Case study 28- Social Interaction Challenges seen in 4.7 year old child

The child aged, 4.7-year-old boy, initiated behavior therapy, due to various concerns. He struggles with making eye contact, responding to his name, and maintaining attention. Social interactions are challenging for him, and he exhibits temper tantrums, including excessive crying, head banging, hitting others, and rolling on the floor. He also shows hyperactive behaviors and engages in self-harming actions like self-hitting, hitting his own head when frustrated. He lacks emotional expressions and seems unaware of personal boundaries and surroundings.
The child was born out of a non-consanguineous union, he was delivered by Caesarean section at full term with a birth weight of 3.4kg. While he achieved motor milestones on time, delays were observed in speech and social development. Although he can speak, his words lack meaningful content, and he doesn’t use language for communication purposes. By 1.5 years old, he could identify shapes, colors, and write the alphabet, but meaningful conversations were absent. Also, he experiences sensory issues and engages in repetitive movements, such as increased finger movements and making loud sounds.
The child has been actively engaged in behavior therapy, social skills, and address behavioral concerns. The initial month prioritized building rapport, improving eye contact, and eliciting name call responses. Subsequent months targeted sitting and waiting tolerance, while the third month aimed at achieving command following.
Throughout the therapy, issues like tantrums, aggression, and self-harm were promptly addressed with appropriate consequences. Different strategies were used, including positive and negative reinforcement, extinction, and differential reinforcement, all aimed at encouraging positive behaviors.
Upon reaching the third month, notable improvements are evident. Initially challenging, establishing rapport has become easier as he now started expressing affection through gestures like hugging and kissing. Name call response, once absent, has improved significantly as he can now responds to calls by looking. Eye contact, initially difficult to establish and maintain, is now achieved for extended durations, although a tendency towards avoidance persists.
Sitting tolerance, once marked by restlessness and tantrums, has greatly improved. He can now sit for 45 minutes without disruptive behaviors. Despite progress in waiting tolerance and command following, therapy is unfortunately coming to an end. Also, there is a significant decrease in aggressive and self-harming behaviors. He can now understand when told to stop such actions.
He is an exceptionally bright and capable child. Throughout the intervention period, notable improvements have been observed in his developmental skills, showcasing his inherent potential. His cognitive abilities are notable, marked by a strong memory that enables him to tackle challenging puzzles with ease and speed. It is evident that he has the capacity to excel further with continued rehabilitation and support. His current achievements are indicative of a promising future.
I am sincerely happy to work for this lovely child. I also want to use this opportunity to thank Child’s parents who was really hard working throughout the intervention.
Shaziya Shamsudheen
Consultant Psychologist