Case Study #6

Tasha

Assessment #1
December 2005
Referral Question:

Age 8:0

Grade 3

What factors potentially underlie Tashas difficulties in

managing daily school responsibilities/demands? What interventions would
support Tasha?

Background Information:
-

requires much assistance to remain focused and work production is limited

struggles to work independently
experiences episodes of frustration, outbursts, or will shut down
confident, outgoing, enjoys social aspect of school
positive interactions with peers are a challenge
argumentative, disrespectful, disrupts the learning of others
one in-school suspension in November 2005 (reason not provided)
requiring constant redirection in classroom setting
behavior escalates during unstructured times
school team concerned Tasha doesnt seem to take behavior or consequences
seriously

Assessment #1 - Grade 3
Academic Information:
-

Tasha has received intensive literacy support - 1:1 assistance with reading and
writing
Modified programming in place
Frequent communication between home and school
School provided a letter in April 2005 for the physician outlining Tashas difficulties
and encouraged parents to seek medical consultation regarding her difficulties
(attention, impulsivity, distractibility)
Behavior incentives being used

September 2005 level of academic functioning:

-

Word Reading - Instructional Grade 1 (San Diego Graded Word List)

Reading Comprehension - Frustration Grade 1 (Alberta Diagnostic Reading
Inventory)
- Spelling - Grade Equivalency - 2.0 (Edmonton Spelling Test)
- Math - Skill Estimate - Beginning Grade 2 (No assessment)
Family Background - None provided

Classroom Behavior
Classroom Observation:
-

50 minutes on one occasion - 2:40-3:30

presented as highly distractible
engaged in self-distracting behaviors or responding to environment
off-task unless specifically redirected by the teacher 1:1
responded appropriately but unable to maintain focus
desktop disorganized
experienced difficulty locating materials required for tasks
seemed unable to follow step-by-step instructions unless provided to her 1:1, one
step at a time

Assessment Behavior
Cognitive Assessment (December 1, 2005)
-

appropriately engaged
physically restless (kneeling on chair, laying body on work table)
maintained focus
demonstrated memory strategies and mental control
self talk
required reminders to continue on paper-pencil tasks after finishing a line
appeared to approach tasks very systematically or very randomly

Academic Assessment (December 5, 2005)

-

testing completed in room off gymnasium

commented tasks were hard, I dont think I can
defiant during Sentence Combining - I know what Im doing but Im changing it!
impatient with instructions, defensive
announcement about a change in routine because of weather sent her into a total
flap
assessor speculated academic tasks may have contributed to her behavior

WISC IV
Scale

Composite Score

95% Confidence
Interval

Percentile Rank

Descriptive
Category

Verbal
Comprehension

87

81-95

19

Low Average

Perceptual
Reasoning

81

75-91

10

Low Average

Working Memory

80

74-90

Low Average

Processing
Speed

85

78-95

16

Low Average

Full Scale

79

74-85

Borderline

Verbal Comprehension
Percentile
Similarities
Vocabulary
Comprehension

Standard Score
6
10

9
50
7

Working Memory
Percentile
Digit Span
Letter-Number
(Arithmetic)

Standard Score
8

25
5

10

5
50

16
(Information)
(Word Reasoning)

Perceptual Reasoning
Percentile
Block Design
Picture Concepts
Matrix Reasoning
(Picture Completion)

8
9

25
37

Standard Score
4
11
6
8

2
63
9
25

Processing Speed Standard Score

Percentile
Coding
9
Symbol Search
6
(Cancellation)
10

37
9
50

Bender-Gestalt II
Visual-Motor Functioning:
Visual Motor Skills - Standard score of 95 (87-103 at 95% confidence level) - 37th
percentile - Average
Visual Motor Memory - Standard Score of 103 (91-113 at 95% confidence level) 58th
percentile- Average

WIAT-II
Subtests/Composites

Standard Scores

Percentile Rank

Reading Composite

81

10

Word Reading

79

Reading Comprehension

78

Pseudoword

81

37

Mathematics Composite

89

23

Numerical Operations

99

47

Math Reasoning

84

14

Spelling

88

21

BASC-2
Self-Report of Personality (SRP-C)
-

unusual thoughts and perceptions

having little control over events/blamed for
things she didnt do
difficulty establishing and maintaining close
relationships
feeling lonely/isolated
worry/nervousness/inability to relax
feeling sad/misunderstood
dissatisfied with performance despite effort
engaging in restless/disruptive behaviors

Examiner suggested generalized anxiety,

depressive affect, and negative self-image to be
potentially affecting her performance at school.

Teacher Rating Scales (TRS-C)

-

overall level of problem behavior exceeding

most children her age
frequent episodes of aggression, hyperactivity,
rule defiance, engaging in behaviors that affect
others, difficulty with self-control
significant difficulties sustaining attention
unusual difficulty comprehending and
completing schoolwork
appears disconnected from surroundings
engages in behaviors that are strange/odd
seems alone, difficulty making friends,
difficulty joining group activities

BASC-2
Parent Rating Scales (PRS-C)
But
-

engages in many disruptive, impulsive,

uncontrolled behaviors,
can be aggressive, argumentative, defiant,
threatening,
engages in rule-breaking behavior
tendency to become irritable quickly,
difficulty maintaining self control when
faced with adversity
poor expressive/receptive communication
difficulty seeking information
independently
.
able to adapt to new situations
possesses appropriate social skills
able to overcome stress and adversity

Summary
Recommendations:
-

modification to grade level curriculum, direct teaching

strategy instruction for memory and retention
develop confidence in herself as a learner, encourage her to take academic risks
would benefit from purposeful engineering of her environment
social skills instruction
involvement of pediatrician to rule out an attentional disorder
close monitoring and reassessment at some future date

Critique
-

no background information about the family

recommendations and report in general are not written in a teacher or parent
friendly way
no score summary page for the BASC-2
classroom observation done at the end of the day and without context

Assessment #2
October 2007
Referral Question:

Age 9

Grade 5

Does Tasha meet diagnostic requirements for severe

disabilities categorization? What recommendations can be made for intervention?

Family Background Information

-

lives with her mother and stepfather

has 2 older brothers - one lives with father in B.C., other lives independently
Tasha and her brother were apparently exposed to some sexualized behaviors by a
babysitter when Tasha was 3
both children acted out some of the behaviors
Tasha apprehended CFS and brother moved to B.C. to live with father
Tasha was in foster care from September 2006 - December 22 2006
Tasha and her brother see one another and have had therapy
family received in home support
mom feels Tasha is doing fine, would like her to return to her community school in
Grade 6
mom reported no behavior problems at home and is most concerned about
academics

School Background Information

-

attended community school until Grade 3

history of physical aggression, impulsivity, defiance
received both in school and formal suspensions
involved in significant bullying incidents
sexually inappropriate with younger children
Short Term Observation Program (STOP) from September 5 - October 27 2006 (while
in foster care)
- home schooled briefly after discharge while waiting for a placement in Bridges
Program
Bridges Program Interventions
- closely monitored and escorted to the bathroom
- receives positive reinforcement
- time out and problem solving are used to her benefit
- social skills are taught
- receives individual assistance
- peer tutoring is used
- participates in a morning sharing circle, extra time, preferential seating, support if
frustrated

Behavioral Concerns
impulsive
sly
many conflicts with peers
hurts others
doesnt take responsibility
manipulative
verbally and physically aggressive
sold treats for money
manipulated younger children to share food on bus
made a mess in the bathroom
wrote swear words on the computer and printed them
hidden under swings with a little boy
hidden under the slides
disrespectful tone of voice and attitude
has yelled when upset
argumentative

BASC-2

adaptive scale chart here

Summary
-

Results show Tasha displays chronic, extreme, pervasive

behaviors and requires high level of structure and services.
- Requires close supervision and support
- continued sneaky and manipulative behavior despite high
levels of support and supervision in Bridges Program.
- Tasha is unhappy with herself
Diagnosis:
Conduct Disorder, Childhood-Onset Type

Assessment #3
June 2009
Reason for Referral:

Age 11:5

Grade 6

The DSM-IV diagnosis which supported Tashas

identification with a Severe Emotional/Behavioral Disability has become outdated. A
reassessment is requested to confirm that she meets diagnostic eligibility for Alberta
Education. Her current cognitive and academic profile also needs to be updated.

Assessment Techniques

Consultation with School Principal and Classroom Teacher

Review of Student Record
Student Interview
Classroom Observation
Behavior Assessment System for Children - Structured Developmental
Questionnaire
BASC-II
o Parent Rating Scale - Child (PRS-C)
o Teacher Rating Scale - Child (TRS-C)
o Self-Report - Child (SRP-C)
WISC-IV
WIAT-II
Childrens Interview for Psychiatric Symptoms (ChIPS)
Parent Form

Assessment #3 Grade 6
Family Background Information:
- She lives with her mother and stepfather in Calgary and reports a
positive home environment
- One older brother lives with her dad in British Columbia and the
other older brother lives independently
- Nothing unusual during moms pregnancy with Tasha. She was
born full term and her developmental milestones were met
appropriately.
- She was prescribed glasses one year ago and infrequently wears
them to school.
- Mom described Tasha as an outgoing young girl with a great
sense of humor and a charming personality

Assessment #3 Grade 6
Previous Assessments
-

December 2005 psycho-educational assessment:

- met diagnostic criteria as a student with Mild/Moderate
Emotional/Behavioral Disability
- overall cognitive ability in the Borderline range
- academic skills were below grade level expectations
- September 2007 psycho-educational assessment:
- history of defiance and aggression were reported
- significant bullying behaviors, which resulted in a suspension from
school
- described as sly, manipulative, and argumentative
- met appropriate criteria for a diagnosis of Conduct Disorder Childhood Onset

Educational History and Current

Functioning at School
Past and Current Interventions at School:
Enrolled in STOP
Enrolled in BEST
Currently enrolled in Bridges II Program
Regular support provided by COMPASS
Classroom privilege system
Behaviour Log
Behavior Support Plan
Strengths:
Positive attitude towards learning
Appears to enjoy reading
Is able to successfully manage transitions
between classroom activities
Can be a positive mentor for younger peers

Difficulties:
Difficulties with peer interaction and
engaging in appropriate, prosocial
behavior
Difficulties riding the bus to and from
school
Difficult time appropriately accepting
feedback
Requires reminders of school routines
At times, displays a defiant and
argumentative attitude towards adults
Additional areas of concern include: selfesteem, self-image, and academic
difficulties
Current reports of her behavior in the
Bridges II Program have been positive but
attempts at reintegration have not been
successful.

Classroom Observation
-

63 minutes from 8:55 - 9:58 a.m.

Tasha was working on an art project in a class of five students during the
first half of the observation
seemed pleasant while interacting with her peers
was argumentative on several occasions when she was given feedback
and direction from adults
workplace was disorganized
failed to return materials to their proper place when not prompted
Tasha was in the music room preparing for a school concert during the
second half of the observation
was mature and polite when she had to share her instrument with a
student sitting beside her
Demonstrated some inattentiveness and had difficulty following along
with the rest of the class

Clinical Impression
-

Tasha continues to exhibit some disruptive behaviors within the school

environment
She continues to require daily support within the classroom
Continues to struggle with positive peer interaction and demonstrating
prosocial behavior
Poor self esteem
Continues to struggle with academic content in class
Acknowledgement that Tashas past history of trauma may underlie
difficulties in emotional regulation and transition as well as contributing to
a state of hyperarousal
Based on results from this assessment, she continues to exhibit behaviors
that interfere with her own learning, as well as the learning of other
students
These behaviors include: difficulty accepting personal responsibility and
accountability, difficulties riding the bus, defiant and argumentative

Assessment Behavior
-

Testing was completed in a quiet room that was relatively free from distraction
and interruptions

Generally, Tasha was cooperative throughout the assessment and was positive,
friendly and outgoing

She experienced more difficulty completing the academic tasks

Her approach to some tasks was impulsive (i.e. responding quickly to verbal
questions and poor attention to detail in Block Design subtest).

She responded well to verbal cueing and redirection

She demonstrated age appropriate attention and concentration on each of the

tasks.

She stated that she likes going to school and her favourite subject is math and
likes writing in her journal.

She hopes to someday work with at-risk youth in a school environment

WISC-IV
Scale

Composite Score

95% Confidence
Interval

Percentile Rank

Descriptive
Category

Verbal
Comprehension

91

84-99

27

Average

Perceptual
Reasoning

78

72-89

Borderline

Working Memory

91

84-100

27

Average

Processing
Speed

85

78-95

16

Low Average

Full Scale

83

78-89

13

Low Average

WISC-IV Subtest Scaled Scores

Subtest
Score
Block Design
Similarities

Scaled

Subtest
Scaled Score
Vocabulary

5
9

Letter-Number Sequencing

Digit Span

8
9

Matrix Reasoning

8
Picture Concepts

Comprehension
Coding

Symbol Search
6

Average scores fall between 8 and 12

WIAT-II Summary of Subtest Scores

Subtest

Standard Score

95% Confidence
Range

Percentile Rank

Qualitative
Description

Word Reading

68

62-74

Extremely Low

Reading
Comprehension

87

80-94

19

Low Average

Pseudo Word
Decoding

69

64-74

Extremely Low

Reading Composite

85

67-75

Borderline

Numerical Operations

74

66-82

Borderline

Math Reasoning

72

62-82

Borderline

Math Composite

70

63-77

Borderline

Spelling

75

67-83

Borderline

Written Expression

62

49-75

Extremely Low

Written Language
Composite

55

47-63

0.1

Extremely Low

Summary
Behavior and self-esteem:
IPP goals and accommodations
reflecting emotional and
behavioral needs that address
self-regulation, prosocial
behavior, building social skills,
developing appropriate ways to
express frustration
Positive reinforcement on
prosocial behavior and
compliance
Monitor Tashas well-being and
learning needs
High expectations for behavior
standards at home and at school
Regular communication with
Tashas parents
Encourage Tasha to practice
positive thinking

Reading
Individual or small group
instruction focusing on word level
reading skills
Encourage Tasha to read (reading
program at home, reading group at
school, parent volunteers)
Assign reading that is appropriate
for her instructional reading level
Writing
Extra time in the classroom to
complete writing tasks
Allow the use of a computer where
appropriate
Review basic sentence structure
and proper punctuation
Provide support in helping her plan
and organize her ideas for writing

Math
Look and say the math
operations out loud
before solving the
question
Break problem solving
process into stages
Learn how to identify
extraneous information
Reinforce previously
learned math facts and
apply these skills to
applications in the current
curriculum
Verbalize rules for solving
math problems and have
Tasha explain them in her
own words

Summary
Supports Recommended:
- Additional time to complete assignments
- Allow Tasha to utilize alternative modes of demonstrating and
communicating her ideas
- Access to assistive technology
- Strategy instruction in the areas of reading, writing, and math
- One-on-one instruction with a tutor along with individual tutorials from
the teacher
Conclusion:
A reassessment in junior high school will help direct appropriate programming for Tasha when she enters into senior high
school.