NAME OF DISTRICT
DEPARTMENT THAT YOU ARE HOUSED IN (E.G., SPECIAL EDUCATION)
CONFIDENTIAL PSYCHOEDUCATIONAL REPORT
NAME:
STUDENT NUMBER:
AGE:
GENDER:
BIRTH DATE:
PARENTS:
ADDRESS:
SCHOOL:
GRADE:
DATES EVALUATED:
EXAMINER:
All parts of the name should be written here
The district may or may not require this
Years-Months
Male/ Female
Use U.S. date notation here (mm/dd/yyyy)
Both if available. In some groups, even if m and d are
married, they may not have the same last name. Check.
Use U.S. Address notation here
(### Name Street, City, State, Zip)
Write the complete name for the school
Use numeric grade for K-12, say Pre-K for below K, and
use freshman, sophmore, etc. for college level.
List all dates for the current evaluation (include
interview and intake dates as well
Your name, your credentials (e.g., John Smith, M.S.)
PLEASE NOTE: This is a confidential psychological report to be kept in a locked file
made available only to those professional school personnel directly concerned with the
student or other agencies upon receipt of the parent's or guardian's signed release. This
report MUST NOT BE COPIED OR DUPLICATED. It is the responsibility of the
Individualized Education Program (IEP) Team and not the examiner to determine a
student’s educational performance or educational placement.
REASON FOR REFERRAL
The person or group who referred student referred Name for a psychoeducational
evaluation due to difficulty in list all academic, social, and emotional referral problems.
Several modifications were made prior to this referral. Included in these were list all
prereferral interventions (for a bilingual child, make sure that you include any bilingual
education program or specialized intervention that was targeted to second language
acquisition). Describe impact of the interventions (e.g., even with these modifications,
Name continued to struggle).
BACKGROUND INFORMATION
Describe the sources of information (include any specific types of records (educational,
medical, previous psychological, etc.) and include any personal contacts and interviews).
Background information was obtained from a questionnaire completed by Name’s
mother, Ms. Person, on 01/01/2001, as well as a review of educational records and an
interview with his teacher, Ms. Learn, on 01/01/2001. Describe background information
chronologically starting with his prenatal history through to his current information.
Include medical, developmental, psychological, and educational information here. If
there is nothing abnormal to note in any of these categories, note this example. Name
Name Middle Last
Town Elementary School
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was born following a normal pregnancy and caesarean delivery. He met his
developmental milestones (e.g., walking and talking) at expected intervals. He has no
history of any medical problems.
For a bilingual child, describe any and all knowledge of the child’s language
development. Make sure that you talk about educational history here in both languages
as well as any history of frequent moves or school changes. Make sure that you include a
statement from any specialized staff who work with bilingual children (such as ESOL
teacher) in this section.
Name’s ESOL teacher, Ms. Bilingual, described Name as “doing well” in her class. She
stated that although Name was born in the United States, Name’s dominant language is
Spanish. She added that “his ESOL achievement is in the advanced range.”
PREVIOUS TEST RESULTS AND VISION AND HEARING SCREENINGS
Describe any previous test results here. Make sure that you describe any screening
results, group administered test results (if available), and any language proficiency testing
as reported by the bilingual education or ESOL programs. Include any hearing and
vision test results as well to indicate that these issues have been ruled out as the primary
cause.
Name’s records indicate that he has never received a psychoeducational evaluation prior
to this one. The Student Support Team administered an intellectual screening using the
Kaufman Brief Intelligence Test (K-BIT) on 10/26/2004. Name’s composite score cannot
be interpreted given the significant difference between subtest scores. Subtest scores
include a very delayed score on Vocabulary (standard score = 63) and an average score
on Matrices (standard score = 105).
Town Elementary School administered the Kaufman Test of Educational Achievement
(KTEA) on 10/17/2003, as a measure of academic achievement. Name scored in the
below average to low average range on all subtests, except for Spelling. He scored in the
average range for Spelling.
Name passed a hearing and a vision screening (without glasses) on 10/11/2004.
ASSESSMENT MEASURES AND PROCEDURES
List all formal and informal measures here.
Woodcock-Muñoz Language Survey, Revised (WMLS-R): English Edition
Woodcock-Muñoz Language Survey, Revised (WMLS-R): Spanish Edition
Kaufman Assessment Battery for Children, Second Edition (KABC-II)
Kaufman Brief Intelligence Test (K-BIT) [school administered]
Batería III Woodcock-Muñoz: Pruebas de Aprovechamiento (Batería III)
Expressive One-Word Picture Vocabulary Tests: Spanish-Bilingual Edition
(EOWPVT-SBE)
Name Middle Last
Town Elementary School
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Receptive One-Word Picture Vocabulary Tests: Spanish-Bilingual Edition
(ROWPVT-SBE)
Test of Written Language, Third Edition (TOWL-3)
Kaufman Test of Educational Achievement (K-TEA) [school administered]
Student Interview
Informal Adaptive Behavior Rating
Informal Teacher Report
Review of Previous Educational History
TEST BEHAVIOR AND OBSERVATIONS
Describe testing behavior as you would for an English-only report. But, you should add a
discussion about which language appeared to be more preferred (give examples if you
have them) and any examples of code switching.
During testing, Name was appropriately groomed and appeared his chronological age.
He maintained consistent attention and motivation throughout testing, and rapport was
easily established and maintained. He appeared to be a quiet child who exhibited a flat
affect and smiled infrequently. Name responded to questions asked of him, but he did not
spontaneous speak with the examiner. When he spoke informally, he always spoke in
English. When asked which language he preferred, Name said, “English.” Given this,
test results appear to be an accurate representation of his ability.
ANALYSIS AND INTERPRETATION OF TEST RESULTS
Test results should start with any language testing that was done. A statement at the end
of the language proficiency section should state which language will be used for the rest
of the testing. Also, as many bilingual or other language tests may not be familiar to the
average reader, you may have to go into greater detail about how these are conducted
than you might ordinarily.
LANGUAGE PROFICIENCY
The Woodcock-Muñoz Language Survey was given in both English and Spanish to
determine the language used in further testing. His broad English score (standard score =
80) fell in the below average range, and his broad Spanish score (standard score = 72) fell
in the delayed range. Name should be considered as having limited English skills and
very limited Spanish skills. Given that he is not completely fluent in either language, all
further testing was done in both languages (when available) or nonverbally.
INTELLECTUAL FUNCTIONING
Name was given the Kaufman Assessment Battery for Children, Second Edition (KABCII) as a measure of intellectual ability. All of the subtests were administered in English or
nonverbally, except the Riddles subtest where he could answer in English or in Spanish.
His composite scores (including all verbal subtests, even those that allowed for Englishonly items) fell in the low average range (standard score = 85). His nonverbal composite
score also fell in the low average range (standard score = 86). Cluster scores indicate a
significant strength in Learning (e.g., tests requiring him to learn the names for pictures
Name Middle Last
Town Elementary School
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or drawings and recite those names at a later time) and significant weakness in
Knowledge (e.g., tests requiring him to demonstrate his current knowledge of word
meanings and common facts).
ACADEMIC FUNCTIONING
The Batería III Woodcock-Muñoz: Pruebas de Aprovechamiento (Batería III) was
administered as a Spanish achievement measure. Name scored in the delayed range on
Written Expression and Passage Comprehension and in the average range on Letter Word
Identification, Calculation, and Applied Problems. In Spanish, Name was able to
confidently read familiar, multi-syllabic words, and he would attempt to read words that
he did not know. Name could add and subtract multi-digit numbers and could multiply
and divide with single-digit numbers. He could do some basic fractions; however, he
could not reduce.
In addition to the WJ-III, the Expressive and Receptive One-Word Picture Vocabulary
Tests: Spanish-Bilingual Edition (EOWPVT-SBE and ROWPVT-SBE) were
administered. Name was allowed to answer each question on the test in whichever
language (Spanish or English) he preferred. When given this option, he performed in the
delayed range for receptive vocabulary (standard score = 79) and in the low average
range for expressive vocabulary (standard score = 85).
Due to his delayed score on writing on the Batería III, a further measure of writing ability
was given. Name scored in the delayed range (standard score = 75) on overall writing
ability on the Test of Written Language, Third Edition (TOWL-3). This score is
comprised of subtests measuring the areas of Contrived Writing (standard score = 68) and
Spontaneous Writing (standard score = 87).
Briefly discuss any limitations of any instrument administered in this area.
ADAPTIVE BEHAVIOR
Write something in this section even if nothing is noted. Remember that in some cultures
boys are not expected to do certain self-help type skills so adaptive behavior may appear
to be delayed for them.
Briefly discuss any limitations of any instrument administered in this area.
The Student Support Team gave an informal assessment of adaptive behavior to Name’s
teacher, Ms. Learn, to complete. She did not describe any significant problems with
adaptive behavior, thus no further assessments were conducted in this area.
SOCIAL/EMOTIONAL/BEHAVIORAL FUNCTIONING
Write something in this section even if nothing is noted. Remember, that for bilingual
children, sometimes there are acculturation issues that need to be described.
Briefly discuss any limitations of any instrument administered in this area.
Name Middle Last
Town Elementary School
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Although his teacher describes him as “shy” and “bashful,” she noted no significant
social, behavioral, and emotional problems. An informal student interview was
conducted with Name on 5/3/2005. He stated that he likes school, particularly math
class. He said that social studies is his hardest subject. Name described having friends at
home and at school with whom he spends time. When asked if he is sad or worried a lot,
he answered, “no.” When asked what he would change about himself, he answered,
“nothing.”
SUMMARY
For a bilingual child, you need to describe the language chosen for testing and why
before listing the test results. Describe the results in terms of his academic and cognitive
skills in either or both languages depending on the language of testing. This should still
be limited to one (or tops, two) paragraphs.
Name is a 12-year-old male in the fifth grade at Town Elementary School. Records
indicate that this is Name’s first psychoeducational evaluation. Language proficiency
testing indicated that his English and Spanish skills fall in the delayed to below average
range. Thus, all future testing was administered in both languages or nonverbally.
Current test results find that Name is a child with low average cognitive ability.
Academically, he scored in the below average to average range in all areas except written
expression and receptive language. He scored in the delayed range in both of these areas
regardless of the language in which he was tested. Although his scores in written
expression and receptive language fall in the delayed range, they are still considered to be
commensurate with his overall cognitive ability.
RECOMMENDATIONS AND SUGGESTIONS
The information contained in this report should be considered along with information
provided by the parent and other school personnel in educational planning. Review of
Name’ eligibility by an Individualized Education Program Team is recommended.
The Team may wish to consider the following instructional suggestions:
Classroom recommendations for second language learners: A list of bilingual specific
recommendations should be listed for all bilingual children.
a. Provide information visually by using computer graphics, maps, graphs, charts,
cartoons, posters, diagrams, graphic organizers, and text with a lot of pictures.
b. Focus more on the content of what is produced than the grammar, spelling, and
style in which the content is presented.
c. If possible, pair him with another, more proficient student who speaks the same
language to work on group projects.
d. Recognize that some children will not volunteer to answer a question or chose to
ask when they need help because they have been taught that this is rude.
e. Recognize that some cultures teach their children more by doing an activity than
asking the child to verbally repeat the steps.
f. Give directions in small, simple units instead of one large assignment.
g. Speak slowly and clearly while looking at him.
Name Middle Last
Town Elementary School
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h. Use non-verbal cues (such as gestures, pictures, and concrete objects) in your
teaching to assist comprehension.
Name Middle Last
Town Elementary School
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Add a different section of classroom recommendations for each problem the child is
experiencing.
a. Thing one to do.
b. Thing two to do.
_________________________________
Your Name Here, Your Credentials here
School Psychology Practicum Student
Name Middle Last
Town Elementary School
Page 8 of 12
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Testing Dates (list all)
PSYCHOMETRIC SUMMARY
(Include all tests that you administered)
KAUFMAN ASSESSMENT BATTERY FOR CHILDREN, SECOND EDITION (KABC-II)
Administered on: 5/4/2005
Administered by: Person who administered and credentials
The KABC-II is a measure of intelligence. It produces a composite score derived from
performance on all of the subtests (except Hand Movements and Block Counting). A
nonverbal composite is derived from Hand Movements, Block Counting, Triangles, Story
Completion, and Pattern Reasoning. All items were administered in English or
nonverbally, except Riddles. He was allowed to answer the questions on the Riddles
subtest in either English or Spanish.
The following subtests yield a scaled score with a mean of 10 and a standard deviation of 3.
Scores between 7 and 13 are considered average.
Subtests
Scaled
Score
Atlantis
12
Story Completion
5
Number Recall
8
Rover
9
Verbal Knowledge
7
Rebus
8
Triangles
7
Block Counting
7
Word Order
11
Pattern Reasoning
9
Hand Movements
12
Riddles
4
The following subtests yield a standard score with a mean of 100 and a standard deviation of 15.
Standard scores between 85 and 115 are considered average.
Scale Indices
Standard
Confidence
Score
Band
Sequential/ Gsm
97
89-105
Simultaneous/ Gv
88
81-97
Learning/ Glr
100
93-107
Planning/ Gf
82
74-92
Knowledge/ Gc
77
72-84
COMPOSITE (FCI)
85
80-90
NONVERBAL INDEX
86
81-93
Name Middle Last
Town Elementary School
Page 9 of 12
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Testing Dates (list all)
KAUFMAN BRIEF INTELLIGENCE TEST (K-BIT)
Administered on: 10/26/2004
Administered by: Person who administered and credentials
The K-BIT is a screening measure of intelligence comprised of two subtests: Matrices
and Vocabulary. Scores from these two subtests are combined to form the IQ
Composite, which serves as the measure of intelligence on the K-BIT.
The following composite standard scores have a mean of 100 and a standard deviation of 15.
Scores between 90 and 110 are considered average.
Domains
T-Score
Vocabulary:
63
Matrices:
105
Composite:
82
WOODCOCK-MUÑOZ LANGUAGE SURVEY: (WMLS)
Administered by: Person(s) who administered and credentials
Administered on: 12/8/2004
The Woodcock-Muñoz Language Survey is an individually administered language
proficiency test that is given in English and Spanish. It is comprised of a number of
subtests, the results of which are combined into a language composite score.
The WMLS yields standard scores with a mean of 100 and a standard deviation of 15.
Standard scores between 90 and 110 are considered average.
Spanish
English
Domains
Standard
Standard
Score
Score
Picture Vocabulary
68
71
Verbal Analogies
76
84
ORAL LANGUAGE ABILITIES
72
78
Letter-Word Identification
87
90
Dictation
72
84
READING-WRITING ABILITIES
80
87
BROAD ENGLISH/SPANISH ABILITY
72
80
Cognitive Academic Language Proficiency (1 = low; 5 = fluent)
2
3
Name Middle Last
Town Elementary School
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Testing Dates (list all)
BATERIA III WOODCOCK-MUNOZ PRUEBAS DE APROVECHAMIENTO
(BATERIA III)
Date administered: 5/3/2005
Administered by: Person who administered and credentials
The Batería III is an individually administered achievement test given in Spanish.
The Batería III yields standard scores with a mean of 100 and a standard deviation of 15.
Standard scores between 85 and 115 are considered average.
Standard
Conf.
Domains
Score
Interval
Identificación de letras y palabras (Letter-Word Identification)
98
96-100
Passage Comprehension (Comprensión de Textos)
77
74-81
Calculation (Cálculo)
91
64-72
Applied Problems (Problemas Aplicados)
86
83-89
Spelling (Ortografía)
68
64-72
Writing Fluency (Fluidez en la Escritura)
81
76-86
Writing Samples (Muestras de Redacción)
82
74-90
Written Expression (Expresión Escrita)
81
76-85
BROAD WRITTEN LANGUAGE (AMPLIO LENGUAJE ESCRITO)
74
71-77
ACADEMIC SKILLS (DES ACADÉMICAS)
87
85-89
ACADEMIC APPLICATIONS (APLICACIONES ACADÉMICAS)
80
77-82
KAUFMAN TEST OF EDUCATIONAL ACHIEVEMENT (K-TEA)
Administered by: Person who administered and credentials
Administered on: 10/28/2004
The K-TEA is an individually administered measure of school achievement.
It yields standard scores with a mean of 100 and a standard deviation of 15.
Standard scores between 90 and 110 are considered average.
Standard
Domains
Scores
Math Applications
81
Math Computation
80
MATH COMPOSITE
80
Reading Decoding
85
Reading Comprehension
82
READING COMPOSITE
83
Spelling
92
BATTERY COMPOSITE
79
Name Middle Last
Town Elementary School
Page 11 of 12
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Testing Dates (list all)
TEST OF WRITTEN LANGUAGE, THIRD EDITION (TOWL-3)
Administered on: date
Administered by: Person who administered and credentials
The TOWL-3 was designed as a comprehensive measure of writing ability that can be
used to determine strengths and weaknesses in writing. For the Spontaneous Writing
Section, the child is asked to write a story that tells about the picture presented.
The following subtest scores have a mean of 10 with a standard deviation of 3.
Scores between 7 and 13 are considered average.
Domains
Subtest Scores
Vocabulary
6
Spelling
8
Style
5
Logical Sentences
3
Sentence Combining
5
Contextual Conventions
8
Contextual Language
7
Story Construction
9
The following quotient has a mean of 100 with a standard deviation of 15.
Quotients between 85 and 115 are considered average.
Quotient
Quotient Score
Contrived Writing Quotient
68
Spontaneous Writing Quotient
87
OVERALL WRITING
75
EXPRESSIVE ONE-WORD PICTURE VOCABULARY TEST: SPANISHBILINGUAL EDITION (EOWPVT: SBE)
Date administered: date
Administered by: Person who administered and credentials
The EOWPVT: SBE is designed to examine expressive language ability across
languages. The test consists of a series of pictures, and the test-taker is asked to identify
the picture in either English or in Spanish. For this reason, the test yields a combined
English/Spanish expressive language score and not a language proficiency score.
EOWPVT:SBE provides standard scores with a Mean of 100 and a Standard Deviation of 15.
Scores between 85 and 115 are considered average.
Standard Score
Confidence Interval
Percentile Rank
85
80-90
16
Name Middle Last
Town Elementary School
Page 12 of 12
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Testing Dates (list all)
RECEPTIVE ONE-WORD PICTURE VOCABULARY TEST: SPANISH-BILINGUAL
EDITION (ROWPVT: SBE)
Date administered: date
Administered by: Person who administered and credentials
The ROWPVT: SBE is designed to examine receptive language ability across languages.
The test consists of a series of pictures, and the test-taker is asked to identify the picture
in either English or in Spanish. For this reason, the test yields a combined
English/Spanish receptive language score and not a language proficiency score.
ROWPVT:SBE provides standard scores with a Mean of 100 and a Standard Deviation of 15.
Scores between 85 and 115 are considered average.
Standard Score
Confidence Interval
Percentile Rank
79
75-83
8