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Conners Comprehensive Behavior Rating Scales (Conners CBRS) Parent and Teacher Forms

Kinetic Family Drawing

Millon Pre-Adolescent Clinical Inventory (M-PACI)

Achenbach Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) Behavior Rating Inventory of Executive Function (BRIEF): Parent Form

Academic Achievement

Kaufman Test of Educational Achievement–Third Edition (KTEA-3)

Test Results

Intellectual Functioning

In order to assess Jenna’s intellectual and cognitive abilities, she was administered the WISC-V. This test has six composite scores: Verbal Comprehension Index, Visual Spatial Index, Fluid Reasoning Index, Working Memory Index, Processing Speed Index, and Full Scale IQ. A score derived from a combination of subtest scores from these composites is considered the most representative estimate of Jenna’s global intellectual ability, which is in the Average to Low Average range when compared to other children her age (Full Scale IQ/FSIQ = 88, 21st percentile). Jenna’s general intelligence can also be summarized by a score111111111 that is less impacted by working memory and processing speed, and in that case, her overall intellectual ability is in the Average range and at the 30th percentile (General Ability Index/GAI = 92). The difference between these two scores representing her global ability indicates that Jenna’s cognitive proficiency, as measured by

working memory and processing speed, led to a lower overall FSIQ. While the FSIQ and GAI provide a broad representation of her cognitive functioning, a description of Jenna’s specific cognitive abilities is provided below for a more thorough understanding of her current level of functioning.

Verbal Reasoning and Word Knowledge Abilities

Jenna’s ability to access and apply acquired word knowledge was in the Average range. Specifically, her ability to verbalize meaningful concepts, think about verbal information, and express herself using words was reflected in Jenna’s performance on subtests within the Verbal Comprehension Index (VCI), which was typical for her age and emerged as a relative strength for Jenna (VCI = 100, 50th percentile). She performed comparably across verbal reasoning and word knowledge tasks, indicating that these abilities are similarly developed.

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Visual-Spatial Abilities

Similar to her average verbal reasoning and word knowledge, Jenna’s ability to evaluate visual details and understand visual spatial relationships in order to construct geometric designs from a model were typical of a child her age. These tasks require visual spatial reasoning, integration and synthesis of part-whole relationships, attentiveness to visual detail, and visual-motor integration. During this evaluation, visual-spatial processing was one of Jenna’s strengths, with performance in the Average range (Visual Spatial Index/VSI = 102, 55th percentile). Jenna showed Average to High Average performance when putting together geometric designs using a model. Her mental rotation skills and ability to understand part-whole relationships may be particularly strong when compared to her other abilities. However, Jenna had di culty on a measure (on the NEPSY) of her visuoconstructional ability and visuomotor integration assessing her ability to reproduce simple abstract designs with paper and pencil.

Reasoning Abilities

In contrast, Jenna’s ability to detect the underlying conceptual relationship among visual objects and to use reasoning to identify and apply rules was in the Low Average range. Overall, Jenna’s performance on tasks that required identification and application of conceptual relationships, inductive and quantitative reasoning, broad visual intelligence, simultaneous processing, and abstract thinking was slightly low for her age (Fluid Reasoning Index/FRI = 85, 16th percentile). Thus, she may experience some di culty solving complex problems111111111that require her to identify and apply rules. Her pattern of strengths and weaknesses suggests that she may currently experience relative di culty applying logical reasoning skills to visual information, but she may have relatively strong ability to verbalize meaningful concepts.

Memory Abilities

Working Memory

Jenna evidenced impaired ability to register, maintain, and manipulate visual and auditory information in conscious awareness on the Working Memory Index (WMI). Working memory was one of Jenna’s weakest areas of cognitive performance, with scores that were below most other children her age (WMI = 79, 8th percentile, Very Low range). Jenna showed significant di culty recalling and sequencing series of pictures and lists of numbers. Her visual and auditory working memory appear to be similarly impaired.

To further understand how well she takes in, stores, and remembers information presented both visually and verbally, Jenna was administered tasks from the NEPSY. Some memory deficits were noted on both symptom validity tasks as well as structured memory tasks.

Visual Memory

Jenna had no di culty on a task assessing her encoding of facial features, as well as face discrimination and recognition, and she scored in the High Average to Superior range on this task (with stimulant medication). In contrast, on the same day of testing, Jenna’s performances were very impaired on a test of spatial memory for novel

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visual material assessing both spatial recall and visual content recognition. Both her immediate recall and her delayed recall were weak on this task.

Verbal Memory

Jenna struggled on a measure of narrative memory assessing her contextual verbal memory for organized verbal information (with stimulant medication). Her free recall, cued recall, and her recognition memory were all weak on this task. Without stimulant medication, Jenna was administered a measure of the strategies and processes involved in learning and recalling verbal material within the context of an everyday shopping task. On this task, Jenna’s ability to repeat a list of words the first time she heard it indicates a Low Average initial attention span for auditory-verbal information. Similarly, on her fifth learning attempt, her performance was also Low Average. In addition, her total recall of the word list across the five learning trials was Low Average compared to others her age. After both a short delay and a longer delay, Jenna’s recall of the list was Low Average. Category cueing helped Jenna about the same as others her age. Jenna’s ability to discriminate between words that were on the list and those that were not was Low Average for her age. Jenna’s ability to recognize information was about the same as her ability to recall it.

Taken together, these findings suggest that Jenna experienced di culty in encoding verbal information and more complex visual information into memory.

Jenna’s overall processing speed was low for her age on tasks that measured Jenna’s speed and accuracy of visual identification, decision making, and decision implementation. Her ability to rapidly identify, register, and implement decisions about visual stimuli was in the Low Average Range (Processing Speed Index/PSI = 80, 9th percentile). It is important to note that Jenna’s relatively slow processing speed may have inhibited her performance on tasks involving complex mental operations, such as verbal reasoning and visual spatial reasoning tasks. The PSI consists of two timed subtests, and performance across these tasks was similar, suggesting that Jenna’s associative memory, graphomotor speed, and visual scanning ability are similarly developed.

Sensory-Motor Functioning

Jenna is right-handed. On written tasks, her letters were clearly formed and she evidenced a mature pencil grip. Her simple and complex finger dexterity and motor speed was intact bilaterally. In contrast, Jenna had di culty on a measure of rapid motor programming assessing her ability to learn and automatize a series of rhythmic movements. She clearly struggled with motor regulation on this task. In addition, her performance was mildly impaired on a measure of Jenna’s graphomotor skills. She tended to work quickly but a little carelessly on this task when required to draw a line through a curved track.

Attention and Executive Functions

Various subtests and rating scales were used to assess how well Jenna is able to plan, organize, change, and control her behavior. Although Jenna’s sustained attention tended to be intact with stimulant medication, her executive functioning was variable.

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With medication, Jenna struggled on a task assessing her ability to formulate basic concepts, to sort these objects into categories, and to shift set from one concept to another. This subtest is a measure of executive functioning assessing initiation, cognitive flexibility, and self-monitoring. Similarly, her nonverbal behavioral productivity was impaired on a measure of her ability to generate unique designs by connecting up to five dots, presented in two arrays: structured and random. In contrast, her verbal behavioral productivity was strong on a task assessing verbal fluency. Some di culties were noted on a computerized assessment of her concept formation skills assessing

her ability to form abstract concepts and to maintain set. Jenna did appear to benefit from computerized feedback indicating when her responses were incorrect; however, she struggled to generate alternate problem solving strategies, reflecting some deficits in concept formation.

On a measure of inhibition, Jenna’s performance was variable on a task designed to assess the ability to inhibit automatic responses in favor of novel responses and the ability to switch between response types. Although Jenna struggled with response control di culties on this task, intact cognitive flexibility was noted as well as overall good self-monitoring. She performed in 111111111the Low Average range on another task of inhibition that required Jenna to learn tones that allow progression (go) or required inhibition (no-go).

Jenna’s auditory sustained attention was intact with stimulant medication. She had no di culties on an auditory continuous performance task measuring selective and sustained attention, response inhibition, and executive functioning, and in fact Jenna evidenced High Average performance on the first part of this subtest that is designed to assess selective auditory attention and the ability to sustain it (i.e., vigilance). Her performance was intact on the second part of this subtest designed to assess the ability to shift and maintain a new and complex set involving both inhibition of previously learned responses and correctly responding to matching or contrasting stimuli. She also evidenced Average performance on a task requiring Jenna to listen to a recording of single-digit numbers and to respond with the number that precedes the occurrence of all specific double-digit stimulus presentations.

Without stimulant medication, Jenna’s sustained attention and response control was further assessed by means of a computerized task that is intended to be mildly boring and demanding of sustained attention over a 13-minute period of time. Jenna did not validly respond to visual test stimuli. She may have been impaired in her ability to shift sets from the auditory to the visual modality and therefore her performance in the auditory domain only can be interpreted. In terms of her response control, Jenna’s ability to inhibit responses to auditory stimuli was strong. This ability indicates that

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she is not likely to make careless errors to auditory stimuli and that she has the ability to stop and think rather than overreact when stressed in her daily life. If there are functional problems with inhibition or self-control with respect to auditory stimuli, causal emotional factors other than ADHD could be considered. Jenna had no deficits in her ability to be consistent in her responses to auditory stimuli. She is able to process new information in a reliable manner and “keep up the pace.” She can usually ignore ordinary auditory distractions in the environment. Jenna’s response time to auditory stimuli became faster over the course of the test. In a school setting, she is likely to be capable of meeting the demand to perform and to achieve goals in a timely manner unless other psychological or emotional factors are present that impair her functioning. Jenna is unlikely to exhibit problems with inappropriate o -task behavior in her home or school environment. She does not engage in fidgety or impulsive behaviors to any significant degree. She may be reasonably tolerant of “boring” tasks.

In contrast, Jenna showed some problems with her general auditory attentional functioning on the computerized task. At times she was inattentive to key auditory stimuli. Consequently, she is likely to demonstrate occasional problems in the school environment in maintaining her auditory attention and her e orts to listen. Environmental stressors and social distractors may exacerbate her auditory attentional problems at times. She may also have “good and bad days” with respect to her attentional abilities. Her ability to pay attention under low demand conditions to the

auditory targets was moderately to severely impaired. In other words, she had signifi-

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cant problems remaining alert when the nontargets were prevalent. This dysfunction in auditory attention indicates that she is likely to “tune out” periodically when there is little demand to perform, unless she is actively engaged in the task at hand. Behavioral interventions need to be considered to keep her on task and better manage her problems sustaining attention. She was able to maintain her attention and remain alert under high demand conditions. Jenna did not show any problems with her overall auditory processing speed. Her recognition reaction time falls within the normal range.

Further measures of Jenna’s attentional functioning were obtained by having Jenna’s parents and teacher complete various rating scales. Jenna was rated by both her parents and her teacher as evidencing moderate to severe deficits in her attention, but somewhat less severe concerns were noted regarding her hyperactivity/ impulsivity. Some significant executive functioning deficits were identified by her mother in terms of extreme problems with emotional control, moderate deficits with task initiation, working memory, and organization of materials, and only mild concerns regarding response inhibition and problems planning and organizing tasks.

Oral Language Processing

Phonological Processing

In order to assess her phonological processing, Jenna was administered measures of phonological awareness, phonological memory, and rapid naming. Phonological awareness refers to the ability to understand the sound structure of oral language.

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For example, it includes a child’s ability to understand that letters represent sounds, how sounds are blended, and how those sounds can build words. Phonological memory is the ability to hold a sound in one’s short-term or working memory. Rapid naming measures one’s ability to retrieve language information from long-term or permanent memory. Research indicates that these three kinds of phonological processing appear to be especially relevant for developing reading and writing skills.

In the area of phonological awareness, Jenna’s overall score falls within the Poor range. Within this skill area, consistent di culty was evident. Jenna evidenced Below Average performance when required to remove sounds from spoken words to form other words, such as removing the “b” from “bold” to say “old.” Her performance was also Below Average on a subtest requiring her to combine sounds to form words, as in blending the sounds “c-oh-n” together to form the word “cone.” More di culty was noted on a task assessing Jenna’s ability to identify target sounds in words (such as the second sound in the word “dog”), and she performed in the Poor range on this task.

In contrast to these di culties, Jenna evidenced intact performance overall on tasks that assessed her ability to code information phonologically for temporary storage. However, some inter-subtest variability was observed. Jenna evidenced Low Average performance when asked to recall a series of numbers of varying length; however, she performed in the Average range when asked to repeat nonwords, such as “mistruf.”

Jenna displayed Above Average ability in her e cient retrieval of phonological

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information from long-term memory. E ciency and fluency allow the reading process to become automatic, which allows mental energy to be directed to the higher-level skill of comprehension. Her speed of naming letters and numbers was within the Average range.

Oral Language

Jenna’s oral language skills were assessed by means of the WIAT-III and one subtest from the NEPSY-II.

Jenna exhibited relatively strong oral vocabulary skills. On a measure of receptive vocabulary that required Jenna to point to the picture that best represented a given word/concept, Jenna scored in the Average range. Similarly, on a measure of expressive vocabulary that required Jenna to say the names of pictured concepts, Jenna also scored in the Average range.

Two measures of sentence and passage-level listening comprehension were administered. The first measure (NEPSY-II Comprehension of Instructions) required Jenna to respond to oral instructions of increasing complexity, and Jenna scored in the Average range. The second measure (WIAT-III Oral Discourse Comprehension) required Jenna to listen to an oral passage and then orally respond to literal and inferential comprehension questions that she read on her own. Her performance was Below Average on this task. To some degree, Jenna’s di culties on this listening task may be related to her di culties with maintaining auditory attention and poor working memory. However, Jenna exhibits language comprehension weaknesses during listening as well as reading tasks, which suggest a broader language comprehension concern.

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Jenna’s oral expression abilities were assessed further with measures of verbal fluency and sentence repetition. A measure of oral word (verbal) fluency required Jenna to say things belonging to a given category by retrieving words from memory quickly and e ciently, and Jenna scored in the Very Superior range. A measure of sentence repetition required Jenna to listen to sentences of increasing length and complexity and repeat each one verbatim. Jenna scored in the Below Average range. Her errors on this task suggested weaknesses in grammar and auditory verbal working memory.

Academic Skills

Jenna’s academic skills were assessed by means of the WIAT–III, in the areas of reading, math, and writing.

Reading

Jenna’s overall reading skills measured in the Average range; however, variability was noted in her skills. Jenna’s basic reading skills are relatively strong, but her reading comprehension and fluency skills are relatively weak. Her ability to read real words and to decode “fake” words were both in the Average range. However, Jenna evidenced di culty in reading comprehension, scoring in the Below Average range. Jenna appeared to misunderstand details from the text, and she was somewhat careless in her response style. Her reading style was somewhat passive in that she did not appear to comprehend details as she was reading 111111111

and she reread passages numerous times in order to answer questions. When asked to read grade-level passages aloud, Jenna evidenced Below Average performance in her reading fluency, rate, and accuracy. Her reading errors included omissions, additions, and substitutions.

Mathematics

Jenna’s math skills were estimated in the Low range overall. Her math problem solving performance was Below Average, and her math calculation skills were Low. In contrast, she performed in the Average range on timed tests of addition and subtraction math fluency, which required her to complete as many simple math problems as possible under a time limit.

Spelling and Written Expression

Jenna evidenced Average performance on a measure of her spelling skills. However, Jenna exhibited significant weaknesses in specific areas of written expression. On a test of sentence composition that required her to combine sentences and then build sentences using a target word, Jenna scored in the Below Average range. She had particular di culty writing grammatically correct sentences with target words. When asked to write a short essay, Jenna’s word count and productivity was in the Average range, but her performance in the areas of theme development, text organization, and grammar and mechanics were in the Low to Below Average range.