Abdul Hnnan a 12 year old boy, who has been presented with language, academic and behavior difficulties. Hnnan had a traumatic delivery and suffered from hypoxia. Hnnan’s early motor and language milestones were grossly delayed. He sat and crawled at 2.6 years of age and walked after 3 years. His language was delayed and he spoke his first words at 4.6 years to 5 years and in sentences after 5 years. His speech was unclear and could be understood by his parents at age 6 years. However, even now outsiders understood 75% of what he said. His gross motor skills and fine motor skills were poor. He started climbing stairs at 4 to 5 years and started pedaling at 5 years. He still could not pedal a bicycle, tie his shoelaces and button his shirt. Hnnan was a placid baby who did not respond, had no eye contact and had a squint. He slept for long hours and had to be force-fed. He was hyperactive, destructive and aggressive after 3 years. He banged his head. He disliked visitors and could get very distressed. He hated any object in the house being displaced and insisted on having everything in order. He was very difficult to manage. He liked to spin around and jump. At the age of 4 to 5 years, he started noticing other children and started taking interest in them. He became less hyperactive, less aggressive and was more amenable to instructions. However, presently he was still restless and jumped a lot. He could still spin around for hours. He liked being on his own but also could be talkative, over friendly and odd. He repeatedly asked the same questions and was naive. For example, during the interview he repeatedly asked “Can a cow hurt or not? What if I play with it, will it hurt me or not?” He had writing problems because of his hand tremors. He was always restless and distractible and could not sit for more than a few minutes. His memory was very good but his understanding was weak. His mother has to sit with him for hours to teach him language and concepts. He has difficulty with understanding complex or abstract concepts. He did not have problems in social interaction but had difficulties in social communication and imaginative and flexible thinking. Difficulties with self control is presenting as restlessness, inability to follow adult agenda and paying attention to other people, to what they might be saying, thinking or feeling. SOCIAL HISTORY
Abdul Hnnan was born in Lahore, Pakistan by Pakistani parents. He was the first child in the family. His mother, Wajiha, had a positive family history. One of her cousins was mentally retarded. Hnnan was born at term. His mother had high blood pressure. The labour was prolonged, 11 hours and a caesarean was suggested but refused. He was born limp and blue. He had hypoxia. He was in NICU for 5 days. His birth weight was 2.54 kilos. He cried well after 15 days of life. Hnnan’s early motor and language milestones were grossly delayed. He started noticing children at 4 or 5 years and started taking interest in them. Hnnan’s younger sister, Amen, 3 years of age was very sociable and talkative. Hnnan’s father was more patient and his mother more irritable. Hnnan was very difficult till age 6 years and was aggressive, non-compliant and unreasonably demanding. As he grew older he became more co-operative and could be rationalized with. Whenever his mother asked him to do something he ignored 5 to 6 times. After that he started to argue. His mother used reprimands, bribes, threats and force to make him do things. Hnnan did not go to school. The family moved to Saudi Arabia when he was 7 years old. His parents took him to a Neuro-Developmental Pediatrician when he was 9 years old. His mother reported that he did not like to play with toys. All he did was jump on a bed or spin around. He was very restless and distracted and had a short attention span. He could be very stubborn and insisted on doing...