach, his younger brother helped him. As he

was the youngest one the client had much attachment with him. He had a co-operative behavior toward client. No psychological or physical problem was reported . General Home Atmosphere. The client had a nuclear family system. The total number of family members in a house was 5. The client belonged to a middle class family. His father was authoritative figure in a family. The family was and non co-operative towards the children. The over all general home atmosphere was satisfactory and calm. History of any family physical or psychiatric disorder in family No family history of any psychiatric and physical disorder was reported by mother Personal History Birth and Childhood The clients birth was through normal delivery. Total number of pregnancies reported by mother was three. All were live births no abortions were reported. Father age at the time of birth was 27 .Mother age at the time of clients birth was 25 years. The mother took no medicines other than those prescribed by the gynecologist during her pregnancy period. There was no significant illness during pregnancy. There was no emotional trauma accept the anxiety of first pregnancy as reported by the mother. Duration of pregnancy was less than the expected time given by the gynecologist. No birth injuries or significant complication was reported by the mother. Clients weight at the time of birth was 3 pounds. First cry at the time of birth was not present. As cry was delayed, his color after I hour of birth was blue. Significant illness of jaundice, meningitis was reported with in three months after birth. Duration of breast feed was less than 2 years because of the digesting problem, so formula milk was continued .No as such feeding problems were reported. Developmental History Milestones Neck holding Sitting with support Crawling Walking Talking (sounds) Eating without help Bladder control Achieved by the client

Neurotic trait of thumb sucking was reported. Temper tantrum were reported to seen occasionally when the client was in stubborn mood .Stated earlier that balder control was not gained yet so bed

wetting was frequent. Sleep disturbances were also reported by mother since his birth. He had very little sleep .Wake ups during night sleep were reported by her mother. His all sensory modalities were reported to be intact as touch, smell, taste. Appetite was reported to be normal, but gross and fine motor skills were reported to be impaired. Client loved to play with toys and watching cartoons especially music. He was moody sometimes irritates others at home due to her stubbornness. He was a social child in sharing his toys or belongings or having other thing. Clients favorite game was football .His great interest in music and movies was also reported by mother. Educational History The client was brought to CWC with the complaints of inability to speak, delayed milestones and short memory. In addition to this, the client had visual .The client had no exposure to school. Cline was CP use to be on wheel chair. The client was brought to Child Welfare Center when he was 7 years old. Client had no exposure to school before this because he was physically handicapped and milestones were delayed and parents did not give importance to clients problem, so that schooling was late. Initially client showed off seat behavior he use to leave his CP chair and use to crawl in the class. He was not able to pay full attention to classroom tasks and used to ignore the instructions of school teacher and enjoyed more in the games or recreational activities as compare to educational activities. Client was not interested in the classroom tasks. He usually doesnt complete the task with full attention. His relations with his classmates were reported to be helping and caring. Clients attention span was hardly 4-5 minutes, so he was not able to pay attention in classroom tasks. Clients mother was satisfied with the diligence of class teacher she gave all credit of clients current functioning to the class teacher. She had complaining attitude towards the physio therapy but over all she was happy with clients improvement in motor areas. Mother was satisfied with clients performance in school timings. Clients socialization was improving day by day. Clients present level of functioning was much better than when he was admitted to School but require improvement in it The parents consideration about the education and management of the client problem of the client was satisfactory. Physio therapy was provided in CWC but that was not sufficient for client. No extra therapy was reported by mother. Client also had speech problem client hardly had 2-3 word speech .Speech therapy was being provided in CWC, but no extra speech therapy was reported

History of present illness of child Child history of present illness started 9 years and 11 months back immediately after client birth. When client was born he looked like normal but his skull was very little differing from the normal size but with the passage of time this difference in size went on increasing and after one month doctors told her mother that their child is microcephalic. His skull size will be small as compare to normal so brain development will be slow so his development will also be slow. On third month after birth he had severe attack of jaundice. When client was taken to the doctor for check up he was admitted to hospital for almost 8 days .After jaundice attack when his complete medical check up was done it was informed by the doctors that the childs having cerebral palsy the parents were educated by the doctors regarding the associated problems of this disorder as his milestones and development will be at slower rate as compare to normal child .He had quadriplegia type of CP. Client medical checkups also revealed his seizures problem, so regular medicines were prescribed for this problem. Severe attack of jaundice was reported to be the major reason of clients present problem. After doctors briefing regarding clients problem at first the parents were shocked but acceptance of child as CP was very difficult step in their lives. Although 9 years have passed still parents have not accepted their child completely .The client showed delayed milestone of, neck holding crawling walking holding this was an indication of his delayed development. When client was in his 8th month he was again attacked by jaundice but this time the duration was less than that of first one. He was not admitted to hospital he was discharged from hospital after medication. He showed sitting behavior at the age of 2 .AT the age of 3 when the client did not start his speech parents took him to doctor. At present he used to be on wheel chair due to quadriplegia. Physio therapy was provided in CWC but that was not sufficient for client. No Extra therapy at home was provided. Client also had speech problem Speech therapy was being provided in CWC, but no extra speech therapy was reported by mother. The client was initially very helping and compliant but now with the passage of time his behavior was becoming irritable. There were no regular physical checkups were reported by the mother in first 7 years but since 2 years he had occasional checkups in children hospital.