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University of Calgary Applied Psychological & Educational Services (UCAPES)

Assessment, Intervention and Professional Development


Director: Kelly Dean Schwartz, Ph.D., R.Psych.
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2nd Floor, Education Block (Room 281) 2500 University Drive NW Calgary, AB T2N 1N4 Tel: (403) 220-2851 Fax: (403) 210-8712 Email: UCAPES@ucalgary.ca
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CLIENT NAME: JONES, Kitty BIRTHDATE: December 3, 2002 AGE: 9 Years 7 Months SCHOOL: Meow School, Calgary, Alberta GRADE: Four DATES OF ASSESSMENT: July 17 & 19, 2012 DATE OF REPORT: August 10, 2012 ASSESSED BY: Rhonda Williams B.A., B. Ed. Andrea Nardi B.A., B. Ed. Jacqueline Munroe B.A., B. Ed.

Statement of Confidentiality
All psychological assessments are confidential in nature as they contain private information, which may be used inappropriately by others. To protect the privacy and ensure confidentiality of the persons involved, please ensure that this report is only circulated to those who are considered essential to related judgments and decision-making. The intent of this report is to provide opinions and recommendations in the context of psychological intervention, educational and vocational decision-making, and any use of this report outside of that purpose should only be done with the informed consent of the parties and in consultation with the writer. REASON FOR REFERRAL: Mr. and Mrs. Jones (parents) sought out a psychoeducational assessment to further investigate their daughters difficulties with emotional regulation, inflexibility, getting along with her peers, and potential learning difficulties in the area of reading comprehension.

FACULTY OF EDUCATION
2500 University Drive N.W., Calgary, Alberta, Canada T2N 1N4 www.ucalgary.ca

JONES, Kitty 2

BACKGROUND INFORMATION The following information was obtained from a semi-structured interview with Kittys mother (Shelly Jones), Kitty and from a background questionnaire which was completed by Mrs. Jones prior to the interview. Kitty is a 9 year old girl who lives with her mother, father and 6 year old sister in a predominantly English speaking home in Calgary, Alberta. Mrs. Jones described Kitty as an intelligent, mathematically-inclined, very artistic, and visually perceptive girl who likes to spend time with friends and family. Family Information and History Mrs. Jones described her family as very loving and indicated that they enjoy doing many things together, such as movie nights, watching television, camping, visiting friends, and going out for supper together. Kitty described her family as supportive and fun to be around, and her mother reported they enjoy laughing and having fun together. Although English is primarily spoken in the home, Mrs. Jones is fluent in French, and Kitty sometimes practices reading and speaking French with her mother. Mrs. Jones noted that sometimes Kittys emotional outbursts can cause some disruption within the home and that it is difficult to find rewards and consequences that influence her behavior. Mrs. Jones related that she has been diagnosed with depression and her father and grandfather have reported symptoms of depression as well. She also reported that her husband reports difficulties with attention but has not been formally diagnosed. Developmental and Medical History Mrs. Jones reported receiving prenatal care and was prescribed Diclectin for severe and extended morning sickness during her pregnancy. Labour was induced and a Caesarean section was performed after 24 hours of labour. Kitty reportedly did not show signs of fetal distress, despite receiving a lump on her head from the long delivery. No neonatal care was required, and she was able to leave the hospital with no known lasting effects. Mrs. Jones reported that Kitty was colicky the first three months and was difficult to soothe. She would often cry for extended periods of time and also cry herself to sleep. Mrs. Jones reported that Kittys developmental milestones were met at appropriate times. Kitty experienced a fever of above 104C at 12 months, whooping cough at 2 years, broken bones at 18 months and 8 years, and knocked out her four upper front teeth at 5 years. Kitty reportedly struggled with sleeping through the night until the age of 4 when she was diagnosed with ongoing ear infections and tubes were inserted in her ears. At the age of 6 the silicone earplugs were removed after being lodged too deep in the ear canal, and in December, 2011, a tympanoplasty was performed. A hearing exam in March, 2012 indicated that Kitty experienced some minor hearing loss that does not impair her functioning within the classroom. Kitty reported that it is sometimes difficult to hear her teacher out of her right ear. In addition, she is currently taking Flovent for asthma. Social/Emotional Information Socially, both Kitty and her mother report that she has a group of friends she spends time with, as well as a best friend. Kittys teacher (Ms. Page), Mrs. Jones and Kitty all report struggles with

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JONES, Kitty 3 getting along with her peer group. Her mother stated that Kittys emotional outbursts can be alienating and have resulted in other children calling her names or dismissing her and that they avoid being around her. Kitty has become increasingly aware that she manages her emotions differently from her peers and is beginning to get embarrassed about her reactions to the point where she will leave the immediate situation and go elsewhere until she is able to calm down by using self-talk. Kitty identified one of her strengths as her ability to recognize what she has done wrong in a situation and apologize once she is calm. During moments of intense emotion Kitty makes negative self-statements such as No one likes me and indicated that her life is very difficult. Mrs. Jones reported that Kitty has displayed severe tantrums since about the age of 2, and that these were sometimes physical in nature until about 5 years of age. Since then, Kitty often cries, yells and argues with others rather than being physically aggressive. Mrs. Jones also related that Kitty tends to have more emotional struggles in the spring; however, this school year it began in November. In addition to being very emotional, she reported that Kitty is a perfectionist and struggles with transitioning from one activity to another, especially if she is required to end a preferred activity. Despite several transitional warnings, Kitty will often becomes upset. However, as Kitty matures, her negative reactions have decreased overall in intensity. Outside of school, Kitty enjoys participating in gymnastics, ballet, swimming, and biking with friends and family. She also enjoys drawing and colouring, computer and ipod games, and watching television shows. Educational History Kitty will be beginning Grade Five at Meow School in the French Immersion program in September, 2012. Kitty receives most of her instruction in French with the exception of her English language arts curriculum. Mrs. Jones reported that Kitty has been able to learn French fairly easily and is fluent in reading and speaking French. However, her mother has become increasingly concerned over the last school year with Kittys academic performance and with reports from the teacher that she has become more inattentive in class. During the past school year her reading comprehension skills have declined. Both Kitty and her mother stated that Kitty does not like reading, even though she is able to do it well. Mrs. Jones reported that homework is often a challenge, resulting in a power struggle. Previous Assessments Mrs. Jones reported that Kitty has not participated in any previous formalized psychoeducational assessments. However, she did note that when Kitty was 6 years old, both her and her husband went to see a psychologist about Kittys emotional dysregulation. After a few sessions (without Kitty present), the psychologist recommended they read the book called The Explosive Child by Dr. Ross Greene to explain what Kitty was experiencing and some additional ways to parent her. ASSESSMENT INSTRUMENTS: Parent/Child Interview Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IVCDN) Wechsler Individual Achievement Test - Third Edition (WIAT-III) A Developmental Neuropsychological Assessment Second Edition (selected subtests) (NEPSY-II) Delis-Kaplan Executive Function System (D-KEFS) Conners Continuous Performance Test II (CPT II V.5)

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JONES, Kitty 4 Behavior Assessment System for Children (BASC-2) Conners Third Edition (Conners-3) Behavior Rating Inventory of Executive Function (BRIEF) Childrens Depression Inventory 2 (CDI 2)

ASSESSMENT OBSERVATIONS: Kitty was a very friendly, young girl who easily engaged in casual conversation and liked to draw and colour. She appeared motivated to try her best, was attentive throughout all tasks, persevered through challenging activities, and only became emotional on one occasion when talking about how she feels when other children tease her. However, she was able to quickly recover and move on to the next task. Overall, the results of this assessment are believed to be an accurate representation of her abilities. ASSESSMENT RESULTS: Wechsler Intelligence Scale for Children Fourth Canadian Edition (WISC-IVCDN) The WISC-IVCDN is a standardized intelligence test consisting of a series of ten core subtests and five optional subtests designed to measure the intellectual functioning of an individual as compared to others of the same age. A Full Scale Intelligence Quotient (FSIQ) is derived from the combined results of the core subtests. The WISC-IVCDN also provides four factor-based scores, including Verbal Comprehension, Perceptual Reasoning, Working Memory and Processing Speed. Canadian norms were used to score this measure. The WISC-IV was administered in order to gain an understanding of Kittys overall current level of intellectual functioning and is believed to be an accurate indication of her true abilities. She obtained a Full-Scale IQ (FSIQ) at the 86th percentile, indicating that her cognitive ability is within the High Average range. This score indicates that her overall cognitive abilities are equal to, or better than, approximately 86 percent of children of similar age. Furthermore, there is a 95% likelihood that her true FSIQ score lies between 110 and 121. This score is considered to be a reliable and valid measure of Kittys overall cognitive ability. Verbal Comprehension Kittys ability to understand and use language to communicate and engage in verbal reasoning tasks was assessed using the Verbal Comprehension Index (VCI). She performed in the Average range, at the 66th percentile, indicating that her abilities with spoken language, verbal reasoning and verbal knowledge are what would be expected of someone her age. Kitty obtained scores in the Average range on each of the three tasks used in this domain. She performed in the 75th percentile on a task that examined her ability to express the meaning of individual words and in the 63rd percentile when asked to describe how two common objects or concepts are alike. She performed at the 50th percentile on a task requiring Kitty to use her prior knowledge to answer questions based on her understanding of general principles and social situations. These results indicate that Kittys abilities to learn implicitly from her environment and engage in verbally based problem solving are at the expected level relative to her same-age peers. Perceptual Reasoning

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JONES, Kitty 5 The Perceptual Reasoning Index (PRI), which examines Kittys ability to process and reason with non-verbal (visual) information was within the Superior range (95th percentile). Her performance indicates that processing and understanding visual information is a strength for Kitty and is better developed than her same-age peers. On a visual-spatial processing task where she was required to reproduce designs using coloured blocks, Kitty performed within the Average range (75th percentile). She obtained a High Average (84th percentile) score on a non-verbal reasoning task that required her to select the missing picture in an incomplete pattern. Another area of strength was Kittys ability to identify which pictures were conceptually related to one another as she performed in the Very Superior range (98th percentile), indicating very strong non-verbal deductive reasoning abilities. When compared to her performance on a verbal reasoning task measuring a similar skill, Kitty performed significantly higher when language demands were removed. Taken together, these results indicate that Kitty has well developed, non-verbal reasoning skills and her strength is working with and analyzing visual information. Working Memory Kittys ability to retain and manipulate orally presented information in short-term memory was measured using the Working Memory Index (WMI) whereby she scored within the Average range (70th percentile). Kitty was able to repeat strings of numbers forwards and backwards (Average range; 63rd percentile), as well as repeat letters and numbers in sequential order (Average range; 75th percentile) demonstrating her ability to retain several elements in her working memory that do not have any logical relationship to one another. This is an important component for problem solving and other higher-order cognitive processes and Kittys working memory abilities are at the expected level relative to her same-age peers. Processing Speed The Processing Speed Index (PSI) is a measure of mental processing speed, psychomotor speed, attention, concentration, short-term visual memory, and visual-motor coordination. Kittys overall performance in this domain was in the Average range (73rd percentile). On a task that measured both speed of mental operation and psychomotor speed, she was required to use a legend to recreate symbols to corresponding numbered boxes and performed in the Average range (50th percentile) on this task. Kitty also performed within the High Average range (84th percentile) on a task that measured her ability to process simple visual material without making errors. Across both tasks, she was careful when responding and referred back to the legends in order to ensure she did not make any errors. Kitty demonstrated that she is able to accurately process visually presented information under timed conditions. Wechsler Individual Achievement Test - Third Edition (WIAT-III) The WIAT-III is a standardized test of achievement and functioning. The WIAT III is an individually administered measure that examines performance in the areas of Reading, Written Language, Mathematics and Oral Language. Scores in each of these domains are then combined to provide an overall achievement score. Kittys level of academic achievement and functioning was assessed using the WIAT-III which assesses comprehension in tasks of reading, writing, mathematics and oral language. Relative to students of comparable age, her total academic achievement was found to be in the Above Average

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JONES, Kitty 6 range (88 percentile). However, an individual examination of the different academic domains may best represent her current level of academic performance.
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Reading The Total Reading composite measures basic reading skills, reading fluency and understanding of written language. Kittys overall performance was within the Above Average range (86th percentile) and was consistent across the various tasks. Her ability to read words and use phonological skills to sound out non-words was in the Average range (84th percentiles) as was her ability to read fluently and accurately (58th percentile). Kitty was able to understand and make inferences from what she read at the Average range (84th percentile). Overall, she comprehends written text at an age and grade appropriate level. Written Expression Kitty performed in the Above Average range (93rd percentile) on tasks of Written Expression measuring spelling, sentence composition and essay writing. Within individual domains of writing, Kittys spelling performance was found to be in the Average range (75th percentile), her ability to combine sentences was in the Superior range (98th percentile), and in the Above Average range (88th percentile) when composing sentences. Kittys ability to organize and develop her ideas on an essay composition task was within the Average range (73rd percentile), as was her overall written output (70th percentile). Overall, she is performing at a grade appropriate level is all areas of writing and is able to express herself effectively in various tasks of written expression, including spelling, grammar, and punctuation. Mathematics Kitty performed in the Average range (63rd percentile) on tasks measuring mathematical reasoning and basic computations. Within individual domains of Mathematics, Kitty performed in the Average range (63rd percentile) in tasks requiring problem solving skills and performed similarly on tasks of written calculation (61st percentile). Her ability to quickly and accurately solve addition, subtraction and multiplication problems was in the Average range (61st percentile). Kitty seems to complete mathematical tasks with careful attention to detail, answering problems and then rechecking for accuracy. These results indicate that Kitty is able to effectively problems solve (reason) mathematically and perform calculation tasks at an age and grade appropriate level. Oral Language Kitty performed in the Above Average range (86th percentile) on Oral Language tasks measuring her ability to listen, comprehend and express herself orally. Kitty performed in the Average range (77th percentile) on tasks measuring comprehension of formal speech from information presented via audio CD. Her ability was within the Above Average range (87th percentile) on speaking vocabulary tasks. Kittys ability to accurately read orally at an appropriate speed was in the Average range (58th percentile), and she performed in the Average range (84th percentile) on measures of word retrieval skills. Similarly, Kitty was able to accurately repeat dictated sentences, demonstrating an awareness of speech structure in the Average range (66th percentile). Considered together, Kitty has strong skills in oral expressive language.

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JONES, Kitty 7 Developmental Neuropsychological Assessment - Second Edition (selected subtests) (NEPSY-II) The NEPSY-II assessment is a measure of an individuals neuropsychological functioning. It incorporates six domains: Attention and Executive Functioning, Language, Social Perception, Visuospatial Processing, Memory and Learning, and Sensorimotor. Often, a clinician chooses to only administer the subtests most relevant to the individual clients needs. Attention and Executive Functioning: Three subtests on the NEPSY-II were administered in order to address concerns brought forward by Kittys parents and teacher regarding her inattention. The first task within the Attention and Executive Functioning domain required Kitty to organize a number of cards into two distinct categorical groups of four based on conceptual similarity, within a given time limit. Overall, she performed Above Expected Level (91st percentile) on this task. She was able to create a number of correct combinations of pictures (91st percentile) but also made more incorrect combinations than expected compared to her same-age peers (6-10th percentile). These scores indicate that Kittys task initiation and flexibility in thinking are above the expected level for her age; however, her ability to self-monitor her behavior is slightly below the expected level, as shown by her impulsivity in creating incorrect sorts. Another task evaluated Kittys ability to sustain attention (maintaining focus on a task over time), her selective attention (attending to relevant stimuli while ignoring irrelevant stimuli), and her ability to inhibit impulsive responses. The auditory attention component required her to listen to an audio recording and touch a specific colored circle every time the target word was heard throughout the presentation of a string of random words. Kitty performed At Expected Level (50th percentile) in terms of her total correct responses, indicating that she is able to inhibit impulsive responding and sustain her attention. The next component of this task was more complex in that Kitty was required to respond using a new and more complex instruction set, hold multiple rules in working memory, and inhibit the responses from the previous component. She performed Above Expected Level (84th percentile) in terms of her total correct responses. Overall, Kittys selective and sustained attention is at a level expected for her age. Lastly, Kitty performed a variety of tasks that assessed her ability to use inhibitory control, selfmonitoring and cognitive flexibility. The initial component of this task required her to look at a series of symbols and rapidly name each symbol where she performed Above Expected Level (91st percentile). The second component of this task was more complex and required her to provide the opposite name for the symbols, assessing her ability to inhibit the more automatic response in favour of a counter-intuitive one. Kitty performed At Expected Level (37th percentile) when completion time and errors were taken into consideration. A final variation of this task required her to provide alternate names for symbols based on more complex instructions and, again, she performed At Expected Level (37th percentile) when completion time and errors were considered. Overall, when taking speed and accuracy into consideration, Kitty consistently performed At Expected Level (25th percentile). She was able to sustain attention, process information, inhibit

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JONES, Kitty 8 impulsive responses, and switch from previously learned behaviours. When Kitty did make errors, she was able to correct herself, indicating she is capable of monitoring her behaviour. Delis Kaplan Executive Function System (D-KEFS) The D-KEFS assesses higher-level cognitive functions in children and adults aged 8 to 89. It consists of nine tests designed to measure various aspects of executive functioning, such as attention, language, and perception to generate higher levels of creative and abstract thought. Often a clinical chooses to administer the tests most relevant to the individual clients needs. Kitty completed the Tower test on the D-KEFS, which examined her spatial planning, rule learning, inhibition of impulsive, and perseverative responding. She was required to move up to five disks of varying sizes across three pegs to replicate a presented model and was given two specific rules to follow to build the tower in the fewest moves possible. On this task Kitty performed in the Average range (63rd percentile). Over the course of the task, she made no rule violations and was able to solve the majority of the puzzles within the time limit. However, she did go over the maximum number of moves needed to solve the task, performing in the Low Average range (16th percentile). These results demonstrate that Kittys overall ability to plan using visual information is at a level expected for her age. Conners Continuous Performance Test II Version 5 (CPT-II Version 5) The CPT-II V.5 is an assessment tool that measures an individuals sustained and selective attention and impulsivity. The individual is presented with a repetitive, boring task and is required to maintain their focus over a period of time in order to respond to targets and inhibit their responses when they are required to. Kittys performance on the CPT-II indicates that the results better match a non-clinical than clinical profile of individuals with Attention-deficit/Hyperactivity Disorder. The chances are 51.71 out of 100 that no significant attention problem exists. The CPT-II is a computerized assessment that presents target letters on a computer screen. Kitty was asked to press the space bar whenever a letter other than X appeared and made an average number of omission errors when compared with her peers (e.g., not responding when she should have) and made the average number of commission errors (e.g., responding when she shouldnt have). However, her mean reaction time was very fast in comparison with her peers. The percentage of perseverations (e.g., either unusually slow responses to a preceding stimuli, a random response, or an anticipatory response) was also higher than her peers. As the test progressed, Kittys responses became less consistent, indicating difficulty maintaining and sustaining attention. Despite these difficulties, Kittys pattern of responses does not match the typical pattern of an individual with attention problems. Behavior Assessment System for Children (BASC-2) The BASC-2 is an assessment tool that evaluates the behavior and self-perceptions of children ages 4 to 18 years. It measures numerous aspects of behavior and personality including positive (adaptive) as well as negative (clinical) dimensions. The BASC-2 provides information about a child from a variety of sources, allowing for a more complete understanding of the child. On the BASC-2, scores that fall in the Clinically Significant range suggest a high level of maladjustment. Scores in the At-Risk range identify either a significant problem that may not be severe enough to require formal treatment or the potential of developing a problem that needs careful monitoring.

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JONES, Kitty 9 The BASC-2 was completed independently by Mrs. Jones (Kittys mother) and Ms. Page (Kittys grade 3/4 teacher). Kitty also completed a self-report with reading assistance from the examiner. Mrs. Jones and Ms. Page both rated Kitty in the Clinical range for Depression, indicating that Kitty is easily upset and frequently cries, changes moods quickly, often says things such as Nobody likes me and I dont have any friends and often complains about being teased at school. Ms. Page also reported Kitty in the Clinical range for Withdrawal as she often plays alone, refuses to talk with others and is chosen last by other students for games. Mrs. Jones also reported similar concerns with Kitty sometimes struggling to fit into group activities with other children, rating her in the At-Risk range. In addition, Ms. Page also rated Kitty in the At-Risk range for Anxiety noting she often worries about things that cannot be changed and sometimes worries about what other children think, is nervous and is afraid of making a mistake. In addition, Kitty rated herself in the At-Risk range for Locus of Control, indicating she feels a lack of control over what happens to her, that things go wrong even when she tries hard and that she gets blamed for things she does not do or for things that she cannot help doing. Mrs. Jones and Ms. Page both indicated concerns with Aggression in the Clinical range at school and in the At-Risk range at home. They reported that Kitty loses her temper very easily, argues with her parents when she does not get her own way, annoys others on purpose, and sometimes teases and bullies other students. In addition, Ms. Page rated Kitty in the At-Risk range for Hyperactivity and Attention Problems, noting that she often bothers other students when they are working, seeks attention while doing schoolwork, struggles to listen attentively, and is easily distracted from class work. Kitty also rated herself in the At-Risk range for Attention Problems. Mrs. Jones and Ms. Page both rated Kitty in the At-Risk range in Adaptability, indicating that she is difficult to soothe when angry, is often stubborn and struggles to recover quickly from setbacks. At home, Mrs. Jones also rated her At-Risk in Activities of Daily Living, reporting that Kitty often has trouble following regular routines and organizing chores and tasks. In the school environment, Ms. Page rated Kitty in the At-Risk range for Social Skills, Leadership, Study Skills, and Functional Communication. She noted that Kitty sometimes struggles to complete homework, struggles to work well under pressure and facilitate people working together in a group, struggles to interact positively with her peers (complimenting peers , helping others, encouraging others), often has trouble getting information when needed, and struggles significantly to describe her feeling accurately with others. Conners Third Edition (Conners-3) The Conners-3 uses observer ratings to help assess a childs behavior related to inattention, hyperactivity/impulsivity, learning problems, executive functioning, aggression, and peer relations. In addition, the scale provides a total score indicative of an attention or behavioral disorder. Scores in the Very Elevated range indicate a possible significant problem and scores in the Elevated range indicate a possible concern. The Conners-3 was completed independently by Mrs. Jones (mother) and Ms. Page (teacher). Kitty also completed a self-report with help from the examiner.

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JONES, Kitty 10 Parent Form On the Conners-3, Mrs. Jones rated Kitty in the Very Elevated (Clinical) range for Defiance/Aggression, Learning Problems and Executive Functioning at home. She also identified Peer Relations within the Elevated range (At-Risk). Furthermore, based on Mrs. Joness ratings, Kitty meets diagnostic criteria for Oppositional Defiant Disorder. These ratings suggest serious difficulties with anger control, argumentativeness, academic struggles, planning and organization skills, and distractibility which are impacting Kittys relationships, school performance and home life. Teacher Form On the Conners Teacher scales, Ms. Page rated Kitty in the Very Elevated (Clinical) range for Defiance/Aggression, Peers Relations, Inattention and Learning Problems/Executive Functioning. She also rated Kitty in the Elevated (At-Risk) range for Learning Problems. Based on Ms. Pages ratings, Kitty meets diagnostic criteria for Oppositional Defiant Disorder and ADHD Predominantly Inattentive type. Ms. Page indicates that Kitty has significant struggles with being moody and emotional at school, often crying, losing her temper and becoming easily frustrated. She also indicated that Kitty is easily distracted, distracting other students from their work and has trouble finishing tasks. Similar to the results from the BASC-2, it appears as though Kitty is experiencing significant problems with focusing, completing academic work, regulating her emotions, and getting along with classmates. Self-Report On the self-report, Kitty rated herself in the Elevated (At-Risk) range for Inattention but did not indicate any areas to be Very Elevated or Elevated. However, she did indicate slightly more concerns than are typically reported (High Average) in the areas of ADHD-Inattentive, ADHDHyperactive/Impulsive type and Oppositional Defiant Disorder. Although only slightly elevated, these areas were also reported within the parent and teacher forms suggesting the same concerns consistently across all raters. Kitty reports being easily distracted and has trouble keeping her mind on work while at school which is impacting her academic performance and ability to complete assignment in school. These results indicate that Kitty is consistently exhibiting a great deal of difficulty within the classroom and home settings. Her inability to regulate her emotions, manage anger and frustration, follow expectations, attend to school work, interact positively with peers, and finish tasks on a consistent basis greatly impacts her relationships with others, her academic performance and her home life. Behavior Rating Inventory of Executive Function (BRIEF) The BRIEF is a questionnaire for parents and teachers of school age children that enable professionals to assess executive function behaviors in both the home and school environments. Executive functions are a collection of processes that are responsible for guiding, directing, and managing cognitive, emotional, and behavioral functions. Each form contains 86 items within eight theoretically and empirically derived clinical scales that measure differing aspects of executive functioning. The clinical scales form two broader Index categories, Behavioral Regulation and Metacognition, and an overall score, the Global Executive Composite.

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JONES, Kitty 11 The Parent form of the BRIEF was completed by Mrs. Jones, reflecting her perception of Kittys executive functioning. Overall, Mrs. Jones rated her daughters executive functioning skills in the Clinical range (97th percentile). In particular, she rated Kitty in the Clinical range for Emotional Control (99th percentile) and Shift (97th percentile), indicating that Kitty has significant difficulty moving from one situation or activity to another, tolerating change, switching attention, and changing from one mindset or topic to another. Kitty also struggles with expressing and controlling emotional responses, is easily upset and experiences excessive periods of emotional upset as also indicated on the Conners-3 and the BASC-2. Mrs. Jones also rated Kitty in the Clinical range for Monitor (97th percentile), Plan/Organize (97th percentile), Organization of Materials (94th percentile), and Initiate (91st percentile), indicating significant difficulty with initiating, planning, organizing and self-monitoring throughout activities and tasks. Kittys difficulties with anticipating future events, developing sequential steps ahead of time and organizing information negatively impacts her problem solving abilities. These results indicate that Kitty has difficulty assessing her performance during a task, checking her work and lacks awareness of how her behaviour impacts others. Childrens Depression Inventory (CDI) The CDI is both a self-reported inventory and a teacher/parent questionnaire that measures depressive symptoms in children ages 7 to 17. The CDI quantifies levels of depressive symptoms using reports from the child, parents, educators, and other caregivers. Main features of the assessment tool include large normative samples, multidimensional scales assessing various facets of depression, clinical relevance, multi-perspective characterization of depression, easy administration, and strong reliability and validity. In order to further explore Kittys symptoms of sadness and depression identified by Mrs. Jones and Ms. Page on the BASC-2, the Childrens Depression Inventory was completed by both Kitty and her mother. Mrs. Jones did not rate Kitty in the Clinical or At-Risk range for any item. However, it should be noted that the instructions for this measure require the parent to consider only the last two weeks with their child. Mrs. Jones expressed that some of the questions were difficult to answer because some of her ratings could fluctuate depending on Kittys moods. She reported that when Kitty is going through a negative emotional phase, she experiences more signs of sadness and depression. Kitty completed the CDI with reading help from the examiner. She did not rate herself within the Clinical or At-Risk range for any item. However, she did indicate that she is experiencing higher than average feelings of ineffectiveness which is consistent with her BASC-2 Self Report where she indicated an At-Risk Locus of Control, indicating she feels she has less control over her life and her efforts do not change anything despite trying her best. SUMMARY & DIAGNOSIS: Kitty is a 9 year old girl going into Grade Five in a French Immersion school. Her parents referred her for an assessment to investigate her difficulties with emotional regulation, transitioning between activities getting along with other children and reading comprehension concerns. During the

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JONES, Kitty 12 assessment, Kitty was engaged, attentive and friendly. Testing results indicate that she has High Average cognitive reasoning abilities, with exceptional visual spatial reasoning abilities. Academically, Kitty has average to above average abilities in reading, writing, mathematics, and oral language. However, during the essay writing task, she struggled with organizing her thoughts and producing written work, albeit still performing within the Average range. Struggles with reading comprehension were not evident during this assessment. Mrs. Jones reported that Kitty has significant difficulty with cognitive shifting, self-monitoring, planning, organizing, and initiating tasks and activities on her own. However, results from executive functions measures suggest that Kitty has the ability to sustain attention, inhibit impulsive responses, demonstrate cognitive flexibility, self-monitor her responses, and engage in spatial planning are at or above the ability of her same-age peers and more so than what her mother reported. Although inattentive behaviours were reported by Kitty, Mrs. Jones and Ms. Page, she remained attentive throughout the assessment process and during activities specifically targeting inattention. Kitty seemed very motivated by the individual attention she received during the assessment and was able to remain emotionally regulated for most of the time. At home and in the school setting Kitty appears to struggle with regulating her emotions and has low frustration tolerance. When upset, she yells at others and cries, then becomes embarrassed and leaves the immediate situation to calm down which has resulted in her being ostracized by her peers. Kitty struggles to function effectively during group work activities and is easily frustrated by others. After an emotional outburst she reports feeling embarrassed about her actions and will then apologize without being cued to do so. Since age 2 Kitty has generally externalized her frustrations, upsetness and anger, but in the past year she has been displaying more internalizing behaviours. She struggles to talk with others about what is bothering her, engages in fatalistic thinking when upset and often appears sad. These escalating internalizing behaviours should be closely monitored and further investigated by a psychiatrist given the family history of depression. Kitty also exhibits some of the features of Oppositional Defiant Disorder which may be a manifestation of her feelings of frustration, irritability and sadness rather than a desire to intentionally oppose or defy adults. Given the results of the current assessment, Kitty presents with mild behavioral/emotional concerns and would benefit from continued support and accommodations in the school setting to help her develop skills to better manage her behaviors. RECOMMENDATIONS: Based on the current assessment the following suggestions are offered for consideration. Kittys parents and teachers may already be implementing some of these strategies, so it is expected that they choose those recommendations that best fit with classroom and home routines. 1. Emotion Regulation Strategies: Kitty would benefit from engaging in counseling of an expressive modality to help her learn adaptive ways of managing her emotions. Other areas of focus may be helping her set goals, develop coping skills, and develop problem-solving and conflict resolution skills.

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JONES, Kitty 13 It may be beneficial for Kitty to see a psychiatrist about depressive symptoms through a referral to the Community Outreach of Pediatrics and Psychiatry in Education (C.O.P.E.) through the Calgary Board of Education. More information about this can be found at www.cbe.ab.ca/partners/cope.asp. Her parents may also wish to seek a psychiatric assessment through their family physician. To increase Kittys ability to understand her own emotions, it is important that she learns more about how her brain works when she is calm, when she becoming emotional and when she is very upset. She may also benefit from learning how to identify physiological sensations to help recognize warning signs and triggers. Biofeedback programs such as HeartMath can help identify and practice selfcalming strategies and can be used both at home and at school. For an example of how the program is being used, this video may helful: http://www.youtube.com/watch?v=-VrNJxJLVnc . Kitty should have help in setting up an agreed upon plan of where she can go to calm down and a signal she can give to communicate that she needs some space. Kitty would benefit from engaging in collaborative problem-solving at home or school when conflicts arise. Choose routines or situations that are most problematic for her in terms of frustration to work through together. o Supportive adults can empathize with Kitty by acknowledging her feelings (e.g. It must be frustrating for you when this happens). o Assist Kitty to rephrase the problem. For example, help her rephrase the general statement, Everyone hates me into a more specific problem, My friend and I disagreed how to complete our project together. o Brainstorm solutions to the problem, making sure to include all possible solutions to promote the creative process. o Ask Kitty to look at all the solutions and pick the one she likes best. o Circle the top three to five choices and then narrow them down by talking about the benefits or risks associated with each choice. o Ask Kitty if she needs help carrying out the choice. o Talk about what will happen if the first solution does not work,and generate a backup plan. o Offer praise for effort at problem-solving steps and when solutions are implemented.

2. Social Behaviour Strategies: Several resources are available to support Kittys positive social behaviour at home and at school. Home: Kitty would continue to benefit from play dates, especially with one other person, in a monitored home environment to provide assistance with social problem-solving. To learn more about helping her maintain friendships, indivdiuals working with her may find this book helpful - The Unwritten Rules of Friendship: Simple Strategies to Help Your Child Make Friends by Natalie Elman and Eileen Kennedy-Moore. School:

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JONES, Kitty 14 Kitty would benefit from interactive CD-ROM games, such as You Are a Social Detective, which challenges students to decipher the understanding of expected and unexpected social behavior or, My School Day, which teaches appropriate interactions and basic classroom social skills such as compromising, resolving conflicts, responding to teasing, and following the rules. She would also benefit from participation in social skills group that deals with communication, how to make and keep friends and how to problem solve in social situations. An example of this type of group is the Social Skills Level I Program, which can be found through the Learning Disabilities Association of Alberta. For more information, visit http://www.ldaa.net/kids.php. To support positive interaction with her peers, Kittys teachers are encouraged to complete the following: o Assign a peer to sit/work directly with Kitty. As she becomes more comfortable working with this student, gradually increase the size of the group. o Choose class groupings that increase Kittys success at working cooperatively with others (e.g. particularly other students that can work well with her). o When possible, allow Kitty to work on projects alone or pre-assign specific tasks to students within the group. o To support her with positive peer interactions, teachers are encouraged to: Support Kitty with developing social awareness (e.g. people may not like it when you say/do that). Be careful not to inadvertently reinforce Kitty for inappropriate behaviour (e.g. attending to her only when she responds inappropriately to a student). Capitalize on opportunities for Kitty to work together with students appropriately (e.g. when there is a spill, assign students different responsibilities for cleaning it up). 3. Executive Functioning Strategies: Given Kittys difficulties with adjusting to changes in routine, planning and organizing her work, and maintaining attention during school work, the following recommendations are offered for consideration: Transitions: Use a visual timer to help Kitty see how much time is allotted for different activities. Post a visual schedule for classroom routines to help her transition between different activities and tasks throughout the day. A predictable and clear routine may be beneficial to Kittys time management and academic performance. Provide frequent transition reminders (e.g. Ten more minutes of drawing and then you need to come for dinner/begin your homework etc.) Provide praise for positive behaviour regarding successful transition, (e.g. "Kitty, that was great that you cleaned up your art supplies when I asked you to; now we can leave the house on time for gymnastics. Thanks for doing that!") Organization and Planning:

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JONES, Kitty 15 Working with Kitty, identify routines (e.g. homework time, beginning a new writing task) that are the most problematic in terms of structure and organization, and work on these areas one at a time. Goals can be developed for how the routine should be carried out, and it can be broken down into smaller parts. Supplement instructions with visual aids where possible, especially in math and writing. Introducing Kitty to visual aids such as mind maps and word webs will help with idea organization during longer writing tasks. Illustrating math problems with pictures, allowing hers to manipulate physical objects to solve math problems, and encouraging her to use math software will enrich verbal instruction. Teachers are encouraged to chunk assignments into parts and provide feedback when each step is finished for Kitty. Use graphic organizers (e.g. columns with headings) to help her stay on track with class notes. Outline the essential components of paper or project with mind maps or summary tables and charts. Maintaining Attention: Before presenting instructions, make sure Kitty knows what to do if she does not understand the task (e.g. can ask the teacher or a friend nearby). Support her with positive reinforcement comments that focus on effort when she is focused (e.g. Youve been working hard at paying attention). Ensure Kitty is actively listening to any instructions that are presented (e.g. eye contact, hands are free of materials) and check for understanding by asking her to explain the assignment to the teacher or another student she feels comfortable with. Teachers are encouraged to provide a choice of work areas for Kitty to move between in the classroom. For homework, time should be clearly structured with as few interruptions as possible, and work can be broken up into several sections. Encourage Kitty to highlight key words to keep her focused on the tasks, and to take breaks after completing each section of work. Provide opportunities for body breaks periodically throughout the day to allow Kitty opportunities to move around. This will help her regulate herself and regain focus in the classroom. Collaborate with Kitty to decide the optimum seating placement for her in the classroom that will allow her to feel safe and support her both academically and socially. It was a pleasure to have had the opportunity to work with Kitty. I trust that the information and recommendations contained in this report will aid in providing her with the most appropriate support. If you have any questions regarding this report or if you require any assistance in implementing the programming suggestions, please do not hesitate to contact the UCAPES clinic (403-220-2851).

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JONES, Kitty 16

______________________________

_____________________________

Rhonda Williams, B.A, B. Ed.

Cheryl Chase, M. Sc. Registered Psychologist

NOTE: Due to the developing and changing nature of an individuals skills and abilities, the
results and recommendations contained in this report are intended for current use. Care must be taken not to characterize an individual on the basis of statements in this report, and not to assume that such statements apply indefinitely. Any reference to these results and recommendations in the future should be made with caution.

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JONES, Kitty 17 Appendix 1.A. Wechsler Intelligence Scale for Children, 4th Edition The Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) is an individually administered, comprehensive clinical instrument for assessing the intellectual abilities of children ages 6 years, 0 months through 16 years, 11 months. The WISC-IV provides composite scores that represent intellectual functioning in specified cognitive domains (i.e., Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI) and Processing Speed Index (PSI)). Lastly, the WISC-IV provides a composite score that represents a childs general intellectual ability (i.e., Full Scale IQ (FSIQ)). Percentile scores, scaled scores, and confidence intervals are also provided to assist in interpretation. The IQ and Index scores have a mean of 100 and a standard deviation of 15. Each of the subtests has a mean of 10 and a standard deviation of 3. The subtests can be broken down as follows: Full Scale IQ (FSIQ): is a standardized composite score comprised of four factors verbal comprehension, perceptual reasoning, working memory, and processing speed and represents a measure of general intelligence. Verbal Comprehension Index (VCI): is composed of subtests measuring verbal abilities utilizing reasoning, comprehension and conceptualization. Similarities, Vocabulary and Comprehension are the three core subtests that comprise the VCI, and Information and Word Reasoning are the two supplemental subtests of the VCI. Perceptual Reasoning Index (PRI): is composed of subtests measuring visuospatial perception, nonverbal fluid reasoning and perceptual organization. Block Design, Picture Concepts and Matrix Reasoning comprise the three core subtests of the PRI, and Picture Completion is the sole supplemental subtest of the PRI. Working Memory Index (WMI): is composed of subtests measuring attention, concentration and working memory. Digit Span and Letter-Number Sequencing comprise the two core subtests of the WMI and Arithmetic is the sole supplemental subtest of the WMI. Processing Speed Index (PSI): is composed of subtests measuring the ability to process simple or routine visual material. Coding and Symbol Search are the two core subtests that comprise the PSI, and Cancellation is the sole supplementary subtest of the PSI. The results of the Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI) and Processing Speed Index (PSI) are reported in the following tables. The scores on the WISC-IV have a mean of 100 and a standard deviation of 15.

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JONES, Kitty 18 Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) Composite Standard Scores Summary Composite Scale Standard 95% CI Percentil Score e Verbal Comprehension Index 106 98-113 66 Perceptual Reasoning Index 124 113-130 95 Working Memory Index 108 99-115 70 Processing Speed Index 109 100-116 73 Full Scale IQ (FSIQ) 116 110-121 86 Classification Average Superior Average Average High Average

Subtest Scores Verbal Comprehension Index Similarities Vocabulary Comprehension Perceptual Reasoning Index Block Design Picture Concepts Matrix Reasoning

Subtest Scaled Scores Summary Scaled Score Percentile 11 12 10 12 16 13 11 12 10 13 63 75 50 75 98 84 63 75 50 84

Classification Average Average Average Average Very Superior High Average Average Average Average High Average

Working Memory Index Digit Span Letter-Number Sequencing Processing Speed Index Coding Symbol Search

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JONES, Kitty 19

Appendix 1.B: Wechsler Individual Achievement Test, 3rd Edition The Wechsler Individual Achievement Test, 3rd Edition (WIAT-III) is a reliable source of information about an individuals academic skills and problem-solving abilities that can be used to guide appropriate academic interventions. It is a comprehensive and flexible measure tool that is useful for achievement skills assessment and for decision-making regarding learning disability diagnosis, special education placement, curriculum planning, and clinical appraisal for individuals aged 4 to 50 years. The WIAT-III provides composite scores that represent academic ability in several domains. These domains include Oral Language, Total Reading, Basic Reading, Reading Comprehension and Fluency, Written Expression, Mathematics and Math Fluency. Percentile scores, scaled scores, and confidence intervals are also provided to assist in interpretation. The Composite and Scaled scores have a mean of 100, and a Standard Deviation of 15. The composites can be described as follows: Oral Language Composite: is composed of subtests evaluating listening comprehension and oral expression. Students are required to listen to and understand words, sentences, and discourse. In the expressive and receptive (speaking and interpreting) tasks, the student looks at a picture and responds to it either verbally or by pointing. The subtests included in the Oral Language Composite are Receptive Vocabulary, Expressive Vocabulary, Oral Discourse Comprehension, Oral Word Fluency and Sentence Repetition. Total Reading Composite: is composed of the following subtests: Oral Reading Fluency, Reading Comprehension, Pseudoword (nonsense word) Decoding, and Word Reading. The subtests in this composite evaluate word reading accuracy, fluency (speed and accuracy), decoding (sounding out words), and comprehension of a variety of texts. Basic Reading Composite: is composed of subtests evaluating the word attack skills (sounding out words) and word reading accuracy of simple to complex words. Subtests in this composite include Word Reading and Pseudoword Decoding. Reading Comprehension and Fluency Composite: is composed of the following subtests: Reading Comprehension and Oral Reading Fluency. In this composite, the student must respond to a variety of texts to demonstrate their understanding of what they have read. Reading fluency, how quickly and accurately the student reads, is also evaluated in this composite. Written Expression Composite: is composed of evaluating spelling, writing the letters of the alphabet within a given time limit and writing complete sentences with word prompts. Subtests in this composite include Alphabet Writing Fluency, Spelling, Sentence Combining, and Sentence Building. Mathematics Composite: is composed of the following subtests: Math Problem Solving and Numerical Operations. In this composite, the student is required to complete basic facts in

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JONES, Kitty 20 addition, subtraction, multiplication and division, and to apply math concepts to everyday situations. Math Fluency Composite: is composed of evaluating the speed and accuracy of basic addition and subtraction facts within a given time limit. Subtests in this composite include Math FluencyAddition, and Math Fluency-Subtraction. The Math Fluency Composite is not included in the Total Achievement Composite Score. WIAT-III Subtest and Composite Scores Summary Subtest or Composite Standard Score 95% CI Percentile Rank 86 77 87 Classification

ORAL LANGUAGE Oral Language Composite Listening Comprehension Oral Expression READING Total Reading Composite Reading Comprehension Word Reading Pseudoword Decoding Oral Reading Fluency WRITTEN EXPRESSION Written Expression Composite Sentence Composition Spelling Essay Composition MATHEMATICS Mathematics Composite Math Problem Solving Numerical Operations Math Fluency Composite Math Fluency Addition Math Fluency Subtraction Math Fluency Multiplication TOTAL ACHIEVEMENT

116 111 117

106-126 98-124 106-128

Above Average Average Above Average

116 115 115 115 103 122 131 110 109

112-120 103-127 111-119 110-120 95-111 115-129 121-141 103-117 99-119

86 84 84 84 58 93 98 75 73

Above Average Average Average Average Average Above Average Superior Average Average

105 105 104 104 99 108 103 118

97-113 95-115 95-113 97-111 86-112 98-118 94-112 114-122

63 63 61 61 47 70 58 88

Average Average Average Average Average Average Average Above Average

Appendix 1.C: Collaborative Problem Solving Model

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JONES, Kitty 21 1. Make sure that you can recognize when Kitty is beginning to become frustrated. It is important to effectively intervene at this time, or on the front-end of the outburst, instead of with consequences on the back-end. 2. Make sure that you understand what is causing Kitty to begin to have a meltdown. 3. Decide which of three baskets the problem/situation falls in: Basket A, Basket B, or Basket C: Basket Basket A Basket B Basket C Description Reserved for problems/situations that would affect Kittys safety or well-being or the well-being of others. Reserved for problems/situations that do not fall into Basket A or Basket C Reserved for problems/situations that are trivial in the grand scheme of things Example Kitty is running away or being physically aggressive towards others. Kitty does not want to complete chores around the house. Kitty wants to stay up for 10 minutes passed her bedtime.

4. Implement an intervention or strategy that corresponds with the particular Basket: Basket Basket A Intervention/Action

There is a threat to Kittys safety and do whatever it takes to ensure that she is safe even if it means she is going to demonstrate behaviours consistent with a meltdown or behavioural outbursts Basket B Ensure that you first recognize the situation and emotions Kitty might be feeling, and then begin to work on a plan together to solve the problem. For example, say, Kitty, I understand that you do not want to clean your room because you want to watch TV, but I need you to clean your room today. It is important to me. What do you think we can do about that? Can you think of a solution? Let Kitty attempt to problem-solve or communicate a solution first, if she is able to, and then, with your guidance and feedback, work together (negotiate) until the solution satisfies both individuals agendas. You may need to go back and forth a few times. Basket C Allow Kitty to have her way as it was deemed that the situation/request is not major or worth the stress of Kitty having a meltdown over See: The Explosive Child, by Ross Greene, for more information on this strategy and what to do if it is not working.

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