CONFIDENTIAL PSYCHOLOGICAL REPORT

Name: D SMF#: #### DOB:

School: Middle School Evaluator:

Case Code: Title: School Psychologist

Areas of Assessments:

Background Information, Behavioral Observations, General Intelligence, Academic

Performance, Educational Functioning, Curriculum , Adaptive Behavior, Social/Emotional
Status, Fine/Gross Motor, Communicative Status

Evaluation methods and activities:

Observation(s) Interview(s) Trial Intervention(s)

Record Review Classroom-Based Assessment Other

Curriculum-Based Assessment Norm-Referenced Assessment

Summary of assessment(s), including results and instructional implications:

D is a 12-year-old African American male who is currently attending regular 6th grade classes at
Middle School. He is currently repeating 6th grade. D was referred by his 6th grade teachers due to
chronic externalizing behavior problems and poor academic performance. D presents with cognitive
abilities in the Deficient range (WISC-III Full Scale IQ=66), academic achievement scores that range
from Borderline to Low Average (WJ-III Broad Reading=81, Broad Math=75, Broad Written
Language=70), and documented deficits in the adaptive behavior (VABS Classroom Edition
Communication=43, Daily Living Skills=64, Socialization=58). Results from the BASC indicate the
presence of significant externalizing behavior problems, deficits in social adaptive skills, and deficits in
attention and learning. D’s deficits in cognitive abilities, academic skills, and adaptive behavior are
indicative of mild mental retardation and are contributing significantly to his externalizing behavior
problems in the classroom setting. It is not apparent that D’s behavior problems are indicative of an
emotional disturbance. It is recommended that D be considered by the evaluation team for primary
special education placement in Developmentally Handicapped (DH) with behavioral support services
provided as needed.
BACKGROUND INFORMATION
D is a 12-year-old African American male who is currently attending regular classes at Middle School.
He is currently repeating 6th grade. D was referred by his sixth grade teachers due to concerns about
disruptive behavior problems in school and poor academic performance. Behavior problems reported
by his teachers are externalizing in nature and include noncompliance, arguing with teachers and other
students, throwing objects, knocking over desks, and inappropriate outbursts of anger. D’s mother,
Beatrice Lockett, does not report significant behavioral problems at home and states that he did not
have behavioral problems at school until the beginning of sixth grade at . He is not currently taking
medication and has no history of illness or injury. A psychoeducational evaluation completed at
University Medical Center in 1998 revealed cognitive abilities that fell in the Deficient range and
academic achievement scores that ranged from Deficient to Average (WISC-III Full Scale IQ=67, WJ-R
standard scores ranged from 91 to 63).

D’s school records indicate a history of failing grades in all subjects and poor attendance. He repeated
second grade and is currently repeating 6th grade. Results from his second grade retention did not
result in a marked improvement in his school performance. He has attended six different schools since
kindergarten. School discipline records between September 2000 and November 2001 show 29
incidents involving gross insubordination, truancy, disruption of class, fighting, profanity, issuing threats
to students, and violations of school rules. These incidences have resulted in a total of 32 days of out-
of school suspension, 11 days of in-school suspension, and placement in the P.A.L.S. program.

BEHAVIORAL OBSERVATIONS
During the 2 hour and 45 minute testing session, D was pleasant and cooperative. He engaged the
examiner in appropriate conversation about his favorite sports as well as his experiences in school. D
plays football and basketball in organized youth leagues and says that he would like to play both sports
in high school. D states that some schoolwork is hard for him, particularly math and language arts. His
favorite subjects are science and history. D admitted to having trouble with his behavior at school and
to his numerous suspensions, though he attributed fault for recent incidences to his teachers. During
testing, D followed verbal instructions without difficulty. He exhibited appropriate attention to the tasks
presented and appeared to think about his responses before answering. His speech was decipherable.
D presented with a positive mood and appropriate range of affect. Overall, D’s behavior during testing
did not interfere with his performance.

GENERAL INTELLIGENCE
Name/Title of Person Conducting Assessment: , School Psychologist
Date of Assessment:

WECHSLER INTELLIGENCE SCALE FOR CHILDREN –

THIRD EDITION (WISC-III)

Verbal Scale IQ: 67 Performance Scale IQ: 70 Full Scale IQ: 66

Scaled Scaled
Verbal Tests Scores Performance Tests Scores

Information 4 Picture Completion 5

Similarities 3 Coding 3
Arithmetic 5 Picture Arrangement 5
Vocabulary 4 Block Design 5
Comprehension 5 Object Assembly 7

On the WISC-III, D earned scores that ranged from Borderline to Deficient. He earned a Full Scale IQ
score of 66, which falls in the Deficient range and in the 1st percentile. This indicates that D performed
as well as or better than one percent of children his age in the WISC-III standardization sample. There
is a 95% probability that D’s true Full Scale IQ score falls between 62 and 73. D’s Verbal IQ score fell
in the Deficient range and his Performance IQ score fell in the Borderline range. The three-point
difference between his VIQ and PIQ was not significant, indicating similar verbal and perceptual-
organizational skills.

INSTRUCTIONAL IMPLICATIONS:
Deficient range cognitive ability will have an adverse effect on D's ability to learn and process new
information as readily as same aged peers. Material will need to be presented at his functional level
using multiple presentation formats.

ADAPTIVE BEHAVIOR:
Name/Title of Person Conducting Assessment: ,
Date of Assessment:

VINELAND ADAPTIVE BEHAVIOR SCALES- (VABS)

Interview Edition Classroom Edition

Standard Scores Standard Scores

Communication Domain 83 43
Daily Living Skills Domain 89 64
Socialization Skills Domain 75 58
Adaptive Behavior Composite 76 54

Information regarding D’s social adaptive functioning was obtained from his mother using the Vineland
Adaptive behavior Scales: Interview Edition and from his sixth grade teachers using the Vineland
Adaptive Behavior Scales: Classroom Edition. The Vineland Scales are rating forms used to determine
strengths and weaknesses in social-adaptive behavior. On the VABS interview edition, D’s scores
ranged from Borderline to Low Average. He received an Adaptive Behavior Composite score of 76,
which falls in the Borderline range and at the 5th percentile. He received domain standard scores in
Socialization that fell in the Borderline range and scores in Communication and Daily Living Skills that
fell in the Low Average range. On the VABS classroom edition, D’s scores consistently fell in the
Deficient range. He received an Adaptive Behavior Composite score of 54, which falls at a percentile
rank of 0.1 and in the Deficient range. His domain standard scores in Communication, Daily Living
Skills, and Socialization fell in the Deficient range and were indicative of functional deficits.

INSTRUCTIONAL IMPLICATIONS:
D's deficits in Communication, Daily Living Skills, and Socialization are having a negative impact on his
educational performance in the classroom. Appropriate socialization skills such as working with others,
following school and classroom rules, are important for success in a cooperative learning environment.
Social skills training should be implemented to teach specific classroom related skills. D’s deficits in
Daily Living Skills and Communication, can also be expected to present problems in the school
environment. Appropriately developed receptive, expressive and written communication skills are
needed in order to experience success in the general education curriculum. Daily living skills such as
safety and personal hygiene are necessary for day to day self-management. Instructional lessons may
need to be implemented to encourage appropriate behavior in these areas.
ACADEMIC PERFORMANCE, EDUCATIONAL FUNCTIONING, CURRICULUM
Name/Title of Person Conducting Assessment: , , School Psychologist
Date of Assessment:

WOODCOCK-JOHNSON TESTS OF ACHIEVEMENT, THIRD

(WJ-III)

Standard Scores Percentiles

Total Achievement 69 2

Broad Reading 81 11
Letter Word Identification 88 22
Passage Comprehension 79 8
Reading Fluency 81 10

Broad Mathematics 75 4
Calculation 71 3
Applied Problems 80 9
Math Fluency 73 4

Broad Written Language 70 2

Spelling 88 21
Writing Samples 72 3
Writing Fluency 52 <0.1

READING:
D achieved a standard score of 81 in Broad Reading, which falls at the 11th percentile and in the Low
average range. He performed in the Low Average range in Letter Word Identification and in the
Borderline range in Passage Comprehension.

MATH:
D achieved a standard score of 75 in Broad Mathematics, which falls at the 4th percentile and in the
Borderline range. He performed in the Low Average range in Applied Problems and in the Borderline
range in Calculation.

WRITTEN LANGUAGE:
D achieved a standard score of 70 in Broad Written Language, which falls at the 2nd percentile and in
the Borderline range. He performed in the Borderline range in Writing Samples and in the Deficient
range in Writing Fluency.

INSTRUCTIONAL IMPLICATIONS:
D's achievement scores in Reading, Math, and Written Language are well below age and grade
expectations and are adversely affecting his educational performance. He will likely have difficulty
reading materials and completing work at his grade level. D would benefit from frequent review and
repetition of new material and having new information presented at his functional reading level using a
variety of presentation formats.
SOCIAL/EMOTIONAL STATUS
Name/Title of Person Conducting Assessment: , School Psychologist
Date of Assessment:

BEHAVIOR ASSESSMENT SCALE FOF CHILDREN (BASC)

SELF REPORT OF PERSONALITY
Clinical Scales t-Score Percentile Rank Rating
Attitude Toward School 49 53 Average
Attitude Toward Teachers 51 62 Average
Sensation Seeking 49 50 Average
Atypicality 52 65 Average
Locus of Control 50 58 Average
Somatization 60 84 At-Risk
Social Stress 44 36 Average
Anxiety 40 20 Low
Depression 52 72 Average
Sense of Inadequacy 48 53 Average

Adaptive Scales
Relations with Parents 57 78 Average
Interpersonal Relations 54 49 Average
Self-Esteem 58 77 Average
Self-Reliance 52 47 Average

Composite Scales
School Maladjustment 50 53 Average
Clinical Maladjustment 49 52 Average
Personal Adjustment 57 72 Average
Emotional Symptoms Index 44 35 Average
 BEHAVIOR ASSESSMENT SCALE FOF CHILDREN (BASC)
TEACHER RATING SCALES-ADOLESCENT – (Reading/Language Arts Class)
Clinical Scales t-Score Percentile Rank Rating
Hyperactivity 88 99 Clinically Significant
Aggression 82 98 Clinically Significant
Conduct Problems 63 91 At-Risk
Anxiety 48 47 Average
Depression 53 75 Average
Somatization 44 30 Low
Attention Problems 71 97 Clinically Significant
Learning Problems 61 85 At-Risk
Atypicality 97 99 Clinically Significant
Withdrawal 51 65 Average
Adaptive Scales
Social Skills 30 1 Clinically Significant
Leadership 34 4 At-Risk
Study Skills 33 4 At-Risk

Composite Scales
Externalizing Problems 81 81 Clinically Significant
Internalizing Problems 48 48 Average
School Problems 67 67 At-Risk
Behavioral Symptoms Index 79 79 Clinically Significant
Adaptive Skills 31 1 At-Risk

BEHAVIOR ASSESSMENT SCALE FOF CHILDREN (BASC)

TEACHER RATING SCALES-ADOLESCENT – (Math)
Clinical Scales t-Score Percentile Rank Rating
Hyperactivity 86 99 Clinically Significant
Aggression 93 99 Clinically Significant
Conduct Problems 63 91 Clinically Significant
Anxiety 49 50 Average
Depression 96 99 Clinically Significant
Somatization 75 97 Clinically Significant
Attention Problems 74 99 Clinically Significant
Learning Problems 84 99 Clinically Significant
Atypicality 120 99 Clinically Significant
Withdrawal 66 92 At-Risk
Adaptive Scales
Social Skills 29 1 Clinically Significant
Leadership 31 1 At-Risk
Study Skills 30 1 Clinically Significant

Composite Scales
Externalizing Problems 84 99 Clinically Significant
Internalizing Problems 78 98 Clinically Significant
School Problems 81 99 Clinically Significant
Behavioral Symptoms Index 96 99 Clinically Significant
Adaptive Skills 28 1 Clinically Significant
Behavior Rating Scales
D’s social-emotional functioning was assessed using the Teacher and Self-Report versions of the
Behavior Assessment System for Children (BASC). D’s teachers provided consistent ratings within the
Externalizing Problems, School Problems, and Adaptive Skills domains. Ratings were inconsistent
within the Internalizing Problems domain. In the Externalizing Problems domain, both teachers
reported clinically significant ratings in Hyperactivity, Aggression, and Conduct Problems. In the School
Problems domain, both teachers reported either At-Risk or Clinically Significant ratings in the Attention
Problems and Learning Problems scales. In the Adaptive Skills domain, Both teachers provided At-
Risk or Clinically Significant ratings on the Social Skills, Leadership, and Study Skills scales. Within the
Internalizing Problems domain, D’s math teacher reported clinically significant ratings within the
Depression and Somatization scales, whereas his reading/language arts teacher provided average
ratings in these areas. These results suggest that D is displaying a high frequency of behaviors in
different classes that indicate significant externalizing problems, deficits in social adaptive skills, and
deficits in attention and learning. These results are consistent with anecdotal reports of D’s classroom
behavior and with his documented deficits in cognitive, academic, and adaptive skills.

On the Self-Report version of the BASC, caution is warranted when interpreting the results. D’s
responses resulted in an L-Index score that fell in the Extreme Caution range, indicating a high
likelihood that D was responding in a socially desirable manner. His responses were not indicative of
significant school, personal, clinical, or adaptive maladjustment.

INSTRUCTIONAL IMPLICATIONS:
D’s externalizing behavioral problems in school are contributing to his academic difficulties. However,
his deficits in cognitive, academic skills, and social adaptive behavior must also be considered as
contributing factors to his externalizing behaviors. It is likely that D is reacting to work that is highly
frustrating for him and that this actively contributes to his disruptive behavior in the classroom setting.
D would benefit from a structured classroom environment where work is provided at his functional level
and rules for conduct are clearly communicated and enforced consistently with appropriate
consequences. Systematic positive reinforcement should be employed to promote cooperative
behavior during class. D may also benefit from social skills training given in a small group setting.

FINE/GROSS MOTOR
Name/Title of Person Conducting Assessment: , , School Psychologist
Date of Assessment:

D did not present observable evidence of fine or gross motor impairment.

COMMUNICATIVE STATUS
Name/Title of Person Conducting Assessment: , , School Psychologist
Date of Assessment:

D presented with age appropriate speech that was clearly decipherable during the testing session.
 SUMMARY OF OBSERVATION

Student's Name: D SMF#: #### DOB:

School: Middle School

(Multiple observations are required for ED evaluations. Each individual conducting an observation should
complete a Summary of Observation form).

Date of Observation: 01/09/01, 01/16/01 Setting: Math Class, Health Class

Activity: Teacher directed instruction, Video

Conducted by (Name and Title): , , School Psychologist

A. Summarize relevant behaviors:

1. Describe behavior patterns:

Throughout both observation periods, D displayed behaviors that were disruptive to the classroom
environment, including talking, making tapping noises, and picking on peers seated around him. D’s
peers also engaged in these same classroom behaviors.

2. Describe the frequency of problem behavior(s):

Behaviors occurred continuously during the observation periods.

3. Describe the intensity of the problem behavior(s):

The intensity of D’s behavior problems intensified during periods in which his peers were engaging in
similar behaviors.

B. Describe the relationship of behavior(s) to the student's academic functioning:

D’s behaviors resulted in frequent reprimands and resulted his nonparticipation in classroom activities.

C. Describe instructional implications of behavior problems:

D would benefit from a structured classroom environment where rules are consistently communicated and
enforced using systematic appropriate consequences. Positive reinforcement should be used to encourage
appropriate classroom conduct.

__________________________________________ / /
Signature Date
 TEAM SUMMARY
AND
INTERPRETATION OF EVALUATION

Student Name: D SMF #: #### DOB:

School: Middle School

Summary of Current Performance:

D is a 12-year-old African American male who is currently attending regular 6th grade classes at Middle School.
He is currently repeating 6th grade. D was referred by his 6th grade teachers due to chronic externalizing
behavior problems and poor academic performance. D presents with cognitive abilities in the Deficient range
(WISC-III Full Scale IQ=66), academic achievement scores that range from Borderline to Low Average (WJ-III
Broad Reading=81, Broad Math=75, Broad Written Language=70), and documented deficits in the adaptive
behavior (VABS Classroom Edition Communication=43, Daily Living Skills=64, Socialization=58). Results from
the BASC indicate the presence of significant externalizing behavior problems, deficits in social adaptive skills,
and deficits in attention and learning. D’s deficits in cognitive abilities, academic skills, and adaptive behavior are
indicative of mild mental retardation and are contributing significantly to his externalizing behavior problems in
the classroom setting. It is not apparent that D’s behavior problems are indicative of an emotional disturbance.
It is recommended that D be considered by the evaluation team for primary special education placement in
Developmentally Handicapped (DH) with behavioral support services provided as needed.

Description of Educational Needs:

ƒ Improved basic reading skills
ƒ Improved reading comprehension skills
ƒ Improved fluency in math calculations
ƒ Improved general knowledge of mathematics concepts
ƒ Improved general writing skills
ƒ Improved classroom behavior
ƒ Improved social behavior with school staff
ƒ Improved adaptive functioning in communication, daily living skills, and socialization

Implications for Instruction (Strategies) and Progress Monitoring:

Deficient range cognitive ability will have an adverse effect on D's ability to learn and process new information as
readily as same aged peers. Material will need to be presented at his functional level using multiple presentation
formats.

D's deficits in Communication, Daily Living Skills, and Socialization are having a negative impact on his
educational performance in the classroom. Appropriate socialization skills such as working with others, following
school and classroom rules, are important for success in a cooperative learning environment. Social skills
training should be implemented to teach specific classroom related skills. D’s deficits in Daily Living Skills and
Communication, can also be expected to present problems in the school environment. Appropriately developed
receptive, expressive and written communication skills are needed in order to experience success in the general
education curriculum. Daily living skills such as safety and personal hygiene are necessary for day to day self-
management. Instructional lessons may need to be implemented to encourage appropriate behavior in these
areas.

D's achievement scores in Reading, Math, and Written Language are well below age and grade expectations and
are adversely effecting his educational performance. He will likely have difficulty reading materials and
completing work at his grade level. D would benefit from frequent review and repetition of new material and
having new information presented at his functional reading level using a variety of presentation formats.

D’s externalizing behavioral problems in school are contributing to his academic difficulties. However, his deficits
in cognitive, academic skills, and social adaptive behavior must also be considered as contributing factors to his
externalizing behaviors. It is likely that D is reacting to work that is highly frustrating for him and that this actively
contributes to his disruptive behavior in the classroom setting. D would benefit from a structured classroom
environment where work is provided at his functional level and rules for conduct are clearly communicated and
enforced consistently with appropriate consequences. Systematic positive reinforcement should be employed to
promote cooperative behavior during class. D may also benefit from social skills training given in a small group
setting.