PSYCHOLOGICAL EVALUATION
(Confidential)
Name:
Date of Birth:
Age:
Referred by:
Place of Examination:
Date of Examination:
Date of Report:
Examiner:
Adam Client
May 10, 1987
19
Psychiatrist’s Name
A private practice in Illinois
2006
2006
Carol L. Oster, Psy.D.
Reason for Referral:
Adam Client was referred for testing by Dr. Psychiatrist to clarify reasons for his recent
academic struggles, determine whether he has a learning disability, and facilitate academic
planning.
Procedures:
Clinical Interview of Mr. and Mrs. Client and Adam
Wechsler Adult Intelligence Scale III (WAIS-III)
Woodcock-Johnson Test of Cognitive Ability – Revised (WJ-Cog-R)
Woodcock-Johnson Test of Achievement – Revised (WJ-Ach-R)
16 Personality Factors Test (16PF)
Background Information:
The following background information is an amalgamation of data from interviews with A
and his parents.
At the start of testing, Adam Client was an 18 year old college student who had just
returned home from his second semester at Xxyy University, where he intended to major in
writing. Adam reported that he had left college because he felt intimidated by how
talented the other writing students were, and because he heard stories about how hard it is
to break into writing as a career. He felt hopeless about his chances for success.
According to Mr. and Mrs. Client, Adam did well enough in college classes except for one
class, which they feel he should have dropped. They stated that writing is not actually one
of Adam’s strengths, in their view. They pointed out that Adam has never liked to “show
his work” on tasks, that he dislikes writing with a pencil or pen, preferring a computer, and
that he has trouble getting started on tasks. Adam concurred that he has never wanted to
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bother with “busy work”. In fact, in third grade, the entire class was on a reward system
for perfect homework, and Adam was often the only one who did not turn in his work,
even though the whole class pressured him to do so. He remembered, “I just didn’t want to
do it,” and wondered, “Did I feel I was above it?”
Adam reported that he graduated high school with a 2.0 grade point average, and that he
was admitted to the college of his choice and a top writing program on the strength of his
ACT score of 29. This was the only school he applied to, and they accepted him without
seeing his high school transcripts. Adam is not sure what he will do if he does not pursue
writing, but is considering education and business as alternatives. His parents said they
would have predicted he would have chosen a science, such as veterinary medicine or
marine biology. They were concerned that he is choosing a major based on what his
friends choose, rather than selecting something in line with his own strengths and interests.
Adam reported that he participated in the high school radio station, serving as sports
journalist.
Adam and his parents reported that he was an early reader and that he always had
exceptionally strong memory. Adam reported he was the spelling bee champion in 4th and
5th grade. He learned math quickly and easily. He states that his favorite subject is history,
especially American history, and he described himself as a history buff. Math is his least
favorite subject, because he finds it repetitive. He described his science skills and interest
as “middle of the road”, pointing out that he is color blind, and that the color blindness
“screws [him] up inside,” making scientific observations difficult and frustrating.
Despite his academic strengths, Adam’s grades varied throughout junior high and high
school. He reported that his grades according to how lenient each teacher was regarding
homework and completion of other “busy work.” He has difficulty initiating tasks, but
“gets it done in the end.” He said it has always been a struggle to get started, and that he
“just needs to do his stuff” in order to do well. His standardized test scores have always
been above average.
Adam had hernia surgery in fourth grade, and two fused vertebrae in eighth grade. He also
reported he has had “a few concussions” from football and lacrosse injuries, in spring 2005
and “about four years ago”. He recalls that, “My head hurt for days,” but does not
remember any medical attention for either of the concussions. His parents are unaware of
any head injuries, and Adam reported that the coaches mostly had him “shake it off” when
he hurt himself. He has no history of ear infections, high fevers, or other illnesses beyond
those typical in childhood.
Adam’s father reported that he himself has difficulty with spelling and writing, and in fact
left a job because it demanded too much writing. Adam’s maternal uncle has “the same
issues” as Adam does, although Mrs. Client wondered if perhaps her brother is
underachieving due to laziness. Adam’s cousin has “some kind of processing problem”
and is an “underachiever”. There is no other history of mental illness or learning
difficulties in the family.
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At the time of testing, Adam was working as a teacher’s aide at an elementary school, a job
he very much enjoyed. He added janitorial duties to this at the end of the elementary
school year, which meant that he would be working full-time during the summer. He
spoke appreciatively of his relationships with adults at his job, and indicated his work was
supporting his budding interest in teaching. He had been in therapy with Dr. Psychiatrist
since his return from college, with a diagnosis of major depression.
Behavioral Observations:
Adam is a 19 year old college student who was both tall and “husky” in appearance. He
typically arrived for sessions wearing shorts, sandals, and a t-shirt. Although he was very
cooperative, friendly, and generally responsible, he had shorter persistence than would be
typical for his age. He usually “lost steam” within an hour or so of testing, and generally
did not sustain his effort beyond a second hour. Most teenagers younger than he are able
to sustain effort in 3-hour blocks with a break half-way through. At times, Adam appeared
inattentive to auditory stimuli, particularly if those stimuli were accompanied by visual
materials. He focused better when he could read along with verbal stimuli than when
stimuli were presented only verbally. He used reading to focus his attention. When tasks
required writing, Adam used extremely light pressure, barely touching pencil to paper and
using a grip more appropriate to painting than writing, and he did not use pencil and paper
to help with verbal math problems until he absolutely had to.
Within the limits of his ability to tolerate the length of testing sessions, Adam was
cooperative, invested, and persistent on challenging tasks, returning to items he had
difficulty with to try again. He needed no prompting to begin tasks, but did sometimes
seem ready to give up before he completed a task or before time ran out. His responses
sometimes had unusually long latencies, as if he was having trouble retrieving what he
knew.
Based on his cooperation and effort, the results are likely to be a valid assessment of
Adam’s current functioning.
Results:
Adam’s performance on the WAIS-III earned him an overall IQ score of 122, which is
within the superior range of intellectual functioning, higher than 93% of persons his age.
(IQ scores of 90 to 110 are average.) Were he tested again, there is a 95% chance that he
would score between 117 and 126.
WAIS-III subtests cluster in four broad areas of cognitive functioning called Indexes.
Adam’s index and subtest scores are as follows. Index scores of 90 to 110 and subtest
scores of 8 to 12 are average. Percentile indicates his standing relative to others his age.
4
A Client
Index
Verbal IQ
Verbal
Comprehension
Index
Vocabulary
Similarities
Information
Comprehension
Working Memory
Index
Arithmetic
Digit Span
Letter-Number
Sequencing
Score
130
129
Percentile
Index
98
Perceptual IQ
97
Perceptual
Organization Index
19
10
16
16
108
14
12
8
70
Picture Completion
Block Design
Matrix Reasoning
Picture
Arrangement
Processing Speed
Index
Coding
Symbol Search
Paired Recall
Free Recall
Score
110
123
Percentile
75
94
11
15
15
10
91
27
7
10
9-25
50
Adam’s Verbal Intelligence (VIQ) and Perceptual Intelligence (PIQ) scores are
significantly different, due entirely to the impact of his Processing Speed score on his PIQ.
The implications of this are addressed below.
Verbal tasks on the WAIS-III are of two types: those measuring verbal comprehension and
those measuring working memory. Verbal Comprehension tasks required Adam to
define words, answer common-sense questions about social situations, demonstrate his
fund of general information, and identify similarities between two concepts or words. On
these tasks, Adam scored in the very superior range. His vocabulary is particularly strong,
and his fund of general information is also a strength. Compared to his other verbal
abilities, his ability to handle abstract verbal concepts is relatively weak, although still in
the average range. This suggests that he is likely to interpret things more concretely or
literally than would be expected, given his overall intelligence.
The subtests that make up the construct Working Memory measured Adam’s ability to
keep information active in memory long enough to perform some cognitive operation on it.
Working memory is engaged when, for example, Adam tries to remember multiple things
he needs to do without a “to do list”, perform mental math, or take organized lecture notes
as the professor talks. Both Adam’s immediate auditory recall of meaningless information
(Digit Span and Letter-Number Sequencing) and recall and processing of meaningful
information (Arithmetic) are assessed in this area. Adam’s Working Memory score is
average to low average, and significantly below what would be predicted from his Verbal
and overall IQ. A probably has a harder time retrieving what he knows from memory, and
keeping it in mind long enough to solve problems, than would be expected from his overall
ability. Relatively low working memory can make it difficulty for him to demonstrate
what he knows on tests, particularly essay tests where he has to keep in mind not only
complex instructions, but also an array of facts. Adam probably experiences this problem
most acutely when he is struggling to master or express his understanding of novel
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material, where his prior learning does not provide him with easy cues to aid recall. As he
begins to learn a new task, he will struggle to remember new concepts “on the fly”, but as
he becomes familiar with the vocabulary, concepts, and relationships in new material, his
performance will more closely match his potential.
Non-verbal tasks on the WISC-III are of two types: those measuring visual-perceptual
reasoning, and those measuring speed of information processing. The first of these,
Perceptual Organization, required Adam to use visual models to guide hands-on problem
solving, understand visual concepts, use abstract reasoning to solve visual problems, and
distinguish between essential and non-essential visual detail. Adam’s performance in this
area was in the superior range, comparable to his Verbal Comprehension. He performed
relatively better on tasks that required abstract visual problem solving, and less well when
attention to visual detail or visual analysis of social situations was required. He may be
more successful using his strong visual talents in puzzling out how things fit together or
work than he is in understanding social situations using visual cues. That is, he may not
“read people” as well as he would like to, and this may come across as lack of social grace
at times. The difference between his visual and verbal abstract reasoning abilities, as
measured by the WAIS-III, reinforces the hypothesis that he has difficulty expressing what
he knows.
Processing Speed subtests assess the speed with which Adam learns, and his visual
attention and alertness. The resulting score is a general indicator of the speed with which
he learns new material, integrates new information with what he already knows, and
processes information. Adam’s Processing Speed score is in the average to low-average
range, significantly lower than all of his other scores. His lower processing speed likely
impairs his performance on a variety of academic tasks, including reading comprehension,
performance on tests and other time-limited tasks, note-taking, and so on, because it takes
longer for Adam to incorporate and respond to new information. It will take more
repetitions for him to register new material than would be expected from his general
intellectual ability.
Working memory and processing speed are vulnerable to neurological problems such as
learning disabilities, injury, and neurological disorders. The General Ability Index is
calculated from the WAIS-III subtests that are less reactive to neurological problems, and
is used in place of the FSIQ when there is a significant difference between the person’s
verbal and perceptual reasoning on the one hand and working memory and processing
speed on the other hand. The GAI is considered to be a more pure assessment of overall
ability. Adam’s GAI is 131, significantly higher than his Full Scale IQ of 122. The
difference indicates that Adam’s lower processing speed and working memory are
significantly affecting his cognitive functioning.
The Woodcock-Johnson Test of Cognitive Abilities – III also assesses intellectual
processes and helps identify information processing deficits. Comparison with the WISCIV sheds further light on any problems identifies by the first test. The Woodcock-Johnson
Achievement Test – III, in contrast, is generally taken as an assessment of the person’s
acquired knowledge compared to that of age mates. Both information processing problems
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and differences between ability and achievement may suggest a learning disability. The
subtests of the Woodcock-Johnson cluster in various ways to reveal strengths and
weaknesses, and Adam’s scores are reported on the next two pages.
Adam’s pattern of relative strengths and weaknesses on the WJR-Cognitive Test is
consistent with his performance on the WAIS-III. His Verbal Ability, the best indicator of
overall intelligence, is superior, virtually identical to his FSIQ on the WAIS-III. His
memory and his processing speed are both average to low average on this test, significantly
below his Verbal Ability. Further, both of these functions fluctuate depending on the type
of task. Where the task calls for not just reacting but also working through a problem, his
processing speed is lower. Since academics require judgment and processing of complex
information, his processing of academic tasks will be much slower than predicted by his
overall intelligence.
Of particular concern is Adam’s very low delayed recall of both visual and auditory
information. Delayed recall is the ability to pull information from memory after a longer
period of time – in the case of this test, after a half hour to an hour. Adam’s scores on
measures of delayed recall are in the lowest one percent of the population, suggesting that
what he learns is either not easily transferred to his long-term memory (He remembers it
when asked to repeat, but cannot remember it just a short time later.) or that he is having
difficulty accessing what is in his long-term memory (He knows it, but cannot easily pull it
out of memory.). Either of these will seriously impact academic functioning, particularly
on tests.
Adam’s scores on the WJR-Achievement test indicate that his overall academic
achievement (Total Achievement = 112) is lower than would be predicted by his general
ability (GAI = 131). In some areas, particularly speed of academic performance
(Academic Fluency = 104), the difference between expected and observed performance
rises to the level of a learning disability. In other areas, such as his written language skills,
his performance is superior, in line with his overall ability. The effects of lower processing
speed and memory are evident in his scores on Story Recall, Understanding Directions
(which requires working memory), and all fluency tasks. (Fluency = speed.) He needs
extra time to complete in-class tasks such as time-limited tests.
Adam’s written language skills and reading skills are much stronger than his oral language
skills. The primary reason for the discrepancy is his difficulty with rapid processing of
what he hears. He will learn best from reading, and he will best express what he knows in
writing. He will need both adequate preparation time and supportive materials to manage
oral presentations in front of groups, and he will need supportive materials to help him
capture lecture material.
(Discussion of test results continues on the bottom of page 8.)
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A Client
W-J Cognitive Results
Cluster/Test
Verbal Ability
Cognitive Efficiency
Decision Speed
Cognitive Fluency
Comprehension-Knowledge
General Information
Verbal Comprehension
Knowledge
Working Memory
Numbers Reversed
Auditory Working Memory
Memory for Words
Long-Term Retrieval
Visual-Auditory Learning
Retrieval Fluency
Delayed Recall
Visual-Auditory Learning Delayed
Short-Term Memory
Fluid Reasoning
Concept Formation
Analysis-Synthesis
Planning
Processing Speed
Visual Matching
Decision Speed
Pair Cancellation
Broad Attention
Numbers Reversed
Auditory Working Memory
Pair Cancellation
Executive Processes
Concept Formation
Planning
Pair Cancellation
Visual-Spatial Processing
Spatial Relations
Picture Recognition
Planning
Functioning Level
56
84
74
84
60
45
55
34
28
Standard
Score
122
100
94
104
122
121
122
118
96
115
78
92
101
98
111
Z=-4.17
Z = -5.95
102
115
110
115
104
98
102
94
91
83
7
28
50
74
60
28
47
60
35
60
115
78
91
100
110
104
91
99
104
94
104
High Average
Below Average
Average
Average
High Average
Average
Average
Average
Average
Average
Average
%ile
93
51
34
60
93
92
93
88
40
83
7
30
53
44
78
Superior
Average
Average
Average
Superior
Superior
Superior
High Average
Average
High Average
Below Average
Average
Average
Average
High Average
Very Low
Very Low
Average
High Average
High Average
High Average
Average
Average
Average
Average
Average
8
A Client
W-J Achievement Results
Cluster/Test
Broad Reading
Letter/Word Identification
Reading Fluency
Passage Comprehension
Basic Reading Skills
Reading Comprehension
Story Recall
Story Recall – Delayed
Word Attack
Reading Vocabulary
Oral Language
Understanding Directions
Oral Expression
Listening Comprehension
Oral Comprehension
Picture Vocabulary
Broad Written Language
Spelling
Writing Fluency
Written Expression
Writing Samples
Basic Writing Skills
Editing
Punctuation & Capitalization
Broad Math
Calculation
Math Fluency
Applied Problems
Math Reasoning
Quantitative Concepts
Academic Skills
Academic Fluency
Academic Applications
Academic Knowledge
Total Achievement
%ile
72
82
57
81
82
80
51
74
69
60
28
61
58
75
63
95
95
75
87
94
93
72
90
63
46
45
77
71
61
87
60
87
80
80
Standard
Score
109
114
102
113
114
112
100
Z=.61
110
108
104
91
104
103
110
105
125
125
110
117
123
122
109
119
105
98
98
111
108
104
117
104
117
113
112
Functioning Level
Average
High Average
Average
High Average
High Average
High Average
Average
Average
High Average
Average
Average
Average
Average
Average
High Average
Average
Superior
Superior
High Average
High Average
Superior
Superior
Average
High Average
Average
Average
Average
High Average
Average
Average
High Average
Average
High Average
High Average
High Average
(Discussion of test results continues here.)
Adam’s pattern of scores on all tests is not attributable to depression or other emotional
factors alone. Research demonstrates that depression has a mild impact on processing
speed, and little impact on memory as assessed by these tests. Emotional or motivational
factors are, therefore, not adequate explanations for Adam’s test results.
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Throughout the tests, Adam’s pencil grip was very atypical, and his strokes on paper were
typically very light, almost as if it is painful for him to produce typical pressure on paper.
This needs evaluation by a doctor specializing in hand and wrist, with attention to possible
explanations such as carpal tunnel syndrome or other nerve or muscle damage.
Adam also took the 16 Personality Factors Questionnaire (16PF), to determine how
emotional and personality factors contribute to his academic difficulties, and to help
identify personality strengths and patterns that may help him make decisions about his
education and career. The 16PF is frequently used in career counseling and in counseling
individuals with no psychopathology.
Adam’s responses on the 16PF were typical of an individual with above-average creative
potential. He is likely to be nurturing of others, and to have altruistic motivations. He is
also likely to be more emotionally responsive than the typical male, reflected in his
parents’ view of him as “sensitive”. Adam has a strong imagination and a tendency to be
absent-minded. He is more interested in ideas than practical details, and probably needs to
consciously attend to details when needed. He can be creative and innovative, yet logical,
in his problem-solving. He has a strong independent streak, and can be quite stubborn
about doing things his way. His communication style is likely to be assertive and direct.
He may occasionally come across as so self-assured as to be “smug”, but this likely covers
some anxiety about his abilities, and will likely moderate to a confident demeanor as he
finds himself in his early to mid-career.
Adam’s overall style is similar to individuals who seek out and are both successful and
happy in careers that allow independence, creative self-expression, and strong nurturing
connections with others, while rewarding assertiveness and forthright communication. His
scores were most like those of school counselors, social workers, elementary school
teachers, career counselors and personnel managers, but also similar to bank managers and
persons in sales and real estate. The skill set for each of these careers includes sensitivity
to others’ needs and desires, the ability to communicate, and an ability to invest in the
success of others. Further, each of these careers requires the professional to be
independent in judgment and action. For example, a teacher must be sensitive to what a
student needs in order to learn, the ability to communicate new material, dedication to
helping students succeed, and the ability to function without supervision and to direct the
activities of an entire classroom of children. Real estate sales requires the ability to draw
out from the buyer or seller what they need, dedication to meeting those needs, the ability
to communicate well with adults, and strong independence and competitiveness.
Adam’s scores were only moderately like those of professional writers or journalists,
suggesting that his initial choice of writing may not be a good fit for him. His more recent
interests in education and business are better fits. If he seeks a career in business,
however, he should focus on people rather than products or profit, to best match his
strengths and personality.
10
A Client
Summary:
Adam Client is a 19 year old college student referred for testing to determine whether he
has a learning disability that might account for his history of poor academic performance
relative to his apparent overall intelligence, and to provide additional guidance in academic
decision-making.
Adam participated willingly and cooperatively in testing. He earned a superior intelligence
score (FSIQ = 122). His General Ability Index of 131, in the very superior range, is a
more accurate indication of his overall intelligence. Adam’s average to low average
processing speed and his average working memory are significantly below his GAI, and
indicate the possibility of some neurological problem that may be attributable to either
learning disability or possible sports-related injury. Adam’s achievement scores were
inconsistent, reflecting the relative influence of memory and processing speed on the tasks
on the test. His strengths were in reading comprehension and written expression. He
demonstrated a serious weakness in delayed recall, and a relative weakness in processing
speed or academic fluency. The differences rise to the level of a non-specific learning
disability due to impairment of critical information processing functions necessary for
learning and academic performance. Throughout testing, Adam used a very unusual pencil
grip and very light writing pressure, suggesting the need for further evaluation by a
hand/wrist specialist, or possibly neurologist.
Adam’s 16PF responses indicate he will do well in fields that engage his creative,
expressive, nurturing, independent, and assertive characteristics. These include teaching,
counseling, sales, and similar people-oriented careers.
Diagnosis:
Axis I:
Axis II:
Axis III:
Axis IV:
Axis V:
Previously diagnosed with depression by Dr. Psychiatrist
Learning Disability NOS –
deficits in processing speed, retrieval, and working memory
None, per client and parent report.
Past history of possible concussions.
Rule out problems with grip strength or other explanations for unusual
pencil grip and light pencil pressure.
Psychosocial Stressors:
Moderate: academic problems and confusion about career and academic
direction.
Global Assessment of Functioning: N/A to this assessment.
Recommendations:
1. To address Adam’s relatively low working memory and problems with delayed
recall:
a. Use memory aids whenever possible. These may include simple steps such
as making lists or using Post-a-Notes to remember daily tasks to using a
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A Client
b.
c.
d.
e.
f.
day-minder, appointment book, the alarm setting on a cellular phone, or a
Palm Pilot type of device.
Use mnemonic devices to help remember important information for tests.
These include things like using the acronym HOMES to remember the
Great Lakes. Ask teachers for similar memory “tricks” for critical
information.
Another method to improve memory is to tell oneself a memorable story
about the information that includes strong auditory or visual clues.
Relate new information to information you already know, to make it more
familiar. Look for parallels and commonalities to enhance both learning
and recall, and to speed up recall.
Utilize repetition to both register and practice rapid recall of new material.
Take in information on multiple modalities: read it, listen to it, do it, recite
it to yourself. This provides multiple opportunities to learn and to register
the information in more than one way.
2. Adam’s low processing speed, particularly in combination with his relatively low
working memory and impaired delayed recall, significantly impair his academic
performance and rise to the level of a non-specific learning disability requiring
accommodation. The following accommodations and suggestions address this
issue:
a. Provide extended time for in-class assignments such as tests.
b. Allow taping of class lectures so that he does not have to take in everything
at once.
c. Provide copies of notes, or facilitate note-sharing, so that Adam can both
attend to the lecture and be able to compare his notes to those of a peer to be
sure he has gotten down everything he needs.
d. Reduce demands on rapid retrieval by allowing full preparation for any
verbal tasks. I.e., do not require extemporaneous verbal presentations.
e. Reduce the length and complexity of verbal instructions. Present verbal
instructions as a series of steps. Supplement verbal explanations with
written instructions.
f. Allow written demonstration of what he knows rather than grading on
verbal participation.
3. A can address his slower processing speed by the following:
a. Compare your class notes with those of a peer to make sure your notes are
complete.
b. Pad your schedule to make sure you have adequate time for homework,
papers, and other tasks. Give yourself a “time and a half” accommodation.
c. Develop a habit of asking for repetition and clarification of points in a
lecture. This earns you “participation points.” Further, if you have a
question about the material, others in the class do, too!
d. Repeat important information in conversation or discussion, to give yourself
more time to register and respond to it.
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A Client
e. Develop “scripts” for gaining extra time, such as, “Let me think about it and
get back to you,” or “Let me check on that before I commit myself,” or “I
wonder if we need more information before we finalize what we’re doing.”
4. To address observed pencil grip problems include:
a. Follow up with a hand/wrist specialist to evaluate Adam’s difficulties with
writing using a pencil or pen.
b. Adam should be allowed to complete class work and in-class tests using a
computer rather than using handwriting.
5. In regard to career direction, while writing requires the independence,
assertiveness, competitiveness, and interest in others seen in Adam’s personality, it
is not a good fit for him due to his strong compassionate and altruistic interest in
fostering others’ development. Journalistic writing’s “cut-throat” environment will
violate some of Adam’s deeply held values. He will likely be happier in fields that,
while rewarding his independence and assertiveness, also engage his creative,
expressive, and nurturing characteristics. These include teaching, counseling, sales,
and similar people-oriented careers.
6. Adam should continue to work with Dr. Psychiatrist to address his depression and
anxiety relative to his academics, as well as to help him further clarify his career
direction.
It was a pleasure working with Adam. If I can be of further assistance, please contact me.
_______________________________
Carol L. Oster, Psy.D.
Clinical Psychologist
Illinois License #nnnnnnnnnnn