UCAPES Case Conference

The Flames
JAYLENE, FRANCE, BONNIE, BREANNE, KRISTA, JO, TERRI
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Referral Information & Question:

Boy is 14 years, 9 months Boys parents requested a psychoeducational assessment due to learning difficulties he is experiencing. His mother is also looking for recommendations to assist Boy as he transitions from junior to senior high. Sensitive and caring.

Previous Assessments:
This is Boys first formal psycho-educational assessment. A previous OT assessment was noted on his IPP indicated that he completed a Beery VMI as well as a Movement Assessment Battery for Children in October 2006. Boys latest IPP also reported that in January 2007, a letter from Dr. H.M. Mom (FRCP) stated that he met the diagnosis for Primary Attention Deficit Disorder.

Background Information: Family

Boy is an only child who lives at home with his parents. Boys mom is a full-time homemaker while his father installs industrial laundry equipment throughout Alberta. Both parents have completed grade 11. Both parents did well in school. Maternal grandmother was deaf.

Maternal aunt born with a hair lip and cleft palate.

Cousin on an IPP.

Background Information: Development

While mom classified her pregnancy with Boy as high risk, Boy was born at 40 weeks gestation. He had to be revived after birth because he was not breathing. Boy spent a few hours in ICU after birth as well. Boy achieved all developmental milestones within the expected time frame. No significant illnesses reported Still has difficulty with riding a bike, tying shoelaces. SLP support when younger. Had difficulty with the /S/ sound.

Background Information: Medical

No medical issues or allergies noted at this time. At 10-11 years, Boy was taking medication for ADHD. (Concerta, Methylphenidate and Dexedrine.) No longer on any medication.

Parents currently in good health.

Boy does not do any drugs or alcohol as he is too mature for that.

Background Information: School

Boy was in French Immersion from Kindergarten to Grade Six. He attended Kindergarten to Grade Five in one school then went to another school in Grade Six. Grade Seven to Nine was at a Fine Arts school. Report Cards reported average grades. Since Grade Seven, Boys grades have increasingly declined. Moving on to a large high school in the fall.

Background Information: Social

Boy has a few friends. One close friend is his cousin, his mothers great nephew.

He enjoys camping, hunting, and playing video games.

Boy reported during the DICA-IV he has experienced bullying at school since Grade Six. He has been teased and taunted at school this past school year.

Assessment Observations:
Friendly, engaging and willingly participated in all aspects of the evaluation even when he appeared tired. A pleasant young man who was a gentleman with those assessing him.

Assessment Measures:

Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV)

Wechsler Individual Achievement Test Third Edition (WIAT-III)

Woodcock Johnson III Tests of Achievement (WJ-III ACH) Beery-Buktenica Developmental Test of Visual-Motor Integration - Fifth Edition (Beery VMI)

Childrens Memory Scale (CMS)

Delis-Kaplan Executive Function System (D-KEFS) Developmental Neuropsychological Assessment - Second Edition (NEPSY-II) Behavior Assessment System for Children (BASC-2) Conners Third Edition (Conners-3) Diagnostic Interview for Children and Adolescents Fourth Edition (DICA-IV) Clinical Assessment of Depression (CAD)

WISC-IV
SCALE

VCI
PRI WMI PSI

COMPOSITE SCORE 116 118 86 78

%ILE

DESCRIPTION

86
88 18 7

High Average
High Average Low Average Borderline

FSIQ
GAI

101
120

53
92

Average
Superior

WISC-IV
Subtest Summary
SUBTEST SCALED SCORE %ILE DESCRIPTION
VERBAL COMPREHENSION INDEX

Similarities Vocabulary Comprehension Block Design Picture Concepts Matrix Reasoning Digit Span

15 12 11 12 12 14 7

95 75 63 75 75 91 16

Superior Average Average Average Average Above Average Low Average

PERCEPTUAL REASONING INDEX

WORKING MEMORY INDEX

Letter-Number Seq.
Symbol Search Coding

8
7 5

25
16 5

Average
Borderline Low Average

PROCESSING SPEED INDEX

WIAT-III
COMPOSITE STANDARD SCALE SCORE TOTAL READING 84
BASIC READING READING COMP & FLUENCY WRITTEN EXPRESSION

%ILE

CLASSIFICATION

14
12 25 8

LOW AVERAGE
LOW AVERAGE AVERAGE BORDERLINE

82 90 79

MATHEMATICS
MATH FLUENCY

91
86

27
18

AVERAGE
LOW AVERAGE

WIAT-III
SUBTEST SS %ILE DESCRIPTION

Reading Comp. Math Problem Solving Sentence Composition Essay Composition Word Reading Pseudoword Decoding Numerical Operations Oral Reading Fluency Spelling Math Fluency-Addition Math Fluency-Subtraction Math Fluency-Multiplication

95 100 95 81 91 72 85 91 73 86 88 89

37 50 37 10 27 3 16 27 4 18 21 23

Average Average Average Low Average Average Borderline Low Average Average Borderline Low Average Low Average Low Average

WJ III ACH
Selected Subtests
SUBTEST SS %ILE DESCRIPTION

Word Attack Spelling of Sounds

86 90

21 25

Low Average Average

Beery VMI
BEERY VMI
RAW SCORES STANDARD SCORES SCALED SCORES PERCENTILES

VISUAL MOTOR PERCEPTION COORDINATION

18 60 2 .8

28 98 10 45

20 70 4 2

CLASSIFICATION

VERY LOW AVERAGE

LOW

D-KEFS
Colour-Word Interference Test
SCALED SCORE COLOUR NAMING WORD READING INHIBITION INHIBITION/SWITCHIN G 7 7 3 RANGE LOW AVERAGE LOW AVERAGE EXTREMELY LOW -

Tower Test
SCALED SCORE TOTAL ACH SCORE 10 RANGE AVERAGE

MEAN FIRST-MOVE TIME

TIME-PER-MOVE-RATIO

6
9

BELOW AVERAGE
AVERAGE

MOVE ACCURACY RATIO RULE-VIOLATIONS-PERITEM RATIO

10 8

AVERAGE AVERAGE

NEPSY-II: Attention and Executive

Functioning
SCALED SCORES AUDITORY ATTENTION TOTAL CORRECT AUDITORY ATTENTION COMBINED RESPONSE SET TOTAL RESPONSE SET COMBINED AA VS RS %ILE CLASSIFICATION

6 7 28 4 5

6-10 16 2-5 2 5

BELOW EXPECTED LEVEL BORDERLINE BELOW EXPECTED LEVEL BELOW EXPECTED LEVEL BELOW EXPECTED LEVEL

NEPSY-II: Visuospatial Processing

SCALED SCORES %ILE CLASSIFICATION

ARROWS TOTAL GEOMETRIC PUZZLES

35 34

14 11

ABOVE EXPECTED LEVEL AT EXPECTED LEVEL

CMS
INDEX
VISUAL IMMEDIATE VISUAL DELAYED

S.S.

%ILE

CLASSIFICATION

118
109

88
23

HIGH AVERAGE
AVERAGE

VERBAL IMMEDIATE
VERBAL DELAYED ATTENTION/ CONCENTRATION LEARNING DELAYED RECOGNITION GENERAL MEMORY

106
97 88 115 115 113

66
42 21 84 84 81

AVERAGE
AVERAGE LOW AVERAGE HIGH AVERAGE HIGH AVERAGE HIGH AVERAGE

BASC-2: Parent Report

SCALE Externalizing Problems
Hyperactivity Aggression Conduct Problems

Rating Average
Average Average At Risk

T-Score 50
51 48 65

Internalizing Problems
Anxiety Depression Somatization

At Risk
Average At Risk At Risk

61
46 67 64 68 44 68

School Problems
Attention Problems Atypicality Withdrawal

At Risk Average At Risk

Adaptive Skills
Adaptability
Social Skills Leadership Activities of Daily Living Functional Communication

Average
At Risk At Risk At Risk At Risk

41
37 32 36 34

BASC-2: Teacher Report

SCALE Externalizing Problems
Hyperactivity Aggression

Rating Average
Average Average

T-Score 42
41 42

Conduct Problems

Average

43

Internalizing Problems
Anxiety

Average
Average

56
47

Depression
Somatization

Average
At Risk Average Clinically Significant Average At Risk At Risk

58
60 59 70 52 65 37

School Problems
Attention Problems Learning Problems Atypicality Withdrawal

Adaptive Skills
Adaptability

Social Skills
Leadership Study Skills Functional Communication

Clinically Significant
At Risk At Risk At Risk

30
40 40 36

BASC-2: Self Report

SCALE Externalizing Problems
Hyperactivity

Rating
Average

T-Score
48

Internalizing Problems
Anxiety Depression Somatization

At Risk
Average Clinically Significant Clinically Significant

64
39 73 71

School Problems
Attention Problems Atypicality

Average
Clinically Significant Average

58
73 56

Conners-3: Parent
SCALE
Inattention Hyper/Impulsivity Learning Problems Executive Functioning Defiance/Aggression Peer Relations

RATING
Very Elevated Average Elevated Very Elevated Average Very Elevated

T-SCORE
76 58 68 82 53 90

ADHD-I ADHD-H/I CD ODD

Very Elevated Average Average Elevated

85 59 47 61

Conners-3: Teacher
SCALE
Inattention Hyper/Impulsivity Learning Problems Executive Functioning Defiance/Aggression Peer Relations

RATING
Elevated Average Elevated Very Elevated Average Very Elevated

T-SCORE
62 42 61 70 58 75

ADHD-I ADHD-H/I CD ODD

Very Elevated Average Elevated Average

Very Elevated Average Elevated Average

CAD
SCALE DEPRESSED MOOD ANXIETY/ WORRY DIMINISED INTEREST COGNITIVE & PHYSICAL FATIGUE CAD TOTAL SCALE SCORE T-SCORE %ILE CLASSIFICATION MILD CLINICAL RISK NORMAL MILD CLINICAL RISK NORMAL

53

60

84

23
17 23 116

51
67 57 65

55
94 79 94

MILD CLINICAL RISK

DICA-IV: Self

Boy was assessed for ADHD-past, ADHD-present, Major Depressive Episode-Past, Major Depressive EpisodePresent and Dysthymic Disorder
According to his report, Boy has not met the above DSMIV criteria for Attention-Deficit/Hyperactivity Disorder, Past or Present. Boy has not met all of the DSM-IV criteria for Major Depressive Episode, Past or Present, and therefore is not eligible for the diagnosis. Boy has met the above DSM-IV criteria for Dysthymic Disorder according to his report, and is eligible for the diagnosis.

DICA-IV: Parent

This assessment was conducted over the phone. Questions asked centered on ADHD-Past, ADHDPresent and Dysthymic Disorder. According to his mothers report, Boy has not met the criteria for Attention-Deficit/Hyperactivity Disorder, Past or Present. Boy has met the DSM-IV criteria for Dysthymic Disorder and is therefore eligible for the diagnosis.

Clinical Impressions
Cognitive
His GAI was in the superior range. Similarities were in the superior range while Matrix Reasoning was in the Above Average Range. Coding was in the Borderline Range, which may be due to his fine motor abilities as well as his processing.

Academic
Boy scored in the Low Average Range in most areas. Pseudoword Decoding and Spelling were areas of concern. Required more encouragement during sentence combining and sentence building. Writing was a significant weakness.

Clinical Impressions
Behaviour
Boy presented with no behavioural difficulties during the assessment. Although he appeared a little tired the first day of testing, he willingly completed all tasks.

Social
Boys mom reported he sometimes complains of stomach aches and wants to stay home from school. Boy reported difficulties with some of his peers at school. Teasing and taunting at school began in Grade Six. He said it only stopped once he stood up for himself. School and parents are not aware of the full situation.

Diagnosis?
Axis I: 300.4 Early Onset Dysthymic Disorder
315.00 Reading Disorder 315.2 Disorder of Written Expression 315.4 Developmental Coordination Disorder

Axis II: V71.09 No Diagnosis Axis III: None Axis IV:

Problems related to the social environment Educational problems

Axis V: GAF = 55 (current)