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Psychosocial Functioning

Jenna evidenced a strong self-concept. Despite her history of anxiety, she did not report any serious struggles in this regard. She did indicate that she becomes worried when her teacher makes her finish a task at recess or after school, but no significant anxiety was noted. Likewise, her testing did not indicate a high level of depression or anger. Jenna values her relationships with others. She seeks out interesting peers and wants to be seen as socially appealing. She tends to deny troublesome emotions and she seeks harmony with others. Jenna attempts to restrain negative emotions and to avoid losing control. However, at times her need to maintain proper appearances may result in a rigid behavior pattern and conformity to the rules of others.

Jenna is strongly connected to her family and she spoke positively about her mother, father, and brother. On rating scales, Jenna was rated by her mother as evidencing mild internalizing concerns in terms of anxiety. Her teacher indicated no concerns. No other psychological struggles were noted.

Neuropsychological Implications and Diagnostic Impressions

Jenna Bronson is a pleasant third-grade girl who is struggling with variable neurocognitive functions. Testing suggests that Jenna struggles to e ciently process information when involved in learning and problem solving. Her higher-order cognitive abilities like verbal reasoning and visual spatial111111111 skills appear to be a strength compared to abilities that facilitate cognitive processing e ciency, like speed of processing and certain parts of her memory. As a result, relative weaknesses in her mental control and her speed of visual scanning may sometimes create challenges as Jenna engages in more complex cognitive processes, such as learning new material or applying logical thinking skills. This is clearly evident on memory tasks and tasks of executive functioning.

Jenna continues to meet diagnostic criteria for ADHD. Although she does appear to benefit somewhat from stimulant medication in terms of improved sustained attention, Jenna’s deficits in executive functioning, learning, inhibition, and nonverbal fluency are not impacted by medication. Clearly, Jenna is a hard-working child who wants to please, and it is a daily struggle for her to cope with these enduring deficits. Her parents, doctors, teachers, and tutors share in this struggle as they work to ease Jenna’s di culties with inconsistent results.

Jenna’s academic functioning is highly variable and she continues to show some areas of serious impairment. Significant deficits are evident in Jenna’s math computation and problem solving skills, reading and listening comprehension skills, reading fluency, and written expression. Jenna’s phonological awareness was also observed as an area of weakness, although her basic reading and spelling skills are commensurate with her grade level peers. Jenna continues to meet diagnostic criteria for Language

ILLUSTRATIVE CASE REPORTS 345

Disorder with impairments in language comprehension, vocabulary, and grammatical knowledge.

Jenna has made great strides in her personal development over the past 21∕2 years. She is no longer the highly anxious and unhappy child who was assessed by this examiner just over 2 years ago, and she presents as a more confident and content girl who is proud of her athletic endeavors. She does not evidence serious school avoidance, and she has managed to make some significant gains in her reading skills. Jenna’s hard work in these areas is commendable.

Based upon these neuropsychological findings, the following diagnoses are made:

314.00 ADHD; Predominately Inattentive Type

Specific Learning Disorder with impairments in

315.1Mathematics (Accurate calculation; Accurate math reasoning)

315.2Written Expression (Grammar and punctuation; Clarity and organization)

315.0Reading (Comprehension; Fluency)

315.39Language Disorder

Recommendations

Academic Interventions

1. Ongoing placement at her elementary school is critical. At this stage it would

be anticipated that this will continue to be an excellent placement for Jenna

111111111

through middle school.

2.It is critical that Jenna has her full recess period and is not required to complete academic tasks during this time.

3.Thirty minutes of academic support after school would be beneficial should Jenna have di culty completing her work during classtime.

4.In addition, sessions with her tutor should be scheduled at least twice a week, preferably during the school day to address Jenna’s severe math di culties.

5.Fifty percent extended time on standardized and class tests is critical.

6.Jenna will learn new information at a rate that is somewhat slower than other children her age, and may have particular di culty with abstract thinking. Preteaching and reteaching lessons learned in school will give her additional exposure to new concepts and may facilitate her comprehension and recall of information. Due to deficits in auditory attention and listening comprehension, it may be helpful to present new content material in multiple modalities, using relatively simple vocabulary and sentence structure.

7.Encourage Jenna to subvocalize when working on visual tasks. Her verbal fluency skills are strong and might help her on these tasks.

8.Jenna may need more repetition of material to learn it. Care should be taken not to frustrate her by presenting too much information too quickly. She may

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benefit from shorter periods of learning and longer breaks between periods of learning. Jenna would also likely benefit from memory training exercises designed to enhance her encoding skills.

9.Teach Jenna to chunk information and connect new information to concepts that she already knows (e.g., use preparatory sets).

10.Jenna likely has a relative strength in explaining concepts aloud, but may have more di culty applying logical thinking to visual information. It may be beneficial for Jenna to talk herself through problems rather than attempting to solve them in her head. It may also be useful for her to leverage her verbal skills when attempting to memorize information.

11.Due to deficits in fluid reasoning, Jenna may benefit from structure and practice when approaching tasks that are challenging to her. Asking questions about stories or movies (What is the main idea? What might happen next?) can further build fluid reasoning skills. Reinforcing her ideas with positive feedback may encourage her to grow in this area.

12.Ongoing involvement in enjoyable extracurricular activities is critical in order to build Jenna’s competency in a variety of arenas.

Psychopharmacological Interventions

13.Mr. and Mrs. Bronson are encouraged to discuss these test results with Jenna’s psychiatrist in order to determine her111111111 ongoing course of treatment.

Ongoing Monitoring of Jenna’s Progress

14.A re-evaluation of Jenna’s neuropsychological functioning in fifth grade would likely be prudent.

Thank you for this opportunity to assess Jenna. It has been my pleasure to spend time with this engaging and interesting girl once again. Please let me know if I may be of any further assistance.

Michelle Lurie, Psy.D.; ABPdN

Clinical Neuropsychologist

Diplomate of the American Board of Pediatric Neuropsychology

Psychometric Summary for Jenna

Table 6.2 Medical Symptom Validity Test

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Table 6.3 Wechsler Intelligence Scale for Children–Fifth Edition (WISC-V)

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Table 6.4 California Verbal Learning

Test–Children’s Version (CVLT-C)

Table 6.5 Test of Everyday Attention for Children (TEA-Ch)

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Table 6.7 Wisconsin Card Sort Test–64: Computer

Version 2 (WCST-64)

Table 6.9 Wechsler Individual Achievement Test–Third Edition (WIAT-III)

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