Case Study Paeds Hukm Nadiah

8/6/2019 Case Study Paeds Hukm Nadiah

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SITI NADIAH MD BASRI Page 1

MARA University of Technology

(UiTM)

Diploma in Occupational Therapy

CASE STUDY OCC 376

PAEDIATRIC AREA

NAME: SITI NADIAH BINTI MD BASRI

ID Number: 2007213752


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1. DEMOGRAPHIC DATA

Name : Adek An

Age : 45 mths / 3 years 9 mths old

Gender : male

Race : Malay

Address : Saujana Impian, Kajang, Selangor.

Sibling : 1st from 3

D.O.B. : 07 November 2006

Diagnosis : Autism Spectrum Disorder with mild ADHD

Refer for : social skills, cognitive function and sensory skills.

2. DEFINITION OF DIAGNOSIS

Autism is one of a group disorders known as autism spectrum disorders (ASDs).

ASDs are developmental disabilities that cause substantial impairments in social

interaction & communication and the presence of unusual behaviors and interest.

Many people with ASDs also have unusual ways of learning, paying attention and

reaction to different sensations.

The thinking and learning abilities of people with ASDs can vary from gifted to

severely challenge.

An ASD begins before the age of 3 and lasts throughout a persons life.

(Centers for Disease Control and Prevention 2007)


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CHARACTERISTICS OF AUTISM


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ADHD is Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD) is a

neurobehavioral developmental disorder. It is primarily characterized by the co-existence

of attention problems and hyperactivity, with each behavior occurring infrequently alone

and symptoms starting before seven years of age.

Subtypes

ADHD has three subtypes:

1. Predominantly hyperactive-impulsive

o Most symptoms (six or more) are in the hyperactivity-impulsivity categories.

o Fewer than six symptoms of inattention are present, although inattention may still

be present to some degree.

2. Predominantly inattentive

o The majority of symptoms (six or more) are in the inattention category and fewer

than six symptoms of hyperactivity-impulsivity are present, although

hyperactivity-impulsivity may still be present to some degree.

o Children with this subtype are less likely to act out or have difficulties getting

along with other children. They may sit quietly, but they are not paying attention

to what they are doing. Therefore, the child may be overlooked, and parents and

teachers may not notice symptoms of ADHD.

3. Combined hyperactive-impulsive and inattentive

o Six or more symptoms of inattention and six or more symptoms of hyperactivity-

impulsivity are present.

o Most children with ADHD have the combined type.

(Wikipedia)
http://en.wiktionary.org/wiki/neurobehavioralhttp://en.wikipedia.org/wiki/Developmental_disorderhttp://en.wikipedia.org/wiki/Hyperactivityhttp://en.wikipedia.org/wiki/ADHD_predominantly_inattentivehttp://en.wikipedia.org/wiki/ADHD_predominantly_inattentivehttp://en.wikipedia.org/wiki/Hyperactivityhttp://en.wikipedia.org/wiki/Developmental_disorderhttp://en.wiktionary.org/wiki/neurobehavioral


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3. FRAME OF REFERENCES

a. Sensory Integration FOR

SI is the process of organizing sensory information in the brain to make

an adaptive response (Ayres,1972)

b. Psychosocial FOR

...with improved sensory processing/ learning strategies to compensate

for deficits, children begin to participate in everyday activities without

difficulty This frame of reference focuses on assessing and helping

children develop play interest, skills, and interpersonal relationship that

are supportive of their mental health (Kramer, P. & Hinojosa, J..)

c. Behavioral FOR

Behavioral theory focuses on reinforcement of childrens performancesthrough specific feedback. (Case-Smith, 2005)

4. HISTORY

SOCIAL HISTORY

o Patient is very close to his father.

o Patient still unable to share with others.

o

Patient able to play with other without talking. MEDICAL HISTORY

o History of present medical illness

Mother noted that patient has patient has problem in sharing things and

social with others.

Patient also has some unusual sensitivity towards sticky things, and soft

toys.

Doctors at the CDC have diagnosed him as Autism Spectrum Disorder

with Mild ADHD and were sent to OT for assessment and intervention

besides to Speech Therapy for speech delayed problem.


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o Past medical history

Birth history

Patient is Full Term Normal Delivery baby.

The baby has no jaundice or other medical complication.

Motor development

No obvious delayed in gross motor development.

According to mother, client started to walk at 1 year.

Drug history

Client did not take any medication or dietary supplements.

FAMILY HISTORY


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5. EVALUATION

Subjective Assessment

(interview mother and observe patient on 20th August 2010)

Patient comes piggyback by his father.

Patient is very active and explores everything when he enters the sensory

integration room. Patient avoids stepping on the stairs in the SI room.

Patient is playful during doing activity.

Patient dislikes soft pet and theraputty.

Mother c/o pt dislikes sticky and soft things.

Patient is cries when therapist asks to do activity.

Client Priority

(Interview mother on 20th August 2010)

Mother c/o patient is very active at home and unable to focus to one task for a

long period.

Patient also unable to focus during play.

Mother is very concern in improving the childs attention span towards activity.

OBJECTIVE ASSESSMENT


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Pediatric Evaluation of Disability Inventory (PEDI) (assessed on 20th August)

Results:

Composite Scores

Domain Raw

Score

Normative

StandardScore

Standard

Error

Scaled

Score

Standard

Error

Self Care Functional

Skills

48 24.8 2.8 60.5 1.6

Social

Function

Functional

Skills

18


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Short Sensory Profile (SSP)(assessed on 20th August 2010)

Results:

Interpretation:

Client need more controlled environment in order to be productive. (ex: quieter place to

work)

Child seeks out movement and constantly on the go to seek for sensation.

Child is afraid of high place.


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6. PROBLEM IDENTIFICATION

I. Occupational Performance Area

Basic Activities of Daily Living (BADL)

Below are the BADL activities that has been highlighted from PEDI where patient

encountered some difficulties/ further explanation need to be given.

BADL PERFORMANCEGrooming & Personal Hygiene Functional Skills:

Patient unable to thoroughlybrushing teeth.

Patient unable to comb his hairappropriately.

Patient unable to care for nose.Bathing Functional Skills:

Patient unable to wash and dries

body thoroughly.Bladder management Functional Skills:

Patient unable to indicate whenwet in diapers or training pants.

Patient unable to indicate need tourinate (daytime).

Bowel management Functional Skills: Patient able to indicate need to be

changed. Patient unable to indicate need to

use toilet.

Patient unable to distinguishesneed for urination and bowelmovements.

Toileting Functional Skills: Patient able to assists with

clothing management before andafter toileting.

Patient did not try to wipe selfafter toileting.

Dressing Functional Skills: Patient able to put on and

removes front-opening shirt notincluding fasteners.

Patient able to put on pants andremoves pants with elastic waist.

Patient unable to zips, unzips,separates and hooks zipper.

Patient able to put on socks.


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ii. Play (PEDI Social Function Domain)

Functional Skills:

Patient unable to takes turn in simple play when cued for turn.

Patient unable to uses real or substitute object in simple pretend sequences.

Patient unable to puts together materials to make something.

iii. Leisure (PEDI Social Function Domain)

Functional Skills:

Patient likes to watch television commercials.

iv. Social Participation (PEDI Social Function Domain)

Functional Skills:

Patient does not interact with other children and did not play with other children.


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II. Occupational Performance Component

a) Motor skills (interview using PEC)

a. Patient able to ride bicycle with small wheels.

b. Notice that patient has difficulties to do catching and throwing ball with

correct skills.

c. Pencil Grasp Pattern: Tripod Static Grasp

d. Client has difficulties with threading activity, buttoning and unbuttoning,

copies horizontal, vertical and circular line.

b) Cognitive Skills (observation, PEC)

a. Patient able to fully attends towards an activity for not more than 5

minutes.b. Patient still doesnt know basic concept.

c) Communication Skills (PEDI, observation)

a. Patient unable to uses gestures with clear meaning.

b. Patient shouts to express need.

c. Patient able to understand simple 1 step-command.

7. PROBLEM LIST

a. Patient seeks out movement and constantly on the go.

b. Patient has tactile sensitivity to sticky things and soft toys.

c. Patient is afraid of high place.

d. Patient has lack of attention and concentration in performing task.

e. Patient has poor eye contact towards people and activity.

f. Patient has difficulties with visual-motor integration activity.

g. Patient has behavior problem in giving cooperation to do activity.

h. Patient displays inappropriate play behavior sometimes and did not

interact with peers.

i. Patient still doesnt know basic concept.

j. Patient still dependent in ADL in buttoning, grooming, bathing and toiletingskills.


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8. PATIENTS ASSETS

a. Patient has no physical limitation.

b. Patient has good family support.

c. Patients mother apply the home programs given and shown improvement

in certain parts.

9. FORMULATING AIMS

SHORT TERM GOALS

a. To decrease patients actively seeking for sensation and constantly on the

go.

b. To decrease patients sensitivity to sticky things and soft toys.

c. To improve patients sensitivity to high place.

d. To improve patients attention and concentration in performing task.

e. To improve eye contact towards activity and people.

f. To improve patients visual-motor integration activity.

g. To improve patients behavior problem in giving cooperation to do activity.

h. To encourage appropriate peer play and interaction with peers.

i. To improve patients basic concept knowledge.

j. To improve patients level of independency in ADL in term of buttoning,

grooming, bathing and toileting skills.

LONG TERM GOALS

LONG TERM GOAL SHORT TERM GOALTo increase patients independency

level in ADL. To improve patients attention and

concentration in performing task. To improve patients buttoning

/unbuttoning and zipping/unzipping. To increase patients level of

independency in grooming. To increase patients level of

independency in bathing. To increase patients level of

independency in bowel and bladdermanagement.

To increase patients level of

independency in toileting skills.To improve patients social skill andappropriate play.

To improve patients behaviorproblem in giving cooperation to doactivity.

To improve and maximize clients motorskills that is vital for preschoolreadiness.

To improve eye contact towardsactivity and people.

To improve patients attention andconcentration in performing task.


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10. TREATMENT PLAN AND IMPLEMENTATION

GOALS METHODS OFINTERVENTION

PLANNING IMPLEMENT REVIEW

Todecreasepatientsactivelyseeking forsensationandconstantlyon the go.

Jointcompression

Jumptrampoline

Patient

Todecreasepatientssensitivityto stickythings andsoft toys.

Sensorystimulationtechnique.

Patient able toplay with stickythings duringsecond

appointmentd/t exposure tostickythings/soft toysduring firstsession andhomeprograme.

To improvepatientssensitivityto highplace.

SI activitywith ActiveInvolvement.

Patient stillcontinue SIactivity andhome

programme.

To improvepatientsattentionandconcentration inperformingtask.

Table-topactivity

SI activity

Patient able topay attentionfor 5-10minutes duringtable-topactivity buteasilydistracted withsurrounding.

To improve

eye-contacttowardsactivityandpeople.

Eye-level

activity Imitationactivity


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To improvepatientsvisual-motorintegrationactivity.

Fine motoractivity

To improvepatientsbehaviorproblem ingivingcooperation todo activity.

Behaviormodification Play activity.

Patient ableto givecooperationduringsecondappointment.

To encourageappropriatepeer play andinteraction

with peers.

Group play Family

education

To improvepatients basicconceptknowledge.

Multisensoryapproach

To improvepatientsbuttoning

/unbuttoningandzipping/unzipp

ing.

SimulationActivity

Hand on hand Visual/gesture

cues Adaptive

method

Patient ableto unbuttonbut slightlydifficult to dobuttoningafter session.

To increasepatients levelofindependencyin grooming.

Positivereinforcement

Visual cues

To increasepatients levelofindependencyin bathing.

Familyeducation

Visual cues Verbal

prompting.

To increasepatients levelofindependencyin toileting skillincludingbowel andbladder mx.

Toilet trainingprogramMother hasstarted thetoilet trainingprogram butseldom.


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TREATMENT IMPLEMENTATION

PROBLEM 1 Patient seeks out movement andconstantly on the go. (the childseeking for sensation)

TREATMENT 1. Joint compression2. Jumping on trampoline

TERMINAL BEHAVIOUR Patient will become more calm andable to regulate themselves.

METHOD 1. When patient enter the SI room,therapist gives joint compression topatient. Joint compression on ULstart from shoulders joint, elbow,wrist and finger. Next, pushing onthe shoulder, compress on headand depress above lip)

2. Therapist ask patient to jump ontrampoline on the count of 10.

CRITERIA 5-10 minutes every sessionRATIONAL Pushing down on shoulder, joint

compression, jumping trampoline givethe child extra proprioceptive input tohelp calm and regulate them.

PRECAUTION Guard patient every time pt jumptrampoline to avoid accident.

HOME PROGRAMME Taught mother to give physical activitybefore doing table-top activity.

REFERENCE Occupational Therapy for Children,Jane Case Smith


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PROBLEM 2 Patient has tactile defensive to sticky things and soft toys.

TREATMENT Sensory stimulation technique.

TERMINAL BEHAVIOUR Patient will decrease tactile defensiveness and be able to dodaily living activity.

METHOD 1. Gives patient soft toys and transfer to other place using hand

on hand technique. Use modeling technique by showing the

patient that it is interesting to play with the toy. After patient has

show less tactile defensive, ask patient to transfer the toy by

himself.

2. Gives patient pink theraputty. Gradually ask the patient to

touch and explore the theraputty

CRITERIA 5 minutes each session until patient able to adapt with the

input.

RATIONAL The emphasis on the innerdrive of the child is another key

characteristic of classical sensory integration therapy (Ayres,

1972b, 1979; Clark et al., 1989; Koomar & Bundy, 2002).

PRECAUTION Do not force patient too much to avoid tense.

HOME PROGRAMME Ask mother to expose patient to different texture.

(ex: bean, cotton, silk, play-dough)REFERENCE Occupational Therapy for Children, Jane Case Smith


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PROBLEM 3 Patient is afraid of high place.

TREATMENT Sensory Integration Activity with active involvement

TERMINAL BEHAVIOUR Patient will be able to perform daily living skills that involve highplace.

METHOD 1. Patient is ask to ride the swing with therapist.2. Patient climb the stair with his father.3. When patient has improve and feel comfortable,

patient are ask to perform alone.4. The high of swing is increasing every time patient fee

secure with the height.

CRITERIA 5-10 minutes every session.

RATIONAL The emphasis on the inner drive of the child is another keycharacteristic of classical sensory integration therapy (Ayres,1972b, 1979; Clark et al., 1989; Koomar & Bundy, 2002).

PRECAUTION Guide patient during activity to avoid accident.

HOME PROGRAMME Parents are asked to bring the patient to the playground and playwith swing and slide.

REFERENCE Occupational Therapy for Children, Jane Case Smith


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PROBLEM 4 Patient has short attention span.

TREATMENT 1. SI activity

2. Table top activity

TERMINAL BEHAVIOUR Patient able to pay attention to the activity for more than 1

minutes

METHOD 1. Patient is instructed to going through SI circuit for 15

minutes. The SI circuit contain of:

Jumping trampoline

Walk through the bridge

Ride on the swing

Climb the stair Walk on the sensory mat

Walk on the Lunar system

Walk through the tunnel

Pick one soft toy and walk through the stepping bucket an

balance beam and throw the soft toys to the basket at the

end of the balance beam.

After finished throw the toy, patient instructed to go throug

the circuit again until 3 rounds.

2. Gives patient drawing activities that involved small

shape only. After pt able to finish it, increase it.

CRITERIA 5 10 minutes per session


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RATIONAL Visual attention skills are enhanced by activities that are

developmentally appropriate and visually and tactilely

stimulating. Manual activities such as drawing or

manipulating clay encourage the eyes to view the

movements involved(Rogow,1992). In addition, the hand

helps educate the eye about object qualities such as weigh

volume, and texture, and helps direct the eye to the object

(Rogow,1987).

HOME PROGRAMME 1. Suggest mother to provide special table for patient to stud

2. Apply behavior modification at home.

PRECAUTION Do not force patient to do big task before patient able to

finish small task to avoid patient become frustrated.

REFERENCE Occupational Therapy for Children , Jane Case Smith


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PROBLEM 5 Patient has poor eye contact

TREATMENT 1. Do eye-level activity

2. Provide imitation activities so that referencing skills are

developed (copying noise, banging, singing)

TERMINAL

BEHAVIOUR

Patient will improve in eye contact and be able to follow

instruction accurately.

METHOD 1. Eye level activity.

Using puzzle.

Therapist call patients name to alert him.

Therapist put the puzzle in front of him.

Therapist ask patient to take it and put in the place.

Therapist take out the piece of puzzle and put at patient

eye-sight to attract him. Therapist guides patient hand to take the puzzle.

2. Imitation activity

Using soft toys.

Therapist call patients name to alert him.

Therapist put the soft toys in front of him.

Therapist ask patient to take it and put in the basket.

Therapist imitates sound when patient doesnt want to

look at the toys.

CRITERIA 5 minutes per session.

RATIONAL Visual attention skills are enhanced by activities that are

developmentally appropriate and visually and tactilely

stimulating. Manual activities such as drawing or manipulating

clay encourage the eyes to view the movements

involved(Rogow,1992).

HOME PROGRAMME 1. Ask mother to do eye-level activity at home.

2. Encourage mother to always call patient before ask patient to d

activity.

PRECAUTION Do not do activity with patient more than 5 minutes if patient

have no attention to avoid patient become more stressful.

REFERENCE Incident, Interpretation, Intervention (Rebecca Kildea)


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PROBLEM 6 Patient has problem in visual motor integration

activity.

TREATMENT 1. Fine motor activity.

TERMINAL BEHAVIOUR Patient able to do visual-motor integration activity.

METHOD 1. Practitioner gives patient fine motor activity such as puzzl

for patient to do.

2. Practitioner breaks down the task.

3. Provide tactile, visual, or auditory cues to help guide

movements.

4. Provide verbal feedback when the child is struggling with

the task.

CRITERIA 5-10 minutes

RATIONAL the hand helps educate the eye about object qualities

such as weight volume, and texture, and helps direct the

eye to the object (Rogow,1987).

HOME PROGRAMME 1. Suggest mother to give patient beading activity.

2. Teach mother the teaching technique to encourage patien

do the activity.

PRECAUTION Do not do activity with patient more than 5 minutes if patient havno attention to avoid patient become more stressful.

REFERENCE Building blocks for learning Occupatiional therapy Approaches (JJenkinson, Tessa Hyde, Saffia Ahmad)


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PROBLEM 7 Patient has behavior problem in giving cooperation to

do the activity.

TREATMENT 1. Play activity.

2. Behavior modification. (negative reinforcement)

TERMINAL BEHAVIOUR Patient will be able to give cooperation to the activity.

METHOD 1. Invite patient to play with activity that he likes.

(Unstructured play).

2. Gives patient time to get comfortable with the environmen

3. Ask patient to involve with the SI activity when patient look

comfortable with the place.

4. Tells patient that he will not be able to do his favorite

activity if he did not do the activity given. (during tabletop

activity)

CRITERIA 5 10 minutes

RATIONAL Play is the multidimensional system to adapt to the environmentand that the exploratory drive of curiosity underlies play behavior(Reilly,1974)

REFERENCE Occupational Therapy for Children, (Jane Case Smith)


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PROBLEM 8 Patient has inappropriate peer play and interaction w

peers.

TREATMENT 1. Group play

2. Family education

TERMINAL BEHAVIOUR Patient will be able to play and interact with peers

appropriately.

METHOD 1. Group Play

Let the patient to have free play with few peers with

the guidance of the therapist.

Cues will be given when inappropriate behavior lik

did not follow turn are displayed.

2. Game play

Patient are given rules to play with peers.3. Family Education

Ask mother to encourage patient to play with his

cousin and brothers.

Teach mother to give cues when patient display

inappropriate behavior.

CRITERIA 10 15 minutes each session

RATIONAL Games with rules teach children to take turns and to

initiate, maintain, and end social interactions. (Johnson,Christie, and Yawkey, 1999)

PRECAUTION Observe patient during play to avoid accident.

REFERENCE Occupational Therapy for Children, Jane Case Smith.


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PROBLEM 9 Patient has problem in recognize basic concept due t

patient still not recognize colors, numbers and shape

TREATMENT Taught patient shape using multisensory approach and

gradually.

TERMINAL BEHAVIOUR Patient will be able to recognize shape.

METHOD 1. Therapist chooses the first shape patient needs to learn.

2. Therapist tells the patient the name of the shape.

3. Therapist take patients hand and ask patient to touch the

shape.

CRITERIA 5 10 minutes per session

RATIONAL Sensory input is the sensory nourishment for the brain, ju

as food is the nourishment for the body. (Ayres ,1979)

HOME PROGRAMME Educate mother to teach patient one colour first. Mother

start with red colour until patient able to recognize the

colour.

PRECAUTION 1. Use same instruction and method every time therapist wa

to teach pt to avoid patient confuse. (ex: if teach patient

circle as circle, do not change circle as bulat)

2. Teach patient one shape first until patient able to master,

then change to second shape.

REFERENCE Occupational Therapy for Children, (Jane Case Smith)


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PROBLEM 10 Patient has problem in buttoning /unbuttoning and

zipping/unzipping activity.

TREATMENT 1. Simulation buttoning activity

2. Hand on hand guide

3. Visual/gesture cues

4. Adaptive method on buttoning activity.

TERMINAL BEHAVIOUR Patient will be able to do buttoning/unbuttoning and

zipping/unzipping activity.

METHOD 1. Simulation act.

Gives patient buttoning kit activity.

Demonstrate to patient and ask patient to follow. Gives hand on hand guide during patient doing the

activity.

2. Adaptive method.

Teach patient to button from bottom. (easier to see

and align )

CRITERIA 10 minutes per session

RATIONAL because clothing manufacturers recognize the value o

universal design, many of these adaptation are availablecommercially. (Schwartz,2000)

PRECAUTION Use same method every time want to teach patient.

The practitioner must respect the childs and family

preferences in hair style, cosmetics, and routines.



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PROBLEM 11 Patient has problem in grooming activity. (brush

teeth)

TREATMENT 1. Adaptative method

2. Hand on hand

TERMINAL

BEHAVIOUR

Patient will be able to do grooming activity independently.

METHOD Tooth brushing actually difficult for child with oral

sensitivity.

The child should use his or her preferred brushing

methods until tolerance improves and he or she can

improve more thorough cleaning.

When the childs gums are tender, the caregiver may

substitute a soft, sponge-tipped toothette for a brush. A hand over hand technique helps a child learn how to

direct the toothbrush in the mouth and to reach all teeth.


RATIONAL Adaptation, therapeutic use of self-purposeful and

meaningful activities, consultation, and education are

methods use to help others learn ADL occupation.

PRECAUTION Make sure the toilet environment is not scary.



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PROBLEM 12 Patient unable to bath independently.

TREATMENT 1. Family education

2. Visual cues

3. Verbal prompt

TERMINAL

BEHAVIOUR

Patient will be able to do bathing activity with

independently.

METHOD 1. Family Education

Educate mother that patient should be able to bath

with supervised at his age.

2. Visual cues.

Make picture sequences to tell patient on bathing

step.

3. Verbal promptMother supervised patient during bath and gives verbal

prompt during the activity.





PRECAUTION Do not left patient alone in the bathroom to avoid anyaccident.



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PROBLEM 13 Patient still not independent in toileting (mx of bowel

and bladder). Patient unable to indicate wet dryper.

TREATMENT Educate mother to do toilet training program

TERMINAL

BEHAVIOUR

Patient will be able to indicate PU and BO and pt able to

manage himself after BO or PU.

METHOD 1. Introduce wet and dry concept to pt.

2. Introduce child with the toilet environment.

3. Simulated play: use doll to demo the act.

4. Establish a routine that becomes habitual and easy for

the child.

5. Make task smaller or larger, depend on the child abilities.6. Use habit training if no pattern is evidence: go at the

same time every day.

7. Have child dress in easy to manipulate clothing.

8. Child does not sit: use timer and instruct child to stay

seated until timer rings.

CRITERIA everyday




PRECAUTION Make sure the toilet environment is not scary.



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11. REASSESSMENT (done on 23rd August 2010)

Patient comes with his parent piggyback by his father.

Patient refuses to do activity asked by student initially.

Patient looks interested when student show some demonstration and play with

him. Show better cooperation than first session.

Patient likes to do scribbling in his book.

Patient has shown improvement in tactile sensitivity. He able to play with sticky

things and soft toys. According to mother, patient is given play dough and play

with it every day.

The next appointment was on 27th September 2010. The re-assessment for ADL

and social are scheduled to be done on 6 months after first assessment due to

mother just started the home programs given.

12. FUTURE PLAN

a. To improve patients social problem gradually and prepare patient for

school.

b. To help patient in improving ADL and become totally independent in ADL.

13. PROGNOSIS

Rehabilitation good

a. Patient has improved in behaviour and show interest in doing activity

during treatment session.

b. Patients mother is very compliance to appointment and cooperative in

doing home programme.


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REFERENCES

1. Occupational Therapy for Children (Jane Case Smith).

2. Building Block for Learning: Occupational Therapy Approaches (John Wiley and

Sons).

3. http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder 4. Incident, interpretation, intervention. A practical guide. (Rebecca Kildea)
http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder

Documents

Case Study Paeds Hukm Nadiah