EXAMPLE REPORT

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Phone: (08) 9388 8044 www.pecs.net.au

Example Intellectual Disability Assessment Report:

John Smith

Strictly Confidential

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OBJECTIVE

This Example Comprehensive Psychological Report is provided to act as an example of the breadth and thoroughness of an assessment performed by Psychological & Educational Consultancy Services (PECS). This example report also reflects changes relating to the recent release of the DSM-5 (APA, 2013).

CONTENTS

(1) Biographical Details (2) Referral Information (3) Current Concerns (4) Background and Clinical Presentation Information (5) Cognitive Assessment (6) Adaptive Behaviour Assessment (7) Global Screening Assessment (8) Summary (9) Conclusion and Summary of Intellectual Disability DSM-5 Criteria (10) Recommendations

BIOGRAPHICAL DETAILS

Name: John Smith Date of Birth: 14/04/2004 Gender: Male Age: 11 years Grade: 6 School: Local Primary School Address: 123 West Coast Drive, TRIGG WA 6029 Parent’s Phone Number: 0444 444 444 Parent’s Email Address: smith@example.net.au

REFERRAL INFORMATION John was referred to Psychological and Educational Consultancy Services (PECS) by Dr Jane Brown (Paediatric Neurologist) for a Comprehensive Psychological Assessment and indication of whether the results are reflective of an individual with Intellectual Disability.

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CURRENT CONCERNS

From a presented list, John’s parents identified concerns in the following areas:

• Academic • Attention • Learning • Mathematics • Spelling • Reading • Written language • Anxiety • Medical or health • Fine motor • Memory

ACADEMIC AREAS Presented below are parent estimates of John’s achievement in the main academic areas:

Maths: Well Below Average Below Average Average Above Average Well Above Average Reading: Well Below Average Below Average Average Above Average Well Above Average Writing: Well Below Average Below Average Average Above Average Well Above Average Spelling: Well Below Average Below Average Average Above Average Well Above Average Language: Well Below Average Below Average Average Above Average Well Above Average John’s parents indicated John has received tutoring or extra remediation for the below academic areas:

Reading Writing Spelling Maths Speech and Language

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BRIEF BACKGROUND INFORMATION

Relevant information reported during the initial interview session with John’s mother:

• John’s mother suffered from hyperemesis gravidarum during her pregnancy with John. • Was born 9 ½ weeks prematurely and weighed less than 5 ½ pounds at birth. • Reached all of the major developmental milestones (e.g., walking, speaking, toileting) late. • Needs glasses/contact lenses. • Normal auditory acuity reported. • Has fine motor movement problems. • Suffers from cryptogenic West Syndrome with infantile spasms. • No current prescription medication use. • Has previously had Occupational Therapy and Speech Therapy intervention • There is a family history of Depression, Anxiety and Epilepsy. • Is presenting with learning and social difficulties at school • John always tries really hard in all tasks. • John is up and down a lot at night (does not sleep through night), is sleepy through the day. • When out of routine, John does not cope well. • John does not cope well out of his comfort zone. • John is not verbally social with strangers. • Cannot follow a series of instructions. • Does not initiate things himself, it is always a parent that does (i.e., play dates). • Cannot count money or tell the time. • Loses concentration quickly. • Cannot use public transport or go out independently. • Has difficulty processing simple information • Is unable to tell the time • Has difficulty with mathematics – needs to use his fingers for all counting • Fixates on things such as his iPad and making lists • Often picking his nose and then putting his finger in mouth • Licks his lips incessantly • Constantly interrupts • Uses a loud voice in public, laughs out loud • Bumps into things-Lack of space & body awareness • Has issues with crossing roads safely and understanding stranger danger (Personal safety) • Many Phobias-bugs, spiders, tunnels • Routine-same order every morning • Aggressive/violent when a change of routine • Requires assistance with personal care-toilet hygiene, bathing, diet, exercise, sleep, medication

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Dr Jane Brown, Paediatric Neurologist Report in May 2010 (at age 11 years 8 months): • John presented at the age of 6 months with a serious form of epilepsy known as West Syndrome,

which refers to a combination of “infantile spasms” (a type of brief tonic seizure), “hypsarrhythmia” (a very irregular electro-encephalogram with very frequent multifocal epileptic activity) and arrest of neurodevelopmental progress.

• Current working diagnosis is cryptogenic West syndrome. • John’s epilepsy has responded well to treatment. However, West syndrome is commonly

associated with significant learning difficulties and impairment of frontal lobe executive functions and unfortunately John has shown significant delays in both linguistic and fine motor skill development, as well as impaired concentration and reading ability.

• He has been assessed by and received therapy from educational psychologists, speech pathologists and occupational therapists.

• Previous trials of stimulant medication have been unhelpful for his short attention span and have not improved his academic performance.

Past testing:

• NAPLAN Year 5: o Reading – well below average (approx 1st percentile of year group) o Writing – well below average (approx 3rd percentile of year group) o Spelling – well below average (approx 5th percentile of year group) o Grammar & Punctuation – well below average (approx 4th percentile of year group) o Numeracy – well below average (approx 4th percentile of year group)

Past Psychometric Test Results:

Year: April 2010 Age: 6 years 0 months Examiner: School Psychologist – Non-Government Schools Psychology Service

WISC-IV Index

Composite

Score

Percentile

Rank

95% Confidence

Interval

Qualitative Intellectual

Classification Verbal Comprehension (VCI) 71 3 66-82 Borderline Perceptual Reasoning (PRI) 70 2 65-81 Extremely Low Working Memory (WMI) 62 1 57-74 Extremely Low Processing Speed (PSI) 62 1 57-74 Extremely Low Full Scale (FSIQ) 64 1 58-76 Extremely Low

Full report sighted by author and provided as an accompanying document.

Please note that only a brief overview was obtained due to John and his parents already having provided more detailed background information to Dr Brown.

See checklists for more behavioural information.

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COGNITIVE ASSESSMENT Psychometric Tests Administered:

Test Date of Administration

Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV, 2003) 23/10/2015 WISC-IV Overview: The Wechsler Intelligence Scale for Children- Fourth Edition (WISC-IV) is an individually administered clinical instrument for assessing cognitive ability of children between the ages of 6 years through to 16 years 11 months. The test provides subtest and composite scores which represent intellectual functioning in specific cognitive domains as well as a composite score which represents general intellectual ability. The WISC-IV has Australian norms and Australian language adaptation, and it takes from 1 ½ to 2 hours to complete. WISC-IV Subtests:

Table 1: WISC-IV Subtest Descriptions

VERBAL COMPREHENSION Similarities The Similarities subtest involves the child being presented with two words

that represent common objects or concepts and describing how they are similar. It is designed to measure verbal reasoning and concept formation. It also involves auditory comprehension, memory, distinction between non-essential and essential features, and verbal expression.

Vocabulary The Vocabulary subtest comprises both picture and verbalised items. For picture items the child names pictures that are displayed in the Stimulus Book. For verbal items the child gives definitions for words that the examiner reads aloud. Vocabulary is designed to measure a child’s word knowledge and verbal concept formation. It also measures a child’s fund of knowledge, learning ability, long-term memory, and degree of language development. Other abilities that may be used by the child during this task include auditory perception and comprehension, verbal conceptualisation, abstract thinking, and verbal expression.

Comprehension The Comprehension subtest requires the child to answer questions based on their understanding of general principles and social situations. It measures verbal reasoning and conceptualisation, verbal comprehension and expression, the ability to evaluate and use past experience, and the ability to demonstrate practical information. It also involves knowledge of conventional standards of behaviour, social judgment and maturity, and common sense.

Information * The Information subtest involves the child answering verbally presented questions that address a broad range of general knowledge topics. It is designed to measure a child’s ability to acquire, retain, and retrieve general factual knowledge. It involves crystallised intelligence, long-term memory, and the ability to retain and retrieve information from school and the environment. Other skills that may be used by the child include auditory perception and comprehension, and verbal expressive ability.

Word Reasoning * Word Reasoning involves the child identifying the common concept being described by a series of clues. This task measures verbal comprehension, analogical and general reasoning ability, verbal abstraction, domain knowledge, the ability to integrate and synthesize different types of information, and the ability to generate alternative concepts.

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PERCEPTUAL REASONING Block Design All items of the Block Design subtest require the child to view a constructed

model or a picture in the Stimulus Book, and use red-and-white blocks to re-create the design within a specified time limit. This subtest measures the child’s ability to analyses and synthesise abstract visual stimuli, It also involves nonverbal concept formation, visual perception and organisation, simultaneous processing, visual-motor coordination, learning, and the ability to separate figure and ground in visual stimuli. The subtest also involves visual observation and matching abilities for younger children, as well as the ability to integrate visual and motor processes.

Picture Concepts Picture Concepts involves the child being presented with two or three rows of pictures and them choosing one picture in each row to form a group with a common characteristic. This subtest measures abstract, categorical reasoning ability. Items are sequenced to reflect increasing demands on abstract reasoning ability.

Matrix Reasoning The child views an incomplete matrix and selects the missing portion from 5 response options on the Matrix Reasoning test. It measures fluid intelligence, visual information processing ability, and abstract reasoning skill.

Picture Completion * Picture Completion requires the child to view a picture and point or name the important part that is missing from the picture, within a specified time limit. It measures visual perception and organisation, concentration, and visual recognition of essential details of objects.

WORKING MEMORY Digit Span The Digit Span subtest is composed of two parts: Digit Span Forward and

Digit Span Backward. Digit Span Forward requires John to repeat numbers in the same order as read aloud by the examiner, and the Digit Span Backward requires the child to repeat the numbers in the reverse order of that presented by the examiner. This subtest measures auditory short-term memory, sequencing skills, attention and concentration. The Digit Span Forward task involves rote learning and memory, attention, encoding, and auditory processing. Digit Span Backward involves working memory, transformation of information, mental manipulation, and visuospatial imaging. The shift from Digit Span Forward to Digit Span Backward requires cognitive flexibility and alertness.

Letter-Number Sequencing Letter-Number sequencing requires the child to read a sequence of numbers and letters and recall the numbers in ascending order and the letters in alphabetical order. The task requires sequencing, mental manipulation, attention, short-term auditory memory, visuospatial imaging, and processing speed.

Arithmetic * The child mentally solves a series of orally presented Arithmetic problems within a specified time limit on the Arithmetic subtest. It involves mental manipulation, concentration, attention, short-term and long-term memory, numerical reasoning ability, and mental alertness. It also involves sequencing, fluid reasoning, and logical reasoning.

PROCESSING SPEED Coding The Coding subtest involved John copying symbols that are paired with

simple geometric shapes or numbers. Using a key, John drew each symbol in its corresponding shape or box within a specified time limit. In addition to processing speed, the subtest measures short-term memory, visual and sequential processing, learning ability, cognitive flexibility, attention, and motivation.

Symbol Search John was required to scan a search group and indicate whether the target symbol(s) matches any of the symbols in the search group within a specified time limit on the Symbol Search subtest. In addition to processing speed, the Symbol Search subtest also involves short-term visual memory, visual-motor coordination, cognitive flexibility, visual discrimination, and concentration. It also taps auditory comprehension, perceptual organisation, and planning and learning ability.

Cancellation * On the Cancellation subtest, John was required to scan both a random and structured arrangement of pictures and mark target pictures within a specified time limit. This subtest measures processing speed, visual selective attention, vigilance, and visual neglect.

* denotes supplementary subtest which may not be administered unless deemed necessary

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Examiner’s Details: EXAMINER: Dr Shane Langsford QUALIFICATIONS: BPsych, BEd (First Class Hons), PhD Test Behaviour: John found all of the subtests difficult to complete, and many required multiple reading of the instructions before John was able to grasp what he was required to do to complete the task. John’s approach to many of the subtests was consistent with that of an individual with an Intellectual Disability. It is my opinion that the scores that John achieved on the WISC-IV are an accurate reflection of his cognitive functioning at this particular point in time. Psychometric Test Results:

Age at Testing: 11 years 1 month

Table 1: WISC-IV Index Scores

WISC-IV Index

Composite

Score

Percentile

Rank

95% Confidence

Interval

Qualitative Intellectual

Classification Verbal Comprehension (VCI) 71 3 66-82 Borderline Perceptual Reasoning (PRI) 70 2 65-81 Extremely Low Working Memory (WMI) 62 1 57-74 Extremely Low Processing Speed (PSI) 62 1 57-74 Extremely Low Full Scale (FSIQ) 64 1 58-76 Extremely Low

Index scores have a mean Composite Score of 100 (50th percentile) and a standard deviation of 15. Percentile Rank refers to John’s standing among 100 children of similar age.

Therefore, a Percentile Rank of 50 indicates that John performed exactly at the average level for his chronological age. FSIQ is not considered to be valid if there is a 18+ difference between the VCI, PRI, WMI or PSI.

The Verbal Comprehension Index (VCI) incorporates the 3 subtests of Similarities, Vocabulary, and Comprehension and is designed to measure verbal abilities utilising reasoning, comprehension, and concept formation. The Perceptual Reasoning Index (PRI) comprises the 3 subtests of Block Design, Picture Concepts, and Matrix Reasoning and is designed to measure perceptual reasoning and perceptual organisation. The Working Memory Index (WMI) measures John’s ability to sustain attention, concentrate, and exert mental control. Mental control is the ability to attend to and hold information in conscious awareness whilst performing some operation or manipulation with it, and producing the correct result. Good mental control may facilitate the processing of complex information and ease the learning of new material. The Processing Speed Index (PSI) is an indication of the rapidity with which John can perform mental and graphomotor processing without making errors. Good speed of information processing may free cognitive resources for the processing of more complex information and ease new learning. The Full Scale (FSIQ) refers to John’s performance across all 10 of the core subtests of the WISC-IV and is generally considered the best estimate of general cognitive ability unless there is marked variability among the Index Composite Scores (ie 18+ difference between the Indexes).

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Table 2: WISC-IV Index Discrepancy Summaries

WISC-IV Index

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate

Verbal Comprehension – Perceptual Reasoning 1 14.70 No 32.7% Verbal Comprehension – Working Memory 9 13.79 No 24.6% Verbal Comprehension – Processing Speed 9 14.70 No 13.4% Perceptual Reasoning — Working Memory 8 15.28 No 28.8% Perceptual Reasoning – Processing Speed 8 16.10 No 13.3% Working Memory — Processing Speed 9 15.28 No 19% Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant. Between Index Interpretation: No statistically significant differences were found between the Indexes.

Table 3: WISC-IV Within-Index Discrepancies

Discrepancy Comparisons

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate

Digit Span — Letter-Number Sequencing -5 3.20 Yes 4.1% Coding — Symbol Search 1 3.90 No 42% Similarities — Picture Concepts 2 3.61 No 29.3% Digit Span & Arithmetic -2 3.30 No 34.3% Letter-Number Sequencing & Arithmetic 3 3.23 No 16% Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant. Within Index/Within-Factor Interpretation: John’s within-Index and within-Factor score pattern illustrated statistically significant discrepancies among the Working Memory Index, therefore, independent interpretation of the individual subtests comprising the WMI may be wise rather than interpretation of the Index as a whole.

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Table 4: WISC-IV Subtest Scaled Scores

Subtests

Scaled Score

Test Age

Equivalent

Percentile

Rank Verbal Comprehension Index Similarities 5 6:2 5 Vocabulary 6 7:2 1 Comprehension 3 4:2 0.1 *Information 4 5:6 2 Perceptual Reasoning Index Block Design 5 6:2 5 Picture Concepts 3 4:2 1 Matrix Reasoning 5 5:2 5 *Picture Completion 2 4:0 0.1 Working Memory Index Digit Span 3 4:10 1 Letter-Number Sequencing 4 5:6 2 *Arithmetic 3 4:10 1 Processing Speed Index Coding 3 4:10 1 Symbol Search 4 5:6 2 See Appendix 1 for complete subtest descriptions. *Non-core subtest.

Table 5: WISC-IV Subtest Discrepancies From Index Subtest Mean

Subtest

Subtest Scaled Score

Mean ScaledScore

Difference

From Mean

Critical Cutoff

.05 Strength or

Weakness

Base

Rate@ Verbal Comprehension Similarities 5 4.00 1.00 2.43 >25% Vocabulary 6 4.00 2.00 2.47 Almost 10% Comprehension 3 4.00 -1.00 2.77 5% *Information 4 4.00 0.00 2.50 Perceptual Reasoning Block Design 5 5.33 0.67 2.37 >25% Picture Concepts 3 5.33 -2.33 2.59 Almost 10-25% Matrix Reasoning 5 5.33 1.67 2.20 >25% *Picture Completion 2 5.33 -2.33 2.50 Almost @ Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant. See Appendix 1 for complete subtest descriptions. *Non-core subtest.

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Table 6: WISC-IV WMI and PSI Subtest Discrepancies From FSIQ Index Subtest Mean

Please note, the statistics provided in this table are not standard WISC-IV analyses and are provided as a guide only

Subtest

Subtest Scaled Score

FSIQ Mean Score

Difference From

FSIQ Mean

Nominal Critical Cutoff

.05 Strength or

Weakness Working Memory Digit Span 3 3.54 -0.54 2.50 Letter-Number Sequencing 6 3.54 2.46 2.50 Almost *Arithmetic 3 3.54 -0.54 2.50 Processing Speed Coding 3 3.54 -0.54 2.50 Symbol Search 4 3.54 0.46 2.50 See Appendix 1 for complete subtest descriptions. *Non-core subtest. Intellectual Strengths and Weaknesses: Statistical analysis of the results revealed the following subtests to be significant (.05) cognitive strengths or weaknesses relative to John’s own performance. Strengths: Zero significant (.05) cognitive strengths relative to John’s own performance were found. Weaknesses: Zero significant (.05) cognitive weaknesses relative to John’s own performance were found.

Table 7: Process Discrepancy Comparison

Subtest/Process Score

Forward Scaled Score

BackwardScaled Score

Difference From Mean

Critical Cutoff

Exceeds .05 Statistical

Significance

Base

Rate@ Digit Span Forward – Digit Span Backward 2 3 -1 3.97 No 47.6% Statistical Significance (Critical Values) at the .05 level. Process Discrepancy Interpretation: John’s performance on the Digit Span Backward portion of the subtest was commensurate with his performance on the Digit Span Forward portion.

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ADAPTIVE BEHAVIOUR ASSESSMENT Adaptive Behaviour Tests Administered:

Test Date of Administration

Adaptive Behaviour Assessment System–Second Edition (ABAS-II, 2008) 23/10/2014 ABAS-II Overview: The Adaptive Behaviour Assessment System – Second Edition provides a comprehensive, norm-referenced assessment of adaptive skills for individuals ages birth to 89 years. The ABAS-II may be used to assess an individual’s adaptive skills for diagnosis and classification of disabilities and disorders, identification of strengths and limitations, and to document and monitor an individual’s progress over time. The comprehensive range of specific adaptive skills and broad adaptive domains measured by the ABAS-II correspond to the specifications identified by the American Association of Mental Retardation (AAMR; 1992, 2002b) and the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition Text Revision (DSM-IV-TR; American Psychiatric Association, 2000). The ABAS-II consists of 5 rating forms, which can be completed independently by a respondent or may be read aloud to a respondent who has limited reading skills. Each rating form is easy to complete and score, requiring approximately 20 minutes to complete and 5-10 minutes to hand score. Respondents read and respond to all items and rate the extent to which the individual performs the adaptive skills when needed. The rating scale for the items allows respondents to indicate if the individual is able to independently perform an activity and, if so, how frequent he or she performs the activity when it is needed.; 0 (Is not able), 1 (Never or Almost Never When Needed), 2 (Sometimes When Needed), or 3 (Always or Almost Always When Needed). Although it is possible to assess the adaptive skills of an individual with a single rating form, the use of multiple rating forms is recommended to provide a comprehensive assessment across a variety of settings. Significant limitations in adaptive behaviour are defined as performance at least 2 Standard Deviations below the mean on (a) the Conceptual, Social or Practical Domain, or (b) an overall score on a standardised measure that assesses these three adaptive domains (e.g. GAC).

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ABAS-II Skills Areas:

Skill Areas for Teacher, Parent and Adult Forms

Communication Speech, language, and listening skills needed for communication with other people, including vocabulary, responding to questions, conversation skills etc

Community Use Skills needed for functioning in the community, including use of community resources, shopping skills, getting around in the community etc

Functional Academics Basic reading, writing, mathematics and other academic skills needed for daily, independent functioning, including telling time, measurement, writing notes and letters etc

School/Home Living Skills needed for basic care of a home or living setting (or for the Teacher Form, school and classroom setting), including cleaning, straightening, property maintenance and repairs, food preparation, performing chores etc

Health and Safety Skills needed for protection of health and to respond to illness and injury, including following safety rules, using medicines, showing caution etc

Leisure Skills needed for engaging in and planning leisure and recreational activities, including playing with others, engaging in recreation at home, following rules in games etc

Self-Care Skills needed for personal care including eating, dressing, bathing, toileting, grooming, hygiene etc

Self-Direction Skills needed for independence, responsibility and self-control, including starting and completing tasks, keeping a schedule. following time limits, following directions, making choices etc

Social Skills needed to interact socially and get along with other people, including having friends, showing and recognising emotions, assisting others, using manners etc

Work Skills needed for successful functioning and holding a part or full-time job in a work setting, including completing work tasks, working with supervisors, and following a work schedule

ABAS-II Composite Score Areas: The Conceptual Domain Composite score is derived from the sum of scaled scores from the Communication, Functional Academics and Self-Direction Skill Areas. Conceptual skills include receptive and expressive language, reading and writing, money concepts and self-direction. The Social Domain Composite score is derived from the sum of scaled scores from the Social and Leisure Skill Areas. Social skills include interpersonal relationships, responsibility, self-esteem, gullibility, naiveté, following rules, obeying laws and avoiding victimisation. The Practical Domain Composite score is derived from the sum of scaled scores from the Self-Care, Home/School Living, Community Use, Health and Safety and Work Skill Areas. Practical skills include basic maintenance activities of daily living (e.g., eating, mobility, toileting, dressing), instrumental activities of daily living (e.g., meal preparation, housekeeping, transportation, taking medications, money management, telephone use) together with occupational skills and maintenance of safe environments. The General Ability Composite (GAC) score is derived from the sum of scaled scores from seven, nine or ten skill areas, depending on the age of the individual and the type of rating form. The GAC represents a comprehensive and global estimate of an individual’s adaptive functioning. The GAC describes the degree to which an individual’s adaptive skills generally compare to the adaptive skills of other individual’s within the same age group.

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ABAS-II Test Results: Parent Form (Ages 5-21) The Parent Form is a comprehensive, diagnostic measure of the adaptive skills that have primary relevance for children’s functioning in the home and community, and can be completed by parents or other primary care providers. The Parent Form is used for children in grades Kindergarten (K) through 12 or ages 5-21 years. The form extends through age 21 to include special education students and other students who continue to be served through a secondary school setting. This form includes 232 items, with 21 to 25 items per skill area.

Age at Testing: 16 years 1 month

Table 1: Sum of Scaled Scores to Composite Score Conversions

Composite

Sum of Scaled Scores

Composite

Score

Percentile

Rank

95% Confidence

Interval

Qualitative

Range Conceptual 5 53 0.1 48-58 Extremely Low Social 2 55 0.1 49-61 Extremely Low Practical 4 40 <0.1 34-46 Extremely Low GAC 11 42 <0.1 38-46 Extremely Low

Adaptive Domain scores have a mean of 100 (50th percentile) and a standard deviation of 15. Percentile Rank refers to John’s standing among 100 individuals of a similar age.

John’s parent-report score on the General Adaptive Composite indicates that his overall level of adaptive behaviour falls at the <0.1st percentile (Extremely Low).

Table 2: ABAS-II Discrepancy Summaries

Domain Composite

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate Conceptual -- Social -2 7.78 No 44.0% Conceptual -- Practical 13 7.78 Yes 10.1% Social -- Practical 15 8.32 Yes 10.8%

Statistical Significance (Critical Values) at the .05 level Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant

Between Domain Interpretation: John functions much better on conceptual domain skills than on practical domain skills. The 13 point difference is statistically significant at the .05 level. John functions much better on social domain skills than on practical domain skills. The 15 point difference is statistically significant at the .05 level.

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Figure 1: ABAS-II Skill Area Scaled Score Profile

Table 3: Raw Score to Scaled Score Conversions

Skill Areas

Scaled Scores

Qualitative Range

Communication (Com) 3 Extremely Low Community Use (CU) 1 Extremely Low

Functional Academics (FA) 1 Extremely Low

Home Living (HL) 1 Extremely Low

Health and Safety (HS) 1 Extremely Low

Leisure (LS) 1 Extremely Low

Self-Care (SC) 1 Extremely Low

Self-Direction (SD) 1 Extremely Low

Social (Soc) 1 Extremely Low Scaled scores have a mean of 10 (50th percentile) and a standard deviation of 3.

Percentile Rank refers to John’s standing among 100 individuals of a similar age.

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Table 4: Strengths and Weaknesses

Skill Areas

Skill Area

Scaled Score

Mean Scaled Score

Differencefrom Mean

CriticalValue

Strength or

Weakness

Base RateConceptual Communication 3 1.67 1.33 1.66 >25% Functional Academics 1 1.67 -0.67 1.61 >25% Self-Direction 1 1.67 -0.67 1.60 >25% Social Leisure 1 1.00 0.00 2.38 100% Social 1 1.00 0.00 2.38 100% Practical Community Use 1 1.00 0.00 2.00 >25% Home Living 1 1.00 0.00 1.93 >25% Health and Safety 1 1.00 0.00 2.33 >25% Self-Care 1 1.00 0.00 2.33 >25% Statistical Significance (Critical Values) at the .05 level Skill Area Strengths and Weaknesses: Statistical analysis of the results revealed the following skill areas to be significant (.05) adaptive behaviour strengths or weaknesses relative to John’s own performance. Strengths: Zero significant (.05) adaptive behaviour strengths relative to John’s own performance were found. Weaknesses: Zero significant (.05) adaptive behaviour weaknesses relative to John’s own performance were found. Adaptive Behaviour Summary: John’s overall level of adaptive behaviour is best described by his ABAS-II General Adaptive Behaviour Composite score (1st percentile; Extremely Low).

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GLOBAL SCREENING ASSESSMENT

Screening Tests Administered: Date of

Test Administration

*child & adolescent psychprofiler (CAPP; Langsford, Houghton, & Douglas 2014) 21/10/2015 CAPP Outline: The CAPP comprises 126 items and utilises three separate screening forms; the Self-report Form (SRF: 126 items), Parent-report Form (PRF: 126 items), and Teacher-report Form (TRF: 126 items) for the simultaneous screening of 14 of the most prevalent disorders in children and adolescents. The CAPP comprises screening criteria that closely resemble the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5: American Psychiatric Association: APA, 2013). The CAPP is appropriate for the screening of behaviour of children and adolescents between the ages of 2 and 17 years, however, only the Parent-report and Teacher-report Forms are administered for children aged below 10 years due to the reading level requirements of the Self-report Form. All items of the CAPP require responses to be made on a six-point scale pertaining to the perceived frequency of the behaviour (ie., Never, Rarely, Sometimes, Regularly, Often, or Very Often). When calculating disorder screening scores, the items are coded as follows: Never = 0, Rarely = 0, Sometimes = 0, Regularly = 1, Often = 1, and Very Often = 1. These values were chosen because although many people with and without disorders may exhibit similar behaviours, it is the frequency of the behaviour that determines whether it is of clinical significance. A small number of exceptions to these scoring rules apply where some of the behaviours (e.g., fighting with a weapon, stealing) are considered to be of sufficient severity that 'Sometimes' is also awarded a score of 1. Therefore, the summation of the items within each disorder produces a screening score for that disorder, which if exceeding the screening cutoff score, designates that the individual has been awarded a positive screen for that disorder. In order to ensure its validity and reliability, the first version of the psychprofiler was subjected to a series of rigorous psychometric analyses over a number of years. This process has involved validation against a large mainstream sample (n>1000) as well as clinical calibration against individuals with formal diagnoses. These analyses found the psychprofiler to be a highly reliable and valid screening instrument. The CAPP is primarily administered in order to provide an objective indication of whether the individual exhibits behaviours characteristic of a suspected disorder, possible comorbid disorders, and issues pertaining to differential diagnosis. The psychprofiler has been the most widely used Australian psychiatric / psychological / educational global screening instrument since 2004. For further information regarding the CAPP, please visit www.psychprofiler.com or contact Dr Shane Langsford on (08) 9388 8044. Please note that any indication of a positive screen on the CAPP does not constitute a formal diagnosis. A positive screen merely indicates that the individual has met sufficient criteria for a disorder to warrant further investigation.

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Global Behavioural Assessment Results: John’s parents reported positive screens for:

• Generalised Anxiety Disorder • Separation Anxiety Disorder • Attention-Deficit/Hyperactivity Disorder: Predominantly Inattentive Presentation • Language Disorder • Speech Sound Disorder • Persistent Depressive Disorder • Specific Learning Disorder – with Impairment in Reading • Specific Learning Disorder – with Impairment in Written Expression • Specific Learning Disorder – with Impairment in Mathematics

John’s teacher reported positive screens for:

• Generalised Anxiety Disorder • Attention-Deficit/Hyperactivity Disorder: Predominantly Inattentive Presentation • Language Disorder • Speech Sound Disorder • Specific Learning Disorder – with Impairment in Reading • Specific Learning Disorder – with Impairment in Written Expression • Specific Learning Disorder – with Impairment in Mathematics

A copy of the CAPP Report is included as an Appendix, as are the completed CAPP Forms. Please refer to the CAPP Report for the individual behaviours which were responsible for the positive screens elicited.

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SUMMARY Reason for Referral:

John was referred to Psychological and Educational Consultancy Services (PECS) by Dr Jane Brown (Paediatric Neurologist) for a Comprehensive Psychological Assessment and indication of whether the results are reflective of an individual with Intellectual Disability. Current Concerns:

From a presented list, John’s parents identified concerns in the following areas:

• Academic • Attention • Learning • Mathematics • Spelling • Reading • Written language • Anxiety • Medical or health • Fine motor • Memory

Background and Clinical Presentation Information:

Many of John’s behaviours and mannerisms are consistent with that of an individual with an Intellectual Disability. Cognitive Assessment:

John achieved Index scores at the following levels:

• Verbal Comprehension Index (VCI) = 3rd percentile • Perceptual Reasoning Index (PRI) = 2nd percentile • Working Memory Index (WMI) = 1st percentile • Processing Speed Index (PSI) = 1st percentile • Full Scale IQ (FSIQ) = 1st percentile

No significant differences were found between any of John’s Indexes. Please note: John achieved a WISC-IV score at the 1st percentile when tested in 2011 at age 6 years 0 months by the School Psychologist – Non-Government Schools Psychology Service Adaptive Behaviour Assessment:

John’s overall level of adaptive behaviour is best described by his ABAS-II General Adaptive Behaviour Composite score (1st percentile; Extremely Low).

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Global Screening Assessment:

John’s parents reported positive screens for:

• Generalised Anxiety Disorder • Separation Anxiety Disorder • Attention-Deficit/Hyperactivity Disorder: Predominantly Inattentive Presentation • Language Disorder • Speech Sound Disorder • Persistent Depressive Disorder • Specific Learning Disorder – with Impairment in Reading • Specific Learning Disorder – with Impairment in Written Expression • Specific Learning Disorder – with Impairment in Mathematics

John’s teacher reported positive screens for:

• Generalised Anxiety Disorder • Attention-Deficit/Hyperactivity Disorder: Predominantly Inattentive Presentation • Language Disorder • Speech Sound Disorder • Specific Learning Disorder – with Impairment in Reading • Specific Learning Disorder – with Impairment in Written Expression • Specific Learning Disorder – with Impairment in Mathematics

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CONCLUSION AND SUMMARY OF INTELLECTUAL DISABILITY DSM-5 CRITERIA Intellectual Disability (Intellectual Developmental Disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. (DSM-5 Definition, p.33). As per the DSM-5, the following three criteria must be met: Criterion A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and learning from experience, confirmed by both clinical assessment and individualised, standardised intelligence testing. A1: Clinical Assessment.

Criterion Met (see Background and Clinical Presentation Information and Test Behaviour section)

A2. Intellectual Assessment

Criterion Met (as per FSIQ/Index/ Subtest scores in Cognitive Assessment section)

Criterion B. Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community. B. Adaptive Functioning

Criterion Met (see Background and Clinical Presentation Information and Adaptive Behaviour section)

Criterion C. Onset of intellectual and adaptive deficits during the developmental period C. Onset prior to age 18

Criterion Met (see Background and Clinical Presentation Information section)

Severity: The various levels of severity are defined on the basis of adaptive functioning, and not IQ scores, because it is adaptive functioning that determines the level of supports required. Levels of severity are Mild, Moderate, Severe, and Profound. Severity. Severe

(see Background and Clinical Presentation Information and Adaptive Behaviour section)

As indicated in the summary table above, John meets the criteria for a diagnosis of an Intellectual Disability, which can be described as being of a “Severe” nature. John’s intellectual disability is a permanent condition and was first identified in 2011 at age 6 years 0 months (FSIQ=1st percentile). John’s clinical presentation is consistent with that of an individual with an Intellectual Disability, and her daily functioning is further complicated/impeded by a number of psychiatric/psychological conditions, none of which are deemed to carry any primary diagnostic implications.

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RECOMMENDATIONS

Please note, PECS does not provide micro-strategies (e.g., sit student at front of classroom, etc) as part of their recommendations. PECS’s provides recommendations on what further assessment is required, what intervention is necessary, and who is the most appropriate to provide the assessment/intervention recommended. Paediatric Neurologist Involvement:

(1) John should once again be seen by Dr Jane Brown, now that this new information is available for incorporation into his paediatric assessment.

School Involvement:

(1) A case-conference involving John's parents, the school psychologist, and key school personnel should be held to discuss John's individual learning requirements.

Disability Services Commission:

(1) John’s parents should provide a copy of this report to the Disability Services Commission.

Dr Shane Langsford

Date of Report Managing Director -PECS

Registered Psychologist APS College of Educational & Developmental Psychologists Academic Member