EXAMPLE REPORT

Suite 5 / 336 Churchill Avenue SUBIACO 6008 PO Box 502 SUBIACO WA 6904

Phone: (08) 9388 8044 www.pecs.net.au

Example Intellectual Disability Assessment Report:

John Smith

Strictly Confidential

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This Example Comprehensive Psychological Report is provided to act as an example of the breadth and thoroughness of an assessment performed by Psychological & Educational Consultancy Services (PECS). This example report also reflects changes relating to the recent release of the DSM-5 (APA, 2013).

CONTENTS

(1) Preface (2) Biographical Details (3) Referral Information (4) Current Concerns (5) Academic Areas (6) Brief Background Information (7) Global Screening Assessment (8) Socio-emotional Assessment (9) Adaptive Behaviour Assessment (10) Cognitive Assessment (11) Summary (12) Conclusion (13) Recommendations (14) Appendix 1 – WISC-IV Subtest Descriptions (15) Appendix 2 – Clinical Cohort Research Findings

PREFACE A Comprehensive Psychological Assessment is the systematic collection, analysis and interpretation of developmental, behavioural, socioemotional, cognitive and/or educational information for the purpose of making inferences about underlying brain function. These inferences are achieved by investigating an individual’s strengths and weaknesses across the aforementioned areas and identifying any patterns that may exist. Ultimately, the investigation’s aim is to rule out the presence of any clinically significant afflictions, or if indeed present, to facilitate diagnosis of the core underlying problem, identify its aetiology and impact on the individual, and identify any comorbid concerns that may exist. The large majority of subsequent diagnoses are genetic, hereditary and familial in nature, with a significant minority environmental/experiential in origin. A Comprehensive Psychological Report contains the information garnered from the Comprehensive Psychological Assessment and is compiled to convey the information to other health and educational professionals for the purpose of specialist diagnosis, further assessment, and/or the implementation of intervention/treatment.

BIOGRAPHICAL DETAILS

Name: John Smith Date of Birth: 14/04/2000 Gender: Male Age: 16 years Grade: 11 School: Local High School Address: 123 West Coast Drive, TRIGG WA 6029 Parent’s Phone Number: 0444 444 444 Parent’s Email Address: smith@example.net.au

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REFERRAL INFORMATION John was referred to Psychological and Educational Consultancy Services (PECS) by Dr Jane Brown (Paediatric Neurologist) for a Comprehensive Psychological Assessment and indication of whether the results are reflective of an individual with Intellectual Disability (Intellectual Developmental Disorder).

CURRENT CONCERNS From a presented list, John’s parents identified concerns in the following areas:

• Academic • Attention • Learning • Mathematics • Spelling • Reading • Written language • Anxiety • Medical or health • Fine motor • Memory

ACADEMIC AREAS Presented below are parent estimates of John’s achievement in the main academic areas:

Maths: Well Below Average Below Average Average Above Average Well Above Average Reading: Well Below Average Below Average Average Above Average Well Above Average Writing: Well Below Average Below Average Average Above Average Well Above Average Spelling: Well Below Average Below Average Average Above Average Well Above Average Language: Well Below Average Below Average Average Above Average Well Above Average John’s parents indicated John has received tutoring or extra remediation for the below academic areas:

Reading Writing Spelling Maths Speech and Language

BRIEF BACKGROUND INFORMATION Relevant information reported during the initial interview session or referral letter:

• John’s mother suffered from hyperemesis gravidarum during her pregnancy with John. • Was born prematurely (9 ½ weeks), and weighed less than 5 ½ pounds at birth. • Reached all of the major developmental milestones (e.g., walking, speaking, toileting) late. • Needs glasses/contact lenses. • Normal auditory acuity reported. • Has fine motor movement problems. • Suffers from cryptogenic West syndrome with infantile spasms. • No current prescription medication use. • Past assessments and interventions include;

o Occupational Therapy. o Speech Therapy.

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• There is a family history of Depression, Anxiety and Epilepsy. • Primary concerns reported include;

o Learning and social difficulties. • John’s mother reported;

o John always tries really hard in all tasks. o John is up and down a lot at night (does not sleep through night) and sleepy through the

day. o When out of routine, John does not cope well. o John does not cope well out of his comfort zone. o John is not verbally social with strangers. o Cannot follow a series of instructions. o Does not initiate things himself, it is always a parent that does (i.e., play dates). o Cannot count money or tell the time. o Loses concentration quickly. o Cannot use public transport or go out independently.

Past testing:

• NAPLAN Year 5: o Reading – well below average (approx 1st percentile of year group) o Writing – well below average (approx 10th percentile of year group) o Spelling – well below average (approx 20th percentile of year group) o Grammar & Punctuation – well below average (approx 10th percentile of year group) o Numeracy – well below average (approx 10th percentile of year group)

• Dr Jane Brown, Paediatric Neurologist in May 2010 (at age 11 years 8 months):

o He presented at the age of 6 months with a serious form of epilepsy known as West Syndrome, which refers to a combination of “infantile spasms” (a type of brief tonic seizure), “hypsarrhythmia” (a very irregular electro-encephalogram with very frequent multifocal epileptic activity) and arrest of neurodevelopmental progress.

o Current working diagnosis is cryptogenic West syndrome. o John’s epilepsy has responded well to treatment. However, West syndrome is commonly

associated with significant learning difficulties and impairment of frontal lobe executive functions and unfortunately John has shown significant delays in both linguistic and fine motor skill development, as well as impaired concentration and reading ability.

o He has been assessed by and received therapy from educational psychologists, speech pathologists and occupational therapists.

o Previous trials of stimulant medication have been unhelpful for his short attention span and have not improved his academic performance.

Please note that only a brief overview was obtained due to John and his parents already having provided more detailed background information to Dr Brown. See checklists for more behavioural information.

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GLOBAL SCREENING ASSESSMENT Screening Tests Administered: Date of

Test Administration

*child & adolescent psychprofiler (CAPP; Langsford, Houghton, & Douglas 2014) 06/11/14 CAPP Outline: The CAPP comprises 126 items and utilises three separate screening forms; the Self-report Form (SRF: 126 items), Parent-report Form (PRF: 126 items), and Teacher-report Form (TRF: 126 items) for the simultaneous screening of 14 of the most prevalent disorders in children and adolescents. The CAPP comprises screening criteria that closely resemble the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5: American Psychiatric Association: APA, 2013). The CAPP is appropriate for the screening of behaviour of children and adolescents between the ages of 2 and 17 years, however, only the Parent-report and Teacher-report Forms are administered for children aged below 10 years due to the reading level requirements of the Self-report Form. All items of the CAPP require responses to be made on a six-point scale pertaining to the perceived frequency of the behaviour (ie., Never, Rarely, Sometimes, Regularly, Often, or Very Often). When calculating disorder screening scores, the items are coded as follows: Never = 0, Rarely = 0, Sometimes = 0, Regularly = 1, Often = 1, and Very Often = 1. These values were chosen because although many people with and without disorders may exhibit similar behaviours, it is the frequency of the behaviour that determines whether it is of clinical significance. A small number of exceptions to these scoring rules apply where some of the behaviours (e.g., fighting with a weapon, stealing) are considered to be of sufficient severity that 'Sometimes' is also awarded a score of 1. Therefore, the summation of the items within each disorder produces a screening score for that disorder, which if exceeding the screening cutoff score, designates that the individual has been awarded a positive screen for that disorder. In order to ensure its validity and reliability, the first version of the psychprofiler was subjected to a series of rigorous psychometric analyses over a number of years. This process has involved validation against a large mainstream sample (n>1000) as well as clinical calibration against individuals with formal diagnoses. These analyses found the psychprofiler to be a highly reliable and valid screening instrument. The CAPP is primarily administered in order to provide an objective indication of whether the individual exhibits behaviours characteristic of a suspected disorder, possible comorbid disorders, and issues pertaining to differential diagnosis. The psychprofiler has been the most widely used Australian psychiatric / psychological / educational global screening instrument since 2004. For further information regarding the CAPP, please visit www.psychprofiler.com or contact Dr Shane Langsford on (08) 9388 8044. Please note that any indication of a positive screen on the CAPP does not constitute a formal diagnosis. A positive screen merely indicates that the individual has met sufficient criteria for a disorder to warrant further investigation.

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Global Behavioural Assessment Results: John’s parents reported positive screens for:

• Generalised Anxiety Disorder • Separation Anxiety Disorder • Attention-Deficit/Hyperactivity Disorder: Combined Presentation • Autism Spectrum Disorder • Language Disorder • Speech Sound Disorder • Persistent Depressive Disorder • Oppositional Defiant Disorder • Specific Learning Disorder – with Impairment in Reading • Specific Learning Disorder – with Impairment in Written Expression • Specific Learning Disorder – with Impairment in Mathematics • Posttraumatic Stress Disorder

A copy of the CAPP Report is included as an Appendix, as are the completed CAPP Forms. Please refer to the CAPP Report for the individual behaviours which were responsible for the positive screens elicited.

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SOCIO-EMOTIONAL ASSESSMENT Checklists Administered:

Checklists Date of Administration Beck Youth Inventories of Emotional and Social Impairment (Beck: BYI-II: 2005) 23/10/14 Checklists Results: Beck Youth Inventories of Emotional and Social Impairment (Beck: BYI-II: 2005) The BYI is a reliable and valid self-report instrument that contains 5 subscales pertaining to self-concept, anxiety, depression, anger, and disruptive behaviour.

BYI Subscales

Raw Score

T-Score

Interpretive Guidelines

Self-Concept 30 39 Much Lower than Average Anxiety 25 61 Moderately Elevated Depression 11 49 Average Anger 22 58 Mildly Elevated Disruptive Behaviour 12 59 Mildly Elevated The BYI results indicate that the areas of Self-Concept, Anxiety, Anger, and Disruptive Behaviour warrant further investigation by a Psychologist to determine if they are indeed a genuine concern and if so, to provide appropriate intervention if deemed necessary.

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ADAPTIVE BEHAVIOUR ASSESSMENT

Adaptive Behaviour Tests Administered:

Test Date of Administration

Adaptive Behaviour Assessment System–Second Edition (ABAS-II, 2008) 23/10/14 The Adaptive Behaviour Assessment System – Second Edition provides a comprehensive, norm-referenced assessment of adaptive skills for individuals ages birth to 89 years. The ABAS-II may be used to assess an individual’s adaptive skills for diagnosis and classification of disabilities and disorders, identification of strengths and limitations, and to document and monitor an individual’s progress over time. The comprehensive range of specific adaptive skills and broad adaptive domains measured by the ABAS-II correspond to the specifications identified by the American Association of Mental Retardation (AAMR; 1992, 2002b) and the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition Text Revision (DSM-IV-TR; American Psychiatric Association, 2000). The ABAS-II consists of 5 rating forms, which can be completed independently by a respondent or may be read aloud to a respondent who has limited reading skills. Each rating form is easy to complete and score, requiring approximately 20 minutes to complete and 5-10 minutes to hand score. Respondents read and respond to all items and rate the extent to which the individual performs the adaptive skills when needed. The rating scale for the items allows respondents to indicate if the individual is able to independently perform an activity and, if so, how frequent he or she performs the activity when it is needed.; 0 (Is not able), 1 (Never or Almost Never When Needed), 2 (Sometimes When Needed), or 3 (Always or Almost Always When Needed). Although it is possible to assess the adaptive skills of an individual with a single rating form, the use of multiple rating forms is recommended to provide a comprehensive assessment across a variety of settings. Significant limitations in adaptive behaviour are defined as performance at least 2 Standard Deviations below the mean on (a) the Conceptual, Social or Practical Domain, or (b) an overall score on a standardised measure that assesses these three adaptive domains (e.g. GAC).

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Skill Areas for Teacher, Parent and Adult Forms

Communication Speech, language, and listening skills needed for communication with other people, including vocabulary, responding to questions, conversation skills etc

Community Use Skills needed for functioning in the community, including use of community resources, shopping skills, getting around in the community etc

Functional Academics Basic reading, writing, mathematics and other academic skills needed for daily, independent functioning, including telling time, measurement, writing notes and letters etc

School/Home Living Skills needed for basic care of a home or living setting (or for the Teacher Form, school and classroom setting), including cleaning, straightening, property maintenance and repairs, food preparation, performing chores etc

Health and Safety Skills needed for protection of health and to respond to illness and injury, including following safety rules, using medicines, showing caution etc

Leisure Skills needed for engaging in and planning leisure and recreational activities, including playing with others, engaging in recreation at home, following rules in games etc

Self-Care Skills needed for personal care including eating, dressing, bathing, toileting, grooming, hygiene etc

Self-Direction Skills needed for independence, responsibility and self-control, including starting and completing tasks, keeping a schedule. following time limits, following directions, making choices etc

Social Skills needed to interact socially and get along with other people, including having friends, showing and recognising emotions, assisting others, using manners etc

Work Skills needed for successful functioning and holding a part or full-time job in a work setting, including completing work tasks, working with supervisors, and following a work schedule

Composite Score Scales The Conceptual Domain Composite score is derived from the sum of scaled scores from the Communication, Functional Academics and Self-Direction Skill Areas. Conceptual skills include receptive and expressive language, reading and writing, money concepts and self-direction. The Social Domain Composite score is derived from the sum of scaled scores from the Social and Leisure Skill Areas. Social skills include interpersonal relationships, responsibility, self-esteem, gullibility, naiveté, following rules, obeying laws and avoiding victimisation. The Practical Domain Composite score is derived from the sum of scaled scores from the Self-Care, Home/School Living, Community Use, Health and Safety and Work Skill Areas. Practical skills include basic maintenance activities of daily living (e.g., eating, mobility, toileting, dressing), instrumental activities of daily living (e.g., meal preparation, housekeeping, transportation, taking medications, money management, telephone use) together with occupational skills and maintenance of safe environments. The General Ability Composite (GAC) score is derived from the sum of scaled scores from seven, nine or ten skill areas, depending on the age of the individual and the type of rating form. The GAC represents a comprehensive and global estimate of an individual’s adaptive functioning. The GAC describes the degree to which an individual’s adaptive skills generally compare to the adaptive skills of other individual’s within the same age group.

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Adaptive Behaviour Test Results: Parent Form (Ages 5-21) The Parent Form is a comprehensive, diagnostic measure of the adaptive skills that have primary relevance for children’s functioning in the home and community, and can be completed by parents or other primary care providers. The Parent Form is used for children in grades Kindergarten (K) through 12 or ages 5-21 years. The form extends through age 21 to include special education students and other students who continue to be served through a secondary school setting. This form includes 232 items, with 21 to 25 items per skill area.

Age at Testing: 16 years 1 month

Table 1: Sum of Scaled Scores to Composite Score Conversions

Composite

Sum of Scaled Scores

Composite

Score

Percentile

Rank

95% Confidence

Interval

Qualitative

Range Conceptual 5 53 0.1 48-58 Extremely Low Social 2 55 0.1 49-61 Extremely Low Practical 4 40 <0.1 34-46 Extremely Low GAC 11 42 <0.1 38-46 Extremely Low

Adaptive Domain scores have a mean of 100 (50th percentile) and a standard deviation of 15. Percentile Rank refers to John’s standing among 100 individuals of a similar age.

John’s parent-report score on the General Adaptive Composite indicates that his overall level of adaptive behaviour falls at the <0.1st percentile (Extremely Low). John’s parent-report score on the Conceptual Domain fell at the 0.1st percentile, at the 0.1st percentile for the Social Domain and at the <0.1st percentile for the Practical Domain.

Table 2: ABAS-II Discrepancy Summaries

Domain Composite

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate Conceptual -- Social -2 7.78 No 44.0% Conceptual -- Practical 13 7.78 Yes 10.1% Social -- Practical 15 8.32 Yes 10.8%

Statistical Significance (Critical Values) at the .05 level Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant

Between Domain Interpretation: John functions much better on conceptual domain skills than on practical domain skills. The 13 point difference is statistically significant at the .05 level. John functions much better on social domain skills than on practical domain skills. The 15 point difference is statistically significant at the .05 level.

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Figure 1: ABAS-II Skill Area Scaled Score Profile

Table 3: Raw Score to Scaled Score Conversions

Skill Areas

Scaled Scores

Qualitative Range

Communication (Com) 3 Extremely Low Community Use (CU) 1 Extremely Low

Functional Academics (FA) 1 Extremely Low

Home Living (HL) 1 Extremely Low

Health and Safety (HS) 1 Extremely Low

Leisure (LS) 1 Extremely Low

Self-Care (SC) 1 Extremely Low

Self-Direction (SD) 1 Extremely Low

Social (Soc) 1 Extremely Low Scaled scores have a mean of 10 (50th percentile) and a standard deviation of 3.

Percentile Rank refers to John’s standing among 100 individuals of a similar age.

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Table 4: Strengths and Weaknesses

Skill Areas

Skill Area

Scaled Score

Mean Scaled Score

Differencefrom Mean

CriticalValue

Strength or

Weakness

Base RateConceptual Communication 3 1.67 1.33 1.66 >25% Functional Academics 1 1.67 -0.67 1.61 >25% Self-Direction 1 1.67 -0.67 1.60 >25% Social Leisure 1 1.00 0.00 2.38 100% Social 1 1.00 0.00 2.38 100% Practical Community Use 1 1.00 0.00 2.00 >25% Home Living 1 1.00 0.00 1.93 >25% Health and Safety 1 1.00 0.00 2.33 >25% Self-Care 1 1.00 0.00 2.33 >25% Statistical Significance (Critical Values) at the .05 level Skill Area Strengths and Weaknesses: Statistical analysis of the results revealed the following skill areas to be significant (.05) adaptive behaviour strengths or weaknesses relative to John’s own performance. Strengths: Zero significant (.05) adaptive behaviour strengths relative to John’s own performance were found. Weaknesses: Zero significant (.05) adaptive behaviour weaknesses relative to John’s own performance were found. Adaptive Behaviour Summary: John’s parent-report score on the General Adaptive Composite indicates that his overall level of adaptive behaviour falls at the <0.1st percentile (Extremely Low). John’s parent-report score on the Conceptual Domain fell at the 0.1st percentile, at the 0.1st percentile for the Social Domain and at the <0.1st percentile for the Practical Domain.

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COGNITIVE ASSESSMENT Psychometric Tests Administered:

Test Date of Administration

Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV, 2003) 23/10/14 Examiner’s Details: EXAMINER: Kristie Robins TITLE: Registered Psychologist REGISTRATION: #PSY0001579297 TEST SITE: Office at Psychological & Educational Consultancy Services Test Behaviour: No behaviours of interest were observed during testing. It is my opinion that the scores that John achieved on the WISC-IV are an accurate reflection of his cognitive functioning at this particular point in time. Psychometric Test Results:

Age at Testing: 16 years 1 month

Table 1: WISC-IV Index Scores

WISC-IV Index

Composite

Score

Percentile

Rank

95% Confidence

Interval

Qualitative Intellectual

Classification Verbal Comprehension (VCI) 71 3 66-82 Borderline Perceptual Reasoning (PRI) 71 3 66-82 Borderline Working Memory (WMI) 62 1 57-74 Extremely Low Processing Speed (PSI) 53 0.1 50-70 Extremely Low Full Scale (FSIQ) 58 0.3 54-66 Extremely Low

Index scores have a mean Composite Score of 100 (50th percentile) and a standard deviation of 15. Percentile Rank refers to John’s standing among 100 children of similar age.

Therefore, a Percentile Rank of 50 indicates that John performed exactly at the average level for his chronological age. Note: Information was substituted for Comprehension.

The Verbal Comprehension Index (VCI) incorporates the 3 subtests of Similarities, Vocabulary, and Comprehension and is designed to measure verbal abilities utilising reasoning, comprehension, and concept formation. The Perceptual Reasoning Index (PRI) comprises the 3 subtests of Block Design, Picture Concepts, and Matrix Reasoning and is designed to measure perceptual reasoning and perceptual organisation. The Working Memory Index (WMI) measures John’s ability to sustain attention, concentrate, and exert mental control. Mental control is the ability to attend to and hold information in conscious awareness whilst performing some operation or manipulation with it, and producing the correct result. Good mental control may facilitate the processing of complex information and ease the learning of new material.

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The Processing Speed Index (PSI) is an indication of the rapidity with which John can perform mental and graphomotor processing without making errors. Good speed of information processing may free cognitive resources for the processing of more complex information and ease new learning. The Full Scale (FSIQ) refers to John’s performance across all 10 of the core subtests of the WISC-IV and is generally considered the best estimate of general cognitive ability unless there is marked variability among the Index Composite Scores (ie 15+ difference between the Indexes).

Table 2: WISC-IV Index Discrepancy Summaries

WISC-IV Index

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate

Verbal Comprehension – Perceptual Reasoning 0 14.70 No Verbal Comprehension – Working Memory 9 13.79 No 24.6% Verbal Comprehension – Processing Speed 18 14.70 Yes 3.4% Perceptual Reasoning — Working Memory 9 15.28 No 28.8% Perceptual Reasoning – Processing Speed 18 16.10 Yes 3.3% Working Memory — Processing Speed 9 15.28 No 19% Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant. Between Index Interpretation: John’s performance on verbal reasoning tasks was commensurate with his performance on nonverbal reasoning tasks. The 0 point difference between the VCI and PRI scores is not statistically significant at the .05 level. The 9 point difference between the PRI and WMI scores is not statistically significant at the .05 level. John’s PRI score is significantly higher than the PSI score. This result suggests that John’s visual perceptual abilities may be hindered by slowed processing speed. Processing visual material quickly is an ability that John performs poorly as compared to his nonverbal reasoning ability. Furthermore, John’s score on the PSI has been identified as a significant weakness relative to his VCI score. These results suggest relatively slow speed in completing visual motor integration tasks but do not necessarily imply a relative weakness in processing auditory or complex problems. Because learning often involves a combination of routine information processing (such as reading) and complex information processing (such as reasoning), a weakness in the speed of processing routine information may make the task of comprehending novel information more time-consuming and difficult for John. Thus, this weakness in simple visual scanning and tracking may leave him less time and mental energy for the complex task of understanding new material. Poor performance on the PSI is characteristic of many neuropsychological conditions such as ADHD, anxiety, depression, and learning disorders.

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Processing Speed weaknesses can cause difficulty learning in the classroom and performing to ability in exams by:

• Difficulty processing large amounts of information, or being able to understand long, complex instructions.

• Poorer performance across timed tasks/exams relative to peers. These children need more time to be able to show what they do know.

• Being overall slower to complete tasks in class or for homework • Being slower at copying information down from the board, or writing down what the teacher is

saying. • Written work is very time consuming, it takes these children a long time to write down what they

know. • Easy to fatigue; these children need to use more cognitive resources to complete the same amount

of work as their peers. • Difficulty following conversations, or keeping track of the plot in books/movies

Table 3: WISC-IV Within-Index Discrepancies

Discrepancy Comparisons

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate

Digit Span — Letter-Number Sequencing -5 3.20 Yes 4.1% Coding — Symbol Search 1 3.90 No 42% Similarities — Picture Concepts 2 3.61 No 29.3% Digit Span & Arithmetic -2 3.30 No 34.3% Letter-Number Sequencing & Arithmetic 3 3.23 No 16% Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant. Within Index/Within-Factor Interpretation: John’s within-Index and within-Factor score pattern illustrated statistically significant discrepancies among the Working Memory Index, therefore, independent interpretation of the individual subtests comprising the WMI may be wise rather than interpretation of the Index as a whole.

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Table 4: WISC-IV Subtest Scaled Scores

Subtests

Scaled Score

Test Age

Equivalent

Percentile

Rank Verbal Comprehension Index Similarities 5 9:2 5 Vocabulary 6 9:10 9 Comprehension 1 7:2 0.1 *Information 4 8:6 2 Perceptual Reasoning Index Block Design 6 10:6 9 Picture Concepts 3 7:2 1 Matrix Reasoning 7 9:6 16 *Picture Completion 1 6:6 0.1 Working Memory Index Digit Span 1 <6:2 0.1 Letter-Number Sequencing 6 8:10 9 *Arithmetic 3 6:10 1 Processing Speed Index Coding 2 8:2 0.4 Symbol Search 1 0.1 See Appendix 1 for complete subtest descriptions. *Non-core subtest.

Figure 1: WISC-IV Subtest Scaled Scores

Vertical bar represents the Standard Error of Measurement.

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Table 5: WISC-IV Subtest Discrepancies From Index Subtest Mean

Subtest

Subtest Scaled Score

Mean ScaledScore

Difference

From Mean

Critical Cutoff

.05 Strength or

Weakness

Base

Rate@ Perceptual Reasoning Block Design 6 5.33 0.67 2.37 >25% Picture Concepts 3 5.33 -2.33 2.59 10-25% Matrix Reasoning 7 5.33 1.67 2.20 >25%

*Picture Completion 1 5.33 -4.33 2.50 Significant Weakness

Verbal Comprehension Similarities 5 4.00 1.00 2.43 >25% Vocabulary 6 4.00 2.00 2.47 10%

Comprehension 1 4.00 -3.00 2.77 Significant Weakness 5%

*Information 4 4.00 0.00 2.50 @ Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant. See Appendix 1 for complete subtest descriptions. *Non-core subtest.

Table 6: WISC-IV WMI and PSI Subtest Discrepancies From FSIQ Index Subtest Mean

Please note, the statistics provided in this table are not standard WISC-IV analyses and are provided as a guide only

Subtest

Subtest Scaled Score

FSIQ Mean Score

Difference From

FSIQ Mean

Nominal Critical Cutoff

.05 Strength or

Weakness Working Memory

Digit Span 1 3.54 -2.54 2.50 Significant Weakness

Letter-Number Sequencing 6 3.54 2.46 2.50 *Arithmetic 3 3.54 -0.54 2.50 Processing Speed Coding 2 3.54 -1.54 2.50

Symbol Search 1 3.54 -2.54 2.50 Significant Weakness

See Appendix 1 for complete subtest descriptions. *Non-core subtest.

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Intellectual Strengths and Weaknesses: Statistical analysis of the results revealed the following subtests to be significant (.05) cognitive strengths or weaknesses relative to John’s own performance. Strengths: Zero significant (.05) cognitive strengths relative to John’s own performance were found. Weaknesses: Four significant (.05) cognitive weaknesses relative to John’s own performance were found; namely Picture Completion, Comprehension, Digit-Span and Symbol Search. The Comprehension subtest requires the child to answer questions based on their understanding of general principles and social situations. It measures verbal reasoning and conceptualisation, verbal comprehension and expression, the ability to evaluate and use past experience, and the ability to demonstrate practical information. It also involves knowledge of conventional standards of behaviour, social judgment and maturity, and common sense. Picture Completion requires the child to view a picture and point or name the important part that is missing from the picture, within a specified time limit. It measures visual perception and organisation, concentration, and visual recognition of essential details of objects. The Digit Span subtest is composed of two parts: Digit Span Forward and Digit Span Backward. Digit Span Forward requires John to repeat numbers in the same order as read aloud by the examiner, and the Digit Span Backward requires the child to repeat the numbers in the reverse order of that presented by the examiner. This subtest measures auditory short-term memory, sequencing skills, attention and concentration. The Digit Span Forward task involves rote learning and memory, attention, encoding, and auditory processing. Digit Span Backward involves working memory, transformation of information, mental manipulation, and visuospatial imaging. The shift from Digit Span Forward to Digit Span Backward requires cognitive flexibility and alertness. John was required to scan a search group and indicate whether the target symbol(s) matches any of the symbols in the search group within a specified time limit on the Symbol Search subtest. In addition to processing speed, the Symbol Search subtest also involves short-term visual memory, visual-motor coordination, cognitive flexibility, visual discrimination, and concentration. It also taps auditory comprehension, perceptual organisation, and planning and learning ability.

Table 7: Process Discrepancy Comparison

Subtest/Process Score

Forward Scaled Score

BackwardScaled Score

Difference From Mean

Critical Cutoff

Exceeds .05 Statistical

Significance

Base

Rate@ Digit Span Forward – Digit Span Backward 2 3 -1 3.97 No 47.6% Statistical Significance (Critical Values) at the .05 level. Process Discrepancy Interpretation: John’s performance on the Digit Span Backward portion of the subtest was commensurate with his performance on the Digit Span Forward portion.

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SUMMARY Reason for Referral: John was referred to Psychological and Educational Consultancy Services (PECS) by Dr Jane Brown (Paediatric Neurologist) for a Comprehensive Psychological Assessment and indication of whether the results are reflective of an individual with Intellectual Disability (Intellectual Developmental Disorder). Current Concerns: From a presented list, John’s parents identified concerns in the following areas:

• Academic • Attention • Learning • Mathematics • Spelling • Reading • Written language • Anxiety • Medical or health • Fine motor • Memory

Academic Areas: Presented below are parent estimates of John’s achievement in the main academic areas:

Maths: Well Below Average Below Average Average Above Average Well Above Average Reading: Well Below Average Below Average Average Above Average Well Above Average Writing: Well Below Average Below Average Average Above Average Well Above Average Spelling: Well Below Average Below Average Average Above Average Well Above Average Language: Well Below Average Below Average Average Above Average Well Above Average John’s parents indicated John has received tutoring or extra remediation for the below academic areas:

Reading Writing Spelling Maths Speech and Language

Global Behavioural Assessment: John’s parents reported positive screens for:

• Generalised Anxiety Disorder • Separation Anxiety Disorder • Attention-Deficit/Hyperactivity Disorder: Combined Presentation • Autism Spectrum Disorder • Language Disorder • Speech Sound Disorder • Persistent Depressive Disorder • Oppositional Defiant Disorder • Specific Learning Disorder – with Impairment in Reading • Specific Learning Disorder – with Impairment in Written Expression • Specific Learning Disorder – with Impairment in Mathematics • Posttraumatic Stress Disorder

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Socio-Emotional Assessment: The BYI results indicate that the areas of Self-Concept, Anxiety, Anger, and Disruptive Behaviour warrant further investigation by a Psychologist to determine if they are indeed a genuine concern and if so, to provide appropriate intervention if deemed necessary. Adaptive Behaviour Assessment: John’s parent-report score on the General Adaptive Composite indicates that his overall level of adaptive behaviour falls at the <0.1st percentile (Extremely Low). John’s parent-report score on the Conceptual Domain fell at the 0.1st percentile, at the 0.1st percentile for the Social Domain and at the <0.1st percentile for the Practical Domain. Cognitive Assessment: John’s overall performance on the WISC-IV (FSIQ = 0.3rd percentile) fell within the Extremely Low range of intellectual functioning. The discrepancy between John’s Verbal Comprehension ability (VCI = 3rd percentile) and Perceptual Reasoning ability (PRI = 3rd percentile) scores was 0, which is not statistically significant at the .05 level. John achieved a score at the 1st percentile for Working Memory (WMI) and at the 0.1st percentile for Processing Speed (PSI).

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CONCLUSION INTELLECTUAL DISABILITY:

John’s combined cognitive (FSIQ = 0.3rd percentile) and adaptive behaviour (ABAS GABC <0.1st percentile) results illustrate that he meets the criteria of an individual with an Intellectual Disability and it can be described as being of a severe nature requiring a high level of ongoing support. John’s results qualify him for Education Support Unit/School placement should his parents wish to consider that type of educational placement. Alternatively, he can remain in mainstream schooling and be provided with additional support.

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RECOMMENDATIONS

Please note, PECS does not provide micro-strategies (e.g., sit student at front of classroom, etc) as part of their recommendations. PECS’s provides recommendations on what further assessment is required, what intervention is necessary, and who is the most appropriate to provide the assessment/intervention recommended. Paediatric Neurologist Involvement: (1) John should once again be seen by Dr Jane Brown, now that this new information is available for

incorporation into his paediatric assessment. School Involvement: (1) A case-conference involving John's parents, the school psychologist, and key school personnel

should be held to discuss John's individual learning requirements. Disability Services Commission: (1) John’s parents should provide a copy of this report to the Disability Services Commission.

Dr Shane Langsford

Date of Report Managing Director -PECS

Registered Psychologist APS College of Educational & Developmental Psychologists Academic Member

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APPENDIX 1 - WISC-IV SUBTEST DESCRIPTIONS

VERBAL COMPREHENSION Similarities The Similarities subtest involves the child being presented with two words

that represent common objects or concepts and describing how they are similar. It is designed to measure verbal reasoning and concept formation. It also involves auditory comprehension, memory, distinction between non-essential and essential features, and verbal expression.

Vocabulary The Vocabulary subtest comprises both picture and verbalised items. For picture items the child names pictures that are displayed in the Stimulus Book. For verbal items the child gives definitions for words that the examiner reads aloud. Vocabulary is designed to measure a child’s word knowledge and verbal concept formation. It also measures a child’s fund of knowledge, learning ability, long-term memory, and degree of language development. Other abilities that may be used by the child during this task include auditory perception and comprehension, verbal conceptualisation, abstract thinking, and verbal expression.

Comprehension The Comprehension subtest requires the child to answer questions based on their understanding of general principles and social situations. It measures verbal reasoning and conceptualisation, verbal comprehension and expression, the ability to evaluate and use past experience, and the ability to demonstrate practical information. It also involves knowledge of conventional standards of behaviour, social judgment and maturity, and common sense.

Information * The Information subtest involves the child answering verbally presented questions that address a broad range of general knowledge topics. It is designed to measure a child’s ability to acquire, retain, and retrieve general factual knowledge. It involves crystallised intelligence, long-term memory, and the ability to retain and retrieve information from school and the environment. Other skills that may be used by the child include auditory perception and comprehension, and verbal expressive ability.

Word Reasoning * Word Reasoning involves the child identifying the common concept being described by a series of clues. This task measures verbal comprehension, analogical and general reasoning ability, verbal abstraction, domain knowledge, the ability to integrate and synthesize different types of information, and the ability to generate alternative concepts.

PERCEPTUAL REASONING Block Design All items of the Block Design subtest require the child to view a

constructed model or a picture in the Stimulus Book, and use red-and-white blocks to re-create the design within a specified time limit. This subtest measures the child’s ability to analyses and synthesise abstract visual stimuli, It also involves nonverbal concept formation, visual perception and organisation, simultaneous processing, visual-motor coordination, learning, and the ability to separate figure and ground in visual stimuli. The subtest also involves visual observation and matching abilities for younger children, as well as the ability to integrate visual and motor processes.

Picture Concepts Picture Concepts involves the child being presented with two or three rows of pictures and them choosing one picture in each row to form a group with a common characteristic. This subtest measures abstract, categorical reasoning ability. Items are sequenced to reflect increasing demands on abstract reasoning ability.

Matrix Reasoning The child views an incomplete matrix and selects the missing portion from 5 response options on the Matrix Reasoning test. It measures fluid intelligence, visual information processing ability, and abstract reasoning skill.

Picture Completion * Picture Completion requires the child to view a picture and point or name the important part that is missing from the picture, within a specified time limit. It measures visual perception and organisation, concentration, and visual recognition of essential details of objects.

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WORKING MEMORY Digit Span The Digit Span subtest is composed of two parts: Digit Span Forward and

Digit Span Backward. Digit Span Forward requires John to repeat numbers in the same order as read aloud by the examiner, and the Digit Span Backward requires the child to repeat the numbers in the reverse order of that presented by the examiner. This subtest measures auditory short-term memory, sequencing skills, attention and concentration. The Digit Span Forward task involves rote learning and memory, attention, encoding, and auditory processing. Digit Span Backward involves working memory, transformation of information, mental manipulation, and visuospatial imaging. The shift from Digit Span Forward to Digit Span Backward requires cognitive flexibility and alertness.

Letter-Number Sequencing Letter-Number sequencing requires the child to read a sequence of numbers and letters and recall the numbers in ascending order and the letters in alphabetical order. The task requires sequencing, mental manipulation, attention, short-term auditory memory, visuospatial imaging, and processing speed.

Arithmetic * The child mentally solves a series of orally presented Arithmetic problems within a specified time limit on the Arithmetic subtest. It involves mental manipulation, concentration, attention, short-term and long-term memory, numerical reasoning ability, and mental alertness. It also involves sequencing, fluid reasoning, and logical reasoning.

PROCESSING SPEED Coding The Coding subtest involved John copying symbols that are paired with

simple geometric shapes or numbers. Using a key, John drew each symbol in its corresponding shape or box within a specified time limit. In addition to processing speed, the subtest measures short-term memory, visual and sequential processing, learning ability, cognitive flexibility, attention, and motivation.

Symbol Search John was required to scan a search group and indicate whether the target symbol(s) matches any of the symbols in the search group within a specified time limit on the Symbol Search subtest. In addition to processing speed, the Symbol Search subtest also involves short-term visual memory, visual-motor coordination, cognitive flexibility, visual discrimination, and concentration. It also taps auditory comprehension, perceptual organisation, and planning and learning ability.

Cancellation * On the Cancellation subtest, John was required to scan both a random and structured arrangement of pictures and mark target pictures within a specified time limit. This subtest measures processing speed, visual selective attention, vigilance, and visual neglect.

* denotes supplementary subtest which may not be administered unless deemed necessary

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CLINICAL COHORT RESEARCH FINDINGS Clinical Cohort: Premature Birth and Cognitive Difficulties: Children with a median age of 6 years, 4 months who were born at 25 weeks gestation or less (n=241) were compared with full-term birth classmates (n=160) on formal tests including standard cognitive, language, phonetic, and speech assessments. Extremely preterm children had an increased risk of language problems (odds ratio [OR] = 10; 95% confidence interval [CI] = 3 to 32), speech problems (OR = 4.4; 95% CI = 3 to 7), and overall school difficulties (OR = 25; 95% CI = 12 to 54). Extremely preterm boys were twice as likely to show deficits as extremely preterm girls, but no such sex-based differences were apparent in the comparison group. Differences in general cognitive scores explained specific language or phonetic awareness deficits, but not speech ratings or educational difficulties, in the extremely preterm children. Language or phonetic difficulties are not specific and indicate general cognitive functional difficulties. The findings have implications for models of global deviation of brain development in extremely preterm children. Similar studies have concluded that the impairment of motor, visuospatial, and sensorimotor function (including planning, self-regulation, inhibition, and motor persistence) contribute excess morbidity over cognitive impairment in extremely preterm children and contributes independently to poor classroom performance at 6 years of age. Sources: Marlow., N., Hennessy., E.M., Bracewell, M.A., & Wolke D. (2007). Motor and executive

function at 6 years of age after extremely preterm birth. Paediatrics, 120, p793-804.

Wolke,. D, Samara, M., Bracewell., M., & Marlow, N, (2008). Specific language difficulties and school achievement in children born at 25 weeks of gestation or less. Journal of Paediatrics, 152, A2.