Integrative Psychological Report (Collaborative) -- Child Sample

Name: Laurie Jones

DOB: 04/01/2007
Age: 11
Gender: Female
Ethnicity: Latino
Date of Report: 01/28/2019

Referral Question:
Laurie was referred by her school counselor for psychological evaluation to address the
following:
What are her educational strengths and weaknesses? What are the recommendations for
intervention to address her recent behavioral changes?

Presenting Problem
Laurie Jones is an 11-year-old fourth grade student at Hawthorne Elementary. She is an active
child, who enjoys hands-on classroom activities. She interacts well with teachers and peers. She
has not had a history of externalizing behavioral challenges at school or at home. However, her
teacher has expressed concern about a recent decline in attention and problems with sitting still
during some classroom lessons.

Methodology
School Records Reviewed
Interview with School Psychologist
Clinical Interview with Aunt and Uncle (01/28/2019)
Clinical Interview with Laurie (01/28/2019)
Mental Status Exam
Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) 1/29/2019
Wechsler Individual Achievement Test, Second Edition (WIAT-II) 1/30/2019
Conners 3rd Edition 1/30/2019

Relevant Background
Laurie Jones was born in Brazil on April 1, 2007 to parents Alejandro (father) and Angelina
(mother) Jones. At the age of 2, Mr. and Mrs. Jones died in a boating accident, which left Laurie
an orphan. She was relocated to Florida at the age of 3 to live with her extended family; uncle
and aunt. Laurie’s care providers speak very little to no English at the home; preferring to use
their native language of Portuguese.

Laurie learned to speak English through watching cartoons and observing others. By watching
people and picking up on their non-verbal cues, she speaks the English language well enough to
communicate with peers and adults at school. An active girl, Laurie is hands-on with classroom
activities, however, she has recently been having problems paying attention or staying still
during classroom lessons. She was referred by school counselor for evaluation of educational
strengths and weaknesses and intervention recommendation.
Interview with Laurie’s aunt and uncle report that client has difficulty staying focused at home
(changes the channel often on the television, fails to finish tasks that she starts, etc…). Uncle
reports that client is easily distracted and “can’t stay still.” Stating that she will sit down to draw,
only to get up when something else catches her eye. Laurie does not have a reported history of
abuse, or delinquency behavior. Laurie was diagnosed with ADHD and takes Ritalin.

Mental Status Exam

Laurie indicated she was 5’0 and weighed 125 pounds and right-handed. Portuguese is her
primary language and English is her secondary. Laurie appears athletic and energetic, offering
direct eye contact as she enters the office. Client is friendly but appears easily distracted by the
objects on desk. There were no indications of homicidal or suicidal ideation. She was oriented to
person, place, time, and context. While her memory and concentration appeared to be in the
normal range, but she does appear to be excessively chatty during the MSE. Her abstract
thinking appeared to be average. The information he presented appears to be mostly reliable.

Test Results:

Scale Composite Score Percentile Rank Confidence Interval 95%

Verbal Comprehension 50 <.01 46-62

Visual Spatial 89 23 82-98

Fluid Reasoning 91 27 84-99

Working Memory 79 8 73-88

Processing Speed 92 30 84-102

Full Scale 72 3 67-79

WISC-V
Laurie was given 16 sub-tests from the Wechsler Intelligence Scale for Children (5th edition); a
broad clinical tool for assessing the intelligence of children between ages 6-16.The 5
primary and secondary subtests are scaled on a mean of 10 and a standard deviation of 3.
 Subset Component Standard Percentile Qualitative
Score Description

Oral Language 90 25 Average

Total Reading 87 19 Average

Basic Reading 84 14 Below Average

Reading Comprehension and 95 37 Average

Fluency

Written Expression 91 27 Average

Mathematics 111 77

Math Fluency 102 55 Average

Total Achievement 93 32 Average

The WISC-V also produces a Full-Scale IQ (FSIQ) composite score that tha represents general
intellectual ability. The FSIQ is on a standard metric and mean of 100, with an SD of 15.

FSIQ
The FSIQ composite score is gathered from seven subtests and generally summarizes ability
across cognitive functioning. Subtest results are gathered from five areas of cognitive ability;
verbal comprehension, visual spatial ability, fluid reasoning, working memory, and processing
speed. Laurie’s FSIQ is Very Low Average and is 3% of those within her age range, in
comparison with other children within her age range. The confidence interval points to the range
of values where there is a chance that the true value lies within, Laurie’s true score lies between
67-79 (FSIQ=72).

Verbal Comprehension
The Verbal comprehension index (VCI) measures Laurie’s ability to access and apply gained
word knowledge. This score reflects Laurie’s ability to verbalize meaningful concepts, think
about verbal information, and express herself with words. Laurie’s performance on the VCI
subtests was much lower than children within her age range, and appears to be an area of
personal weakness compared to her overall ability, with a percentile rank <.01%. (VCI=50, 95%
confidence interval, between 46-62). Laurie’s scores in this area reflects possible issues with
word knowledge, difficulty retrieving information, problems with verbal expression, and
reasoning and problem solving difficulties.

Visual Spatial
The Visual Spatial Index (VSI) measured Laurie’s ability to evaluate visual details and
understand spatial relationships in order to construct geometric designs from a model. The skills
require visual spatial reasoning and visual-motor integration. Laurie’s composite score of 89
demonstrates a borderline average ability in both Block Design (BD) and Visual Puzzles (VP)
were the same scaled score of 8 indicating her low average is equal between her ability to
analyze and synthesize abstract information and measure quantitative and analogical fluid
reasoning.

Fluid Reasoning
Fluid reasoning measures the ability to detect an underlying connection between visual objects
and the use of reasoning to identify and apply rules. The FRI requires inductive and quantitative
reasoning, broad visual intelligence, abstract reasoning, and concurrent processing. Laurie’s
performance on fluid reasoning was particularly strong, in comparison to her language-based
skills. Her FRI is of average range, with the percentile rank of 27% greater than those within her
age range. (FRI=91, CI=84-99). Further testing is required to examine if the difference between
her fluid and crystallized intelligence is due to a preference for visual rather than verbal stimuli.

Fluid reasoning measured Laurie’s ability to detect the underlying conceptual relationship among
visual objects and use reasoning to identify and apply rules. This test measured Laurie’s abilities
in abstract thinking to solve complex problems. Laurie’s composite score 91 demonstrated her
fluid reasoning performance during this test was stronger than her crystalized intelligence in as
demonstrated in her verbal comprehension scores. The fluid reasoning is shown to be a strength
for Laurie in comparison to others scaled scores on the test.

Working Memory
Working memory index (WMI) measures the ability to register, maintain, and work with visual
and auditory information. This cognitive ability utilizes attention and concentration; along with
both visual and auditory discernment. Laurie’’s performance on the WMI was below average,
with the percentile rank 8% above children within her age range. (WMI=79, CI=73-88).
The Working Memory Index (WMI) measured Laurie’s ability to register, maintain, and
manipulate visuals and auditory information in conscious awareness, which requires attention
and concentration, as well as visual and auditory discrimination. Laurie’s composite scores of 7
on Digit Span (DS) and 6 on Picture Span (PS) demonstrate consistency in her low average
ability utilize mental control, concentrate, attentiveness, and hold information without aid of
rehearsal.
Processing Speed
Processing speed measures the speed and accuracy of visual information, identification, decision
making, and decision implementation. Performance in PSI is related to visual scanning, visual
discrimination, short-term visual memory, visuo-motor coordination, and concentration. Laurie’s
PSI performance is in average range and 30% above those within her age range (PSI=92, CI= 84-
102). She appears to have no issues in her ability to rapidly identify, register, and implement
decisions about visual stimuli. Her ability to process visual information with speed and accuracy
appears to be a strength; in comparison to her performance on tasks requiring language based-
reasoning.

The Processing Speed Index (PSI) measured Laurie’s speed and accuracy of visual identification,
decision-making and decision implementation. Laurie’s composite score of 92 is her strongest
score within the test. The score indicates Laurie’s strength in rapidly identifying, registering,
and implementing decisions about visual stimuli.

WIAT-II:

Laurie was administered the WIAT-II (Wechsler’s Individual Achievement Test-II) on January
29, 2019. Client was engaged and euthymic during the testing process. She scored average
throughout most subtests, but was below average in basic reading and sentence repetition. There
were significant difference between her math and oral language, total reading, and basic reading
skills. Her strengths include math, fluid reasoning, and visual processing. With hands-on tasks
that interest her, Laurie is engaged and active. Her weakness include tasks that involve language,
tasks that require multiple steps, are unengaging, or those she deems is boring.

Conner’s 3rd Edition

Laurie was administered the Conner’s 3rd Edition on January 29, 2019. Laurie displays in-
attention, hyperactivity, impulsivity; which is very elevated across all raters. Her executive
functioning is also elevated across all raters. Her learning problems and peer relations is average
across all raters. Her aggression is average at most, but higher in mathematics; perhaps this
category makes her more irritable. Academic difficulties stem from behavioral distractions.

Diagnostic Hypothesis:

Discrepancies in WISC-V and WIAT-II scores are the result of client failing to take her
medication at home during the WISC-V. Client was also in an altercation with a schoolmate
prior to being administered the WISC-V and did not perform well. However, medication was
brought to school and taken on time, the very next day, and Laurie scored more consistently on
the WIAT-II and Conner’s.

Cultural considerations must be made, as English is not Laurie’s first language. Given that she
and her family speak primarily Portuguese at home, the exposure to English is limited to the
school setting. Thusly, client could possibly benefit from specialized classes in English.
Client’s inattentiveness and distractibility is very elevated. Academic difficulties seem to stem
from behavioral distractions; which may meet the criterial A for ADHD. Test scores and
behavioral observations appear to coincide.

Presenting Diagnosis:

Primary Diagnosis:

Attention Deficit Hyperactivity Disorder 314.01 (F90.2) combined presentation, mild

Other Diagnosis:

Other Factors:

Recommendations:

 Client could benefit from ESL or Specialized English classes

 Medication for ADHD could be brought to nursing office and given at school
 Offer child specialized work area, away from distractibility
 Offer child longer time than necessary to complete assignments
 Short assignments in frequent successions; rather than long assignments
 Offer frequent positive feedback to child
 Redirect with patience if child becomes distracted.

Julie Y. Bunnak, PsyD Student, Capella University

Instructor: Dr. Natalie Marr