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Below is an actual test report sent to a public school by an independent evaluator. Names are changed to protect the innocent. Nothing else has been changed (any errors or inconsistencies are left in the report). PSYCHOLOGICAL EVALUATION PRELIMINARY DATA
REASON FOR REFERRAL Kate was referred for psychological evaluation by Dr. Strauss for differential diagnosis of ADD and to better understand why Kate is not doing well in school. BACKGROUND INFORMATION Background information was obtained through interviews with mother. Current family constellation include Mr. and Mrs. Dumont. They have three children, Biff (9); Buffy (8); and Blake (4). Father works as a pharmacist. Mother is a homemaker. Family history is positive for allergies and attentional problems. Mrs. Dumont remembers Kate's development as being normal. Health and development histories were unremarkable with the exception of ear infections through first grade. Psycho-educational evaluation was conducted by Joe Moe, MA, School Psychologist in December 1990 at the parents' request . The following scores were obtained on the Wechsler Scales (WISC-R) Verbal IQ 106, Performance IQ 112, and Full Scale IQ 109 This would place her global level of intelligence within the average range Educational evaluation disclosed scores ranging from Kindergarten to the fifth grade level. Memory for names was a particular weakness. Report cards from school disclose attentional difficulties even in the first grade. Kate is currently in Chapter I reading and math programs, which is a federal program for underprivileged children working below grade level. Kate has visual tracking concerns and was prescribed eye tracking exercises by Dr. D. However, Dr. D believed her problem with reading was due to a learning disability more than strictly an oculomotor problem and referred the parent for further evaluation of an undifferentiated attentional deficit and learning disability. Recent Occupational Therapy evaluation (11/92) indicated that Kate requires repetition of instructions and that Kate completes assignments without fully understanding the expectations. Further Speech/language evaluation was recommended. Kate has a lisp. TESTS ADMINISTERED
TEST BEHAVIOR AND OBSERVATIONS Kate was accompanied to this evaluation center by her mother. Kate separated readily and was generally cooperative and friendly. As the session progressed, Kate became aloof and easily distracted. This behavior was most prevalent during the administration of the academically related material. Attention span was short and concentration was limited. She was easily distracted. TEST SCORES AND CLINICAL INTERPRETATIONS
Verbal Comprehension 117 (87%) High Average The Wechsler Intelligence Scale for Children III was administered to assess Kate's cognitive skills and how she processes information. Her Verbal IQ was 111 (High Average), Performance IQ was 93 (Average), and Full Scale IQ of 102 (Average). These scores would place her average range. Significant strengths were noted in Verbal comprehension, crystallized intelligence, and extent of outside reading. Kate's verbal concept formation, verbal conceptualization, and reasoning skills are in the superior range. Significant weaknesses were noted in short-term auditory memory, attention, and concentration. Additional weaknesses were noted in sequential learning, memory, convergent production, auditory memory, simultaneous processing, nonverbal reasoning, visual motor coordination, trial and error learning, and working under time pressure. Factor analysis suggests weaknesses in Freedom from Distractibility, perceptual organization, and processing speed. The WISC-II ACIDS Profile indicate index scores of 90 to 91. The Emotional and Behavior Problem Scale and Conner's Teacher Rating Scale was completed by Kate's teachers. The results do not suggest severe overt, aggressive behaviors. Rather Kate presents with organizational deficits, short term/long-term memory deficits, lack of preparation for assignments and homework, difficulty with abstract concepts and reading comprehension, as well as the need for drill. Additionally, Kate seems to display some nervous habits (nail biting, etc.) and is easily upset by constructive criticism. These characteristics are consistent with the diagnosis of Undifferentiated Attention Deficit Disorder. The Juvenile Sentence Completion was administered as a projective device. Kate's responses had themes low self-esteem, a need to move on from her current class/grade, normal sibling rivalry (brother), and a pervasive feeling that if she were smarter she would do better in school. During the Diagnostic Interview Kate's responses were very brief. She wanted nothing more than to be free. She fears being hated or shunned by others. When asked for three wishes, Kate wanted a lifetime supply of candy and a mansion (spelled mengen). The rest of her spelling was so poor her writing was illegible. Her favorite age was 11, so she could play soccer at school. The California Test of Personality was administered to assess Kate's overall life adjustment which is a balance between social and personal security. Kate's personal adjustment is at the 60th percentile, meaning she perceives her adjustment as being average. Kate's social adjustment is at the 40th percentile, and her overall adjustment at the 50th percentile. These scores suggest Kate perceives her social and personal adjustment to be average.
Strengths were noted in feelings of self-esteem, denial of withdrawal tendencies, and freedom from nervous symptoms or anti-social tendencies. Weaknesses were noted in community relations, self-reliance, and social standards. Meaning that she is dependent on others and has difficulty subordinating her needs to the desires of the group. The Personality Inventory for Children was completed by her mother. (See the attached print-out.) The following profile is suggested: Parents and teachers are likely to be concerned about the child's limited academic achievement. Classroom performance reflects poor study skills, distractibility, and difficulty completing assignments. As preadolescents the majority of these children receive special education services and are likely to be classified as learning disabled. Diagnostic criteria suggest specific developmental disorders and adjustment disorder. The Wechsler Individual Achievement Test was administered to assess Kate's achievement levels. The following scores were obtained.
These scores suggest weaknesses in oral expression and written language. When compared to her FSIQ of 102, written language is a significant weakness at the .05 level of significance. SUMMARY AND FORMULATION Kate is a nine year old youngster who was referred for evaluation by her physician to evaluate for differential diagnosis of ADD as well as to assess her current abilities. Psychometric evaluation disclosed average intellectual ability with strengths in verbal concept formation, verbal comprehension, reasoning, and conceptualization. Weaknesses were noted in short-term auditory memory, attention, and concentration. Additional weaknesses were not in working under time pressure, sequential learning, visual motor coordination, trial and error learning, retention ability, simultaneous processing, and memory. The ACIDS profile was at the 25%ile (Index 90). Factor analysis suggests weaknesses in Freedom from Distractibility, Perceptual Organization, and Processing Speed. Academic testing suggests weaknesses in oral expression and written language. Personality testing suggest adequate personality development with mild, transitory, reactive stressors such as change of classroom teacher, although they function well within their families and within special education programs. Cognitive deficits, hyperactivity, poor school achievement, and immature .social skills manifest during elementary school. Problems may be associated with genetic influences. Basically these findings are consistent with Attention Deficit Disorder and Specific Developmental Disorders. Diagnosis:
RECOMMENDATIONS 1. These. results should be shared with the school personnel in designing a special education program. Hence, this report should be shared with the school to insure a comprehensive treatment plan. 2. Consultation with Kate's pediatrician regarding treatment of an attention deficit. In view of her parent's objection to medication, other treatment modalities should be evaluated first (e.g.. Cognitive Behavioral). 3. Continued individual counseling focusing on low self-esteem, understanding her learning disability, and problem solving skills. 4. The following educational modifications may aid Kate's teachers to better deal with her attentional problems in school: a. Preferential seating within close proximity of where the teacher provides most of the class lessons.
Certified Psychologist
While the PIC program has selected the child's most characteristic type using a branching tree procedure, other profile types may also be similar. Similarity indexes matching the child's clinical T-score profile to all types for which similarity can be computed are provided below. Type showing similarity values close to or higher than the one given for this child's selected type should be considered in diagnostic hypotheses. Brief descriptions of all types are given on the sheet provided with the PIC program disk. Similarity
CLASSROOM PLACEMENT ANALYSIS PLACEMENT/INTERVENTION PROGRAM SIMILARITY INDEX
SPECIAL EDUCATION Emotionally Impaired .07
In this analysis the child's profile is compared for similarity to seven average profiles obtained from groups of elementary school children found in regular classrooms, receiving counseling, or placed into one of five special education classifications. The index of similarity calculated is comparable to a correlation coefficient, in that larger values indicate those groups with whom this child has the greatest similarity. The table above may be of value in suggesting those educational placements that are the most and the least appropriate. |