CASE�REPORT

ABSTRACT
With	an	upsurge	interest	in	holistic	view	of	physical	and	psychological	disorders,	bio	psychosocial	model	has	
gained	much	attention.	Maternal	depression	is	considered	to	manifold	risks	and	vulnerabilities	and	early	child	
developmental	problems,	including	impaired	cognitive,	social	and	academic	functioning.	The	present	case	
study	will	highlight	the	intricacies	linked	with	maternal	depression	in	the	infancy	and	early	childhood	of	a	12	
years	old	child,	studying	in	a	special	education	institute	of	city	Lahore.	The	history	file	revealed	that	low	
socioeconomic	status	and	parental	conflicts	induced	depression	in	the	mother	of	the	child,	who	showed	
carelessness	to	the	extent	of	making	child	vulnerable	of	experiencing	intellectual	disability.	

Key	Words:	Intellectual Disability, Maternal Depression, Maltreatment.

The	impact	of	maternal	depression	is	not	limited	to	
mother	 only	 but	 its	 exposure	 is	 found	 to	 have	
multiple	 negative	 impacts	 on	 child's	 normal	
development	 in	 infancy	 and	 early	 development,	
including	developmental	delays,	impaired	cognitive,	

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emotional	 and	 behavioral	 functioning. Infants	 of	
postpartum	depressive	mother	have	been	reported	
to	 show	 patterns	 of	 dys-regulated	 attention	 and	

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arousal.
The	 most	 solemn	 negative	 effects	 of	 postpartum	
depression	are	on	the	child's	cognitive	development,	
including	language,	IQ,	and	Piaget's	object	concept	
task.	However,	these	effects	are	completely	mingled	
and	 contextual	 influences.	 The	 studies	 on	 child	
behavior	 indorse	the	sound	effects	of	postpartum	
depression	 on	 children's	 behavior,	 antisocial	
behaviors,	and	psychiatric	disorders	at	home	and	at	

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school.
Among	these	cognitive	impairments	in	children,	one	
is	Intellectual	Disability	(ID).	Intellectual	disability	is	a	
developmental	disorder	describing	the	condition	in	
which	individual's	intellectual	functioning	level	and	
adaptive	skills	are	significantly	below	the	average	of	
his	chronological	age.	As	a	result	of	ID,	individual's	
practical,	 social	 and	 conceptual	 functioning	 is	

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disturbed.
Family	 conflicts	 can	 cause	 maternal	 depression	 in	
postpartum	period	that	is	the	significant	predictors	
of	 child's	 emotional	 and	 behavioral	 behavior	
problems	along	with	Intellectual	Disability	(ID).	The	
aim	 of	 the	 current	 study	 was	 to	 emphasize	 the	
importance	 of	 family	 conflicts,	 mental	 health	 of	
primary	 caregivers,	 specifically	 mothers	 who	 can	
have	 permanent	 negative	 impacts	 in	 child's	
development.	

Introduction	
Parents	 are	 the	 primary	 source	 of	 survival	 and	
development	 of	 children	 throughout	 their	 whole	
lives,	but	early	childhood	development	puts	a	strong	
impact	and	determines	the	future	of	children.	One	of	
the	 disruptions	 in	 the	 healthy	 development	 of	
children	is	maternal	depression	that	is	a	broad	term	
for	 a	 spectrum	 of	 depressive	 conditions	 affecting	
women	 during	 pregnancy	 and	 up	 to	 one	 year	

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postpartum. 	Studies	have	repeatedly	revealed	that	
maternal	depression	is	associated	with	less	optimal	
and	insecure	parenting.	Maternal	mental	health	is	
more	emphasized	in	postnatal	period	as	compared	
to	 prenatal	 period	 as	 the	 postpartum	 depression	
(PPD)	 is	 associated	 with	 weak	 emotional	
involvement,	neglect,	lack	of	attention,	and	hostility	

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towards	the	child. 	Warmness	that	is	the	charm	of	
mother-child	 affiliation	 lacks	 in	 postpartum	
depression	and	is	replaced	by	hostility	towards	child.	
There	are	pertinent	associations	between	maternal	
depression	 and	 multiple	 disruptions	 in	 child	
including	 early	 child	 adjustment,	 developmental	
abnormalities,	 problematic	 parenting,	 family	
conflicts,	 parental	 negligence	 and	 other	 family	

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difficulties.

Maternal	Depression	as	a	Predictor	of	Intellectual	Disability:	Bio	Psychosocial	
Model	Speaks	up
Rabia	Khadim,	Ayesha	Jabeen

Correspondence:
Ayesha Jabeen
Assistant Professor
Department of Clinical Psychology
University of Management and Technology, Lahore
E-mail: ayesha.jabeen@umt.edu.pk

Department of Clinical Psychology
University of Management and Technology, Lahore

Funding Source: NIL; Conflict of Interest: NIL
Received: November 19, 2019; Revised: June 05, 2020
Accepted: June 06, 2020

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Case	Study
The	present	case	study	is	about	a	12	years	old	child	
who	was	referred	by	his	teacher	with	the	presenting	
complaints	 of	 speech	 difficulties,	 academics	 and	
behavioral	problems	of	being	hyper,	aggressive	and	
hitting	others.	The	in-depth	clinical	interview	with	
the	 father	 of	 child	 revealed	 that	 child's	 early	
developmental	years	made	him	vulnerable	towards	
intellectual	 disability.	 Apparently	 child's	 socio-
economic	 status	 was	 below-average.	 There	 were	
inter-parental	conflicts	and	relationship	difficulties.	
The	mother	of	child	also	had	poor	mental	health	that	
made	her	vulnerable	towards	maternal	depression.	
The	child	had	a	healthy	normal	birth	and	there	was	
no	sign	of	abnormality.	He	appropriately	achieved	
the	entire	developmental	milestone	at	2	years	except	
speech	 and	 toilet	 training.	 According	 to	 father,	
mother	had	no	affiliation	with	her	child	and	she	used	
to	 physically	 abuse	 him.	 She	 had	 careless	 and	
neglected	attitude	towards	child.	In	case	of	illness,	
mother	used	to	pick	those	medicines	for	child	that	
induced	dizziness	and	sleepy	effects	as	she	used	to	
give	child	extra	doses	of	cough	syrup.	After	the	child	
got	 accidently	 burned,	 she	 misused	 the	 doctor's	
prescription	for	child	which	had	the	abnormal	effect	
on	child's	development.	The	frequency	of	doses	was	
unknown	 to	 father	 but	 he	 was	 suspicious	 about	
mother	 regarding	 child's	 condition.	 Neglecting	
parenting	 and	 conflicts	 caused	 divorce	 of	 parents	
and	child	remained	with	his	father.	Afterwards,	child	
stopped	 speaking	 and	 showed	 inappropriate	
attention,	 aggression	 and	 hyperactivity	 as	 teasing	
and	hitting	others.	
The	child	started	formal	education	at	4	years	of	age	
but	had	various	unsuccessful	experiences	at	normal	
schooling	 because	 of	 his	 speech	 and	 behavioral	
problems.	So,	at	7	years	of	age,	he	was	admitted	to	a	
special	education	school	where	he	was	suspected	
with	Intellectual	Disability	(ID-moderate),	affecting	
conceptual,	social	and	practical	domains	of	child.	The	
developmental	 assessment	 tool,	 Portage	 Guide	 to	
Early	Education	(PGEE)	revealed	the	9-10	years	of	
overall	 discrepancy	 between	 chronological	 and	
functional	age	of	child.	He	had	2-3	words	speech,	lack	
of	 socialization	 and	 cognitive	 impairment.	 Bender	
Gestalt	 Test	 (BGT)	 was	 administered	 to	 find	 the	
developmental	maturation	of	child	that	was	up	to	3	
years.

Fig.	1:	This	Figure	is	Showing	the	Func�onal	Level	of	the

Child	on	Different	Areas	of	PGEE	

Fig.	2:	This	Figure	is	Showing	the	Comparison	of	

Cogni�ve	Func�oning	On	PGEE	and	BGT

Table	I:	Conceptual,	Social	and	Prac�cal	Domain	of	Child

according	to	his	Severity	Level

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Discussion	
Family	provides	the	grounds	for	the	upbringing	of	
children	where	parents	are	the	primary	caregivers.	
Parental	factors	contribute	towards	the	bio-psycho	
and	social	developmental	processes	of	children	that	
have	 long	 lasting	 impact	 on	 future	 life.	 There	 are	
multiple	 factors	 in	 family	 processes	 that	 can	
influence	 the	 normal	 growth	 patterns	 of	 children	
including	 parental	 conflicts,	 poor	 mental	 health,	
negligence,	lack	of	support	and	parental	divorce.	This	
case	study	brought	all	such	factors	into	light	that	can	
have	adverse	effect	on	normal	children	throughout	
their	whole	life	and	make	it	worse	for	them.	
As	in	child's	case,	his	parent's	maltreatment	made	
life	 full	 of	 negative	 challenges	 effecting	 his	
cognitions,	 emotions	 and	 behaviors.	 Parental	
neglection,	 conflicts,	 financial	 worries	 and	
relationship	difficulties	can	put	negative	impact	of	
one	 of	 the	 spouse	 as	 mother's	 mental	 health	
(maternal	depression)	was	affected	badly	in	current	
case.	 Maternal	 mental	 illness	 is	 associated	 with	

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child's	cognitive,	social	and	academic	impairment. 	
Maternal	 depression	 is	 associated	 with	 multiple	
adverse	outcomes	for	child.	Due	to	mental	suffering	
of	mother	during	postpartum	depression	(PPD),	her	
hostile	behavior	towards	child	put	into	danger	that	
lead	towards	overdose	of	medication.	Studies	have	
revealed	 through	 the	 reports	 of	 overdose	 with	
promethazine	(phenergan)	can	originate	significant	
variations	 into	 the	 nervous	 system	 including	

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dizziness,	 restlessness,	 agitation,	 and	 confusion.
These	 adverse	 effects	 put	 the	 psychology	 of	 child	
into	 danger	 that	 come	 out	 as	 hyperactivity,	
aggressiveness	 and	 hitting	 behavior.	 Along	 with	
these	 behavioral	 issues,	 the	 overdose	 of	
promethazine	 plays	 a	 significant	 role	 towards	 the	
likelihood	of	Intellectual	Disability	(ID).	As	a	result,	
the	child's	intellectual	and	adaptive	functioning	was	
disrupted.	
Studies	 have	 revealed	 that	 the	 social	 factors	 of	
parental	 conflicts,	 divorce	 and	 destructive	 home	
environment	are	those	social	factors	that	can	lead	
towards	 maladjustment	 of	 children	 affecting	 their	
biological,	 psychological	 and	 social	 functioning.	
Similarly,	a	disruptive	home	environment	also	has	
the	profound	effect	on	the	wellbeing	of	children	and	

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interferes	with	the	healthy	development.

The	key	goal	of	this	study	was	to	understand	all	the	

parental	 factors	 including	 maternal	 depression	

which	effect	the	healthy	growth	of	children.
Table	II:	Case	Formula�on	of	Child	According	to	
Bio-Psycho-Social	Factors

The	intervention	plan	was	developed	according	to	

the	needs	of	child	in	which	goals	were	taught	in	one	

setting.	Because	of	single	parent,	father	couldn't	give	

proper	 attention	 to	 child.	 Family	 processes	 are	

accountable	 for	 child's	 development	 and	

intervention	as	both	parents	have	their	own	specific	

roles	to	play.

REFERENCES
1.	 Natasha	 K,	 	 Sriraman,	 Do-Quyen	 P,	 Reeti	 K.	 Postpartum	

Depression:	What	Do	Pediatricians	Need	to	Know?	2017;	

38(12):	541-51.
2.	 Heinisch	C,	Galeris	MG,	Gabler	S,	Simen	S,	Hoffmeister	JJ,	

Fobel	 J	 et	 al.	 	 Mothers	 with	 Postpartum	 Psychiatric	

Disorders:	 Proposal	 for	 an	 Adapted	 Method	 to	 Assess	

Maternal	 Sensitivity	 in	 Interaction	 with	 the	 Child.	 2019;	

10:47.	
3.	 Slomain	 J,	 Honvo	 G,	 Emonts	 P,	 Reginster	 JY,	 Bruyere	 O.	

Consequences	 of	 maternal	 postpartum	 depression:	 A	

systematic	review	of	maternal	and	infant	outcomes.	2019;	

15:	174.		
4.	 Madlal	 SS,	 Kassier	 SM.	 Antenatal	 and	 postpartum	

depression:	effects	on	infant	and	young	child	health	and	

feeding	practices.	2016;	31(1):	1-7.
5.	 Abdollahi	 F,	 Abhari	 FR,	 Zarghami	 M.	 Post-Partum	

Depression	Effect	on	Child	Health	and	Development.	Acta	

Med	Iran	2017;	55(2):109-14.
6.	 Mirhosseini	H,	Moosavipoor	SA,	Nazari	MA,	Dehghan	A,	

Mirhosseini	 S,	 Bidaki	 R	 et	 al.	 Cognitive	 Behavioral	

Development	in	Children	Following	Maternal	Postpartum	

Depression:	 A	 Review	 Article.	 Electron	 Physician.	

2015;7(8):1673-79.	
7.	 American	Psychiatric	Association.	Diagnostic	and	statistical	

manual	of	mental	disorders.	5th	ed.	Washington;	DC;	2013.	

33	p.	
8.	 Abdollahi	 F,	 Rezai	 Abhari	 F,	 Zarghami	 M.	 Post-Partum	

Depression	Effect	on	Child	Health	and	Development	2017;	

55(2):	109-14.

Bio	Psycho-Social	Model	Speaks	UpJIIMC	2020	Vol.	15,	No.2

135