Confidential Psychological Report
Name: Bugs Bunny (Totally made up,
Gender: M
Education: 1st Grade
completely fictional case)
Date of Testing: 10/16/2013
DOB: 10/08/05
Age: 8 years 0 months
Date of Report: 11/11/2013
Telephone: 746-263-9099
Examiner: Gemma Miller, BA
Supervisor: Andrew Davis, PhD, HSPP
Address: 999 Pumpkinshine Ln
Location of Evaluation: Halloweentown
East Halloweentown, SH 50666
Elementary School
Procedures: Wechsler Scale of Intelligence- Fourth Edition (WISC-IV)
Diagnostic Interview with Mr. Bunny
Diagnostic Interview with Bugs Bunny
Diagnostic Interview with Mrs. Fudd
Review of Records
Informed Consent: Potential risks and benefits, limits of confidentiality, and test procedures
were discussed. Following this discussion, the patient’s father agreed to complete the
evaluation.
Reason for Referral
Bugs Bunny was referred for a special education evaluation by his 2nd grade teacher, Mrs. Fudd,
due to reports of academic problems and concerns with his inattention and hyperactivity during
class time.
Background Information
Bugs’s father, Mr. Bunny, reported that Bugs was experiencing behavioral problems at both
home and school. Mr. Bunny reported that he did average in school last year, 1st grade, but this
year there has been “nonstop phone calls and letters” about his behavior. Mr. Bunny said that it
seems as though Bugs is not learning. Mr. Bunny reported that Bugs is a nice kid but he is
experiencing a lot of behavioral problems at home like trouble paying attention, talking back,
concentrating, interrupting, trouble sitting still, losing “stuff”, and sometimes talking too loud.
Personal and Familial Background
According to Mr. Bunny, Bugs was adopted when he was five years old. Mr. Bunny reported that
Bugs lived with his biological parents for a year and a half before he was placed into foster care.
Mr. Bunny reported suspicions of domestic violence in Bugs’s biological home prior to coming
to live with him. Mr. Bunny reported that he does not know whether or not Bugs was abused
himself but he noted suspicions of previous abuse. He said that Bugs’s biological father was
arrested for domestic assault and battery. Mr. Bunny also reported that Mr. Bunny believes that
his biological mother took cocaine during Bugs’s prenatal period and he said she had cocaine in
her system when she gave birth to him. According to Mr. Bunny, Bugs’s biological mother was a
heavy smoker but she denied smoking during her pregnancy with Bugs. Mr. Bunny stated that
the case manager believed that she smoked approximately three packs a day.
Mr. Bunny reported that Bugs was removed from his biological parent’s house due to neglect.
Mr. Bunny said that the biological parents never took Bugs to any doctor’s appointments and the
living conditions in the house were unclean. Mr. Bunny believed that his mother had a lot of
boyfriends hanging around the house and the house was very dirty. Mr. Bunny reported he thinks
that prostitution and drug sales were occurring within the household.
Mr. Bunny reported that Bugs has two older biological sisters, believed to be 15 or 16 now, but
they were placed in a different house. Mr. Bunny says that he and his wife offer to take Bugs to
visit his sisters who live only a town away, but Bugs refuses to see them. Since the adoption, Mr.
Bunny reported that there has been no more contact with the biological parents. Mr. Bunny
reported that “they are dead or in jail”.
Mr. Bunny reported that prior to coming to live with him and Mrs. Bunny in foster care, Bugs
lived in multiple foster homes. He said that although there is no documentation, the case
manager thought that Bugs was physically abused during this time. When Bugs first came under
their foster care, Mr. Bunny reported that Bugs was in “bad shape”. Bugs denied child abuse. Mr.
Bunny said that when Bugs first came the live with the Bunny family under foster care, Bugs
would flinch around males and it took him longer to warm up to Mr. Bunny than Mrs. Bunny.
Mr. Bunny reported that Bugs seems to have gotten over his fear of men since living with them
and there has been no instances of abuse since that he is aware of. Mr. Bunny stated that Bugs
lived with them in foster care for two years before they officially adopted him.
Mr. Bunny reported that one year previously, when Bugs was seven, he and his wife took in four
more children to foster, all under the age of two. According to Mr. Bunny, all the children have
special needs and they, admittedly, take up a lot of the parent’s time. Mr. Bunny reported that he
does not think Bugs particularly likes having the new children in the home.
Medical History
Mr. Bunny reported that Bugs had two ear infections and had myringotomy surgery twice. Other
than that, there were no other major medical problems while he was living with Mr. and Mrs.
Bunny.
Mr. Bunny reported that when Bugs was seven, he fell off his bike while wearing a helmet. Mr.
Bunny reported that Bugs broke his elbow and was taken to the emergency room where he was
treated by Dr. Tweety. Mr. Bunny described Bugs’s behavior as being hazy, but he thought Bugs
was just scared. He said his wife was worried that Bugs has sustained a concussion, although Dr.
Tweety did not believe Bugs had attained one.
Consistent with the review of medical records, Mr. Bunny reported that Bugs was given
Methylphenidate six months previously for his acting out and attention problems. Mr. Bunny
reported that the methylphenidate made Bugs really aggressive so they decided to discontinue
the medicine with the permission of Dr. Duck.
When asked, Bugs denied suicidal ideation. Bugs also denied homicidal ideation. Bugs reported
that he has not experienced any psychosis.
Educational History
Mr. Bunny reported that this year, Bugs has fallen behind in class. Mr. Bunny reported that
Bugs’s second grade teacher, Mrs. Fudd, called Bugs is a “class clown” which Mr. Bunny does
not like. Mrs. Fudd reported that Bugs is having troubling staying in his seat, he wanders around
the classroom, he does not keep his hands to himself, he never pays attention, he asks “stupid
questions, is crazy all the time, and will do anything for attention.” Mrs. Fudd reported that she
talked to Bugs’s first grade teacher, Mrs. Pig, and she said that Bugs was not perfect, but he was
okay. Mrs. Fudd reported that Bugs is extremely behind in math despite school only recently
starting. Mr. Bunny similarly reported Bugs has trouble with math and he admits to not having
enough time at home to help him with his problems because of the time restraints from the foster
children. Mrs. Fudd also reported that as for Bugs’s reading troubles, he seems to know the
letters and words but he is unable to follow along. Mr. Bunny reported that it seems as though
Bugs can read well enough because he can hear Bugs reading words. Mrs. Fudd nor Mr. Bunny
reported why Bugs is having these problems in school.
Mr. Bunny reported that Bugs has never been suspended until recently. Mr. Bunny reported that
Bugs got into his first fight last week because a girl was teasing him due to his weight. He
reported that after the girl punched Bugs, Bugs pushed her back which resulted in both of their
suspensions. According to Mr. Bunny, it is this recent infraction that has cause his raised concern
and prompted him to seek help for his child.
When talking to Bugs about his school, he reported that he forgets his homework almost every
day. Bugs reported that he has trouble in school because it’s boring.
Social Background
Mr. Bunny reported that Bugs has some friends but not many. He reported that Bugs is bossy and
likes to “only do what he wants to do” and he likes to play with other kids but he is unable to
make them or keep them. Mrs. Fudd reported that it seems that Bugs has almost no friends
because he is bossy and uses his size to push kids around. Bugs reported that he has a lot of
friends and that he is very popular. Mr. Bunny reported that Bugs has never been arrested.
Review of Records
A review of records shows that Bugs was given a tentative diagnosis of Attention-Deficit/
Hyperactivity Disorder-Combined Type by his family physician, Dr. Duck. A review of Bugs’s
medical records show that Dr. Duck reported Bugs was given a “trial of Methylphenidate,
parents reported ineffective, weight loss, and aggression. Suggested counseling to parents- not
receptive.” Dr. Duck reported, “patient should be monitored for high blood pressure. Some
concern about a pre-diabetic state.” The review of medical records report Bugs being 4’10” and
300lbs. This is consistent with observations and interviews with Bugs. Bugs reported that he and
his father eat three doughnuts and drinks chocolate milk each morning for breakfast
Behavioral Observations
Consistent with the review of medical records and the interview with Mr. Bunny, Bugs appeared
to be significantly obese. It was observed that Bugs also has halitosis. His physical appearance
and clothing were otherwise clean and fit properly. Bugs was wearing glasses at the time of
testing but it was stated by Bugs that he often forgets to bring them to class. Bugs exhibited some
mannerisms below his expected maturity level such as picking his nose and wiping it underneath
the desk twice, despite being told not to.
During the test, Bugs was mildly inattentive, needed frequent redirection, and was restless in his
seat. These behaviors seem to reflect the behaviors stated by his father and second grade teacher.
Despite these behaviors, Bugs seemed to try hard and care about his performance on the
measures. Bugs responded enthusiastically to reinforcements of Star Wars stickers to encourage
staying on task. No other visual motor deficits nor sensory problems were observed during
testing.
It is likely that the results presented in this evaluation are under representative of some of his
cognitive abilities, and may be reflecting poor attention skills as well as difficulty remembering
directions.
Assessment Results
Wechsler Intelligence Scale for Children- 4th Edition (WISC-IV)
The WISC-IV is a valid and reliable measure of global cognitive functioning. Average scores
on the subtests fall between 8 and 12. Average Index scores fall between 90 and 110. The
following table contains Bugs’ scores on this measure:
WISC-IV Subtests
Scaled Scores
Block Design
Similarities
Digit Span
Picture Concepts
Coding
Vocabulary
Letter Number Sequencing
Matrix Reasoning
Comprehension
Symbol Search
Picture Completion
Information
Arithmetic
Word Reasoning
WISC-IV Composite Scores
8
3
2
10
6
10
4
15
4
1
14
2
2
4
IQ/Index
Percentile
Working Memory Index
59
0.3
Cognitive Functioning
Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV)
Confidence
Interval (95%)
55-70
The 47 point difference between Bugs’s verbal and nonverbal reasoning skills is a rare and
unusual difference. Therefore, Bugs’s FSIQ was not calculated and should be considered
meaningless.
Verbal Comprehension
The 7 point different between Bugs’s verbal abstract reasoning and lexical knowledge is a rare
and unusual difference. Therefore, Bugs’s VCI was not calculated and should be considered
meaningless.
Bugs demonstrated verbal conceptualization skills (Similarities = 3) within the very poorly
developed range, and it is likely that Bugs will have difficulty completing tasks that require him
to conceptualize appropriate relationship between two objects or concepts. Bugs’s score was a
significant weakness compared to his other assessed abilities that occurs in 2-5% of the
population. It is likely that, compared to his peers, Bugs will struggle with determining the
relationship between recently presented concepts. It is also likely that Bugs will have difficulty
with tasks that require him to distinguish between essential (abstract) and nonessential (concrete)
features when compared to his ability to express verbal fluency and word knowledge. Therefore,
Bug’s difficulty with math may be related to his difficulty understanding the relationships
between verbal math instruction and math concepts.
Bugs’s lexical knowledge and language usage skills (Vocabulary=10) fell within the average
ability range. His score was a significant strength compared to his other assessed abilities that
occurs in 10-25% of the population. It is likely that Bugs will show strengths in his verbal word
knowledge and word usage. Therefore, Bugs is likely to have good overall verbal skills and
language development. His problems in reading are, therefore, more likely to be related to
problems with expression, not general word knowledge.
Bug’s social reasoning skills (Comprehension = 4) fell within the very poorly developed range,
and it is likely that Bugs will have difficulty distinguishing between concrete and abstract ideas
while also demonstrating cognitive flexibility. His poor social reasoning skills may also be an
indicator of poor social judgment skills. It is likely that, compared to his peers, Bugs will
struggle with tasks that integrate knowledge acquired in the past. Therefore, Bug’s difficulty
with math may be similarly related to his difficulty understanding and incorporating previously
learned knowledge.
Bugs’s verbal deductive reasoning (Word Reasoning = 4) fell within the very poorly developed
ability range. It is likely that Bugs’s diminished score is a result of his poor verbal skills. Bugs’s
problems in reading may be lessened if he is able to see a visual representation of the given
information.
His ability to recall verbally encoded information (Information = 2) is in the very poorly
developed range of language. Bugs’s problems in his reading class is maybe due to problems
with his ability to recall information that is presented to him verbally and express this through
language skills. Bugs’s score may be a reflection of an inability to express his knowledge. His
abilities may be improved through calling attention to the basic facts so he can distinguish
between essential and nonessential information.
Perceptual Reasoning
The 7 point different between Bugs’s nonverbal fluid reasoning and concept formation skills is a
rare and unusual difference. Therefore, Bugs’s PRI was not calculated and should be considered
meaningless.
Bugs performed in the average range on a task assessing visual gestalt formation (Block Design
= 8). It is likely that he will do well on tasks where he is asked to work with visual
manipulatives. The problems he has been experiencing in his math class maybe a result of verbal
instruction and errors may be lessened if given the opportunity to work with visual instruction
materials.
He performed on the on the average range for a tests assessing nonverbal conceptualization
(Picture Concepts = 10). It is likely that Bugs will do well in tasks that measure visual
connections between concepts. Bugs’s problems in reading may be focused on his inability to
comprehend verbally presented concepts. Therefore, he would succeed in situations where he is
able to visually work out information concepts that are presented to him.
Bugs performed on the above average range for his test assessing visual attention (Picture
Completion = 14). It is likely that Bugs does well with information that is presented to him
visually and he is able to focus his attention on this kind of stimulus. Problems that Bugs is
experiencing in his math and reading may be based off of verbal attention deficits and could be
lessened with the use of visually presented information in collaboration with the verbal lessons.
He performed in the above-average ability range on a test of abstract reasoning and problemsolving (Matrix Reasoning = 15). This is a significant strength compared to his other skills that
were assessed that occurs in less than 1% of the population. Bugs’s scores suggest that his
analogical visual-perceptual reasoning is better developed than his perceptual analysis when
working under a time pressure. The strength in his measurement of fluid intelligence is an
indicator of Bugs’s ability to learn. This strength indicates that Bugs is likely to exceed in tasks
that involve integration of reasoning skills.
Working Memory
Bugs’s working memory abilities fell in the Extremely Low range and was ranked at the .3
percentile (Working Memory = 59). There is a 95% chance Bugs’s true working memory score
fell in the range of 55-70.
He demonstrated performance on the very poorly developed range on tasks requiring verbal
attention and rote recall (Digit Span = 2) which is a significant weakness that occurs in 2-5% of
the population. Bugs performed more poorly on his encoding and attention compared to his
ability to hold and mentally manipulate information. This may indicate a problem with attention
rather than a rigidity in cognitive flexibility. Bugs will likely struggle with tasks that require a lot
of attention, concentration, and reasoning.
Bugs’s short-term auditory working memory (Letter-Number Sequencing = 4) skills fell within
the very poorly developed range. This is a significant weakness compared to his other assessed
abilities which occurs in 10-25% of the population. Bugs will likely struggle when he is asked to
remember and manipulate recently presented information. This means that Bugs will most like
struggle learning information that is presented in multiple steps, especially when the first step
must be quickly learned or remembered in order to solve later aspects of the problem. This may
at least partially account for some of the difficulties he reported in completing his homework and
completing in class assignments.
Bugs performed in the very poorly developed range on the short-term auditory memory skills
and computation (Arithmetic=2). This measures Bugs’s auditory short-term memory and
auditory working memory. His poor auditory memory skills is a reflection of his poor math
scores he is receiving in class. Bugs will have difficulty manipulating verbally presented
information and computing it in his head. Therefore, Bugs may benefit from being presented the
information on a sheet of paper and expected to compute from the paper.
Processing Speed
The 5 point different between Bugs’s processing speed and visual perception skills is a rare and
unusual difference and only occurred in 6.3% of the standardized sample. Therefore, Bugs’s PSI
was not calculated and should be considered meaningless.
Bugs’s incidental learning, visual attention, and visual-motor integration skills fell within the
poorly developed range (Coding = 6). It is likely that compared to his peers, Bugs will struggle
with tasks where he is required to copy information down from the board accurately. Bugs may
also struggle compared to his peers with tasks that require him engage in rapid learning and
function under pressure.
Bugs also demonstrated performance in the very poorly developed range on a measure of visual
perception and discrimination and psychomotor speed (Symbol Search = 1). This is a significant
weakness compared to his other assessed abilities that occurs in less than 1% of the population.
Bugs is likely to struggle considerably more than his peers with tasks that require visual acuity
and discrimination. Bugs may also struggle with timed tasks.
Summary
Bugs was referred for a special education evaluation. His father and his teacher reported
concerns with his attention, behavior, following rules in class, hyperactivity, and falling grades.
During the evaluation, Bugs appeared to struggle greatly with activities that involved attention,
short-term memory and working memory. At this point, I do not suspect that Bugs has problems
with his general intellectual functioning. I do suspect that a large portion of the problems he has
been experiencing in school is due to attention deficits and well as problems with verbal
processing of information.
Bug’s verbal abstract reasoning difficulties is likely to be a result of deficits in his ability to
distinguish between abstract and concrete information. Bugs may struggle in seeing relationships
between two seemingly abstract thoughts. Bugs did show a strong overall word knowledge and
verbal skills. Therefore, Bugs’s problems in reading is not due to a lack of reading skills, but
rather incorporating the verbally presented information into larger, abstract ideas.
Bugs’s ability to process, manipulate, reason, and form concepts with visual and spatial
information indicate his fluid intelligence is strong but he shows deficits in his ability to
perceptually analyze information while working under a time pressure. This deficit may be
present when Bugs is taking tests and working in class. Bugs shows the potential to learn but is
unable to work within the time pressure to succeed in his expectations.
His working memory abilities demonstrated that consistent with interviews with Bugs’s father
and teacher, deficits in attention, concentrating, and reasoning are present. Bugs’s verbal
attention and short term auditory working memory showed significant weaknesses. This is likely
to be a big issue when Bugs is in a classroom environment. Bugs may struggle learning new
information and integrating it into new assignments. His inattention difficulties is a likely
indicator of his problems with completing his homework.
Bugs’s poor processing speed skills is also likely to be a result of visual attention deficits. His
deficit in processing speed and shot term visual memory may be a result of poor perceptual
discrimination and poor perceptual associative skills. Bugs’s problems may also lie in his ability
to work under a time pressure. Bugs’s processing speed skill deficits may be seen when working
on in class assignments and tests.
In sum, Bugs’s processing difficulties are consistent with his tentative diagnosis of AttentionDeficit/ Hyperactivity Disorder (ADHD). Children with ADHD tend to achieve scores near the
normative range, but may perform worse on measures of processing speed and working memory
than measures of verbal learning and visual and spatial reasoning. Bugs’s difficulties with
attention, processing speed, and verbal conceptualization may lead him to struggle with
integration of multiple pieces of information.
Recommendations
1) Bugs’s persistent deficits in conceptualizing auditory information may be an underlying
factor for a large part of his problems in school. It is my recommendation that he see a
physician regarding his ear tubes that were inserted earlier in his childhood. This would
determine if his trouble understanding auditory information is based on a medical
problem or an additional problem. A nearby physician Mr. Bunny could contact is
Dr. Donald Duck, M.D
89 Candyland Ln
East Halloweentown, SH 50666
(746) 989-8099
2) Because of reports of his behavioral problems at school like his recent fight, counseling is
recommended. The aim of this counseling is for Bugs to work out his aggression.
Another aim of the meeting would be to discuss any problems he is having at home with
recent addition of foster kids. I recommend Bugs see Dr. Coyote, a nearby counselor.
Dr. Coyote, PhD, HSPP
1932 W Ghost Dr.
East Halloweentown, SH 50666
(746) 272-2992
3) It was observed that Bugs had halitosis, so it is recommended that he goes to see a dentist
immediately to check for any dental problems. A nearby dentist is Dr. Fang located at:
Dr. D Fang, DDS
7773 Sycamore Ct
Halloweentown Heights, SH 50669
(746) 283-2443
4) It was observed during the interview and with the review of records that Bugs is severely
overweight and engages in unhealthy eating patterns with his three doughnuts each
morning. It is recommended that Mr. Bunny contact a physician for Bugs to seek
immediately regarding his obesity and health habits. A nearby family physician is Dr.
Donald Duck, located at:
Dr. Donald Duck, M.D
89 Candyland Ln
East Halloweentown, SH 50666
(746) 989-8099
5) Because Bugs was showing problems with his problem mental inflexibility and set
shifting, it is recommended that he be sent to a specialist to test for cognitive flexibility
deficits. If this problem persists, it will breach into both his academic and social behavior.
The aim of this testing would be helpful for determining the root of Bugs’s academic and
social problems he has been experiencing in school. With the confirmation of this deficit,
a more specific intervention could be developed to best help Bugs. The closest outpatient
psychologist is Dr. Snow White. Mr. Bunny should contact her office at:
Dr. Snow White, PhD, HSPP
2273 N Main St
Suite 201
East Halloweentown, SH 50666
(374) 263-2374
6) Bugs showed a large deficit in his processing speed and visual attention skills, it is
recommended that he be given extra time when completing tests. The aim of giving him
extra time on tests will allow him to work past his deficits of working under pressure and
better allow him to fulfill his intellectual potential. His teachers should be notified of this
and instructed to give him extra time on tests. Bugs should be given the opportunity to
take the test in a quiet environment separate from his classmates which would allow for
extra time without the unnecessary distractions.
7) Bugs showed a deficit in his verbal conceptualization skills which required him to build a
relationship between two abstract ideas. It is recommended that Bugs be given extra
instruction to help him develop cognitive flexibility and reason past his concrete
reasoning and move onto abstract thinking. This Tier 2 intervention would give him small
group instruction to focus on his conceptualization skills. The intervention should be
given by the school’s school psychology practicum students, and take place during his
quiet reading hour within Halloweentown Elementary School.
8) Compared to his peers, Bugs demonstrated weakness in his ability to concentrate and pay
attention. This weakness is likely to play a role in his ability to remember homework
assignments and copy information down from the board. It is recommended that his
teachers give him assignment information that has been already copied down. A system
should also be developed so Mr. and Mrs. Bunny are aware of the homework for each
day so they know whether Bugs has homework to complete. The aim of this would be to
reduce his homework truancy. Homework could be put in a take-home folder and signed
by the parent each day to ensure that they were aware of the homework. His teacher, Mrs.
Fudd and parents should be notified of the new system to monitor its use.
9) Bugs also showed a weakness in his auditory short term memory, meaning he may
struggle with the ability to remember and operate recently stated information. This can
impact his understanding of verbal instructions. It is recommended that teachers ask him
to restate what she just said using his own words to check for comprehension of the
material. The aim of this would be to help him review what was stated so he understands
what was instructed. This can be done within the classroom and Mrs. Fudd needs to be
notified of this change in instruction.
10) Due to the observation that Bugs showed a significant strength in his visual-perceptual
reasoning skills, it is recommended that this skill be emphasized in the classroom.
Information should be presented to him visually rather than verbally. The aim of this
would be to emphasize Bugs’s strengths which would help his learning abilities. Bugs is
likely to succeed more when given visual instruction rather than verbal instruction. Mrs.
Fudd should be informed of this and it can be implemented within the general classroom.
11) During the interview, Bugs reported a habit of losing his glasses which may be a
contributing factor in his decline in grades. It is recommended that a system be devise
where Mrs. Bunny gives Bugs daily reminders of bringing his glasses to class. An
additional pair should be given to Mrs. Fudd to keep in the classroom just in case.
Signature
__________________________________________
Gemma Miller, BA
1st Year Student in School Psychology
Ball State University
________________
Date
__________________________________________
Dr. Andrew Davis, Ph.D., HSPP
Licensed Psychologist #738212
Licensed School Psychologist #6588921
________________
Date