University of Calgary Applied Psychological & Educational Services (UCAPES)

Assessment, Intervention and Professional Development Kelly Dean Schwartz, Ph.D., Director
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2nd Floor, Education Block (Room 281) 2500 University Drive NW Calgary, AB T2N 1N4 Tel: (403) 220-2851 Fax: (403) 210-8712 Email: UCAPES@ucalgary.ca
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CLIENT NAME: BIRTHDATE: AGE: GRADE: Key Clinician(s):

Jonas, Joe May 8, 1997 12 years 2 months 6 France Goulard

DATES OF ASSESSMENT: July 2009

Statement of Confidentiality
All psychological assessments are confidential in nature as they contain private information, which may be used inappropriately by others. To protect the privacy and ensure confidentiality of the persons involved, please ensure that this report is only circulated to those who are considered essential to related judgments and decision-making. The intent of this report is to provide opinions and recommendations in the context of psychological intervention, educational and vocational decision-making, and any use of this report outside of that purpose should only be done with the informed consent of the parties and in consultation with the writer.

REASON FOR REFERRAL: Joe was referred for a psychoeducational assessment by his parents, Martha and Fred Jonas, as a result of a history of concerns about Joes learning difficulties. Specifically, Joe has encountered difficulties, which include delays in reading, writing, and math skills in addition to memory problems in daily life. This assessment was requested in order to determine whether these difficulties are a result of a learning disorder.

FACULTY OF EDUCATION
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Joe 2

BACKGROUND INFORMATION: The following information was obtained from interviews with Joe, his mother, Martha Jonas, father, Fred Jonas, as well as from the BASC-2 Structured Developmental History (SDH) completed in July, 2009 by Mrs. Jonas. Family Information Joe, a 12-year-old boy, currently lives with his mother and father in Hollywood, California. Joe has an older brother, Nick, who is 14 years old and also lives in the home. Mrs. Jonas reported that there can be tension in the home, particularly surrounding the completion of Joes homework. Joe reported that he sometimes enjoys his brother, but at other times they tend to quarrel. Joes older brother is currently in grade 11 and while school tasks appear to come more easily for him, completion of assignments is an issue. Mr. and Mrs. Jonas are both currently employed by Canada Post. Joe is an avid hockey fan and has been playing the game since he was five years old. He reported enjoying camping, fishing and boating with his family in B.C. Joe described himself as able to make friends who change from year to year. He has had one good friend for the last three years. Joe stated that he does not have trouble getting along with teachers and has not encountered difficulties with any other students. Joe acknowledged some difficulties with remaining happy each day though he reported to experience more happy days than difficult days. Family Psychological or Educational History Both Mr. and Mrs. Jonas graduated High School. Mrs. Jonas reported that she was successful in school while Mr. Jonas reported encountering many difficulties including avoidance of reading. There is a history of depression and mental health issues in Joes extended Family. Prenatal, Perinatal and Early Developmental History Mrs. Jonas reported that Joe was born healthy and experienced no complications other than a small head circumference that doctors stated was not a concern. With the exception of a minor fall down the stairs as a toddler, no other significant medical history or allergies were reported. Mrs. Jonas reported that Joe achieved all developmental milestones (e.g., sitting, talking, and walking) within the standard timeframe. Hearing and vision tests were reported to be normal. Educational History Joe recently completed grade six. He reported some ambivalence toward school. Joe described his enjoyment of gym, hands on learning, and exposure to science topics such as flight, but described language arts as unpleasant, particularly writing. Joe showed some insight into his own learning style in his description of what made some teachers more effective than others by discussing his need for calmness and opportunities to build and experiment. Mrs. Jonas described Joes school experience in detail. Joe attended Kindergarten and grade one in a French immersion program. It became apparent that he was not picking up the French language and Joe was placed in a regular grade 1/2 class for grade two. Joe studied math with the grade two

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Joe 3 students and L.A. with the grade one students. During the summer between grade one and grade two, Mrs. Jonas taught Joe reading in English. Joe received some remedial support toward the end of grade two and was reported to be reading at grade level by the end of the year. Grade three was a turbulent year for Joe. While he did not receive remedial support, he participated in an intensive reading program in his classroom. While some growth occurred in reading, Joe began to express somatic complaints and appeared to be under stress. Joe seemed happier in grade four. He continued to struggle in language arts and was referred by his parents to Sylvan Learning Centre for 120 hours of support. Joes grades went up initially, but leveled off with no improvement in the last 36 hours of instruction. Joe received directed studies support in place of French instruction in grades five and six. He received support from an aid in the classroom and tests were modified for his learning needs. It was reported that Joe scored poorly on provincial achievement tests in spite of the accommodations and extensive studying. Mrs. Jonas has been extremely supportive of Joes learning over the years helping with homework and ensuring that Joe is reading books. This is Joes first formal psychoeducational assessment. ASSESSMENT INSTRUMENTS: Given the referral concerns and information gathered through the interview, an evaluation of cognitive, academic, memory, language, behavioral, and attention difficulties was conducted. This included: Parent/Child Interview Wechsler Intelligence Scale for Children Fourth edition (WISC-IV) Wechsler Individual Achievement Test Second edition (WIAT-II) Woodcock Johnson Tests of Cognitive Ability-3rd edition (WJ-III Cog) Childrens Memory Scale (CMS) A Developmental Neuropsychological Assessment - Second Edition (NEPSY-II) Peabody Picture Vocabulary Test 4th edition (PPVT-4) Expressive Vocabulary Test 2nd edition (EVT-2) Conners Rating Scale- parent and teacher versions Conners Continuous Performance Task (CPT II) Other reports: Behavioural Assessment System for Children 2nd edition (BASC-2) Parent Rating Scale (PRS) completed by Mrs. Jonas in July 2009 Teacher Rating Scale (TRS) completed by his teacher Self report scales (SRS) completed by Joe Jonas ASSESSMENT OBSERVATIONS: Joe presented as a pleasant and cooperative boy during the interview and assessment process. He appeared to try his best on all subtests presented and maintained a positive attitude in spite of having to complete many challenging tasks. Having said this, Joe sometimes required instructions to be repeated and frequently appeared distracted while completing assessment tasks. For example, Joe sometimes stared at interesting items in the room such as the mirror, or become distracted by the texture of the furniture and equipment. At one point Joe fell over on his chair, which he had been

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Joe 4 pivoting at an awkward angle. Joe performed acceptably when permitted to eat, drink, or play with objects in his hands or mouth. This type of stimulation appeared to help him remain focused. It is believed that the results of this assessment accurately reflect Joes academic and cognitive abilities. ASSESSMENT RESULTS AND INTERPRETATIONS: Wechsler Intelligence Scale for Children Fourth edition (WISC-IV): The Wechsler Intelligence Scale for Children- Fourth Edition (WISC-IV) is a standardized intelligence test consisting of a series of ten core subtests and five optional subtests designed to measure the intellectual functioning of an individual as compared to others of the same age. A Full Scale Intelligence Quotient (FSIQ) is derived from the combined results of the core subtests. The WISC-IV also provides four factor-based scores, including Verbal Comprehension, Perceptual Reasoning, Working Memory and Processing Speed. Canadian norms were used to score this measure. Joes performance on the WISC-IV indicates that his cognitive abilities are in the Average range, with his General Ability Index (GAI) at the 30th percentile. The GAI was used due to a large discrepancy between the verbal comprehension and the perceptual reasoning subtests, which are more true measures of cognitive functioning. The Working Memory Index (WMI) and the Processing Speed Index (PSI) support the verbal and reasoning process. Therefore, his overall performance across the WISC-IV was equal to, or better than, thirty percent of children his age. This score is considered by the test developers to be the most reliable and valid measure of overall cognitive ability. Joes ability to understand and use language to communicate and engage in verbal reasoning was evaluated by the Verbal Comprehension Index (VCI). Joe obtained a composite score in the Average range at the 32nd percentile, indicating that his verbal reasoning abilities are developing at an average rate compared to his same-age peers. One of the tasks included an assessment of his ability to engage in verbal reasoning and associative thinking (e.g. How are a cow and horse alike?) where he scored in the Average range. Another activity asked Joe to use his prior knowledge to solve social-reasoning based questions (e.g., Where do you go to buy milk?). Here he achieved a score in the Average range. A final activity had Joe answer questions on a broad range of general knowledge topics (e.g., What is a giraffe?). In this area Joe scored also in the Average range. Based on his scores in this area, Joes verbal knowledge and comprehension of verbally presented information is at the same level as a majority of his same age peers. Joes ability to engage in perceptual and fluid reasoning was evaluated by the Perceptual Reasoning Index (PRI), where he obtained a composite score in the Average range at the 32nd percentile. Joe demonstrated Average abilities on a task assessing his ability to engage in non-verbal analogical reasoning (e.g., grouping pictures with a common theme together). His performance on a task requiring him to engage in a non-verbal conceptual thinking task (e.g., completing patterns and sequences) was also in the Average range and his visual-spatial processing abilities (e.g., using blocks to construct specific designs) were in the Low-Average range. These scores indicated that Joes perceptual reasoning abilities are at the same level as a majority of his same age peers.

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Joe 5 Joes ability to retain and manipulate auditory information in short-term memory was evaluated by the WMI. Overall, he demonstrated an auditory working memory capacity in the Extremely Low range at the 2nd percentile. Joe scored in the Low Average range on a task requiring him to repeat strings of numbers forwards and backwards, and in the Extremely Low range on a task requiring him to repeat letters and numbers in sequential order. All of these tasks also required concentration and sustained attention, cognitive flexibility, and numerical awareness. The PSI evaluated Joes ability to quickly and efficiently complete simple visually mediated cognitive tasks. He obtained a composite score in the Borderline range at the 4th percentile, indicating that his speed of processing visual-perceptual information is much lower than most of his same-age peers. Joe performed within the Extremely Low range (1st percentile) on a task that required him to quickly learn and use a set of symbol associations and within the Low Average range (16h percentile) on a task that required visual scanning, discrimination, and matching of abstract symbols. Joes performance on a third task, in which he was required to identify pictures in either an abstract or organized pattern was Extremely Low (2nd percentile). Woodcock Johnson Tests of Cognitive Abilities 3rd edition (one subtest) (WJ-III Cog): The Woodcock-Johnson III Tests of Cognitive Abilities (WJ III COG) are divided into two batteries: the Standard Battery (tests 1 through 10) and the Extended Battery (tests 11 through 20). This assessment instrument provides a comprehensive set of individually administered tests for measuring intellectual abilities. Depending on the purpose of the assessment, the examiner can administer the Standard Battery alone or in conjunction with the Extended Battery. The clusters or grouping of tests are the primary source for interpretive information to help identify performance levels and individual strengths and weaknesses. Norms are provided for individuals ranging in age from 2 to over 90 years. To further examine Joes auditory issues, the Visual-Auditory Learning subtest from the WJ-III Cog was administered. Visual-Auditory Learning assesses Joes long-term retrieval abilities, and required him to learn, store, and retrieve a series of pictographic representations of words that were combined into phrases in increasing complexity and length. Joe scored in the Borderline range, at the 8th percentile, on this subtest. These results indicate that Joe seems to have a hard time retaining information. Wechsler Individual Achievement Test Second Edition (WIAT-II), Canadian Norms: The Wechsler Individual Achievement Test - Second Edition (WIAT-II) is a standardized test of achievement and functioning. The WIAT is an individually administered measure that examines performance in the areas of Reading, Mathematics, Language and Writing. These areas are combined to provide an overall achievement score. Joes ability to perform academically was assessed using the Wechsler Individual Achievement Test, Second Edition (WIAT-II).

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Joe 6 Joes overall performance on tasks involving reading was in the Below Average range at the 9 percentile. Across all three subtests, Joe scored in the Borderline range at the 5th percentile on Reading Comprehension, in the Below Average range at the 9th percentile on word reading ability, and in the Average range at the 30th percentile on Pseudoword decoding, a task that required Joe to use phonetics to sound out non-words. Joe was able to read words that were familiar to him (like the and you) but had a harder time at reading unfamiliar words that needed decoding (like between and stood). In Reading Comprehension, Joe seemed to read the passages at a reasonable pace but was not able to answer most of the questions. He seemed unsure of the answers and often guessed. In Pseudoword decoding, Joe was able to decode nonsense unfamiliar words and was able to decode most of them with ease. Joes overall performance on tasks involving mathematics was in the Average range at the 8th percentile. He scored in the Borderline range at the 7th percentile on tasks that required him to solve written equations, and he scored in the Low Average range at the 19th percentile on tasks examining word problem solving, including problems related to time, money, measurement, and interpreting graphs. In the Numerical Operations subtest, Joe did well with basic facts additions and subtractions (ex.: 9+4), but struggled with multi-digit addition and subtraction (e.g., 42+13). In the Math Reasoning subtest, Joe seemed a little more confident. He was good at using patterns to solve problems and solving problems using money, but was not as successful at telling time and using it to compare and order events, and using quantities less than a whole. Joes overall performance on tasks involving written language was in the Borderline range at the 4th percentile. Joe scored in the Below Average range at the 13th percentile in the Spelling subtest and at the 10th percentile in the Written Expression subtest. In the Spelling subtest, Joe had a hard time spelling familiar sight words and misspelled a couple of words due to their meaning (new instead of knew). During his Written Expression subtest, Joe was also able to link 2 sentences together but made spelling and grammar mistakes. For example, he forgot to put some of his capital letters at the beginning of the sentences, forget to add the s for plural words, and some of the punctuation mark at the end of the sentences. Joes overall performance on oral language tasks was in the Low Average range at the 23rd percentile. He scored in the Average range at the 32nd percentile on the Listening Comprehension subtest, where he was required to either choose a picture to match the word verbally provided or verbally provide a word that matched the picture. He also scored in the Average range at the 27th percentile on the Oral Expression subtest, where he was required to repeat sentences orally presented to him, create stories based on visual story boards, or give directions based on pictorial cues. In the Oral subtests, Joe was able to identify some of the receptive and expressive vocabulary but needed some encouragement. He seemed unsure of certain words but did ok overall. A Developmental Neuropsychological Assessment - Second Edition (selected subtests) (NEPSYII) The Developmental Neuropsychological (NEPSY-II) assessment is a measure of an individuals neuropsychological functioning. It incorporates six domains: Attention and Executive Functioning, Language, Social Perception, Visuospatial Processing, Memory and Learning, and Sensorimotor.
th

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Joe 7 Often, a clinician chooses to only administer the subtests most relevant to the individual clients needs. Select attentional subtests of the Developmental Neuropsychological Assessment - Second Edition (NEPSY-II) were administered to assess Joes attentional abilities. Joes performance on the attention and executive domain of the NEPSY-II varied significantly and fell between the Below Expected Level to Above Expected Level range. Overall, Joe exhibited strength on sorting tasks and performed as expected on auditory attention tasks. Joes performance indicated poorly developed skills on a task in which he was asked to visually recognize and switch between alternating stimuli. He scored in the Borderline range in the Inhibition subtests of Completion Time and Combined Score, and the Response Set Combined Score which indicates signs of impulsivity. Childrens Memory Scale (CMS) The Childrens Memory Scale (CMS) is a standardized test that evaluates the important processes involved in learning and memory and compares performance to that of others of the same age. A General Memory and Index score can be derived from the core subtests. Results are interpreted in accordance with United States norms. Joe completed a number of memory-based tasks that assessed his ability to consolidate, store, and retrieve newly learned information presented either visually or verbally. These tasks involved both meaningful and non-meaningful information and his ability to recall the information was assessed both immediately after learning and after a short delay. Joes performance across these tasks varied depending on whether the tasks were verbal or visual, with a General Memory Index score in the Average range at the 3rd percentile. Joes immediate memory for visually presented information fell in the Average range at the 27th percentile. He performed within the Average range on a non-meaningful (dot patterns) material task and within the Below Average range on a meaningful (faces) task. Joe had a harder time remembering the visually presented meaningful information after a delay, scoring in the Extremely Low range at the 5th percentile. When the tasks involved verbally presented information (stories and word pairs), Joes ability to recall the material in an immediate time frame fell within the Low Average range at the 16th percentile. This reflects that Joe is able to process verbally presented information. Within the verbal domain, Joe obtained higher scores on his ability to recall word pairs immediately after they were presented, in the Low Average range. He also obtained lower scores on his ability to recall word stories delayed, ranking in the Extremely Low range. Furthermore, he scored in the Borderline range in the word pairs delayed recognition. This is an indication that cues did not help his recognition memory. An important distinction concerning memory is recall versus recognition memory. Recognition memory occurs when a cue is provided, such as in a multiple-choice exam where one answer is correct, whereas recall memory uses no such cue. The verbal delayed memory abilities discussed

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Joe 8 above are recall in nature. Joe finished in the Borderline range, ranking at the 3 percentile. This means that Joe has difficulty remembering verbal information after a delay.
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Joe also completed two tasks that assessed his ability to sustain and direct attention, his speed of processing, and his working memory. He performed in the Extremely Low range at the 2nd percentile across these tasks. Specifically, Joe performed in the Below Average range on a task in which he had to repeat number sequences either as they were presented or in reverse order, and within the Extremely Low range on a task requiring him to repeat sequences (e.g., counting by twos, or reciting the days of the week). Usually sequencing requires working memory because you have to remember the numbers in order to put them into the correct sequence. This result can be compared to the Digit Span result on the WISC. Joe struggles with working memory. Expressive Vocabulary Test, Second Edition (EVT-2): The Expressive Vocabulary Test, Second Edition (EVT-2) is designed to measure expressive vocabulary and word-retrieval abilities, or the ability to retrieve and pronounce the correct word in order to communicate verbally. Joe was administered the EVT-2 Form B, and was required to respond with a one-word answer when presented with a question pertaining to either a picture or stimulus word. He obtained a score in the Average range at the 25th percentile, indicating that his expressive vocabulary functioning is equal or better than 25 percent of his peers. This means that Joe has a Below-Average expressive vocabulary when compared to his age group. Peabody Picture Vocabulary Test-4th Edition Form X administered (PPVT-IV) The Peabody Picture Vocabulary Test-4th Edition (PPVT-IV) is a test of listening comprehension for spoken English. It is designed to measure a students vocabulary acquisition that does not require a spoken response. Joe was administered the PPVT-4 Form B, and was required to respond by pointing to one picture among four pictures when presented with a stimulus word pertaining to a picture on each page. He obtained a score in the Average range at the 37th percentile, indicating that his receptive vocabulary functioning is equal or better than 37 percent of his peers. This indicates that Joe has intact receptive oral language ability and is able to recognize the connections between words and pictures. Behavior Assessment System for Children (BASC-2) The Behavior Assessment System for Children (BASC-2) is an assessment tool that evaluates the behavior and self-perceptions of children ages 4 to 18 years. It measures numerous aspects of behavior and personality including positive (adaptive) as well as negative (clinical) dimensions. The BASC-2 provides information about a student from a variety of sources, allowing for a more complete understanding of the student. On the BASC-2, scores that fall in the Clinically Significant range suggest a high level of maladjustment. Scores in the At-Risk range identify either a significant problem that may not be severe enough to require formal treatment or the potential of developing a problem that needs careful monitoring.

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Joe 9 The Behavioral Assessment for Children, Second Edition (BASC-2) was completed independently by his classroom teachers and by his mother, Mrs. Jonas. Joes teachers completed the BASC-2 providing a measure of his problematic behaviors in the classroom and school setting. Joes teachers rated him in the Clinically Markedly Atypical range for Anxiety (99th percentile) and for Learning Problems (98th percentile). His teachers rated him the Mildly Atypical range for Depression and Social Skills. They also rated him in the Slightly Atypical range for Atypicality and in the Average range for Hyperactivity, Somatization, and Attention Problems. Scores in the 98th and 99th percentile for Anxiety and Learning Problems are almost as high as Joe could have scored indicating significant problems in these areas. Also, the Atypicality score should be monitored. Joes mother completed the BASC-2 providing a measure of problematic behaviours in the home. She rated him in the Moderately Atypical range for Depression (95th percentile), Mildly Atypical for Anxiety, Somatization, and Withdrawal (ranging between 90-92nd percentile). She rated him Slightly Atypical for Hyperactivity, Conduct Problem, Atypicality, and Attention Problems. She rated him Extremely Low for Functional Communication and Adaptability. She also rated him in the Average range for Aggression and Social Skills. Depression was indicated quite high by Joes mother, as was Anxiety, Somatization, and Withdrawal. These results can be compared to those from Joes teacher and by Joe himself. Joe completed the BASC-2 providing a measure of problematic behaviours towards himself. He rated himself in the Slightly Atypical range for Atypicality, Sensation Seeking, Depression, and Relationship with Parents (ranging between 74-84th percentile). He rated himself very Low for SelfEsteem and Attitude to Teachers and in the Average range for Hyperactivity, Attention Problems, and Locus of Control. Joes scores show that he has limited insight into his own difficulties. . Conners Continuous Performance Test-second edition (CPT-II) The Conners Continuous Performance Test II (CPT) was designed for use in detecting difficulties with inattention, especially that of attention deficit hyperactivity disorder. This test requires the respondent to view alphabet letters appearing on the computer screen, with the requirement that the test-taker press the space bar for all letters except X. The letters and the Xs appear at varying rates and the task occurs for approximately fifteen minutes. The Confidence Index, as denoted immediately below, indicates the degree of fit with most clinical samples (e.g., ADHD) versus those without a clinical problem. Sustained Attention is the ability to stay on task during continuous or repetitive activity. In the classroom, there are many tasks that require Joe to pay attention to material that he might find challenging, boring and repetitive such as completing many pages of arithmetic calculations or listening to a teachers lecture. The CPT-II task was administered to Joe to assess for inattention. For this task, he looked at a computer screen that had letters pop up in varying intervals. He was required to press the space bar on the keyboard as quickly as possible after each letter except for the letter X. The Confidence Index indicates that Joes performance was inconclusive when compared to a clinical profile of ADHD. Examining Joes performance further showed an indication of inattention demonstrated by his somewhat slower hit reaction time. Conversely, his hit reaction time

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Joe 10 demonstrated that Joe was not highly impulsive. Inconclusive results do not indicate ADHD but they also do not deny ADHD. There is just not enough information provided by this test alone to be sure. Other tests need to be considered. Impulsivity is often an indicator of attention difficulties. Conners Third Edition (Conners -3) The Conners-3 uses observer ratings to help assess a childs behavior related to inattention, hyperactivity/impulsivity, learning problems, executive functioning, aggression, and peer relations. In addition, the scale provides a total score indicative of an attention or behavioral disorder. Scores in the Very Elevated range indicate a possible significant problem and scores in the Elevated range indicate a possible concern. The Conners-Third Edition (Conners-3) was completed independently by Joes mother and himself. Joes mother completed the Conners-3 providing a measure of his Hyperactivity, Inattentiveness, and Behaviour Issues in the home environment. His mother rated him in the Very Elevated range for Learning Problems and in the High Average range for ADHD-I. This supports the diagnosis of ADHD and/or learning problems. Joe completed the Conners-3 and rated himself in the Very Elevated range for Learning Problems and in the High Average range for ADHD-I. Which were the same findings as his mother. There was a better insight here from Joe. Multidimensional Anxiety Scale for Children (MASC) The Multidimensional Anxiety Scale for Children (MASC) assesses the presence of a variety of anxiety symptoms across several significant symptom domains. The MASC consists of the following scales and indexes: the Physical Symptoms Scale (which assesses the presence of physical symptoms and differentiates between somatic and tension symptoms), the Social Anxiety Scale (which assesses the presence of social anxieties and differentiates between humiliation fear and performance fear symptoms), the Harm Avoidance Scale (which assesses the presence of avoidance behaviors and differentiates between perfectionism symptoms and anxious coping symptoms), the Separation/Panic Scale (which assesses separation anxiety and panic as well as autonomic and somatic symptoms), Total Anxiety, and the Anxiety Disorders Index (which assesses the likelihood of the presence of an anxiety disorder). This is a self-report measure. Joe completed the MASC independently. He did not rate himself in the clinical range for any item. He rated herself in the Average range for all categories with the exception of Anxious Coping at the low end of the At Risk range. As such, this level should be monitored. FORMULATIONS/SUMMARY: Joe is a 12 year old boy who is currently in grade 6. An educational assessment was conducted to determine his academic strengths and weaknesses. Overall, Joe presented himself in a polite and friendly manner. On the WISC-IV general measures of cognitive ability and academic potential, he obtained scores indicative of Average cognitive abilities

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Joe 11 as described by his General Ability Index (GAI=92); His Working Memory was in the Extremely Low range on the WISC-IV, which suggests that he will need support in remembering instructions. His Processing Speed was in the Borderline range suggesting he might need extra time to process information. Joes performance on the attention and executive domain of the NEPSY-II varied significantly. Overall, he exhibited strength on sorting tasks and performed as expected on auditory attention tasks. Joes performance indicated poorly developed skills on tasks requiring mental flexibility. Results of the CPT-II indicated that Joes performance was inconclusive when compared to a clinical profile of ADHD. Joe struggles in the academic areas of reading comprehension and math reasoning, although he has a relative strength in oral expression, including good expressive and receptive language abilities. His reading, writing, and mathematics were assessed with the WIAT-II. Results of the achievement testing indicated Borderline performance of basic academic skills. The PPVT-IV indicates that Joe has Average receptive vocabulary. Furthermore, the results of the EVT-2 indicate that Joe has Average expressive vocabulary. Joes relative strength with verbal information combined with his relative strengths in receptive and expressive vocabulary should be of benefit when he is learning new material. Socially and behaviorally, Joes teachers expressed possible concerns surrounding Internalizing Problems. According to the parent BASC-2, Joe has some externalizing problems, internalizing problems, as well as some behavioral symptoms (withdrawal, Atypicality and attention problems) that are possibly significant. According to the self-report BASC-2, Joe scored in the Slightly Atypical range for Sensation Seeking, Atypicality, Sense of Inadequacy, and Relations with Parents. Joes mother completed the Conners 3 parent scale and Joe completed the self-report. On the Content scales, Mrs. Jonas rated Joe in the Clinical range for Learning Problems and in the At-Risk range for Inattention, Executive Functioning, and Peer Relations. On the DSM-IV-TR Symptoms scale, Mrs. Jonas responses indicated that Joe probably met the criteria for ADHD Predominantly Inattentive type and at the low end of the At-risk range for Oppositional Defiance Disorder. On the Content scales, Joe reported himself in the Clinical range for Learning Problems and in the At-risk range for Inattention. Within the DSM-IV-TR Symptom Scales, Joes responses indicated that he within the Clinical range for ADHD Predominantly Inattentive Type. Both Joes mother and his teacher rated Joe at being in the clinical range for Anxiety. Clinical impressions support Mrs. Jonass reports of behavioural difficulties at home in Aggression, Withdrawal, and Attention Problems. The same was true for the Learning Problems at school.

FINAL REMARKS

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Joe 12 Even though Joes performance results were variable, the most common indicator of weakness contributing to his overall learning difficulties is indicated by inattention. Evidence of this is shown in the assessment scores, interview with Joes parents, indicated by Joes teacher, and observed throughout the assessment. Joes biggest difficulty was on memory tasks requiring his ability to sustain and direct attention. However, his performance improved on more meaningful tasks, which held his attention. Joe performed as expected on auditory attention tasks. His performance indicated poorly developed skills on tasks requiring mental flexibility of which attention is again a large determinant. Although results regarding an ADHD clinical profile were inconclusive on the behavioral parent, teacher, and self-reports, it is determined at this time that the triangulated evidence clearly indicates an attention deficit. Given the results of the current assessment and the behavioral patterns demonstrated, Joe meets criteria from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revised (DSM-IV-TR) for the following diagnostic categories: Axis I Axis II Axis III Axis IV Axis V 314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type V71.09 No Diagnosis none Educational Problems 65

RECOMMENDATIONS
Based on the current assessment, the following suggestions are offered for consideration:

Academic Functioning Recommendations:

1. It is recommended that the school prepare an IPP for Joe to help him with his reading comprehension. It would be important to choose a subject that is of interest to him and let him choose between two stories. -By using strategies such as the following: Prior to reading: Preview the book with Joe by reading everything except the regular printed text. This information includes reading titles, subtitles, captions, chapter review questions, graphics and pictures. Activating prior knowledge (e.g., ask questions, make predictions). Before Joe reads a chapter or a book, let him know that you will have a conference after he is finished to discuss with him his reaction to the material. -During reading: Creating graphic organizers to help organize new learning in a visual format that can later be retrieved and manipulated. Regularly summarizing, connecting what he has read with what he already knows and determining the most important ideas, events and the relationships between them.

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Joe 13 Re-reading portions of the text he finds confusing. Making a movie in his mind about the information being read. -After reading: Draw a picture or write a reading response about new learning. Talk to a peer, teacher or parent about information learned. -Other strategies such as: -Highlighting the question, highlight key elements in the story, and highlight unfamiliar words might help him remember them the next time he sees them and it might help his parents and teacher to see exactly which words or part of a word is hard for him to understand. 2. Due to weakness in phonemic awareness and decoding words, intense letter and phonemic review may be helpful. Also, enhance the organization of the written information by using different colors, numbers, and clear separations between sections. When discussing certain ideas based on the printed information, use colored markers to highlight or circle the phrases you are addressing. 3. Due to weakness in working memory and mental manipulation involved in numerical operations such as addition, subtraction, multiplication, and division, focus on Joes strength in immediately solving problems by providing visuals of timetable charts and necessary formulas. Manipulatives may also be helpful and should be at his disposition. 4. Due to weaknesses in spelling, provide Joe with visuals with commonly spelled words and access to a personal dictionary that he can use as needed. Access to a computer and spelling software, such as WordQ and games, such as Word World may also be beneficial. 5. Due to weaknesses in written language, provide Joe with scaffolding activities to build his spelling and grammatical knowledge. Also, provide graphic organizers and visual webs, such as the Inspiration software, to help him organize his thoughts and ideas into written form. 6. Due to weaknesses in processing speed affecting reading and writing fluency, give Joe opportunities to practice his reading and writing as well as additional time to complete assignments and exams. Aim for quality rather than quantity. 7. Due to weaknesses in processing speed affecting mental math, allow Joe practice opportunities in the form of flash cards and games, such as MIA MATH. 8. It would be beneficial to incorporate Joes background knowledge into assignments and activities.

Cognitive Functioning Recommendations:

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Joe 14 1. Due to weakness in working memory and Joes demonstrated strength in retrieving verbal information, Joe may benefit from keeping oral directions short and simple. Limit to two or three steps, and ask Joe to repeat them. 2. Due to difficulty in memory encoding, Joe may benefit from providing intensive repetition, practice and review in learning activities (concentrate on strength in immediate problemsolving). 3. Due to weakness in speed of mental operation, present all types of verbal information accompanied by visual stimuli that clearly illustrate the concept being taught. Examples are: pictures, charts, graphs, semantic maps, and videotapes. Simultaneous visual-verbal presentation will improve comprehension and retention of information. 4. Due to memory difficulties when information processing is demanded, specific memory teaching strategies would be useful, such as taking notes versus memorizing factual information for a test. Examples include Chunking, Verbal Rehearsal, Visual Imagery, and First Letter Mnemonics (e.g., PAR Picture it, Associate it, and Review it, Acronym HOMES Huron, Ontario, Michigan, Eerie, Superior, Acrostic Every Good Boy Deserves Fudge, Substitute words Mini soda for Minnesota, Pegword (Number/rhyme) 1 bun, 2 shoe, 3 tree) 5. Organization facilitates memory. Teach Joe with strategies for organizing all types of information and tasks, including the content of reading material, school-related materials and notes, information for a test, tasks he has to accomplish over the month. Story planners, graphs, and pictures may be beneficial.

Information Processing Recommendations:

1. Due to difficulties with delayed visual and verbal memory, give Joe opportunities to benefit from recognition cues in his learning and make learning meaningful. Give exams in Multiple Choice or Matching format. 2. Due to weakness in fine-motor skills involved in processing speed, allow Joe extra time on timed tasks involving fine-motor coordination and speed. 3. Due to weakness in fine-motor coordination involved in handwriting, using the computer when writing a story would be beneficial.

Personality, Behaviour, Emotionality Recommendations:

1. Give Joe opportunities for success to reduce his anxiety level.

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Joe 15 2. Due to reported aggression at home, encourage Joe to reflect on his own behaviour, using practical and visual strategies. Analyse what happened after the event, so that he might be able to do things better next time around. 3. A Functional Behavioural Analysis (FBA) would be beneficial in order to finding out what triggers his aggression at home. 4. Jo would benefit from taking up a hobby that he can do at home. Therefore, when he gets frustrated, he would have something else to concentrate on instead of putting his anger on other people. 5. Due to attentional difficulties, encourage Joe to ask for clarification and repetition of instructions, ensure eye contact with Joe before speaking to him or giving oral instructions, make oral instructions clear and concise, and simplify complex instructions. It was a pleasure working with Joe and his family. Please do not hesitate to contact me if you have any questions or concerns regarding this report.

____________________________ France Goulard (M.Ed. Student)

NOTE: Due to the developing and changing nature of an individuals skills and abilities, the
results and recommendations contained in this report are intended for current use. Care must be taken not to characterize an individual on the basis of statements in this report, and not to assume that such statements apply indefinitely. Any reference to these results and recommendations in the future should be made with caution.

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Joe 16 Appendix 1.A. Wechsler Intelligence Scale for Children, 4 Edition The Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) is an individually administered, comprehensive clinical instrument for assessing the intellectual abilities of children ages 6 years, 0 months through 16 years, 11 months. The WISC-IV provides composite scores that represent intellectual functioning in specified cognitive domains (i.e., Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI) and Processing Speed Index (PSI)). Lastly, the WISC-IV provides a composite score that represents a childs general intellectual ability (i.e., Full Scale IQ (FSIQ)). Percentile scores, scaled scores, and confidence intervals are also provided to assist in interpretation. The IQ and Index scores have a mean of 100 and a standard deviation of 15. Each of the subtests has a mean of 10 and a standard deviation of 3. The subtests can be broken down as follows: Verbal Comprehension Index (VCI): is composed of subtests measuring verbal abilities utilizing reasoning, comprehension and conceptualization. Similarities, Vocabulary and Comprehension are the three core subtests that comprise the VCI, and Information and Word Reasoning are the two supplemental subtests of the VCI. Perceptual Reasoning Index (PRI): is composed of subtests measuring the speed of mental and graphomotor processing. Block Design, Picture Concepts and Matrix Reasoning comprise the three core subtests of the PRI, and Picture Completion is the sole supplemental subtest of the PRI. Working Memory Index (WMI): is composed of subtests measuring attention, concentration and working memory. Digit Span and Letter-Number Sequencing comprise the two core subtests of the WMI and Arithmetic is the sole supplemental subtest of the WMI. Processing Speed Index (PSI): is composed of subtests measuring the speed of mental and graphomotor processing. Coding and Symbol Search are the two core subtests that comprise the PSI, and Cancellation is the sole supplementary subtest of the PSI. The results of the Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI) and Processing Speed Index (PSI) are reported below. The scores on the WISC-IV have a mean of 100 and a standard deviation of 15.
th

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Joe 17 Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) Composite Scale Scores Summary Composite Scale Std 95% CI Percentile Score Verbal Comprehension Index (VCI) 93 86-101 32 Perceptual Reasoning Index (PRI) 93 85-102 32 Working Memory Index (WMI) 68 63-79 2 Processing Speed Index (PSI) General Ability Index (GAI) 73 92 67-84 87-98 4 30 Classificatio n Average Average Extremely Low Borderline Average

Subtest Scores (S.S.) Summary Subtests S.S. Percentile Classification Verbal Comprehension Index Similarities 9 37 Average Vocabulary 9 37 Average Comprehension 8 25 Average Perceptual Reasoning Index Block Design 7 16 Low Average Picture Concepts 11 63 Average Matrix Reasoning 9 37 Average Working Memory Index Digit Span 7 16 Low Average Letter-Number Sequencing 2 0.04 Extremely Low Processing Speed Index Coding 3 1 Extremely Low Symbol Search 7 16 Low Average Cancelation 4 2 Extremely Low

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Joe 18

Appendix 1.B. Wechsler Individual Achievement Test, 2nd Edition

The Wechsler Individual Achievement Test, Second Edition (WIAT-II) is a rich and reliable source of information about an individuals academic skills and problem-solving abilities that can be used to guide appropriate intervention. It is a comprehensive yet flexible measurement tool useful for achievement skills assessment, learning disability diagnosis, special education placement, curriculum planning, and clinical appraisal for preschool children through adults. The WIAT-II provides composite scores that represent academic ability in several domains (i.e., Reading, Mathematics, Written Communication, and Oral Communication). Percentile scores, scaled scores, and confidence intervals are also provided to assist in interpretation. The Composite and Scaled scores have a mean of 100 and a standard deviation of 15. The composites can be broken down as follows: Reading Composite: is composed of subtests measuring pre-reading, reading, and decoding skills. Word Reading, Reading Comprehension, and Pseudoword Decoding are the three subtests in this area. Mathematics Composite: is composed of subtests measuring the ability to evaluate and write numbers, to solve written calculation problems, identify geometric shapes, solve multi-step problems, and identify mathematical patterns. Numerical Operations and Math reasoning are the two subtests in this area. Written Language Composite: is composed of subtests evaluating spelling and written communication including sentence and paragraph construction. Spelling and Written Expression are the two subtests in this area. Oral Language Composite: is composed of subtests measuring the ability to listen for details, generate a word that matches a given picture and oral description, generate stories from visual cues, and generate directions from visual or verbal cues. Listening Comprehension and Oral Expression are the two subtests in this area.

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Joe 19 Wechsler Individual Achievement Test, Second Edition (WIAT-II) Composite Scale Scores Summary Composite Scale Standard Score 95% CI Percentile Reading Composite 80 76-84 9 Mathematics Composite 79 72-86 8 Written Language Composite 73 65-81 4 Oral Language Composite 89 78-100 23 Total Achievement 74 70-78 4 Classification Below Average Borderline Borderline Low Average Borderline

Subtest Scores Reading Composite Word Reading Reading Comprehension Pseudoword Decoding Mathematics Composite Numerical Operations Math Reasoning Written Language Composite Spelling Written Expression Oral Language Composite Listening Comprehension Oral Expression

WIAT-II Subtest Scores Summary Standard Score 95% CI Percentile 80 76 92 78 87 83 81 93 91 73-87 69-83 85-99 70-86 77-97 75-91 68-94 80-106 79-103 9 5 30 7 19 13 10 32 27

Classification Below Average Borderline Average Borderline Low Average Below Average Below Average Average Average

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Joe 20 WJ-III Cog Subtest Scores Summary Composite Scale Std 95% CI Percentile Classificatio Score n Visual Auditory Learning 79 69-88 8 Borderline

CMS Scores (S.S.) Subtests S.S. Visual Immediate Index 91 Dot Locations Immediate 11 Faces Immediate 6 Visual Delayed Index 75 Dot Locations Delayed 11 Faces Delayed 1 Verbal Immediate Index 85 Stories Immediate 7 Word Pairs Immediate 8 Verbal Delayed Index 72 Stories Delayed 4 Word Pairs Delayed 7 Attenion/Concentration 69 Numbers 6 Sequences 4 Learning Index 97 Dot Locations Learning 11 Word Pairs Learning 8 Delayed Recognition Index 82 Stories Delayed Recognition 9 Word Pairs Delayed Recognition 5 General Memory 72

Summary Percentile Classification 27 Average Average Below Average 5 Borderline Average Extremely Low 16 Low Average Low Average Average 3 Borderline Extremely Low Low Average 2 Extremely Low Below Average Extremely Low 42 Average Average Average 12 Below Average Average Borderline 3 Borderline

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Joe 21 NEPSY-II Subtest Scores Subtests S.S. Animal Sorting Total Correct Sorts 16 Animal Sorting Combined Score 17 Auditory Attention Total Correct 12 Auditory Attention Combined Score 11 Response Set Total Correct 5 Response Set Combined Score 6 Design Fluency Total Score 3 Inhibition Naming Completion Time 5 Inhibition Naming Combined Score 3 Inhibition Inhibition Completion Time 6 Inhibition Inhibition Combined Score 6 Inhibition Switching Completion Time 5 Inhibition Switching Combined Score 3 Inhibition Total Errors 4 (S.S.) Summary Percentile Classification 98 Above Expected Level 99 Above Expected Level 75 At Expected Level 63 At Expected Level 5 Below Expected Level 9 Borderline 1 Below Expected Level 5 Below Expected Level 1 Below Expected Level 9 Borderline 9 Borderline 5 Below Expected Level 1 Below Expected Level 2 Below Expected Level

Continuous Performance Test second edition (CPT-II) Joe completed the computerized CPT-II. Results of the CPT-II indicated that Joes performance was inconclusive when compared to a clinical profile of ADHD. His scores were approximately 50% clinical and 50% non clinical. Examining Joes patterns of performance further showed an indication of inattention as demonstrated by his somewhat slower hit reaction time which is the average speed of correct responses for the entire test. Conversely his hit reaction time demonstrated that Joe was not highly impulsive.

Composite Scale PPVT-4 EVT-2

PPVT-4/EVT-2 Summary Standard Score 95% CI Percentile 95 87-103 37 90 82-98 25

Classification Average Average

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Joe 22 MASC T-Scores Summary Subtests T-Score Classification Physical Symptoms 57 Average Tense/Restless 54 Average Somatimc/Autonomic 58 Average Harm Avoidance 59 Average Perfectionism 54 Average Anxious Coping 61 At Risk Social Anxiety 44 Low Humiliation/Rejection 46 Low Performance Fears 42 Low Separation/Panic 53 Average MASC Total 54 Average Anxiety Disorder Index 53 Average

CONNERS-3 Content Scales T-Scores Summary Domain T-Score Parent Self-Report Inattention 69 63 Hyperactivity/Impulsivity 58 58 Learning Problems 89 90 Executive Functioning 69 Defiance/Aggression 55 43 Peer Relations 64 Family Relations 45

CONNERS-3 Symptom Scales T-Scores Summary Domain T-Score Parent Self-Report ADHD-I 70 74 ADHD-H 56 55 CD 50 41 ODD 61 42

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Joe 23 Behavior Assessment System for Children, Second Edition (BASC-2) Parent Teacher Scale Rating Percentile Rating Percentile Externalizing Problems Comp. 56 78 43 25 Hyperactivity 58 82 45 43 Aggression 52 67 42 19 Conduct Problems 57 81 43 32 Internalizing Problems Comp. 69 95 69 95 Anxiety 63 90 79 99 Depression 69 95 70 94 Somatization 64 90 48 56 School Problems Composite 65 92 Attention Problems 52 59 Learning Problems 76 98 Behavioral Symptoms Index 64 91 54 71 Atypicality 59 85 58 84 Withdrawal 65 92 51 66 Attention Problems 61 83 Adaptive Skills Composite 34 6 45 32 Adaptability 30 4 39 16 Social Skills 49 49 64 90 Leadership 37 10 43 25 Study Skills 47 41 Activities of Daily Living 38 13 Functional Communication 27 1 36 10
Interpretive Guidelines for T-Scores and Percentiles

T-Score 70 + 66-70 61-65 56-60 45-55 40-44 35-39 30-34 <30

%ile 98+ 95-98 86-94 74-85 27-73 16-26 6-15 2-5 <2

Guideline Markedly Atypical (Indicates Significant Problem) Moderately Atypical (Indicates Significant Problem) Mildly Atypical (Possible Significant Problem) Slightly Atypical (Borderline: should raise concern) Average Slightly Atypical (low scores are good; not a concern) Mildly Atypical (not a concern) Moderately Atypical (not a concern) Markedly Atypical (not a concern)

The BASC is an integrated system of rating scales that is designed to facilitate the classification of a variety of emotional and behavioral difficulties in children. Ratings within the clinically significant range indicate a high level of maladjustment. Ratings in the at risk range indicate a moderate amount of difficulty that requires monitoring.

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Joe 24 Behavior Assessment System for Children, Second Edition (BASC-2) Self-Report Scale Rating Percentile School Problems Composite 47 41 Attitude to School 46 42 Attitude to Teachers 38 10 Sensation Seeking 59 80 Internalizing Problems Composite 49 54 Atypicality 59 84 Locus of Control 55 71 Social Stress 43 27 Anxiety 47 44 Depression 44 36 Sense of Inadequacy 55 74 Somatization 44 35 Inattention/Hyperactivity Composite 51 58 Attention Problems 48 49 Hyperactivity 54 68 Emotional Symptoms Index 50 57 Personal Adjustment Composite 49 42 Relations with Parents 58 78 Interpersonal Relations 51 46 Self-Esteem 37 11 Self-Reliance 51 52
Interpretive Guidelines for T-Scores and Percentiles

T-Score 70 + 66-70 61-65 56-60 45-55 40-44 35-39 30-34 <30

%ile 98+ 95-98 86-94 74-85 27-73 16-26 6-15 2-5 <2

Guideline Markedly Atypical (Indicates Significant Problem) Moderately Atypical (Indicates Significant Problem) Mildly Atypical (Possible Significant Problem) Slightly Atypical (Borderline: should raise concern) Average Slightly Atypical (low scores are good; not a concern) Mildly Atypical (not a concern) Moderately Atypical (not a concern) Markedly Atypical (not a concern)

The BASC is an integrated system of rating scales that is designed to facilitate the classification of a variety of emotional and behavioral difficulties in children. Ratings within the clinically significant range indicate a high level of maladjustment. Ratings in the at risk range indicate a moderate amount of difficulty that requires monitoring.

Empowering People Building Strengths