CONFIDENTIAL NEUROPSYCHOLOGICAL and
PSYCHO-EDUCATIONAL TESTING EVALUATION
Name: xxxxxxxxxxxxxxx
Date of Birth: xxxxxxxxx
Age: 10 years, 4 months
Gender: Female
School: xxxxxxxxxxxxx
Report Date: xxxxxxxxxxx
Examiner: Scott Andrews, Ph.D., H.S.P.
Test Site: PTC
Evaluation Start Date: xxxxxxxxx
Grade: 5
Reason for Referral:
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxx.
Other comments and concerns reported by xxxxxxxxx’s parents, xxxxx, and xxxxx and xxxxxx, xxxxx’s
5th grade teachers, are below.
Mother:
 “xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.”
Father:
 “xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxx.”
xxxxxxxxxxxxxxx (5th grade xxxxxxxxxx xxxxxxxx teacher):
 “xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.”
xxxxxxxxxxxxxxxxx (5th grade xxxxxx xxxxxxxxx teacher)
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
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“xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxx.”
xxxxxxxx:
 “xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxx.”
The current evaluation will assess xxxxxxxxx’s neuropsychological, cognitive, emotional and
behavioral functioning for indications of ADHD as well as generate recommendations to enhance her
overall adaptation to the school setting. It will also attempt to rule out disorders that frequently cooccur with ADHD (e.g., learning disorders and executive dysfunction) or masquerade as ADHD (e.g.,
mood disorders, anxiety disorders, and biologically based cognitive disorders).
Evaluation Procedures:
Achenbach Child Behavior Checklist (Informants: mother and father)
Child’s History Form (Informant: mother)
Conners 3 (Informants: mother, father, Xxxxxx, 5th grade xxxxxx xxxxxxx teacher, and 5th grade xxxxxx
xxxxxxx xxxxxxx teacher)
NEPSY: Second Edition (A Developmental Neuropsychological Assessment)
Teacher Report Form (Informants: 5th xxxxx xxxxxx teacher and 5th grade xxxxxxx xxxxxx xxxxxx
teacher)
Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV)
Wechsler Individual Achievement Test—Third Edition (WIAT-III)
Clinical Observations and Evaluations:
Diagnostic Clinical Interview PTC: xxxxxxxxxx
Collateral Interviews and Review of Records:
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
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xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.
Relevant Background Information:
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
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xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.
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Prenatal, Natal, and Perinatal History
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.
Developmental History
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxx.
Medical History
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.
Educational History
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.
Behavioral and Mental Health History
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
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xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.
Family History
Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
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xxxxxxxxxxxxxx.
Observations:
xxxxxx is an English speaking, 10-year, 4-month-old female with a right hand preference. She was taking
no prescription or over-the-counter medications over the course of testing. Notably, Xxxxxx has no history
of visual, auditory or motor disabilities. Rapport was quickly established with Xxxxxx and she appeared
interested and motivated. Moreover, Xxxxxx was systematic and methodical in her problem-solving
behavior as well as alert and persistent in her work style. However, it is notable that Xxxxxx’s processing
was slow on several tasks including the Clocks, Comprehension of Instructions, Design Fluency-Structured
Array, and Design Copying tasks of the NEPSY-II. Her slow rate of processing may be secondary to
Xxxxxx’s difficulty processing some aspects of visual spatial information. On all three tasks, Xxxxxx had
to work exceptionally hard to achieve her average scores. Nevertheless, Xxxxxx’s approach and attitude
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toward the testing and the conditions for testing overall were positive. As such, the test results appear to be
reliable and valid estimations of her current level of functioning.
Test Results:
Cognitive Testing
To assess Xxxxxx’s ability to reason and to solve problems, verbally and nonverbally, the Wechsler
Intelligence Scale for Children: Fourth Edition (WISC-IV) was administered.
WISC–IV Results
Composite Scores Summary
Scale
Verbal Comprehension (VCI)
Perceptual Reasoning (PRI)
Working Memory (WMI)
Processing Speed (PSI)
Full Scale (FSIQ)
Sum of
Scaled
Scores
Composite
Score
Percentile
Rank
95%
Confidence
Interval
Qualitative
Description
28
31
27
20
106
96
102
120
100
105
39
55
91
50
63
89-103
94-109
111-126
91-109
100-110
Average
Average
Superior
Average
Average
WISC–IV Composite Score Profile
Note. Vertical bar represents the Standard Error of Measurement (SEM).
Composite Score Differences
Index Comparisons
VCI - PRI
VCI - WMI
VCI - PSI
PRI - WMI
PRI - PSI
Scaled
Score 1
Scaled
Score 2
96
96
96
102
102
102
120
100
120
100
Diff.
Critical
Value
Sig.
Diff.
Y/N
Base
Rate
-6
-24
-4
-18
2
10.6
10.99
11.75
11.38
12.12
N
Y
N
Y
N
34.6%
4.2%
43%
10.2%
47%
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WMI - PSI
120
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100
20
12.46
Y
10.2%
Differences between Subtest and Mean of Subtest Scores
Subtest
Subtest
Scaled
Score
Block Design
10
Similarities
8
Digit Span
15
Picture Concepts
10
Coding
9
Vocabulary
9
Letter-Number Sequencing
12
Matrix Reasoning
11
Comprehension
11
Symbol Search
11
Note. Overall: Mean = 10.60, Scatter = 7, Base Rate = 53.9%
Statistical Significance (Critical Values) at the .05 level
Mean
Scaled
Score
Diff.
Critical
Value
10.6
10.6
10.6
10.6
10.6
10.6
10.6
10.6
10.6
10.6
-0.60
-2.60
4.40
-0.60
-1.60
-1.60
1.40
0.40
0.40
0.40
3.01
3.01
2.87
3.39
3.17
2.70
2.63
2.68
3.44
3.56
S/W
Base
Rate
>25%
10-25%
5-10%
>25%
>25%
>25%
>25%
>25%
>25%
>25%
S
Subtest Score Differences
Discrepancy Comparisons
Digit Span - Letter-Number Sequencing
Coding - Symbol Search
Similarities - Picture Concepts
Scaled
Score 1
Scaled
Score 2
15
9
8
12
11
10
Diff.
Critical
Value
Sig.
Diff.
Y/N
Base
Rate
3
-2
-2
2.83
3.55
3.36
Y
N
N
18.0%
30.2%
32.4%
Verbal Comprehension Subtest Score Summary (Total Raw Score to Scaled Score Conversions)
Subtest
Similarities
Vocabulary
Comprehension
Raw Score
Scaled Score
Percentile Rank
17
31
24
8
9
11
25
37
63
Perceptual Reasoning Subtest Score Summary (Total Raw Score to Scaled Score Conversions)
Subtests
Raw Score
Scaled Score
Percentile Rank
Block Design
34
10
50
Picture Concepts
17
10
50
Matrix Reasoning
23
11
63
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Working Memory Subtest Score Summary (Total Raw Score to Scaled Score Conversions)
Raw Score
Scaled Score
Percentile Rank
Digit Span
Subtests
21
15
95
Letter-Number Sequencing
19
12
75
Processing Speed Subtest Scores Summary (Total Raw Score to Scaled Score Conversions)
Subtests
Raw Score
Scaled Score
Percentile Rank
Coding
41
9
37
Symbol Search
25
11
63
WISC–IV Subtest Scaled Score Profile
Note. Vertical bar represents the Standard Error of Measurement (SEM).
Process Summmary and Discrepancy Analysis
Process Scores
Digit Span Forward
Digit Span Backward
Raw Score
12
9
Scaled Score
14
14
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Process Scores
Longest Digit Span Forward (LDSF)
Longest Digit Span Backward (LDSB)
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Raw Score
7
5
Base Rate
33.5%
26%
Process Discrepancy Comparisons
Subtest / Process Score
LDSF - LDSB
Raw Score 1
Raw Score 2
Difference
Base Rate
7
5
2
62.4%
Note. Base Rate by All Ages
Subtest / Process Score
Digit Span Forward - Digit Span Backward
Scaled
Score 1
Scaled
Score 2
Diff.
Critical
Value
Sig. Diff.
Y/N
14
14
0
3.62
N
Base
Rate
Note. Statistical Significance (Critical Values) at the .05 level
Summary of Test Results:
On the WISC-IV, Composite Score standard scores of 90-109 are considered average, and scaled scores of
8 to 12 (25th to 75th percentiles) are considered average for the individual tasks.
The WISC-IV results show that Xxxxxx reasons in the Average range with the use of language, with a
Verbal Comprehension Composite Score standard score of 96 (39th percentile). Similarly, she functions in
the Average range on nonverbal tasks (Perceptual Reasoning Composite Score standard score = 102, 55th
percentile). Finally, Xxxxxx earned a Full Scale IQ score in the Average range (Full Scale composite
score = 105, 63rd percentile), suggesting that her estimated overall intellectual level is somewhere in
the middle of the Average range to lower end of the High Average range for a child her age.
In the Verbal Comprehension domain, Xxxxxx demonstrated her average ability to conceptualize and
generalize using language (Similarities scaled score = 8, 25th percentile). Next, Xxxxxx’s performance was
in the Average range on the Vocabulary task that required her to orally define words (scaled score = 9, 37th
percentile). Finally, Xxxxxx completed the Comprehension task, which evaluated her understanding of
appropriate judgment and behavior for social situations. Here, she again obtained an Average range scaled
score of 11 (63rd percentile).
In the nonverbal domain, Xxxxxx’ ability to think in terms of categories in order to sort pictures of
common objects was in the Average range for children of comparable age (Picture Concepts scaled score =
10, 50th percentile). Xxxxxx next completed the Matrix Reasoning task that required her to reason with
purely abstract visual information. For this task she was shown arrays of shapes and asked to pick the one
that continued or completed a pictured design. Xxxxxx’s scaled score of 11 (63rd percentile) was in the
Average range for her age. On another task, the Block Design task, Xxxxxx showed average ability to
analyze abstract visual spatial material. Here, geometric designs are presented using a picture, and she
recreated the designs using blocks. Xxxxxx’s Block Design score places in the Average range of
functioning (scaled score = 10, 50th percentile).
In the area of Working Memory, Xxxxxx earned a score placing within the lower end of the Superior range
(Composite Score = 120, 91st percentile). On the first task in this domain, Xxxxxx demonstrated Superior
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range ability to recall rote auditory information (Digit Span scaled score = 15, 95th percentile). There are
two conditions to this task – Digit Span Forward and Digit Span Backward. For Digit Span Forward,
Xxxxxx is read a sequence of numbers and she recalls the numbers in the same order. This component of
the task involves rote learning and memory, attention, encoding, and auditory processing. She achieved a
scaled score of 14 (91st percentile) on Digit Span Forward – a score in the lower end of the Superior range
for an individual her age. For Digit Span Backward, Xxxxxx is read a sequence of numbers and she recalls
the numbers in reverse order. Notably, cognitive flexibility, and mental alertness are required when
shifting from one Digit Span task to another. Xxxxxx earned a score in the lower end of the Superior range
on Digit Span Backward (scaled score = 14, 91st percentile). This condition of the task involves working
memory, transformation of information, mental manipulation, and visuospatial imaging. Her performance
was somewhat lower on a similar task requiring Xxxxxx to hold auditory information in her mind and
manipulate it (Letter-Number Sequencing, scaled score = 12, 75th percentile). Specifically, she was asked
to listen to and rearrange series of letters and numbers, placing the numbers first. Notably, generally
speaking, Xxxxxx’s age appropriate performance in the Working Memory domain contraindicates
problems with attention and concentration. However, it is also important to note that children
diagnosed with ADHD can sometimes rise up to the challenge on tasks they find novel and interesting
but this does not mean they do not have overall problems with attention and concentration.
On the Processing Speed Index tasks, which are timed, pencil and paper tasks, Xxxxxx’s performance
placed within the middle of the Average range for this Index (composite score = 100, 50th percentile). For
the Coding task, she was asked to copy symbols to match numbers, using a key or “code.” Here, Xxxxxx
received a score in the Average range (scaled score = 9, 37th percentile). On another task, the Symbol
Search task, Xxxxxx’s score was slightly higher (scaled score = 11, 63rd percentile). Here, Xxxxxx scans a
search group and indicates whether one of the symbols in the target group matches. It is a timed visual
vigilance and scanning task and, unlike the Coding, the Symbol Search task requires very little fine motor
output.
The Composite Score Differences analysis table (see table above) shows that Xxxxxx’s abilities in the
Working Memory domain are more developed than her abilities in the Verbal Comprehension, Perceptual
Reasoning, and Processing Speed domains. Notably, the size of the disparities between Working Memory
and each of the other three domains (24, 18, 20 standard score points, respectively) - favoring Working
Memory – are relatively unusual in the normative sample (base rates of 4.2%, 10.2%, and 10.2%,
respectively). Collectively, these findings suggest that Xxxxxx’s cognitive skills are unevenly
developed.
Achievement Testing
In order to determine Xxxxxx’s current level of achievement in several academic subjects, the Wechsler
Individual Achievement Test: Third Edition (WIAT-III) was administered.
WIAT–III Results
Subtest Score Summary
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Subtest
95%
Normal
Raw Standard Confidence Percentile Curve
Score Score
Interval
Rank
Equiv. Stanine
Page |9
Grade
Equiv.
Listening Comprehension
—
103
92–114
58
54
5
5.7
Reading Comprehension
27*
93
83–103
32
40
4
3.2
Math Problem Solving
45
93
84–102
32
40
4
4.6
Sentence Composition
—
98
86–110
45
47
5
4.9
Word Reading
35
88
83–93
21
33
3
3.2
Essay Composition
—
83
73–93
13
26
3
<3.0
Pseudoword Decoding
22
92
87–97
30
39
4
2.9
Numerical Operations
34
115
107–123
84
71
7
6.7
Spelling
22
91
84–98
27
37
4
4.0
Math Fluency—Addition
23
87
74–100
19
32
3
3.2
Math Fluency—Subtraction
24
100
90–110
50
50
5
4.9
Math Fluency—Multiplication 24
105
96–114
63
57
6
5.7
– Indicates a subtest with multiple raw scores (shown in the Subtest Component Score SumXxxxxx).
* Indicates a raw score that is converted to a weighted raw score (not shown).
† Indicates that a raw score is based on a below grade level item set.
Subtest Score Profile
Note. The vertical bars represent the confidence interval at 95%.
Age
Equiv.
Growth
Score
10:10
8:4
9:8
9:10
8:8
8:0
8:0
12:0
9:0
8:4
10:4
11:0
526
500
531
509
503
490
490
603
527
487
563
650
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Supplemental Subtest Score Summary
Score Name
Raw
Score
95%
Normal
Standard Confidence Percentile Curve
Grade
Score
Interval
Rank
Equiv. Stanine Equiv.
Essay Composition:
Grammar and Mechanics
32
95
82–108
37
* Indicates a raw score that is converted to a weighted raw score (not shown).
43
4
4.1
Age Growth
Equiv. Score
9:0
N/A
Cumulative Percentages
The score is the same as or higher than the scores obtained by 50%
of students in the normative sample; 50% of students in the
normative sample scored higher than this score.
The score is the same as or higher than the scores obtained by 50%
of students in the normative sample; 50% of students in the
normative sample scored higher than this score.
Word Reading Speed
Pseudoword Decoding Speed
Subtest Component Score Summary
Normal
Raw Standard Percentile
Curve
Score
Score
Rank
Equivalent Stanine
Subtest Component
Qualitative
Description
Listening Comprehension
Receptive Vocabulary
Oral Discourse Comprehension
13
15
110
96
75
39
64
44
6
4
Average
Average
13
18
102
95
55
37
53
43
5
4
Average
Average
38
3
88
81
21
10
33
23
3
2
Average
Below Average
8
85
16
29
3
Average
Sentence Composition
Sentence Combining
Sentence Building
Essay Composition
Word Count
Theme Development and Text Organization
Oral Expression
Expressive Vocabulary
Composite Score Summary
Composite
Sum of
Subtest
95%
Normal
Standard Standard Confidence Percentile Curve
Scores
Score
Interval
Rank
Equiv. Stanine
Qualitative
Description
Basic Reading
180
90
86–94
25
36
4
Average
Written Expression
272
88
81–95
21
33
3
Average
Mathematics
208
104
97–111
61
56
6
Average
Math Fluency
292
97
90–104
42
46
5
Average
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Differences Between Composite Standard Scores
Comparison
Difference
Critical Value Significant
(Significance Difference
Level .05)
Y/N
Base Rate
Basic Reading vs. Written Expression
2
7.16
N
>15%
Basic Reading vs. Mathematics
-14
6.26
Y
>15%
Basic Reading vs. Math Fluency
-7
6.80
Y
>15%
Written Expression vs. Mathematics
-16
8.33
Y
>15%
Written Expression vs. Math Fluency
-9
8.74
Y
>15%
Mathematics vs. Math Fluency
7
8.01
N
>15%
Note. A negative difference indicates that the second composite has a higher score than the first composite listed in the comparison.
Ability–Achievement Discrepancy Analysis
Ability Score Type:
WISC–IV FSIQ
Ability Score:
105
Predicted Difference Method
Predicted
Actual
Critical Significant
WIAT–III WIAT–III Expected
Value Difference
Score
Score
Difference
.05
Y/N
Standard
Deviation
Base Discrepancy
≥1 SD
Rate
WIAT–III Subtest
Listening Comprehension
Reading Comprehension
Math Problem Solving
Sentence Composition
Word Reading
103
103
103
103
103
103
93
93
98
88
0
10
10
5
15
12.50
11.50
9.46
11.11
6.16
N
N
Y
N
Y
N/A
>15%
>15%
>15%
≤10%
N/A
N
N
N
Y
Essay Composition
Essay Composition: Grammar and
Mechanics
Pseudoword Decoding
Numerical Operations
Spelling
102
83
19
10.42
Y
≤10%
Y
103
103
103
103
95
92
115
91
8
11
-12
12
12.44
5.76
8.36
7.38
N
Y
Y*
Y
>15%
>15%
N/A
≤15%
N
N
N/A
N
Math Fluency—Addition
Math Fluency—Subtraction
Math Fluency—Multiplication
102
103
102
87
100
105
15
3
-3
11.65
10.55
9.55
Y
N
N
≤15%
>15%
N/A
Y
N
N/A
103
103
90
88
13
15
5.25
7.99
Y
Y
≤15%
≤10%
N
Y
WIAT–III Composite
Basic Reading
Written Expression
Mathematics
104
104
0
7.48
N
N/A
N/A
Math Fluency
103
97
6
7.69
N
>15%
N
Note. Base rates and standard deviation discrepancies are not reported when the achievement score equals or exceeds the ability
scores.
* Indicates that the achievement score exceeds the ability score.
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Summary of Test Results:
On the WIAT-III, standard scores of 85-115 are considered average.
To assess reading, the Word Reading subtest of the WIAT-III was administered, and here Xxxxxx was
asked to read isolated words, including sight words. Her score was in the lower end of the Average range
(standard score = 88, 21st percentile) and significantly lower than her predicted score of 103 (58th
percentile). Moreover, the size of the discrepancy between ability and achievement on the Word Reading
subtest (15 standard score points) was a rare event in the standardization sample (base rate <10%) and has a
standard deviation discrepancy of >1 SD. These results support a diagnosis of Dyslexia (DSM-IV-TR
diagnosis of Reading Disorder).
On the Pseudoword Decoding subtest, no sight words are included. Here, Xxxxxx used decoding skills to
read nonsense words such as “pon” (standard score = 92, 30th percentile). Her score on Pseudoword
Decoding was slightly higher than her Word Reading score and in the Average range for her age.
Nevertheless, her score was significantly lower than her predicted score (standard score = 103, 58th
percentile). However, in contrast to her performance on the Word Reading subtest, the size of the disparity
between Xxxxxx’s obtained score on the Pseudoword Decoding subtest and her predicted score is not a
particularly unusual occurrence in the normative sample (base rate >15%), nor is the standard deviation
discrepancy >1 SD. As such, these results are not as confirming of a Reading Disorder as is her
performance on the Word Reading subtest, but they due indicate a weakness in her phonological
processing skills that is worthy of remedial attention.
On the Reading Comprehension subtest, Xxxxxx was asked to read several passages silently or orally and
was then asked questions about each. Here, she earned a standard score of 93 (32nd percentile) – a score in
the Average range for her age. Additionally, Xxxxxx’s score for Reading Comprehension was generally
on par with her estimated general intellectual capacity (standard score = 103, 58th percentile). Next, her
overall reading skills were shown to be in the Average range of functioning for a child her age (Basic
Reading Composite standard score = 90, 25th percentile) and significantly below her predicted score
(standard score = 103, 58th percentile). Additionally, the discrepancy between ability and achievement for
the Basic Reading Composite score (13 standard score points) is relatively rare in the normative sample
(base rate <15%). Collectively, the results of testing in the Reading domain support a diagnosis of
Dyslexia (DSM-IV-TR diagnosis of Reading Disorder).
In the Written Expression domain, Xxxxxx was asked to combine two sentences to make one complete
sentence that means the same thing. She was also asked to write sentences using target words such as
“until”. Her Sentence Composition standard score of 98 (45th percentile) was in the Average range for her
age and on par with her predicted score of 103 (58th percentile). Xxxxxx next wrote an essay about her
favorite game and was asked to include three reasons why she likes it. Here, she received a score that falls
in the Below Average range on the Essay Composition task (standard score = 83, 13th percentile) – a score
significantly lower than her predicted score of 102 (55th percentile). Notably, the size of the discrepancy
between Xxxxxx’s obtained score and her predicted score for the Essay Composition subtest was both an
unusual occurrence in the normative sample (base rate <10%) and had a standard deviation discrepancy >1
SD. These findings support a diagnosis of Dysgraphia (DSM-IV-TR diagnosis of Disorder of Written
Expression).
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Notably, analysis of her Supplemental Subtest Score Summary and Subtest Component Score Summary
(see table above) shows that Mary’s Word Count standard score of 88 (21st percentile) – a score in the
lower end of the Average range – suggests marginal or borderline written productivity. Similarly, her
Theme Development and Text Organization score (standard score = 81, 10th percentile) was in Below
Average range of functioning for children of comparable age. On another subtest, the Spelling subtest,
Xxxxxx’s performance was in the Average range (standard score = 91, 27th percentile) but significantly
below her expected score of 103, 58th percentile. The size of the difference between ability and
achievement for the Spelling subtest (12 standard score points) is an unusual event in the standardization
sample (base rate <15%) although the standard deviation discrepancy was <1 SD. Notably, analysis of
Xxxxxx’s spelling errors revealed difficulties with several skills including common suffixes/word endings,
irregular vowels, schwa vowel sounds, consonant digraphs, single consonants, T as \sh\ or \ch\, silent
consonants, and insertions.
Next, her Written Expression composite score of 88 (21st percentile) was significantly lower than her
predicted score given her estimated overall intellectual ability (predicted score = 103, 58th percentile).
Here, the difference between ability and achievement (15 standard score points) was both a rare event in
the normative sample (base rate <10%) and had a standard deviation discrepancy >1 SD. Overall, the
findings of testing in the Written Expression domain support a diagnosis of Dysgraphia (DSM-IV-TR
diagnosis of Disorder of Written Expression).
In the Oral Language domain, Xxxxxx was administered a Listening Comprehension subtest. She earned a
score that places within the Average range (standard score = 103, 58th percentile), which is commensurate
with her predicted score of 103 (58th percentile). Notably, Xxxxxx’s score on the Receptive Vocabulary
condition of the Listening Comprehension subtest (standard score = 110, 75th percentile) was in the upper
end of the Average range for an individual her age. These results suggest that her listening
comprehension, particularly her receptive vocabulary skills, is an area of academic strength for
Xxxxxx.
Although a somewhat lower score, Xxxxxx’s performance on the Oral Discourse
Comprehension subtest (standard score = 96, 39th percentile) was also in Average range of functioning for
an individual her age. By contrast, Xxxxxx earned a score in the lower end of the Average range on
Expressive Vocabulary condition of the Oral Expression subtest (standard score = 85, 16th percentile).
Among her lowest scores on the WIAT-III, her score on the Expressive Vocabulary condition of the Oral
Expression subtest was significantly lower (18 standard score points) than her predicted score of 103 (58th
percentile).
Analysis of Xxxxxx’s errors on the Expressive Vocabulary condition of the Oral Expression subtest
revealed several linguistic features of Expressive Language Disorder. These features include limited range
of vocabulary, word finding errors, vocabulary errors, and limited varieties of grammatical structures (e.g.,
verb forms). Notably, her performance on the WISC-IV Comprehension task supports the hypothesis of
expressive language difficulties. On this task, Xxxxxx’s responded orally to questions tapping her
understanding of appropriate judgment and behavior for social situations.
Her responses suggest
difficulties with oral expression including shortened sentences, simplified grammatical structures, limited
varieties of grammatical structures (e.g., verb forms), omissions of critical parts of sentences, and use of
unusual word order. As is frequently found among children with expressive language problems, Xxxxxx’s
nonlinguistic functioning (as measured by WISC-IV Perceptual Reasoning domain) and language
comprehension skills are within normal limits. Notably, Xxxxxx’s impairment in expressive language
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appears to be developmental rather than acquired (i.e., not associated with a postnatal neurological insult of
known origin). Finally, the results summarized above support a diagnosis of Expressive Language
Disorder.
In another domain, the Mathematics domain, Xxxxxx completed math problems using pencil and paper
(Numerical Operations, standard score = 115, 84th percentile). Her score was in the upper end of Average
range for her age and significantly higher than what would be expected given her overall intellectual ability
(predicted score = 103, 58th percentile). The ability to accurately perform mathematical computations is an
area of strength for Xxxxxx. On another task, the Math Problem Solving task, she was asked to read charts
and graphs and to solve word problems. Here, Xxxxxx achieved a score in the lower end of the Average
range (Math Problem Solving standard score = 93, 32nd percentile) - a score significantly below her
predicted score of 103 (58th percentile). However, the 10 point standard score discrepancy between her
obtained score and her predicted score was not a rare event in the normative sample (base rate >15%) nor
was the standard deviation discrepancy >1 SD. These results indicate a weakness in mathematical
reasoning but do not suggest a diagnosis of Dyscalculia.
It may be that Xxxxxx’s performance on the Math Problem Solving subtest was undermined by her
difficulty understanding spatial conceptual terms such as a fraction of an object, a left or right
rotation of an object, and perimeter. This conclusion is supported by Xxxxxx’s low sore on the NEPSYII Geometric Puzzles task and the types of errors she made on the NEPSY-II Comprehension of
Instructions task. On the former task, Xxxxxx’s errors were primarily mental rotation errors. On the latter
task, her errors were predominantly temporal/sequential and spatial concept errors (e.g., but first, above
and beside, left of and underneath, to the right of but not next to it, and diagonal to). It is notable that
Xxxxxx’s overall Mathematics score (Composite Score standard score = 104, 61st percentile) was in the
Average range and commensurate with her predicted score of 104 (61st percentile).
Math Fluency tasks are timed paper and pencil tasks of numerical operations. Xxxxxx’s Math FluencySubtraction (standard score = 100, 50th percentile) and Math Fluency-Multiplication scores (standard score
= 105, 63rd percentile) were in the Average range, and consistent with her predicted scores (103, 58th
percentile and 102, 55th percentile, respectively). On the other hand, Xxxxxx worked accurately but slowly
on the Math Fluency-Addition task and received a score in the lower end of the Average range (standard
score = 87, 19th percentile). Overall, Xxxxxx achieved a Math Fluency Composite Score standard score of
97 (42nd percentile) – a score on par with her predicted score of 103 (58th percentile
Xxxxxx’s performance in the Oral Language, Written Expression and Mathematics domains provide clues
as to Xxxxxx’s learning style. Her performance indicates that she is at her best when processing
language receptively (i.e., listening comprehension at the level of the word, sentence, and discourse);
sentence formulation skills including the use of morphology, grammar, syntax, semantics, and
mechanics; and written mathematics calculation skills under untimed conditions. In general,
Xxxxxx’s learning style can be described as learning by processing oral language, writing using
proper grammar and mechanics, and accurately performing written numerical calculations.
Neuropsychological Testing
Xxxxxx was administered the NEPSY-II as part of an evaluation. The NEPSY–II helps assess academic,
social, and behavioral difficulties in children and adolescents. Results obtained from a NEPSY–II
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assessment can be used to diagnose and aid in intervention planning for a variety of childhood disorders. In
particular, a comprehensive understanding of a child’s cognitive limitations can facilitate the development
of appropriate Individual Education Plans (IEPs) and guide placement and intervention decisions.
To evaluate Xxxxxx's performance on the NEPSY-II, review both the Classification Description Table, and
the Normal Curve Graph below. These tools will serve as a guide to help you obtain a general
understanding of Xxxxxx's performance on the assessment. Below the Classification Description Table is
a description of each domain Xxxxxx was evaluated on. Next to this is a SumXxxxxxof how Xxxxxx
performed on the domains that were assessed.
Classification Description Table
Description
Children whose scores fall within this range have skills that are more developed
Above Expected Level
than 75% of their peers.
Children whose scores fall within this range have skills that are equal to 50% of
At Expected Level
their peers.
Children whose scores fall within this range have skills that are not as developed
Borderline
as 75% of their peers.
Children whose scores fall within this range have skills that are not as developed
Below Expected Level
as 90% of their peers.
Children whose scores fall within this range have skills that are not as developed
Well Below Expected Level
as 98% of their peers.
Classification
Summary of Results
Domain
Description
Result
These tests measure how well a child can plan, Xxxxxx's performance in this domain
Attention and Executive
organize, change, and control behavior.
fell between the Below Expected Level
Functioning
and Above Expected Level.
These tests measure how well a child
Xxxxxx's performance in this domain
understands and uses words and sentences to fell at the At Expected Level.
Language
communicate with others.
These tests measure how a child takes in,
Xxxxxx's performance in this domain
Memory and Learning
stores, and remembers information.
fell between the At Expected Level
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and Above Expected Level.
These tests measure how well a child sees and Xxxxxx's performance in this domain
fell between the Borderline range and
Visuospatial Processing arranges visual information.
Above Expected Level.
Attention and Executive Functioning
Score Name
Animal Sorting Total Correct Sorts
Animal Sorting Total Errors
Animal Sorting Total Repeated Sort
Errors
Animal Sorting Total Novel Sort Errors
Animal Sorting Combined Scaled
Score
Auditory Attention Total Correct
Auditory Attention Combined Scaled
Score
Auditory Attention Total Omission
Errors
Auditory Attention Total Commission
Errors
Auditory Attention Total Inhibitory
Errors
Response Set Total Correct
Response Set Combined Scaled
Score
Response Set Total Omission Errors
Response Set Total Commission
Errors
Response Set Total Inhibitory Errors
AA vs. RS Contrast Scaled Score
Clocks Total Score
Design Fluency Total Score
Design Fluency–Structured Array
Score
Design Fluency–Random Array Score
Inhibition–Naming Completion Time
Total
Inhibition–Naming Combined Scaled
Score
Inhibition–Naming Total Errors
Inhibition–Naming Total SelfCorrected Errors
Inhibition–Naming Total Uncorrected
Errors
Inhibition–Inhibition Completion Time
Total
Inhibition–Inhibition Combined Scaled
Score
Inhibition–Inhibition Total Errors
Raw Scaled Percentile
Cumulative
Scores Scores Ranks (%) Percentages (%)
4
7
16
-6
-2–5
--
Classification
Borderline
Below Expected Level
1
--
51–75
--
At Expected Level
5
--
<2
--
Well Below Expected Level
--
5
5
--
Below Expected Level
29
10
50
--
At Expected Level
--
10
50
--
At Expected Level
1
--
51–75
--
At Expected Level
0
--
51–75
--
At Expected Level
0
--
26–50
--
At Expected Level
34
11
63
--
At Expected Level
--
11
63
--
At Expected Level
2
--
51–75
--
At Expected Level
2
--
51–75
--
At Expected Level
1
-72
22
-11
13
8
>75
63
84
25
-----
Above Expected Level
At Expected Level
Above Expected Level
At Expected Level
9
--
--
11–25
Borderline
13
--
--
26–75
At Expected Level
50
9
37
--
At Expected Level
--
8
25
--
At Expected Level
1
--
26–50
--
At Expected Level
1
--
26–50
--
At Expected Level
0
--
51–75
--
At Expected Level
70
10
50
--
At Expected Level
--
10
50
--
At Expected Level
2
--
51–75
--
At Expected Level
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Inhibition–Inhibition Total SelfCorrected Errors
Inhibition–Inhibition Total Uncorrected
Errors
Inhibition–Switching Completion Time
Total
Inhibition–Switching Combined Scaled
Score
Inhibition–Switching Total Errors
Inhibition–Switching Total SelfCorrected Errors
Inhibition–Switching Total
Uncorrected Errors
IN–Naming vs. Inhibition Contrast
Scaled Score
IN–Inhibition vs. Switching Contrast
Scaled Score
Inhibition Total Errors
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0
--
>75
--
Above Expected Level
2
--
26–50
--
At Expected Level
118
9
37
--
At Expected Level
--
8
25
--
At Expected Level
8
--
26–50
--
At Expected Level
7
--
11–25
--
Borderline
1
--
51–75
--
At Expected Level
--
11
63
--
At Expected Level
--
8
25
--
At Expected Level
11
9
37
--
At Expected Level
Scaled Scores
Score Name
Animal Sorting Total
Correct Sorts
Animal Sorting Combined
Scaled Score
Auditory Attention Total
Correct
Auditory Attention
Combined Scaled Score
Response Set Total
Correct
Response Set Combined
Scaled Score
Clocks Total Score
Design Fluency Total
Score
Inhibition–Naming
Completion Time Total
Inhibition–Naming
Combined Scaled Score
Inhibition–Inhibition
Completion Time Total
Inhibition–Inhibition
Combined Scaled Score
Inhibition–Switching
Completion Time Total
Inhibition–Switching
Combined Scaled Score
Inhibition Total Errors
1
2
3
4
5
6
7
8
9
10
11
12 13
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
14
15 16 17 18
19
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Percentile Ranks
Score Name
Animal Sorting Total Errors
Animal Sorting Total Repeated Sort Errors
Animal Sorting Total Novel Sort Errors
Auditory Attention Total Omission Errors
Auditory Attention Total Commission Errors
Auditory Attention Total Inhibitory Errors
Response Set Total Omission Errors
Response Set Total Commission Errors
Response Set Total Inhibitory Errors
Inhibition–Naming Total Errors
Inhibition–Naming Total Self-Corrected Errors
Inhibition–Naming Total Uncorrected Errors
Inhibition–Inhibition Total Errors
Inhibition–Inhibition Total Self-Corrected Errors
Inhibition–Inhibition Total Uncorrected Errors
Inhibition–Switching Total Errors
Inhibition–Switching Total Self-Corrected Errors
Inhibition–Switching Total Uncorrected Errors
<2
2-10
+
11-25
26-75
>75
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Cumulative Percentages
Score Name
Design Fluency–Structured Array Score
Design Fluency–Random Array Score
<=2
3-10
11-25
+
26-75
>75
+
Language
Score Name
Comprehension of Instructions Total Score
Phonological Processing Total Score
Repetition of Nonsense Words Total Score
Speeded Naming Total Completion Time
Speeded Naming Total Correct
Speeded Naming Combined Scaled Score
Speeded Naming Total Self-Corrected Errors
Word Generation-Semantic Total Score
Word Generation-Initial Letter Total Score
WG Semantic vs. Initial Letter Contrast
Scaled Score
Raw
Scores
26
34
33
57
74
-1
28
21
Scaled
Scores
10
9
10
8
-8
-10
12
Percentile
Ranks (%)
50
37
50
25
26–50
25
11–25
50
75
At Expected Level
At Expected Level
At Expected Level
At Expected Level
At Expected Level
At Expected Level
Borderline
At Expected Level
At Expected Level
--
12
75
At Expected Level
Classification
Scaled Scores
Score Name
Comprehension of
Instructions Total Score
Phonological Processing
1
2
3
4
5
6
7
8
9
10
+
+
11
12 13
14
15 16 17 18
19
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Total Score
Repetition of Nonsense
Words Total Score
Speeded Naming Total
Completion Time
Speeded Naming
Combined Scaled Score
Word GenerationSemantic Total Score
Word Generation-Initial
Letter Total Score
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+
+
+
+
+
Percentile Ranks
Score Name
Speeded Naming Total Correct
Speeded Naming Total Self-Corrected Errors
<2
2-10
11-25
26-75
+
>75
+
Memory and Learning
Raw Scaled Percentile
Cumulative
Scores Scores Ranks (%) Percentages (%)
18
9
37
--
Score Name
Memory for Names Total Score
Memory for Names Delayed Total
Score
Memory for Names and Memory for
Names Delayed Total Score
Narrative Memory Free and Cued
Recall Total Score
Narrative Memory Free Recall Total
Score
Narrative Memory Recognition Total
Score
NM Free and Cued Recall vs.
Recognition Contrast Scaled Score
Word List Interference-Repetition
Total Score
Word List Interference-Recall Total
Score
WI Repetition vs. Recall Contrast
Scaled Score
Classification
At Expected Level
8
12
75
--
At Expected Level
26
11
63
--
At Expected Level
33
12
75
--
At Expected Level
15
12
75
--
At Expected Level
16
--
51–75
--
At Expected Level
--
12
75
--
At Expected Level
18
13
84
--
Above Expected Level
18
11
63
--
At Expected Level
--
10
50
--
At Expected Level
Scaled Scores
Score Name
Memory for Names Total
Score
Memory for Names
Delayed Total Score
Memory for Names and
Memory for Names
1
2
3
4
5
6
7
8
9
10
11
12 13
+
+
+
14
15 16 17 18
19
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Delayed Total Score
Narrative Memory Free
and Cued Recall Total
Score
Narrative Memory Free
Recall Total Score
Word List InterferenceRepetition Total Score
Word List InterferenceRecall Total Score
+
+
+
+
Percentile Ranks
Score Name
Narrative Memory Recognition Total Score
<2
2-10
11-25
26-75
+
>75
Visuospatial Processing
Raw
Scores
27
12
24
14
Score Name
Arrows Total Score
Design Copying General Total Score
Geometric Puzzles Total Score
Picture Puzzles Total Score
Scaled
Scores
9
-6
11
Percentile
Ranks (%)
37
>75
9
63
Classification
At Expected Level
Above Expected Level
Borderline
At Expected Level
Scaled Scores
Score Name
Arrows Total Score
Geometric Puzzles Total
Score
Picture Puzzles Total
Score
1
2
3
4
5
6
7
8
9
+
10
11
12 13
14
15 16 17 18
+
+
Percentile Ranks
Score Name
Design Copying General Total Score
<2
2-10
11-25
26-75
Behavioral Observations
Attention and Executive Functioning
Auditory Attention & Response Set
Out of Seat/Physical Movement in Seat–Off Task
Behaviors Total
Inhibition
INN Points to Stimuli Total
Raw
Score
Cumulative
Percentages (%)
Percent of Normative
Sample (%)
2
11–25
--
0
26–75
--
>75
+
19
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INI Points to Stimuli Total
INS Points to Stimuli Total
0
0
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>75
>75
---
Language
Raw
Score
Comprehension of Instructions
Asks for Repetition Total
Phonological Processing
Asks for Repetition Total
Repetition of Nonsense Words
Stable Misarticulation
Cumulative
Percent of Normative
Percentages (%)
Sample (%)
0
26–75
--
0
26–75
--
Y
--
4
Memory and Learning
Raw
Score
Word List Interference
Asks for Repetition Total
0
Cumulative
Percent of Normative
Percentages (%)
Sample (%)
26–75
--
Summary of Test Results:
On the NEPSY II, scaled scores of 8 to 12 and standard scores of 90 - 110 are average (25th to 75th
percentile). The neurological skills evaluated in the Attention and Executive Functioning domain include
persistence, the ability to inhibit impulsive responding, auditory and visual attention, planning ability, the
ability to adopt, maintain, and change set, and the ability to inhibit the impulse to respond when confronted
with conflicting stimuli.
The Animal Sort task assesses the ability to formulate basic concepts, sort into categories, and shift from
one concept to another. The child sorts picture cards into groups of four, using various self-initiated
criteria. Here, her number of correct sorts was in the Borderline range (Total Correct sorts = 7, 16 th
percentile) suggesting problems initiating problem-solving behavior (poor behavioral productivity).
This interpretation was corroborated by Xxxxxx’s limited written productivity on the Essay Composition
task and her low Math Fluency-Addition standard score of 87 (19th %), as well as her slow performance on
several NEPSY-II tasks (i.e., Clocks, Design Fluency-Structured Array, Comprehension of Instructions and
Design Copying). Additionally, Xxxxxx displayed a high number of novel sort errors (Animal Sorting
Total Novel Sort Errors = 5, 5th percentile) - a score in the Below Expected Level range of functioning.
Korkman et al.’s, 2007, interpretation of Xxxxxx’s profile on the Animal Sort task is as follows:
A high number of Novel Sort Errors (i.e., a low score) in the presence of a low Total Correct
Sorts score may indicate that a child is attempting to comply with the task but has an
idiosyncratic process for conceptualizing the relationships between objects on the cards. This
idiosyncratic style may be interfering with his or her ability to see obvious responses. In other
contexts, these children may miss the most salient aspects of a problem that lead to obvious
answers and over-think problems by focusing on peripheral, nonessential bits of information.
In some cases, this profile of a high number of Novel Sort Errors and low Total Correct Sorts
score may indicate that the child was sorting randomly or not putting forth good effort and
concentration.
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Next, on the first part of the Auditory Attention and Response Set task, Xxxxxx’s simple auditory attention
was in the At Expected Level range for her age (Auditory Attention Combined scaled score = 10, 50th
percentile). Here, she was asked to listen to a long list of words played on a CD, and touch colored circles
on a page when she heard target words. On the second part of this task, the complex auditory attention part
of the task, she was asked to switch sets, i.e., touch a red shape when she heard the word yellow. Xxxxxx
again performed in the At Expected Level range on this second part of the task (Response Set Combined
scaled score = 11, 63rd percentile). Here, Xxxxxx was able to shift and maintain a new and complex set
involving both inhibition of previously learned responses and correctly responding to matching or
contrasting stimuli.
On another task, Xxxxxx’s planning and organization skills, visuoperceptual and visuospatial skills, and
the concept of time in relation to analog clocks were assessed. Here, Xxxxxx drew the image of a clock
and placed the hands where the examiner indicated. For visual items, Xxxxxx read the time on clocks that
either have or do not have numbers. Her performance was in the Above Expected Level range on this task
(Clocks Total score scaled score = 13, 84th percentile). Next, the Design Fluency subtest, a pencil and
paper task, assessed her ability to generate novel designs quickly on structured and unstructured arrays.
Here, Xxxxxx was asked to connect two or more dots with straight lines in every box so that each design is
different from the others. On the Structured Array, Xxxxxx achieved a score in the Borderline range
(Design Fluency–Structured Array raw score = 9, 11-25th percentile). On the Random Array condition of
the task, Xxxxxx’s raw score of 13 (26-75th percentile) was in the At Expected Level range of functioning.
Notably, the Design Fluency task is particularly helpful when a language problem is suspected due to a
language delay or disorder. Xxxxxx’s performance suggests that her expressive language difficulties
(i.e., limited expressive vocabulary) may be due to a problem with behavioral productivity.
On another task, the Inhibition-Naming task, Xxxxxx worked with average speed (Completion Time scaled
score = 9, 37th percentile) accuracy (Total Errors raw score = 1, 26-50th percentile) when naming black and
white shapes and directions of arrows. Her overall performance was in the lower end of the At Expected
Level range of functioning (Inhibition-Naming Combined scaled score = 8, 25th percentile). Xxxxxx next
achieved an overall score in the At Expected Level range on the Inhibition-Inhibition task (Combined
scaled score = 10, 50th percentile). On this task Xxxxxx was asked to say the other shape’s name or state
the opposite direction of the arrow when naming black and white shapes and directions of arrows. This task
adds the demand of control of an automatic response and its replacement with a novel response. This
creates an additional demand of cognitive flexibility because she must replace a logical response with a
novel response. Here, Xxxxxx worked with average range accuracy (Total Errors raw score = 2, 51-75th
percentile) and speed (Completion Time scaled score = 10, 50th percentile).
On the Inhibition-Switching task, Xxxxxx performed with adequate speed (Completion Time Total scaled
score = 9, 37th percentile) and accuracy (Total Errors raw score = 8, 26-50th percentile). Here, Xxxxxx was
asked to name shapes and directions of arrows alternately depending on the color of the shape or arrow.
Overall, Xxxxxx earned a score in the lower end of the At Expected Level range on this task (InhibitionSwitching Combined scaled score = 8, 25th percentile).
In the Language domain, Xxxxxx’s receptive language skills, as evaluated by Comprehension of
Instructions, were in the At Expected Level range for a person her age (scaled score = 10, 50th percentile).
Here, she was asked to listen to increasingly complex oral instructions that instructed her to point to
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pictured target shapes, e.g., point to a red circle but first to a blue square. Notably, Xxxxxx’s errors were
predominantly temporal/sequential and spatial concept errors (e.g., but first, above and beside, left of and
underneath, to the right of but not next to it, and diagonal to). Xxxxxx’s difficulty understanding spatial
conceptual terms may have implications for mathematical processing required for geometry, trigonometry,
and calculus.
Xxxxxx was next administered the Phonological Processing task that assessed her ability to process
phonological information – to comprehend speech-sound patterns. During this task, she had some
difficulty retaining initial and ending phonemes of words when other phonemes were removed or changed.
She earned a score in the At Expected Level range (Phonological Processing scaled score = 9, 37th
percentile). Xxxxxx was also administered the Repetition of Nonsense Words task which assesses
phonological decoding of sound patterns, as well as encoding and articulating complex and unfamiliar
words. Here, she achieved a scaled score of 10 (50th percentile) in the At Expected Level range of
functioning.
On another task, Xxxxxx’s ability to rapidly identify numbers and letters in alternating patterns was in the
lower end of the At Expected Level range (Speeded Naming Combined scaled score = 8, 25th percentile).
On this task, she performed with adequate speed (scaled score = 8, 25th percentile) and accuracy (raw score
= 74, 26-50th percentile). Xxxxxx was next administered the Word Generation task. This task has two
parts – Semantic Word Generation and Initial Letter Word Generation. For Semantic Word Generation,
Xxxxxx was asked to name as many examples of items in a specific category as possible within a 60second time limit. Then she was asked to name as many items in another category as possible within a 60second time limit. For Initial Letter Word Generation, Xxxxxx was required to name as many words as she
can that begin with one letter within a 60-second time limit and as many words as she can that begin with
another letter within a 60-second time limit. Her performance on the first part of the task was in the At
Expected Level range (Word Generation Semantic Total Score scaled score = 10, 50th percentile).
Similarly, Xxxxxx’s performance on the Word Generation Initial Letter (Total Score scaled score = 12,
75th percentile) was in the upper end of the At Expected Level range for her age.
In the Memory and Learning domain, Xxxxxx’s ability to learn the association between a visual stimulus
and its verbal label was assessed. On this task, Xxxxxx was shown eight cards with drawings of children
on them while being read the child’s name. The cards were then shown again and Xxxxxx was asked to
recall the name of the child on the card. Here, her performance was in the At Expected Level range for her
age over three learning trials (Memory for Names Total Score scaled score = 9, 37th percentile). These
findings suggest that Xxxxxx is able to encode, learn, and recall visual-verbal paired-associates over
three trials. Her retrieval of this information after 25 minute delay was in the upper end of the At
Expected Level range (Memory for Names Delayed Total Score = 12, 75th percentile).
Xxxxxx next completed the Narrative Memory task where she was asked to listen to a story and then was
asked to repeat the story. She was then asked questions to elicit missing details from the story. Here,
Xxxxxx’s ability to listen attentively to extended prose, to comprehend what was heard, and to organize
and retrieve this information was in upper end of the At Expected Level range (Narrative Memory Free
Recall Total Score scaled score = 12, 75th percentile). Commensurate with her free recall score, Xxxxxx
earned a score in the upper end of the At Expected Level range on the free and cued recall portion of the
task (Free and Cued Recall Total Score scaled score = 12, 75th percentile). For the Recognition condition
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of the Narrative Memory task, Xxxxxx was asked questions such as “Was the boy in the story named Jim
or Jeff?” Here, Xxxxxx obtained a Narrative Memory Recognition Total Score of 16 (51-75th percentile) –
a score in the At Expected Level range of functioning. These findings confirm the WIAT-III results
suggesting that receptive language is an area of strength for Xxxxxx.
On another task, the Word List Interference task, Xxxxxx was read a word or a brief sequence of
unconnected words and asked to repeat them. She then repeated a second series of words. Thereafter,
Xxxxxx was asked to say the first word list and then the second list. In this way, the second word list acted
as a source of interference for the recall of the first word list. Likewise, recalling the first list acted as
interference for recalling the second list. This test works as a complex working memory test that requires
both repetition and short-term memory for verbal material, as well as requiring the holding of this verbal
material active in memory during a cognitive operation. Xxxxxx’ Word List Interference- Repetition Total
Score (scaled score = 13, 84th percentile) was in the Above Expected Level range for her age. This result
indicates that Xxxxxx is able to repeat word lists of increasing length and that encoding of verbal material
is intact. Similarly, she was able to recall the recently encoded word lists in spite of having to recall
intervening lists (Word List Interference-Recall Total Score = 11, 63rd percentile). Here, her performance
was in the At Expected Level range of functioning. Notably, the recall portion of the task involves aspects
of executive functioning, i.e., the ability to retrieve recently encoded word lists actively from memory or
holding the memory traces in an activated state (working memory). Finally, the Word List Interference
Repetition vs. Recall Contrast scaled score of 10 (50th percentile) was in the At Expected Level range of
functioning for a young person her age.
The Visuospatial Processing domain assesses different components of visual-spatial perception and
production ability. On the Design Copying task, Xxxxxx was asked to copy increasingly complex
geometric forms - a pencil-and-paper task. She performed in the upper end of the At Expected Level range
on this task (Design Copying General Total raw score = 12, >75th percentile). On the Arrows task, Xxxxxx
was asked to look at an array of arrows arranged around a target and she indicated the arrow(s) that points
to the center of the target. This task is designed to assess the ability to judge line orientation. Here,
Xxxxxx worked with accuracy in the At Expected Level range (Arrows scaled score = 9, 37th percentile).
Xxxxxx next performed in the Borderline range on a task designed to assess, visuospatial analysis,
evaluation of directions, and mental rotation (Geometric Puzzles Total Score scaled score = 6, 9th
percentile). Poor performance on this task points to problems with visuospatial perception, particularly
mental rotation. Since her performance was better on Picture Puzzles, her difficulties may involve the
spatial and mental rotation demands of the Geometric Puzzles task. Korkman et al.’s (2007)
description of low scorers on Geometric Puzzles is below.
The child with low scores may have problems in the ability to understand and use the
principles that underlie the positioning of numbers to represent units (e.g., tens, hundreds).
Later, a child may have difficulty with the more complex mathematical processing required
for geometry, trigonometry, and calculus.
On the Picture Puzzles task, Xxxxxx was presented a large picture divided by a grid and four smaller
pictures taken from sections of the larger picture. She was asked to identify the location on the grid of the
larger picture from which each of the smaller pictures was taken. This task is designed to assess the
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nonmotor aspects of visual perception. Xxxxxx earned a score in the At Expected Level range on this task
(Picture Puzzles Total Score scaled score = 11, 63rd percentile).
Emotional, Behavioral and Personality Functioning
To assess Xxxxxx’s emotional, behavioral and personality functioning, the Child Behavior Checklist,
Conners 3, and Teacher Report Form were administered. The results are below. Empty boxes in the
tables that follow indicate that scores were not clinically significant and, therefore, not entered.
Child Behavior Checklist - Syndrome Scale Scores and DSM-Oriented Scales
B = Borderline Clinical Range, C = Clinical Range (T Scores Mean= 50)
Scales
Mother
Father
Xx. Xxxxx
Xx. Xxxxx
5th grade
5th grade
Xxxxx
Xxxxxxxx
xxxxxx
xxxxxx
Teacher
xxxxx
Teacher
Anxious/Depressed
Withdrawn/
Depressed
Somatic Problems
Social Problems
Thought Problems
Attention Problems
Rule-Breaking
Behaviors
Aggressive Behavior
Internalizing Problems
66T-B
(95th %)
68T-B
(97th %)
67T-B
(96th %)
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Externalizing
Problems
Total Problems
60T-B
(84th %)
Affective Problems
DSM-Oriented Scales)
Anxiety Problems
(DSM-Oriented
Scales)
Somatic Problems
(DSM-Oriented
Scales)
AttentionDeficit/Hyperactivity
Problems (DSMOriented Scales)
Oppositional/Defiant
Problems (DSMOriented Scales)
Conduct Problems
(DSM-Oriented
Scales)
65T-B
(93rd %)
Competence Scale Scores for Girls 6-11 – Parent Rating
Scales
Activities
Mother
Father
0T-C
(<3rd %)
Social
School
Total
Competence
34T-B
(6th %)
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Adaptive Functioning Scales – Teacher Rating
Scales
Xx. Xxxxx
Xx. Xxxxx
5th grade
5th grade
Xxxxx
Xxxxxxxx
xxxxxx
xxxxxx
Teacher
xxxxx
Teacher
Academic
35T-C
37T-B
th
Performance
(<7 %)
(10th %)
1 Working hard
2 Behaving
3 Learning
39T-B
(14th %)
37T-B
(10th %)
37T-B
(10th %)
39T-B
(14th %)
37T-B
(10th %)
4 Happy
Sum of items 1,2,3,4
36T-C
(8th %)
Summary of Test Results:
Mother
The Child Behavior Checklist (CBCL) was completed by Ms. Xxxxxx Xxxxxxxxxx, Xxxxxx's biological
mother, to obtain her perceptions of Xxxxxx's competencies and problems. Ms. Xxxxxxxx reported that
Xxxxxx participates in one sport and that she has interests in two hobbies. She also belongs to two social
organizations, teams or clubs and has three jobs or chores. Moreover, Ms. Xxxxxxxx indicated that
Xxxxxx has four or more close friends and that she sees friends three or more times a week outside of
regular school hours. Finally, Ms. Xxxxxxxx rated Xxxxxx's school performance as below average in
reading, average in social studies, above average in math, and average in science.
Xxxxxx's Total Competence score was in the normal range for parents' ratings of girls aged 6 to 11. Her
scores on the Activities, Social, and School scales were all in the normal range.
On the CBCL problem scales, Xxxxxx's Total Problems, Internalizing, and Externalizing scores were all in
the normal range for girls aged 6 to 11. Her scores on the Anxious/Depressed, Withdrawn/Depressed,
Somatic Complaints, Social Problems, Thought Problems, Rule-Breaking Behavior, and Aggressive
Behavior syndromes were in the normal range. Her score on the Attention Problems syndrome was in the
borderline clinical range (93rd to 97th percentiles). These results indicate that Xxxxxx's biological mother
reported more problems than are typically reported by parents of girls aged 6 to 11, particularly attention
problems.
On the DSM-oriented scales, Xxxxxx's scores on all rated scales were in the normal range.
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Father
The CBCL was also completed by Mr. Xxxxxxxx Xxxxxxxx, Xxxxxx's biological father, to obtain his
perceptions of Xxxxxx's competencies and problems. Mr. Xxxxxxxx reported that Xxxxxx participates in
three sports and belongs to one social organization, team or club. Additionally, Mr. Xxxxxxxx reported
that Xxxxxx has two jobs or chores and two or three close friends but that she sees friends less than once a
week outside of regular school hours. Finally, Mr. Xxxxxxxx rated Xxxxxx's school performance as below
average in language arts, below average in social studies, average in math, and average in science.
Xxxxxx's Total Competence score was in the normal range for parents' ratings of girls aged 6 to 11.
However, because of missing information, Xxxxxx had no score on the Activities scale. Her score on the
Social scale was in the normal range, and her score on the School scale was in the borderline clinical range
(3rd to 7th percentiles).
On the CBCL problem scales, Xxxxxx's Total Problems, Internalizing, and Externalizing scores were all in
the normal range for girls aged 6 to 11. Her scores on the Anxious/Depressed, Withdrawn/Depressed,
Somatic Complaints, Social Problems, Thought Problems, Rule-Breaking Behavior, and Aggressive
Behavior syndromes were in the normal range. Her score on the Attention Problems syndrome was in the
borderline clinical range (93rd to 97th percentiles). These results indicate that Xxxxxx's biological father
reported more problems than are typically reported by parents of girls aged 6 to 11, particularly attention
problems.
On the DSM-oriented scales, Xxxxxx's scores on all rated scales were in the normal range.
Teacher
The Teacher Report Form (TRF) was completed by Xxxxxx's 5th xxxxxxxxxx teacher, Xx. Xxxxx Xxxxx
to obtain her perceptions of Xxxxxx's adaptive functioning and problems. Notably, Xx. Xxxxx reported
knowing Xxxxxx for 4 months.
Xx. Xxxxx rated Xxxxxx's performance in English as far below grade level, and social studies as somewhat
below grade level. Moreover, Xx. Xxxxx rated Xxxxxx as working slightly less hard, behaving slightly
less appropriately, learning slightly less, and happy about average compared to typical students of the same
age.
Xxxxxx's Academic Performance score was in the clinical range below the 10th percentile for teachers'
ratings on girls aged 6 to 11. Additionally, Xxxxxx's Total Adaptive Functioning score was in the clinical
range below the 10th percentile.
On the TRF problem scales, Xxxxxx's Total Problems score was in the borderline clinical range (84th to
90th percentiles). Her Internalizing and Externalizing scores were both in the normal range for girls aged 6
to 11. Her scores on the Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social
Problems, Thought Problems, Rule-Breaking Behavior, and Aggressive Behavior syndromes were in the
normal range. Her score on the Attention Problems syndrome was in the borderline clinical range (93rd to
97th percentiles). On the Attention Problems subscales, Xxxxxx's score for Inattention was high enough to
warrant concern while her score for Hyperactivity-Impulsivity was in the normal range. These results
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indicate that Xx. Xxxxx reported more problems than are typically reported by teachers of girls aged 6 to
11, particularly attention problems.
On the DSM-oriented scales, Xxxxxx's scores on the Affective Problems, Anxiety Problems, Somatic
Problems, Oppositional Defiant Problems, and Conduct Problems scales were in the normal range. Her
score on the Attention Deficit/Hyperactivity Problems scale was in the borderline clinical range (93rd to
97th percentiles). On the Attention Deficit/Hyperactivity subscales, Xxxxxx's score for Inattention was
high enough to warrant concern while her score for Hyperactivity-Impulsivity was in the normal range.
Teacher
The TRF was also completed by Xxxxxx's 5th grade xxxxxx xxxxxxxx teacher to obtain her perceptions of
Xxxxxx's adaptive functioning and problems. Notably, Xx. Xxxxx reported knowing Xxxxxx for 4
months.
Xx. Xxxxx rated Xxxxxx's performance in math, science, reading, and vocabulary at somewhat below
grade level, and religion at grade level. Additionally, Xx. Xxxxx rated Xxxxxx as working slightly less
hard, behaving slightly more appropriately, learning slightly less, and slightly more happy compared to
typical students of the same age.
Xxxxxx's Academic Performance score was in the borderline clinical range (10th to 16th percentiles) for
teachers' ratings on girls aged 6 to 11. Xxxxxx's Total Adaptive Functioning score was in the normal
range.
On the TRF problem scales, Xxxxxx's Total Problems, Internalizing, and Externalizing scores were all in
the normal range for girls aged 6 to 11. Scores on all rated syndrome scales were in the normal range. On
the Attention Problems subscales, Xxxxxx's score for Inattention was high enough to warrant concern
while her score for Hyperactivity-Impulsivity was in the normal range.
On the DSM-oriented scales, Xxxxxx's scores on all rated scales were in the normal range. On the
Attention Deficit/Hyperactivity subscales, Xxxxxx's score for Inattention was high enough to warrant
concern while her score for Hyperactivity-Impulsivity was in the normal range.
Conners 3 Rating Scale
Significant T-Scores (T>60)
Scales
Mother
Assessment of
Validity –
Inconsistency Index
Assessment of
Validity – Positive
Impression Index
Assessment of
Validity – Negative
Father
Xx. Xxxxx
5th grade
teacher
Xx. Xxxxx
5th grade
Teacher
Xxxxxx
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
Probably
Valid
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Impression Index
Inattention
72T
(99th %)
Hyperactivity/
Impulsivity
Learning
Problems/
Executive
Functioning
Learning Problems
Executive
Functioning
86T
(99.92%)
88T
(99.92%)
60T
(84th %)
61T
(87th %)
63T
(91st %)
na
na
75T
(99th %)
73T
(99th %)
na
64T
(92nd %)
74T
(99th %)
70T
(98th %)
70T
(98th %)
70T
(98th %)
62T
(88th %)
78T
(99.4%)
69T
(97th %)
69T
(97th %)
Na
Defiance/
Aggression
Peer Relations
Family Relations
na
na
na
Conners 3 Global
Index Total
DSM-IV-TR
Inattention
DSM-IV-TR
HyperactiveImpulsive
DSM-IV-TR
Conduct Disorder
DSM-IV-TR
Oppositional
Defiant Disorder
Anxiety Screener
Items
70T
(98th %)
na
na
64T
(92nd %)
71T
(98th %)
>90T
(99.98%)
79T
(99.6%)
na
61T
(87th %)
Further
Investigation
may be
Necessary
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Depression
Screener Items
Severe Conduct
Critical Items
Conners 3 ADHD
Index Probability
Score
Possible IDEA
Eligibility
Category
29th %
51%
89th %
87th %
66%
Specific
Learning
Disability,
Other Health
Impairment
Emotional
Disturbance,
Specific
Learning
Disability,
Other Health
Impairment
Emotional
Disturbance,
Specific
Learning
Disability,
Other Health
Impairment
Emotional
Disturbance,
Specific
Learning
Disability,
Other Health
Impairment
Emotional
Disturbance,
Specific
Learning
Disability,
Other Health
Impairment
SumXxxxxx of Test Results:
The Conners 3 Rating Scale was administered to Xxxxxx’s mother, father, two 5th grade regular classroom
teachers, and Xxxxxx. Scores for the Inconsistency Index, Positive Impression Index, and Negative
Impression Index suggest that all respondents did attend appropriately to the Conners 3 item content and
did not attempt to present an unrealistically favorable or negative impression in completing the test.
Xxxxxx’s father and both teachers rated Xxxxxx as having more problems with inattention than is typical
of children her age and as having an above average correspondence with DSM-IV-TR diagnostic criteria
for inattentive type ADHD. However, the ratings by Xxxxxx and her mother were lower on this scale and
did not reach clinical significance. On the Hyperactivity/Impulsivity scale, both teacher’s and Xxxxxx were
in agreement that Xxxxxx has more problems with hyperactivity and impulsivity than is typical of children
of comparable age. On the other hand, the ratings of Xxxxxx by both parents did not support this
conclusion.
On the Conners 3 Rating Scale, ratings on the Learning Problems/Executive Functioning scale are only
conducted by classroom teachers. Here, Xx. Xxxxx and Xx. Xxxxx agreed that Xxxxxx has more learning
problems involving executive functioning than is usually encountered among children Xxxxxx’s age. On
another scale assessing overall problems with learning, the Learning Problems scale, all five respondents
agreed that Xxxxxx has more problems generally with learning than is typical of children her age. Next,
there are no self-ratings on the Executive Functioning scale, a scale that assess executive functioning
problems of a more general nature. On this scale, both parents and both teachers were in agreement that
Xxxxxx has more overall problems with executive functioning than is commonly found among children
Xxxxxx’s age.
On the DSM-IV-TR Hyperactive-Impulsive scale, Xxxxxx’s ratings suggested an above average
correspondence with DSM-IV-TR diagnostic criteria for hyperactive-impulsive type ADHD. However,
this conclusion was not corroborated by the ratings of any other respondent. Finally, Xxxxxx was the only
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respondent who endorsed an anxiety screener item (i.e., worries). This finding suggests that further
investigation may be necessary in this area.
Although Xxxxxx rated herself as having more problems with hyperactivity/impulsivity than is typical of
adolescents her age and as having an above average correspondence with DSM-IV-TR diagnostic criteria
for inattentive type ADHD, these concerns were not corroborated by other respondents.
Summary and Clinical Formulation:
Xxxxxx is a 10-year, 4-month old female who is presently living with her biological mother and father and
xxxxxxxxxxxxxxxxx xxxxx xxxxx. She is a 5th grader attending xxxxxxx xxxxxxxxx. The current
evaluation was conducted to assess Xxxxxx’s neuropsychological, cognitive, emotional and
behavioral functioning for indications of ADHD as well as generate recommendations to enhance her
overall adaptation to the school setting. It will also attempt to rule out disorders that frequently cooccur with ADHD (e.g., learning disorders and executive dysfunction) or masquerade as ADHD (e.g.,
mood disorders, anxiety disorders, and biologically based cognitive disorders).
Results of the WISC-IV show that Xxxxxx reasons in the Average range with the use of language (Verbal
Comprehension composite score = 96, 39th percentile). Likewise, without the use of language, she reasons
in the Average range for her age (Perceptual Reasoning composite score = 102, 55th percentile).
Additionally, Xxxxxx achieved a score in the upper end of the Average range of functioning for her overall
intellectual level (Full Scale I.Q. Composite Score = 105, 63rd percentile). Her global intellectual capacity
is estimated to be in the middle of the Average range to the lower end of the High Average range for a
child her age.
Xxxxxx’s abilities in the Working Memory domain of the WISC-IV were significantly stronger than her
capacities in the Verbal Comprehension, Perceptual Reasoning, and Processing Speed domains.
Specifically, Xxxxxx’s ability to recall rote auditory information is a cognitive strength. Notably, she
was equally adept at recalling sequences of numbers in the same order as recalling sequences of numbers in
reverse order. As such, Xxxxxx seems to have well developed capacity to register auditory
information in working memory and to manipulate that information. Additionally, Xxxxxx has
Average range vocabulary skills, abstract verbal reasoning ability, and capacity to think in terms of
categories in order to sort pictures of common objects. Similarly, Xxxxxx’s abilities to understand the
appropriate judgment and behavior for social situations, to process visual information quickly when it is
paired with a motor response, and to reason with purely abstract visual information, are in the Average
range. However, as is discussed more thoroughly below, some aspects of visual perception, i.e.,
visuospatial perception and mental rotation, are vulnerabilities for Xxxxxx. This may have implications for
her performance in higher level math courses such as geometry, trigonometry, and calculus.
Xxxxxx’s academic achievement test scores in Listening Comprehension, Reading Comprehension,
Sentence Composition, Essay Composition: Grammar and Mechanics, Numerical Operations, Math
Fluency-Subtraction, Math Fluency-Multiplication, Mathematics composite, and Math Fluency composite
were all consistent with Xxxxxx’s predicted scores given her estimated general intellectual potential or, in
the case of Numerical Operations, significantly higher than her predicted score. These results suggest that
Xxxxxx is realizing the full expression of her intellect in these academic areas. However, Xxxxxx
struggled with Word Reading, a WIAT-III subtest designed to measure speed and accuracy of single word
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reading. Here, Xxxxxx read with adequate speed but less accuracy than would be expected given her
estimated general intellectual ability. Likewise, Xxxxxx struggled with Pseudoword Decoding, a subtest
designed to measure speed and accuracy of decoding skills. Although she again performed with adequate
speed, her error rate was higher than predicted given Xxxxxx’s estimated overall intellectual capacity.
Finally, Xxxxxx’s overall reading skills were shown to be in the Average range of functioning for a child
her age (Basic Reading Composite standard score = 90, 25th percentile) but significantly below her
predicted score (standard score = 103, 58th percentile). Additionally, the discrepancy between ability and
achievement for the Basic Reading Composite score (13 standard score points) is relatively rare in the
normative sample (base rate <15%). Collectively, the results of testing in the Reading domain support a
diagnosis of Dyslexia (DSM-IV-TR diagnosis of Reading Disorder).
As is frequently found among children with reading difficulties, Xxxxxx also shows signs of
underachievement in spelling skills. On the WIAT-III Spelling subtest, Xxxxxx is asked to listen to a
target word, listen to the word within the context of a sentence, and then to write the word. Her standard
score of 91 (27th percentile) was significantly below her expected score of 103, 58th percentile. The size of
the difference between ability and achievement for the Spelling subtest (12 standard score points) is an
unusual event in the standardization sample (base rate <15%) although the standard deviation discrepancy
was <1 SD. Notably, analysis of Xxxxxx’s spelling errors revealed difficulties with several skills including
common suffixes/word endings, irregular vowels, schwa vowel sounds, consonant digraphs, single
consonants, T as \sh\ or \ch\, silent consonants, and insertions.
In the Written Expression domain, Xxxxxx received a score that falls in the Below Average range on the
Essay Composition task (standard score = 83, 13th percentile). Her low score reflects problems with
theme development and text organization (Theme Development and Text Organization standard
score = 81, 10th percentile) as well as borderline written productivity (Word Count standard score =
88, 21st percentile). Moreover, her Written Expression composite score of 88 (21st percentile) was
significantly lower than her predicted score given her estimated overall intellectual ability (predicted score
= 103, 58th percentile). Here, the difference between ability and achievement (15 standard score points)
was both a rare event in the normative sample (base rate <10%) and had a standard deviation discrepancy
>1 SD. Overall, the findings of testing in the Written Expression domain support a diagnosis of
Dysgraphia (DSM-IV-TR diagnosis of Disorder of Written Expression).
Xxxxxx’s limited written productivity on the Essay Composition task and her low Math Fluency-Addition
standard score of 87 (19th %), as well as her slow performance on several NEPSY-II tasks (i.e., Clocks,
Design Fluency-Structured Array, Comprehension of Instructions and Design Copying), may reflect a
deficit in the executive function skill of behavioral initiation (i.e., problems initiating problem-solving
behavior). Additional support for this conclusion is reviewed later in this sumXxxxxx.
Xxxxxx also received an underachieving score on the Math Problem Solving subtest (standard score = 93,
32nd percentile). Here, Xxxxxx is asked to read charts and graphs and to solve word problems. Although
these results indicate a weakness in mathematical reasoning, they do not suggest a diagnosis of
Dyscalculia at this time. Notably, the 10 point standard score discrepancy between her obtained score and
her predicted score was not a rare event in the normative sample (base rate >15%) nor was the standard
deviation discrepancy >1 SD. It may be that Xxxxxx’s performance on the Math Problem Solving subtest
was undermined by her difficulty understanding spatial conceptual terms such as a fraction of an
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object, a left or right rotation of an object, and perimeter. This conclusion is supported by Xxxxxx’s
low score on the NEPSY-II Geometric Puzzles task and the types of errors she made on the NEPSY-II
Comprehension of Instructions task. On the former task, Xxxxxx’s errors were primarily mental rotation
errors. On the latter task, her errors were predominantly temporal/sequential and spatial concept errors
(e.g., but first, above and beside, left of and underneath, to the right of but not next to it, and diagonal to).
Xxxxxx’s score on the Expressive Vocabulary condition of the Oral Expression subtest (standard score =
85, 16th percentile) was among her lowest scores on the WIAT-III. Her underachievement in this area is
substantial - an 18 point standard score discrepancy between ability and achievement. Many linguistic
features of Expressive Language Disorder were identified in her responses to this task as well as her
responses to the WISC-IV Comprehension task. These features include limited range of vocabulary, word
finding errors, vocabulary errors, limited varieties of grammatical structures (e.g., verb forms) shortened
sentences, simplified grammatical structures, omissions of critical parts of sentences, and use of unusual
word order. These results support a diagnosis of Expressive Language Disorder.
Xxxxxx’s performance in the Oral Language, Written Expression and Mathematics domains provide clues
as to Xxxxxx’s learning style. Her performance indicates that she is at her best when processing
language receptively (i.e., listening comprehension at the level of the word, sentence, and discourse);
written sentence formulation skills including the use of morphology, grammar, syntax, semantics,
and mechanics (i.e., punctuation, capitalization etc. but not spelling); and written mathematics
calculation skills under untimed conditions. In general, Xxxxxx’s learning style can be described as
learning by processing oral language, writing using proper grammar and mechanics (i.e.,
punctuation, capitalization etc. but not spelling), and accurately performing written numerical
calculations.
NEPSY-II test results in the Attention and Executive Functioning domain indicate a problem with
behavioral productivity. More precisely, Xxxxxx appears to have a deficit in behavioral initiation –
difficulty initiating problem-solving behavior. Vulnerability in behavioral initiation can result in slow
processing on a variety of tasks and in a variety of settings as well as contributing to inattentive, distracted,
and off-task behaviors. In fact, poor behavioral initiation – an executive function deficit – is frequently
found among individuals diagnosed with ADHD. These interpretations are further supported by
questionnaire data from multiple respondents pointing to a diagnosis of inattentive type ADHD, as well as
general executive functioning problems, general learning problems and learning problems associated with
executive functioning deficits. Notably, Xxxxxx does not appear to have other executive functioning and
behavioral difficulties frequently found in the ADHD population (e.g., hyperactivity, poor simple auditory
attention, dysinhibition/impulsivity, poor cognitive flexibility, and difficulty managing interference affects
and dual tasking). Nevertheless, it is this examiner’s opinion that Xxxxxx does meet DSM-IV-TR
diagnostic criteria for inattentive type ADHD.
As mentioned above, Xxxxxx struggled with the NEPSY-II Geometric Puzzles task, a task designed to
assess, visuospatial analysis, evaluation of directions, and mental rotation (Total Score scaled score = 6, 9 th
percentile). However, Xxxxxx’s performance on other nonlinguistic tests (i.e., subtests in the WISC-IV
Perceptual Reasoning domain and the NEPSY-II Visuospatial Processing domain) do not support a
diagnosis of Non-Verbal Learning Disability (NVLD). Xxxxxx’s difficulty with the spatial and mental
rotation demands of the Geometric Puzzles task appears to be idiosyncratic and may reflect her
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deficit in behavioral initiation or nonneurostructural factors (e.g., anxiety and stress). Nevertheless,
this finding indicates that Xxxxxx may have difficulty with the more complex mathematical processing
required for geometry, trigonometry, and calculus.
With the exceptions of inattentive type ADHD and learning problems, the results of testing of Xxxxxx’s
emotional, behavioral and personality functioning indicate no significant adaptive liabilities in her
psychological profile.
In conclusion, psycho-educational testing suggests that Xxxxxx is underachieving in several academic
areas. These areas include reading, spelling, theme development and text organization in essay
composition, and oral expression (i.e., limited range of vocabulary, word finding errors, vocabulary errors,
limited varieties of grammatical structures, shortened sentences, simplified grammatical structures,
omissions of critical parts of sentences, and use of unusual word order). Moreover, neuropsychological test
findings and the results of behavior rating scales indicate that problems with inattention and poor
behavioral initiation (i.e., difficulty initiating problem-solving behavior) may underlie Xxxxxx’s learning
problems. Also, nonneurostructural factors such as anxiety and stress may play a role in Xxxxxx’s
academic underachievement.
With regard to Xxxxxx’s reading profile, test results suggest that Xxxxxx has an idiosyncratic central
stage reading disorder with many of the features of deep dyslexia. Her profile is unusual because most
individuals with deep dyslexia have no phonological route (no ability to read a word by converting it to
sound and processing it for meaning as an auditory unit) and a partially impaired direct route (a limited
ability to read a word by processing it directly as a visual unit for meaning). However, Xxxxxx is capable
of segmenting phonemes in some familiar words and is able to convert some familiar words to sound.
Nevertheless, Xxxxxx tends to read by “sight vocabulary.” This is likely due to her deficit in encoding
phonological information into short-term memory and her frustration with processing an auditory unit for
meaning. Unfortunately, Xxxxxx also has difficulty reading words directly as a visual unit for meaning –
the direct route into the semantic system is impaired. Therefore, Xxxxxx has a partially impaired
phonological route and a partially impaired direct route. When both routes are partially impaired, the
profile has many features of deep dyslexia e.g., the individual tends to read by ‘sight vocabulary’, has
difficulty reading new or nonsense words, makes visual errors (e.g., shot for shut), has difficulty reading
grammatical words, and has more difficulty reading abstract words than concrete words. One feature that
appears to be missing for Xxxxxx is semantic errors, e.g., reading ‘chapel’ for church’, ‘pain’ for ‘ache’,
etc.
DSM-IV Multiaxial Assessment
Axis I: Clinical Disorders and Other Conditions That May Be a Focus of Clinical
Attention
314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type, Moderate
315.0 Reading Disorder, Moderate
315.31 Expressive Language Disorder, Moderate
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315.2 Disorder of Written Expression, Moderate
V62.3 Academic Problem
Axis II: Personality Disorders and Mental Retardation
V71.09 No Diagnosis
Axis III: General Medical Conditions
No dx (ICD-9-CM v71.09)
Axis IV: Psychosocial and Environmental Problems
Educational Problems: academic problems
Axis V: Global Assessment of Functioning Scale
Current GAF: 65
Highest GAF Past Year: 68
Recommendations:
General
1. Xxxxxx’s parents should share this report with Dr. xxxxxxxxxx, Ms. Xxxxx xxxxxxx (or other
provider of special education advocacy services as can be acquired through the Federation of Children
with Special Needs or the Council of Parent Attorneys and Advocates), the Xxxxxxxxxxx Public
Schools Department of Special Education, and Xxxxxx’s school team at Xxxxxxxx Xxxxxxxxx.
2. Xxxxxx’s parents should consider requesting a meeting through the Department of Special Education
of the Xxxxxxxxx Public Schools to discuss Xxxxxx’s eligibility for an IEP. Notably, the school
district may require that they conduct their own educational evaluation before eligibility will be
considered. As part of the school district’s educational evaluation, it is recommended that Xxxxxx
receive a comprehensive language evaluation. The current evaluation may be submitted as an
Independent Educational Evaluation (IEE) and reviewed along with the school district’s assessment to
determine eligibility for an IEP.
3. It is recommended that Xxxxxx be found eligible for an IEP and receive special education services
under the category of Multiple Disabilities, i.e., Other Health Impaired and Specific Learning
Disability.
4. It is this examiner’s opinion that, in order to meet Xxxxxx’s needs and promote effective
progress, she requires a school with an academic program designed to serve students with
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language–based learning disorders. A comprehensive language-based program with a small class
size, a peer group with comparable deficits and learning styles, and a highly structured instruction in a
fully enriched program throughout her full day is necessary for Xxxxxx to benefit from her academic
instruction. The program needs to provide a consistent methodology throughout the year and across the
curriculum.
5. The program will need to meet her need for regular feedback as to how to improve her performance as
well as time for reflection or “discussion” between Xxxxxx and her teacher built into the activities.
6. The wide spread use of manipulatives, models, displays, the integration of assistive technologies (e.g.,
Smart Board and Math Computer Lab), using hand signals or gestures along with verbal prompts
(pairing visual and auditory cues), and the systematic use of kinesthetic and proprioceptive learning is
recommended. These strategies will need to be blended appropriately in Xxxxxx’s case to augment her
abilities and to bypass or compensate for deficits.
7. Xxxxxx will need to get adequate intensive instruction in phonics, sight words and spelling as well as
reading practice in decodable text.
8. It is recommended that Xxxxxx’s language class methodically implement token economy and social
reinforcement strategies throughout its curriculum. These reward systems will enhance Xxxxxx’s
attention, motivation and self-confidence.
9. Reevaluation with neuropsychological testing in one to two years is recommended.
Reading
Xxxxxx requires intensive instruction in phonics, sight words, and spelling.
Phonics
1. It is recommended that Xxxxxx receive a multisensory program to teach phonic skills, such as the
Wilson Reading System, that was designed originally for older students. Available from Wilson
Language Training, 175 West Main Street, Millbury, MA, 01527-1441, (800) 899-8454,
http://www.WilsonLanguage.com
Sight Word Identification
1. When teaching sight words, directly teach Xxxxxx to recognize common letter patterns within the word
(e.g., ight in sight, oo in look). Reinforce automatic recognition of the letter pattern by giving practice
finding it in other words and in discriminating it from similar patterns. For example, given a page of
words containing oo, have her track across each line, circling oo. Later, have her circle oo on a similar
worksheet comprised of words that incorporate oo as well as vowel combinations similar to oo such as
ou.
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2. If Xxxxxx continues to have difficulty recognizing and spelling sight words within an instructional
program using decodable text and controlled vocabulary, use a modification of the Fernald method for
initial instruction. Provide the word printed neatly in large bold letters (1½ to 2 inches high) on a strip
of rough paper, such as a grocery bag. Have Xxxxxx repeatedly trace the letters of the word as she says
each sound (not the letter name). When Xxxxxx is positive that she can write the word from memory
with no mistakes, she writes it 5 times, checking his spelling against the model each time, and covering
up his previous attempts. If she makes a mistake at any point, she goes back to tracing
Reading Practice in Decodable Text
1. Provide daily reading practice in decodable text (text based on a controlled vocabulary with many
presentations of the sight words and reading/spelling patterns taught and in the same sequence).
Xxxxxx must read decodable text to integrate new and previously learned subskills into meaningful and
connected text as well as to develop automaticity in word attack and sight word identification in
multiple contexts. Regular basal texts or trade books are not effective for this purpose, as they do not
provide a controlled vocabulary with sufficient presentations of specific reading and spelling patterns in
a specific sequence.
2. Combine phonics instruction with a reading program that uses decodable text. Decodable text is
reading material that is composed primarily of words with regular sound-symbol correspondence.
Reading decodable text provides the opportunity for application of newly learned skills and
generalizing skills learned in isolation to practical use.
3. Set aside at least 15 minutes every day for Xxxxxx to read decodable text. Decodable text is reading
material comprised of the phonics and sight words she has already learned. Reading decodable text
provides the opportunity for application of newly learned skills, reinforcement of sight words, and
transitioning skills learned in isolation to practical use. At her current skill level, reading aloud is best.
4. Supplement Xxxxxx’s phonics instruction with additional decodable books that she can read during
free reading time and at home. Examples of the series available from educational publishers are the
Steck-Vaughn Phonics Readers (Steck-Vaughn), SRA Reading Series (SRA/McGraw-Hill), Decodable
Books (The Wright Group), J & J Language Readers (Sopris West), Phonics-Based Chapter Books
(High Noon), and Scholastic Phonics Readers (Scholastic).
Spelling
1. Attempt to determine the specific strategies (phonological, orthographic, and morphological) that
Xxxxxx uses when spelling by analyzing errors to determine which are sound-based and which are
orthographic/morphological (e.g., letter sequences and word endings).
2. Do not penalize Xxxxxx for misspellings in written work. Provide assistance as needed with correcting
spelling for final drafts.
3. Help Xxxxxx learn to use a spell checker on a word processing program to edit her work.
4. As an aid to spelling, have Xxxxxx use word prediction software that will provide suggestions of words
and spelling based upon the first few letters.
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5. Integrate instruction in spelling and word identification so that Xxxxxx sees the connections between
phonemes and graphemes as well as between graphemes and phonemes.
6. Discuss with Xxxxxx the difference between “invented” or temporary spelling and conventional
spelling. Explain to Xxxxxx how learning to spell words correctly will help her increase knowledge of
English spelling patterns and make it easier for others to read her writing.
7. Use a variety of spelling games and exercises to build interest and to reinforce correct spelling and the
acquisition of spelling generalizations.
8. Focus on mastery of the spelling of commonly used words and teach only a few spelling words at a
time. Have Xxxxxx identify from 3-6 words that she uses in her writing, but spells incorrectly. Write
the words on spelling flow list form. Have her study the words and then test her daily on the words.
Mark each correctly spelled word with a "+" and each incorrect word with a (-). When a word is spelled
correctly 3 days in a row, cross it off the list and add a new word. File all correct words alphabetically
into a word bank. One week later, review the words in the bank. If a word is incorrect, add it back to
the list.
9. Teach Xxxxxx only the most common spelling rules (e.g., when a word ending in y is made plural, drop
the y and add ies; u always follows q; when adding an ending starting with a vowel, double the final
consonant to maintain the short vowel sound). Reinforce generalization to words in classroom writing.
10. Teach Xxxxxx that each syllable within a word must contain at least one vowel. Reinforce Xxxxxx for
including a vowel in every syllable.
11. Do not have Xxxxxx rote-memorize spelling rules. Instead, build her knowledge of the alphabetic
system by teaching her how to segment spoken words into phonemes, how to match up graphemes with
the phonemes, and how to spell common English spelling patterns.
12. An effective way to teach spelling is to use a spelling program that is integrated with an explicit and
systematic reading decoding program. Some programs that are integrated in this manner are Scholastic
Phonics and Scholastic Spelling, the Wilson Reading System, Open Court Phonics, and Saxon Phonics:
An Incremental Development. Available from Scholastic, 555 Broadway, New York, New York 10012,
(800) SCHOLASTIC, http://www.scholastic.com; Wilson Language Training, 175 W. Main Street,
Millbury, MA 01527-1441, (508) 865-5699, http://www.wilsonlanguage.com; Open Court:
SRA/McGraw-Hill, 1221 Farmers Lane, Suite C, Santa Rosa, CA 95405, (888) SRA-4KIDS,
http://www.sra-4kids.com; Saxon Publishers, 2450 John Saxon Blvd., Norman, OK 73071, (800) 2847019, http://www.saxonpub.com.
Home and School
1. Xxxxxx should be taught strategies by which she can expand both her sight-word vocabulary and her
spelling ability. For example, when Xxxxxx reads an interesting article or story, she should identify all
the words that she has difficulty recognizing quickly and write these words on flash cards. Her
understanding of the meaning of the identified words should be checked. Card flashes can be repeated
until the word becomes a part of her sight vocabulary.
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2. Xxxxxx’s reading is combined with other sensory experiences such as writing. For example, she can
read stories that she has written.
3. Use a variety of software programs designed to build accuracy in decoding, spelling, and sight words.
4. For independent reading activities, provide Xxxxxx with a selection of high-interest, low-vocabulary
readers so that she will spend time in independent reading, increase speed of sight word recognition,
and discover that reading is enjoyable.
5. When reading with Xxxxxx at home, let her read any words that she recognizes easily and tell her
words that she has difficulty identifying. Too much time spent trying to figure out unknown words may
detract from comprehension, as well as from the enjoyment of reading with a parent.
6. Sight words from Rudginsky’s How to Spell or Orton-Gillingham lists (Educators Publishing Service))
should be introduced for reading and spelling, a few at a time (about 4 new words each week), using
flashcards or a flip chart. Every two weeks or so, she should review all of the sight words so that she
does not forget the ones learned earlier.
7. To learn to spell the sight words, Xxxxxx can use the following techniques:



Say the sight word, and then spell it out loud, reading it from the flashcard. Then spell it aloud
without looking.
Write the word in the air or on the table using her finger, for kinesthetic reinforcement of the word.
Write each sight word three to five times for practice, and then say or write it in a brief sentence.
Medical
1. It is recommended that Xxxxxx’s parents contact Dr. xxxxxxxx to discuss a possible trial of stimulant
medication for her inattentive type ADHD.
It was a pleasure to work with Xxxxxx and we wish her well in her future.
Respectfully submitted,
_________________________
Scott Andrews, Ph.D., H.S.P.
Developmental Psychologist
Licensed Psychologist
Registered Health Service Provider
Director
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