Date of Report: 6-17-99
Name: Alex
Date of Birth: 7-18-91
Age: 7-10
Sex: Male
Grade: Rising 3

REASON FOR REFERRAL:

Alex was referred for evaluation because of his difficulty attending and following through with tasks in the allotted amount of time. Accordingly, he is not progressing as quickly as most average second graders. Between the time that Alex was referred, and when he was evaluated, he was diagnosed by Dr. Frank with Attention Deficit Disorder without hyperactivity and placed on stimulant medication (during the week of May 10^th). According to the teacher, since medication there is significant improvement in task completion in the classroom, although Alex’s rate of work tends to be a little slower than many of the children. On the referral form, Alex was reported by his teacher to be working below grade level in math and language arts, and at grade level in science and social studies. However, at the time of evaluation, the teacher showed the examiner the results of a recent reading test, which he had passed at the 2.8 grade level with 92% accuracy.

Behaviors noted on the referral form as being typical of Alex include: easily distracted; trouble finding place; avoids eye contact; difficulty copying; careless/doesn’t complete tasks; short attention span; friendly; easily frustrated; neat appearance; demands excessive attention; daydreams; cooperative; does not follow directions (when he doesn’t understand in academic situations). Alex was also described by his teacher on the referral form as a "warm, friendly young man. He is very polite and has a great sense of humor."

Behaviors noted in anecdotal records maintained by the teacher during February included: difficulty starting and completing morning work; difficulty paying attention and keeping up with written examples during math (subtraction renaming); difficulty finding words in the dictionary; difficulty paying attention to discussion during health lesson; difficulty staying on task and copying sentence at end of spelling test; difficulty following along in his book while teacher read orally to class during guided reading; needed help with several words during independent reading; difficulty finishing morning work on time; difficulty locating and recording low and high temperatures on a given day from a picture; difficulty attending to book he was reading during independent reading. Interventions used include: assigning a partner to read together; individual assistance; physical proximity of teacher who pointed out where he should be following along; had a fifth grade helper to read with him; extra use of samples materials; extra drill and practice; reduced language level of materials; behavioral contract; peer tutoring; daily review of classroom rules; teach study/test taking/homework strategies. Improvement was noted, but the issue persisted.

SCREENING RESULTS

Vision and hearing screenings dated 3-16-99 were passes. Speech-language screenings dated 3-29-99 were passed. P.E. screening dated 3-15-99 was passed.

BACKGROUND INFORMATION:

According to information provided by the mother on a Health and Developmental History form dated 3-24-99, Alex is the oldest of two boys living with their adoptive parents. Alex’s responsibilities at home include making up his bed, setting the table, cleaning off the table, or getting the condiments, and cleaning up his room. There is limited information available about Alex’s biological parents.

Since his adoption, Alex has been hospitalized twice: once in April, 1994 in re: TB tests, and again in December, 1996 for a T&A. Prior to the T&A, Alex had ear infections and some hearing loss due to fluid. Alex has allergies and takes medication. More recently (April, 1999), Alex was diagnosed with Attention-Deficit Disorder without hyperactivity by Dr. Frank, and now takes Ritalin. Language development is unknown, although Alex spoke a different language when he was placed with his current family, and began learning English within a few months after arrival in this country. He spoke in sentences after about five months with his current family, when he was 3 years, 2 months. Toilet training was accomplished at 2 years, 11 months. Alex sometimes gets distracted at the table and forgets to keep eating. He will eat slowly, likes a wide range of foods, is small, and possibly underweight.

The mother reported that "Alex is usually a pleaser and usually follows directions in school but once home can throw fits about doing homework, eating or getting ready for bed." Most of the time Alex follows oral directions at home, but he can get distracted and not follow through. Sometimes he has difficulty waiting for his turn or interrupting. He enjoys active, loud games, plays war, guns, fighting bad guys, and plays with legos. Alex does not engage in risky behaviors, but does have frequent accidents.

The mother noted her feeling that Alex has average ability to learn and that he does not like to put forth effort on anything that is hard for him. Alex did well in Montessori (there for the 2, 3, and 4 year old program), was learning, making progress, a model student cooperating with the teacher and following directions. In March ’96, he was placed in language therapy once a week fro the rest of the ’95-’96 school year. The Mother’s major concern about Alex is his inability to stay on task. She noted Alex’s strengths as spatial concepts, puzzles, building with legos, and his weaknesses as: phonological awareness, reading decoding, sight word knowledge, basic math facts, math concepts, and fine motor skills (cannot hold pencil correctly and writes/bears down hard). The mother also noted that Alex processes information slowly, and needs time to think and talk about even topics that interest him. As schoolwork has become more difficult requiring more independent work, the mother reported decreased effort on Alex’s part, and increased difficulties with concentration and sustained attention. The difficulties with concentration and sustained attention are also apparent in other activities such as eating meals, roller blading, riding his bike, playing soccer, working at the computer, or listening to a story. He also has difficulty getting started on a task. The mother reported that Alex says he cannot write as well as others in his class. He does better answering comprehension questions when stories are read to him than when he has to do the reading. Alex "says he doesn’t do well in his work because he has to read hard words by himself and therefore cannot do his work."

Alex is described by his mother as being very considerate, compassionate, understanding, caring, and loving. Behavior management plans are in place at home for morning behavior, school behavior (paying attention, completing work, participating in class), homework behavior (no tantruming), and work chard (making the bed).

PREVIOUS TEST RESULTS:

This is apparently an initial psychoeducational evaluation for Alex.

CSAB score was reported as 92 (9/97).

Alex has been evaluated at the Educational Services Clinic, College of Education, USC, during the summer of 1996, and again during May, 1997. Results are available in reports.

BEHAVIORAL OBSERVATIONS:

Classroom:

Alex was observed in his classroom during language arts for approximately 30 minutes during a story writing activity. He was to copy from his paper into a book and illustrate his writing. Most of the time, Alex appeared intensely involved in the assignment (81% of the time vs. 74% for his classroom peers). He did get out of his seat to sharpen his pencil and stood up several times. Alex appeared to spend a little more time illustrating what he wrote than actually writing it. The teacher came to him several times to give him feedback and encourage him to finish. Generally, Alex’s printing was larger than many of the other children’s’, he tended to write less, and it appeared obviously more pressured.

Testing:

Although Alex was fully cooperative throughout the evaluation sessions, there was a difference in the level of his cooperation when he was tested as a part of the regular school day and when he was taken from the summer camp program to be tested after school had let out. As a part of the regular school day, Alex came willingly with the examiner (after getting the o.k. from his teacher) and seemed intense, motivated to do well. He did choose not to come with the examiner on several days at the very end of the school year when either fun or more unusual things were happening, and he was not pushed to do so. When taken from safari during summer vacation, Alex was resistant, and was clear that he had agreed to only fifteen minutes! Although he reminded the examiner rather frequently about the fifteen minutes, he did appear to put forth good effort in between the reminders!

Some impulsivity was apparent when Alex began a task before the directions were completed. When copying symbols, Alex appeared to have some difficulty tracking form one line to the next.

About school, Alex said that he had had a "fun" year. He could not say what he likes best at school, sometimes, he does not like math. Alex said that he is best at reading, sometimes he is worst at math, sometimes the math scroll is easiest, and math is hardest for him. Alex said that he likes his teacher who he said is "real fun". Alex said that he has friends at school, and that he does not get into that much trouble. He did go on to report about a boy who Alex said calls him names like "Chinese" when he was not born there, and that hurts his feelings. He said that when this happens, he sometimes tells the teacher (not often), and she says to try to work it out first.

A right handed pencil grip was used. Alex’s grip was tense, his hand trembled on some of the more difficult items, he exerted a lot of pressure on the pencil, and sometimes lifted his hand up off the paper while writing/drawing.

When his is not at school, Alex said that he likes to play in the backyard and play with a neighbor. When he grows up, Alex said that he wants to be somebody who "fixes stuff".

PRESENT TEST RESULTS

To obtain an understanding of Alex’s cognitive abilities, the WISC-III was administered. The WISC-III is an individually administered test of general intellectual ability, which is typically used to predict a child’s ability to perform in school. It provides up to 13 subtest scores, separate scores for verbal, performance, and overall learning aptitude, in addition to scores pertaining to distractibility and processing speed. Average IQ and Index scores are considered to be between 90 and 109, low average scores between 80 and 89, and high average scores between 110 and 119. On this measure, the following scores were obtained:

Verbal Scale IQ = 97 Verbal Comprehension Index = 98

Performance Scale IQ =108 Perceptual Organization Index =114

Full Scale IQ =102 Freedom From Distractibility Index = 87

These scores are generally in the average range, overall at the 55^th percentile. However, Alex’s Perceptual Organization Index is significantly higher than his Verbal Comprehension Index (82^nd percentile vs. 45^th percentile). His Freedom From Distractibility Index is his lowest score, at the 19^th percentile. Relative to his other nonverbal abilities, Alex did least well on a timed, paper and pencil copying task; he did best on a task involving synthesis skills, putting together parts into a whole.

To assess single word receptive vocabulary, the PPVT-RL was administered. On this measure, the student is asked to select which of four pictures on each page best shows the meaning of a word spoken by the examiner. The following scores were obtained: standard score equivalent = 104; percentile rank = 61^st; age equivalent = 8 years, 2 months. These scores are in the average range.

To obtain understanding of Alex’s visual-motor integration skills, the Developmental Test of Visual-Motor Integration Skills was administered. This test requires the student to copy designs (three per page) using paper and pencil. On this measure, the following scores were obtained: standard score equivalent = 98; percentile rank = 45^th; age equivalent = 7 years, 6 months. These scores are in the average range.

To obtain a current understanding of Alex’s academic skills, a Learning Specialist, administered portions of the WJTA-R. Average standard scores are generally considered to be between 90 and 109, high average standard scores between 110 and 119, superior standard scores between 120 and 129, low average standard scores between 80 and 89, and borderline standard scores between 70 and 79. The following scores were obtained:

These scores are generally in the low average range, significantly below Alex’s WISC-III nonverbal abilities.

To further assess Alex’s reading skills, he was asked to read three second grade reading passages. The median number of words read correctly per minute was 46. The average number of works read correctly for second grade students in the spring of the year is 65 to 124, which places Alex’s performance in the lowest quartile. Alex needed some words provided (e.g., danced, wonder, carry, under, wagon, soccer, hated, Jason, newest, flowers, growing). He misread several words (e.g., "threw" for thought; "cold" for could; "the" for his), omitted a word (for), and self-corrected a work he initially ready incorrectly. Alex tended to read word for word and through punctuation marks.

Both of Alex’s parents and his teacher completed Achenbach behavior checklists. The Achenbach checklists contain 112 brief descriptions of behavior, which contribute to eight general behavior scales that are often of interest to parents and teachers (Withdrawal, Somatic Complaints, Anxious/Depressed, Social Problems, Thought Problems, Attention Problems, Delinquent Behavior, Aggressive Behavior). Both parents’ ratings of items were significant on the Attention Problems Scale (>98^th percentile), and elevated on the Aggressive Behavior Scale (90^th and 92^nd percentiles. The mother’s ratings were elevated on the Thought Problems Scale (95^th percentile), and the father’s ratings were elevated on two scales: Delinquent Behavior (90^th percentile), and Somatic Complaints (86^th percentile). All of the teacher’s ratings of items were within the normal, average range.

SUMMARY AND RECOMENDATION:

Alex’s scores meet the school district’s criteria for classification with learning disabilities in basic reading skills, reading comprehension, math calculation, math reasoning, and written expression as a result of a significant discrepancy between his nonverbal abilities as measure on the WISC-III and his WJTA-R standard scores. He is eligible to receive special education services.

It is suggested that the multidisciplinary team meet to discuss/determine the most appropriate way(s) to meet Alex’s educational needs. Consideration will need to be given to the balance of pull out special education services and participation in the regular education program, accommodations needed in the regular classroom (e.g., more time for certain assignments and/or reduced amount of work), and developing expectations appropriate for Alex so as to reduce the amount of frustration involved in his learning that seems to be expressed primarily at home.

On-going communication/coordination with the parents and physician concerning attention issues will be important.