& $

DOB:

Page 18 of 21

COUNSELING PSYCHOLOGY AND

SPECIAL EDUCATION

B R I G H A M Y O U N G U N I V E R S I T Y

PSYCHOEDUCATIONAL EVALUATION REPORT

C O N F I D E N T I A L

Name:

& $Comment by Microsoft Office User: Use these symbols to search and replace the first and last names

Date(s) of Evaluation:

Date of Birth:

Parent(s) Names:

$

Age:

Gender:

Hearing Screened:

Examiner(s):

Vision Screened:

Supervisor:

PLEASE REFER TO ALL ADULTS AS MR. OR MS. X THROUGHOUT THE REPORT. CHILDREN CAN BE REFERRED TO BY THEIR FIRST NAMES.

Reason for Referral:

(Who referred the client, history of current complaint/concern, and symptoms, Add detail about the referral question including how often this problem is occurring, how problematic the issue is, how long it has been happening DO NOT SAY THAT THE EVAL IS TO DETERMINE QUALIFICATION FOR SPECIAL EDUCATION OR QUALIFY FOR SERVICES. Should be one paragraph.

Assessment:Comment by Microsoft Office User: You will delete any tests you did not administer, and add any that are not on this list. Also add the DATE each measure was administered and WHO administered each measure (if different individuals from the writer)

Review of Records

Parent Interview

Teacher Interview

Behavioral Observations

Vineland Adaptive Behavior Scales, Third Edition (Vineland-3)

Wechsler Adult Intelligence Scales, Fourth Edition (WAIS-IV)

Wechsler Intelligence Scales for Children, Fifth Edition (WISC-V)

Wechsler Preschool and Primary Scales of Intelligence, Fourth Edition (WPPSI-IV)

Wechsler Memory Scales, Fourth Edition (WMS-IV)

Wechsler Individual Achievement Test, Third Edition (WIAT-3)

Wechsler Nonverbal Scale of Ability (WNV)

Stanford-Binet Intelligence Scales, Fifth Edition (SB-5)

Woodcock-Johnson Fourth Edition, Tests of Cognitive Abilities (WJ-Cog)

Woodcock-Johnson Fourth Edition, Tests of Achievement (WJ-Ach)

Woodcock-Johnson Fourth Edition, Tests of Oral Language (WJ-OL)

Universal Nonverbal Intelligence Test-Second Edition (UNIT-2)

Behavior Assessment System for Children, Third Edition (BASC-3)

Conners ADHD Rating Scales, Third Edition (Conners-3)

Behavior Rating Inventory of Executive Function-Second Edition (BRIEF-2)

Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A

Autism Diagnostic Observation Scales, Second Edition (ADOS-2)

Autism Diagnostic Interview, Revised (ADI-R)

Rey Complex Figure Test (RCFT)

Mullen Scales of Early Learning (Mullen)

Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-3)

Review of Records:

BRIEFLY review any school records or prior evaluation rec ords made available to you. Do not report scores unless they are relevant to your own testing. Summarize the findings and report WHO did the testing WHEN (for prior evals). Specify the source of the records (XYZ school district, etc.)

Interviews:

State who you interviewed and when. This is where you will put all of the history that was not in the review of records. Make sure to ask about family history of any conditions related to the referral question. Also make sure to ask about developmental milestones. Arrange your data in a chronological manner unless there are strong themes in the data to organize around (development, trauma, medical issues, etc.). Do not include irrelevant data (typically embarrassing things about family members that have nothing to do with the referral question). Adverse Experiences of Childhood (ACE) are usually relevant, however.

Observations:

Classroom Observations:

If any classroom observations were conducted by you or reported to you, summarize them here.

Behavioral Observations During Testing:

Be sure to include a statement as to the validity of the results based on your observations (e.g., “Because Izzy was cooperative and engaged throughout the assessment session, it is the opinion of the examiner that the results are valid estimates of her day-to-day function,” “Because of Jackson’s frequently distracted behavior, it is likely that the results may not represent his optimal abilities, but may be a valid representation of his ability to respond under similar conditions (1:1 ratio in a relatively distraction-free environment.)”)

Test Results: Please refer to the Data Summary for more detailed results and interpretation.

TELL US WHAT YOU DISCOVERED. Integrate your findings so they substantiate or possibly contradict each other. Organize the results logically, you do NOT have to go test by test. DO NOT include scores or percentiles. You MAY include a one-sentence description of a test if you must, but you DON’T HAVE to name tests unless you think it necessary. Organizing your results along domains is a better format. Usually no more than 3 paragraphs. Don’t include individual findings that are in the average range – make a statement something like, “All other findings were within the Average range expected for same-age peers.” There are exceptions to all of these rules, but this section should sound much like your oral feedback—you telling the answers to the referral question(s).

Summary: & $ is a ? year old [male/female] with a history of XXX. [He/she] was referred for xxx. 30-second summary of evidence that leads you to your diagnostic conclusion/recommendation. This summary is NEVER test-oriented, is always the holistic picture of the person now that you know what you know about them after assessment. Include a statement of how your findings are likely to be manifest in the person’s daily life. No recommendations here (those come later) – 1 paragraph.

[CLINICAL REPORTS ONLY]

Diagnostic Impression: Include this section in all clinical reports, but NOT in school reports.

Include DSM-5 and/or ICD-9 or ICD-10 codes. Do not list rule outs (per DSM-5), but you can list diagnoses by history for previous diagnoses that you have not found any evidence to contradict. All DSM-5 diagnoses should include appropriate specifiers.

Recommendations:

Each recommendation should be a PARAGRAPH that starts with a rationale (WHY), gives a specific recommendation with enough detail that someone can act on it ASAP, and hopefully at least 3 examples of resources, especially if you are referring for other services.

CLINICAL REPORTS can say “should . . . ” School reports must be more tentative, “many families have found x to be helpful” or “the school team can consider x” because if a school report says “should,” the school has to pay for it. You can have more than 4 recommendations, but should have at least 3.

(1) recommendation to address the referral question

(2) address any safety concerns

(3) . . . .

(4) follow up or further referral

It has been a pleasure to meet &. We remain available to you if you have any questions regarding the evaluation and recommendations.

Your Name, Your Degree

Psychology Practicum Student

Terisa P. Gabrielsen, PhD, NCSP

Licensed Psychologist UT #8615912-2501

Terisa_gabrielsen@byu.edu

801-422-5055

Data Summary:

Standardized Test Scales

Range

Standard

Score

Scaled

Score

T-Score

Percentile

Very High

≥ 130

16-19

≥ 70

≥ 98

High

120-129

14-15

63-69

91-97

Above Average

110-119

12-13

57-62

75-90

Average

90-109

8-11

43-56

25-74

Below Average

80-89

6-7

37-42

9-24

Low

70-79

4-5

30-36

2-8

Very Low

≤ 69

≤ 3

≤ 29

≤ 2

A 95% CONFIDENCE INTERVAL is the range of scores that a person would be expected to earn 95% of the time if the same test was administered 100 times.

YOU MUST ALWAYS INTERPRET FINDINGS IN THE DATA SUMMARY – NOT JUST COPY AND PASTE YOUR TEST RESULTS SECTION

I Highly recommend cutting and pasting the graphs from the computerized scoring reports and selected portions of the tables. See Sample Reports for what this looks like. Any time you cut and paste, you must add “Graph courtesy of NCS Pearson, Inc.” or “Table courtesy of PAR, Inc.” and name the exact publisher. Tables for data that you are NOT able to cut and paste are available in a separate file “Formatted Tables.” I WILL NOT GIVE YOU CREDIT IF YOU CUT AND PASTE INTERPREATIONS FROM SCORING REPORTS, HOWEVER.

Vineland Adaptive Behavior Scales, Third Edition (Vineland-II)

&’s adaptive behaviors were assessed by parent *and teacher* report, using the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3). The Vineland-3 provides information about an individual’s ability to function independently and to get along with others. These skills are age-related and are based on the individual’s typical performance, not optimal ability; that is, the ability has to be demonstrated on a consistent basis. The composite score (i.e., Adaptive Behavior Composite) and scores in each domain are reported as standard scores that have a mean value of 100 and a standard deviation of 15 points; age equivalent scores are also reported.

[INSERT GRAPH AND/OR TABLES HERE]

Describe general adaptive functioning

Describe performance in the different domains

Describe performance in the subdomains

Interpret the pattern of domain standard scores to identify strengths and weaknesses

Generate hypotheses about profile fluctuations

Describe any significant maladaptive behavior

The Wechsler Adult Intelligence Scales, Fourth Edition (WAIS-IV)

The WAIS-IV is an individually administered assessment of cognitive abilities in individuals between the ages of 16 and 90 years. The WAIS-IV provides an estimate of general cognitive ability as well as estimates of cognitive function in the following areas: Verbal Comprehension (ability to understand and use language); Perceptual Reasoning (ability to identify patterns in visual information); Working Memory (ability to keep and sort information for a few seconds); and Processing Speed (ability to complete simple mental tasks quickly). The Full Scale IQ estimate is calculated as a composite of these four areas. Occasionally, a General Ability Index (GAI) may be given, which provides an estimate of general cognitive ability that includes Verbal Comprehension and Perceptual Reasoning abilities, but does not include Working Memory or Processing Speed.

Verbal Comprehension measures acquired word knowledge, verbal concept formation, verbal reasoning, and verbal expression.

Perceptual Reasoning measures ability to detect important elements and patterns among visual objects by understanding abstract conceptual relationships. Inductive and quantitative reasoning, broad visual intelligence, simultaneous processing, and abstract thinking are all skills that contribute to fluid reasoning. It also includes visual-spatial abilities, such as integration and synthesis of part-whole relationships, attentiveness to visual detail, and visual-motor integration.

Working Memory measures ability to register and maintain in temporary storage then manipulate visual and auditory information in conscious awareness. Requires attention, auditory, visual discrimination, and concentration. Some tasks also require mental re-sequencing of information based on the application of a specific rule.

Processing Speed measures speed and accuracy of visual identification, decision making, and decision implementation. Visual discrimination, visual scanning, short term visual memory, visual motor coordination, cognitive flexibility, and concentration are required in processing speed tasks. Processing speed is not measured by simple reaction time or simple visual discrimination; rather, it involves cognitive decision making or learning.

The Full Scale IQ estimate is calculated as a composite of these five areas. A General Ability Index (GAI) may be given, which provides an estimate of general cognitive ability that includes Verbal Comprehension and Perceptual Reasoning abilities, but does not include Working Memory or Processing Speed.

[INSERT GRAPH AND/OR TABLES HERE]

Use the following descriptions if you wish to comment on particular subtests with unusual results, DO NOT SIMPLY COPY AND PASTE – you need to integrate these descriptions into your interpretation: Do not over-interpret subtest results. Their psychometric properties are not usually very robust. They can be interesting only in relation to behavioral observations or consistent patterns observed across domains.

Block Design (reproducing a design with two-colored blocks from a model or picture within a time limit)

Similarities (expressing the common features or ideas represented by 2 related words)

Digit Span (repeating numbers forward or backward)

Coding (copying symbols that have been paired with shapes or numbers, like a code within a time limit)

Vocabulary (naming pictures or saying the definition of words)

Letter-Number Sequencing (remembering and sorting combinations of words and letters)

Matrix Reasoning (identifying patterns within pictures to predict what should belong in a missing space)

Comprehension (answering questions based on understanding of general principles and some social situations)

Symbol Search (scanning a set of symbols to mark a target symbol within a time limit)

Picture Completion (identifying a missing element in a picture)

Cancellation (scanning arranged pictures to mark target pictures within a time limit)

Information (answering questions about a wide range of general-knowledge topics)

Arithmetic (solving verbal story problems within a time limit)

Visual Puzzles (ability to analyze and synthesize abstract information, requiring some mental rotation abilities)

Picture Completion (using reasoning to determine what is wrong or missing in a picture)

Figure Weights (using logic to determine equivalent amounts)

Wechsler Intelligence Scales for Children, Fifth Edition (WISC-V)

The WISC-V is an individually administered assessment of cognitive abilities in children between the ages of 6 years, 0 months and 16 years, 11 months. The WISC-V provides an estimate of general cognitive ability as well as estimates of cognitive function in the following areas:

Verbal Comprehension measures acquired word knowledge, verbal concept formation, verbal reasoning, and verbal expression.

Visual-Spatial measures ability to evaluate visual details and understand visual spatial relationships. Tasks include constructing geometric designs from a model. Visual spatial reasoning, integration and synthesis of part-whole relationships, attentiveness to visual detail, and visual-motor integration are required for visual-spatial tasks.

Fluid Reasoning measures ability to detect important elements and patterns among visual objects by understanding abstract conceptual relationships. Inductive and quantitative reasoning, broad visual intelligence, simultaneous processing, and abstract thinking are all skills that contribute to fluid reasoning.

Working Memory measures ability to register and maintain in temporary storage then manipulate visual and auditory information in conscious awareness. Requires attention, auditory, visual discrimination, and concentration. Some tasks also require mental re-sequencing of information based on the application of a specific rule.

Processing Speed measures speed and accuracy of visual identification, decision making, and decision implementation. Visual discrimination, visual scanning, short term visual memory, visual motor coordination, cognitive flexibility, and concentration are required in processing speed tasks. Processing speed is not measured by simple reaction time or simple visual discrimination; rather, it involves cognitive decision making or learning.

The Full Scale IQ estimate is calculated as a composite of these five areas. A General Ability Index (GAI) may be given, which provides an estimate of general cognitive ability that includes Verbal Comprehension, Visual-Spatial and Fluid Reasoning abilities, but does not include Working Memory or Processing Speed.

The following indices are complementary or ancillary, only include these descriptions if you are reporting the index, otherwise, delete these.

Quantitative Reasoning measures ability to perform mental math operations and to understand quantitative relationships.

Auditory Working Memory measures ability to register, maintain, and manipulate information presented verbally.

Nonverbal measures general intellectual ability with minimized expressive demands for children with special circumstances (i.e., English Language Learners) or clinical needs (i.e., autism spectrum disorder with language impairment). May also be useful estimate of overall ability for some children who are deaf or hard of hearing. “Language reduced” index, not language free.

General Ability is an estimate of general intellectual ability that is less reliant on working memory and processing speed relative to FSIQ.

Cognitive Proficiency is an estimate of efficiency with which information is processed in the service of learning, problem solving, and higher order reasoning.

Naming Speed is a broad estimate of automaticity of basic naming ability drawn from a variety of tasks. Provides useful information regarding visual-processing deficits, information retrieval difficulties, weak language skills, low naming skills, or generally slow cognitive function.

Symbol Translation is a broad estimate of visual-verbal associative memory drawn from a variety of conditions. Provides useful information regarding visual-verbal processing deficits, inattention, distractibility, poor information encoding, difficulties accessing information from memory, rapid forgetting, or general memory impairment.

Storage Retrieval is the sum of standard scores of Naming Speed and Symbol Translation. It is a broad estimate of long-term storage and retrieval accuracy and fluency derived from a variety of tasks designed to assess cognitive processes that are associated with reading, mathematics, and writing skills. Low scores may indicate difficulty encoding and/or retrieving information from long-term memory, difficult acquiring new information, slow processing speed, visual and/or language processing deficits, and/or inattentiveness.

[INSERT GRAPH AND/OR TABLES HERE]

Use the following descriptions if you wish to comment on particular subtests with unusual results, DO NOT SIMPLY COPY AND PASTE – you need to integrate these descriptions into your interpretation: Do not over-interpret subtest results. Their psychometric properties are not usually very robust. They can be interesting only in relation to behavioral observations or consistent patterns observed across domains.

Block Design (reproducing a design with two-colored blocks from a model or picture within a time limit, measures visual spatial comprehension, visual motor coordination)

Similarities (expressing the common features or ideas represented by 2 related words, measures abstract reasoning)

Visual Puzzles measures ability to analyze and synthesize abstract information, requiring some mental rotation abilities.

Digit Span (repeating numbers forward and backward, measuring short term auditory memory function)

Picture Span (measures short term visual memory)

Letter Number Sequencing (mental manipulation short term auditory memory, requiring attention and concentration)

Picture Concepts (identifying pictures that represent members of the same category, abstract reasoning)

Coding (copying symbols that have been paired with shapes or numbers, like a code, within a time limit, measures visual motor dexterity, nonverbal learning, and short term visual memory)

Vocabulary (naming pictures or saying the definition of words, measures verbal word knowledge)

Letter-Number Sequencing (remembering and sorting combinations of words and letters)

Matrix Reasoning (identifying patterns within pictures, measures visual processing and abstract spatial perception)

Figure Weights (measures quantitative and analogic reasoning)

Comprehension (answering questions based on understanding of general principles and some social situations)

Symbol Search (scanning a set of symbols to mark a target symbol within a time limit, measures perception, recognition, accuracy, speed, attention, and concentration)

Cancellation (scanning arranged pictures to mark target pictures within a time limit)

Information (answering questions about a wide range of general-knowledge, practical knowledge and personal experiences)

Arithmetic (solving verbal story problems within a time limit, involves mental manipulation, concentration, attention, memory, numerical reasoning)

Wechsler Preschool and Primary Scales of Intelligence, Fourth Edition (WPPSI-IV)

The WPPSI-IV is an individually administered assessment of cognitive abilities in young children between the ages of 2 years 6 months and 7 years 7 months. The WPPSI-IV provides estimates of general cognitive ability as well as estimates of cognitive abilities in the following areas: Verbal Comprehension (ability to understand and use language); Visual Spatial abilities (ability to understand and manipulate shapes in space); Working Memory (ability to keep and sort information for a few seconds); Fluid reasoning (novel problem solving); and Processing Speed (ability to complete simple mental tasks quickly). In some cases, additional areas of Vocabulary Acquisition, Nonverbal problem solving abilities, a General Ability Index (composite score without Working Memory and Processing Speed), and Cognitive Proficiency (composite of score including only Working Memory and Processing Speed) may be given.

[Insert graphs and/or tables from the Summary Report here]

Block Design (reproducing a design with two-colored blocks from a model or picture within a time limit, measures visual spatial comprehension, visual motor coordination) and Object Assembly (puzzles) require a child to see patterns and reproduce or re-assemble them by visualizing how to make pieces into a whole. These are the Visual Spatial Index subtests.

Information and Similarities ask the child to explain what things are (Information) and (expressing the common features or ideas represented by 2 related words, measures abstract reasoning). These two subtests are used to calculate the Verbal Comprehension Index score.

Picture Concepts and Matrix Reasoning measure abstract reasoning by asking the child to identify pictures that represent members of the same category (things that “go” together). These subtests constitute the Fluid Reasoning Index score.

Bug Search and Cancellation ask the child to search through pictures to find either a match (Bug Search) or members of a category (Cancellation). These two subtests produce the Processing Speed Index score.

Picture Memory and Zoo Locations show the child a target picture (Picture Memory) or target placement (Zoo Locations) to test the child’s ability to remember either the picture from among a field of other pictures, or where the picture was located on a grid. These are the subtests that make up the Working Memory Index score.

[interpret results]

Wechsler Memory Scales, Fourth Edition (WMS-IV)

The WMS-IV is an individualized assessment of memory across different domains, including auditory and visual memory (remembering what you hear or what you see). Working memory is measured (remembering what you have just seen or heard) as is delayed memory (recalling information you saw or heard in the recent past).

[insert graph and/or tables here]

[interpret results]

Wechsler Individual Achievement Test, Third Edition (WIAT-III)

The WIAT-III is an individually administered assessment of academic abilities in reading, writing, math, and oral language.

[insert graphs and/or tables here]

[interpret results]

Wechsler Nonverbal Scale of Ability (WNV)

The WNV is an individually administered assessment of cognitive abilities that is administered using very little verbal language. Gestures and drawings are used to communicate instructions to individuals, who then respond with nonverbal behaviors, such as pointing to indicate responses.

[insert graphs and/or tables here]

[interpret results]

Stanford-Binet Intelligence Scales, Fifth Edition (SB-5)

The SB-5 is an individually administered assessment of cognitive abilities in individuals between the ages of 2 and 85+ years. The SB-5 provides an estimate of general cognitive ability, estimates of verbal and nonverbal abilities, and estimates of cognitive ability in the following areas: Knowledge (accumulation of knowledge from daily life), Fluid Reasoning (novel problem-solving), Quantitative Reasoning (numerical problem solving), Visual Spatial Reasoning (identifying, analyzing, and mentally manipulating objects in three-dimensional space), and Working Memory (ability to hold and sort information for a short time).

[interpret results]

Woodcock-Johnson Fourth Edition, Tests of Cognitive Abilities (WJ-IV, Cog)

The WJ-IV Cog is a comprehensive assessment of cognitive abilities across multiple domains. Cognitive results may be combined with Wj-IV Achievement and WJ-IV Oral Language results for a more comprehensive picture of an individual’s cognitive abilities related to their performance.

WJ-IV Relative Proficiency Index (RPI) TableComment by Terisa Gabrielsen: If you are reporting RPI, use this table to explain. You will need to add an RPI column to the table below.

Reported RPIs

Proficiency

Functionality

Development

Implications

100/90

Very Advanced

Very Advanced

Very Advanced

Extremely Easy

98/90 - 100/90

Advanced

Advanced

Advanced

Very Easy

95/90 - 98/90

Average to Advanced

Within Normal Limits to Advanced

Age-appropriate to Advanced

Easy

82/90 - 95/90

Average

Within Normal Limits

Age-appropriate

Manageable

67/90 - 82/90

Limited to Average

Mildly Impaired to Within Normal Limits

Mildly delayed to Age-appropriate

Difficult

24/90 - 67/90

Limited

Mildly Impaired

Mildly delayed

Very Difficult

3/90 - 24/90

Very Limited

Moderately Impaired

Moderately delayed

Extremely Difficulty

0/90 - 3/90

Negligible

Severely Impaired

Severely delayed

Impossible

Note about WJ scoring reports – you have to decide what information you want reported, you have the choice of z-scores, standard scores, RPI, percentile ranks, proficienty description, etc. you can choose Age equivalent and grade equivalent, but those are notoriously not very accurate. Please always choose the 95% confidence interval band.

[insert graph and/or tables here]

[interpret results]

Woodcock-Johnson Fourth Edition, Tests of Achievement (WJ-IV, Ach)

The WJ-IV Ach is a comprehensive assessment of learned information across the basic academic domains of reading and math.

[interpret results]

Woodcock-Johnson Fourth Edition, Tests of Oral Language (WJ-IV, OL)

The WJ-IV OL is a comprehensive assessment of learned information related to language that is listened to and understood. Some indices are available in both English and Spanish to determine abilities in both languages.

[interpret results]

Universal Nonverbal Intelligence Test (UNIT)

The UNIT is an individually administered assessment of cognitive ability that is administered nonverbally. All instructions are given with gestures and examples rather than in words. All responses are made by choosing items or pointing, so there are no verbal prompts or responses on the UNIT.

[insert graphs and/or tables here]

[interpret results]

Kaufman Assessment Battery for Children, Second Edition (KABC-II)

The KABC-II is an individually administered test of cognitive abilities that has the option of using two different models of understanding brain function. One is the Luria model, which is often used to describe the neuropsychological functioning of a child. The other model is the Cattell/Horn/Carroll (CHC) model that is traditionally used to examine the various types and sub-types of intelligence across several domains.

[insert graph and/or tables here – be sure to specify which model was used for admin. And scoring]

[interpret results here]

Kaufman Test of Educational Achievement, Third Edition (KTEA-3)

The KTEA-II is an individually administered measure of a child’s academic abilities in reading, math, and writing. Multiple domains within these areas are assessed and reported as standard scores that are compared to children the same age, in the same grade as the child from all over the United States.

[insert graph and/or tables here]

[interpret results]

Behavior Assessment System for Children, Third Edition (BASC-3)

The BASC-3 is broad screening tool to assess for wide range of behaviors that may help or be a source of difficulty for a child. Both parents and teachers can assess behaviors to get a comprehensive overview of social and emotional functioning.

Scores are reported as T-Scores, with a mean of 50 and standard deviation of 10. Scores between 41 and 59 are in the Average range. Scores between 60 and 69 are in the “At-Risk” range, indicating need for concern. Scores above 70 are in the “Clinically Significant,” indicating a degree of difficulty that requires intervention for the child to be successful. In the Adaptive Skills section, the scores are reversed. Scores between 41 and 59 fall in the Average range, scores between 31 and 41 are in the “At-Risk” range, and scores below 30 are in the “Clinically Significant” range.

Composite/Clinical Scales

Adaptive Skills Scale

T-score Range

Clinically Significant*

Very High

70 and above

At-Risk*

High

60 – 69

Average

Average

41 – 59

Low

At-Risk*

31 – 40

Very Low

Clinically Significant*

30 and below

*Clinically Significant and At-Risk ranges indicate areas of perceived impairment

(you may copy and paste the plotted graph from the BASC-3 printout here. If you do, please include the following below the printout:)

*Table courtesy of NCS Pearson, Inc.

[interpret results]

Conners ADHD Rating Scales, Third Edition (Conners-3)

The Conners is a behavioral assessment questionnaire focusing on symptoms characteristics of an Attention Deficit Hyperactivity Disorder (ADHD). Behaviors that are sometimes associated with ADHD are also rated. Both parents and teachers typically complete Conners Questionnaires to assess behaviors across settings of home and school. For older students, multiple teachers may complete Conners questionnaires.

[interpret results]

Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2)

or Behavior Rating Inventory of Executive Function, Adult Self-Report (BRIEF)

The BRIEF is an instrument for rating executive function which reports abilities into two areas – ability to regulate behavior and ability to think about cognitive processes to accomplish work.

[insert graphs and/or tables here]

[interpret results here]

(these definitions are given for you to work into a paragraph. DO NOT CUT AND PASTE THESE AS IS INTO YOUR REPORT)

Inhibit = the ability in inhibit, resist, or not act on an impulse and the ability to stop one’s own behavior at the appropriate time.

Shift = ability to move freely from one situation, activity, or aspect of a problem to another as the circumstances demand. The ability to make transitions, problem-solve flexibly, switch or alternate attention, and change focus from one mindset or topic to another.

Emotional Control = ability to modulate emotional responses.

Initiate= related to beginning a task or activity, as well as independently generating ideas, responses, or problem-solving strategies.

Working Memory = capacity to hold information in mind for the purpose of completing a task.

Plan/Organize= ability to manage current and future-oriented task demands.

Organization of Materials = orderliness of work, play, and storage spaces.

Monitor = work-checking habits—checking own performance during or shortly after finishing a task to ensure appropriate attainment of a goal.

Mullen Scales of Early Learning (Mullen)

The Mullen Scales of Early Learning is a standardized, structured assessment administered to assess &’s development. The Visual Reception subtest of the Mullen was administered to obtain an estimate of $’s cognitive developmental age and skills. Visual Reception skills include responding to pictures, identifying patterns, understanding functions of everyday objects, and remembering items removed from view. Receptive and Expressive Language subtests were administered to get an estimate of $’s everyday language abilities in following directions, identifying pictures, and vocalization. Motor skills were measured by the Gross and Fine Motor subdomains. Gross motor skills include walking, running, jumping, throwing, etc. Fine motor skills include grasping, stacking, turning pages, drawing, cutting, etc.

$ successfully * He was able to *. His ability to * did not appear to be as well developed as his ability to *.

Mullen Scales of Early Learning

The Mullen Scales of Early Learning is a structured assessment administered to assess Timothy’s development. An overall Early Learning Composite score is reported as a standard score (an average score is 100, with a standard deviation of 15). Subdomain scores are reported as T-scores (an average score is 50, with a standard deviation of 10).

Standard Score

T-Score

Percentile

Age Equivalent

Descriptive Category

Early Learning Composite

Visual Reception

Receptive Language

Expressive Language

Fine Motor

Gross Motor

Rey Complex Figure Test (RCFT)

The Rey Complex Figure Test is a test of visual-motor integration and visual-spatial memory. & was asked to draw a complex line drawing with the drawing as a reference (Copy trial), then asked to draw the figure again from memory after 3 minutes (Immediate Recall), and again from memory after 30 minutes (Delayed Recall). To measure &’s ability to remember parts of the drawing with a visual cue, a Recognition trial was also administered to determine if & could recognize the various elements of the original drawing, presented separately.

Rey Complex Figure Test

Scores are reported as t-scores, with an average score of 50 and standard deviation of 10. The average range of t-scores is between 40 and 60. T-scores below 30 are considered to be very low and scores above 70 are considered to be very high.

Trials

Copy

Immediate Recall

Delayed Recall

Recognition

Total Correct

Raw Score

T-score

Percentile

IN interpretation of the RCFT, describe any strategies employed, deficits and strengths, and observations about the order in which parts of the drawing were completed. Any comments made by the participant during administration (relative to the task) can also be reported here. Note any consistencies or inconsistencies between trials.

A very low copy score can mean a degree of inattention to visual information. If the Recognition score is in the average range, that can indicate a problem that is mostly related to retrieval, not encoding of information.

Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)

The ADOS is an individually administered behavioral observation that usually takes about one hour. The examiner uses several materials and activities to give the individual opportunities for social interaction. There are five modules of the ADOS that vary according to language ability and age. The Toddler Module is used for children 12-30 months old. Module 1 is for individuals with no verbal language or one-word verbal communication. Module 2 is for individuals with phrase speech, and Module 3 is for children and younger adolescents with fluent language. Module 4 is given to individuals in late adolescence and adults who have fluent language. Scores on the ADOS-2 are not reported according to the authors’ direction. Observations of behavior in the ADOS are listed above, however. The result of &’s ADOS indicated a * level of autism symptoms.

Social Communication Questionnaire (SCQ)

The SCQ is a brief instrument that helps evaluate communication skills and social functioning in children who may have autism or autism spectrum disorders. Completed by a parent or other primary caregiver in less than 10 minutes, the SCQ is a cost-effective way to determine whether an individual should be referred for a complete diagnostic evaluation. The questionnaire can be used to evaluate anyone over age 4.0, as long as his or her mental age exceeds 2.0 years.  Lower cutoff scores are used when the child is younger than 4. The Current Form looks at the child’s behavior over the most recent 3-month period.

The SCQ was completed by &’s mother, Ms. $. A score of 15 or higher means enough symptoms of autism are present to warrant a full evaluation.  For a child &’s age, the cutoff is adjusted to xx. The questionnaire resulted in a score of **, indicating that & displayed enough autism symptoms to merit a comprehensive evaluation.

Social Responsiveness Scale, Second Edition (SRS-2)

The SRS-2 is a parent report measure that is not meant to be diagnostic for autism spectrum disorder, although if high enough, it can be used to indicate the level of impairment reported according to the number of symptoms and their frequency. Several different scales of social behavior are included and scored to indicate how much each particular area is impaired.  Higher scores indicate more impairment.  Subscale scores are intended for treatment planning only. The SCI and RRB index scores are provided to inform DSM-5 criteria decisions, and the SRS-2 total score can be characterized as being within a range of mild, moderate or severe levels of significant symptoms.

 

Social Responsiveness Scales, Second Edition SRS-2

The subscale scores are given as T-scores, with an average of 50 and standard deviation of 10.  Scores that are below 60 are considered to be within normal limits for a typical population.  Scores between 60 and 65 are in the mild range of impairment.  Scores between 66 and 75 are in the moderate range of impairment and scores of 76 or higher are in the high or severe range of impairment, meaning that the symptoms are significant enough to cause everyday difficulty for the individual.  

Subscale

T-Score

Range

Social Awareness

Social Cognition

Social Communication

Social Motivation

Restricted Repetitive Behaviors

Social Communication Index

Total SRS-2 Score

Autism Spectrum Disorder Diagnostic Criteria [your school may not allow use of this in a school report—check. You are always allowed to use it in your case conceptualization and the team is allowed to consider it in their decision making, however]

&’s behaviors (observed and reported) meet the following diagnostic criteria for an autism spectrum disorder as detailed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), 2013, American Psychiatric Association.

DSM-V Criteria

Meets Criteria?

Examples

Social Communication and Interaction (must meet all 3 criteria)

A1. Deficits in social–emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and forth-conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

A2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

A3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Restricted and/or Repetitive Behaviors (must meet at least 2 criteria)

B1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

B2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same rout or eat same food every day).

B3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

B4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Additional Criteria

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demand exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Two versions of the curve are given so you can choose the grey scale for printed reports, or the blue scale for online or full color report delivery. Delete one of the figures in your final report.

BRIGHAM YOUNG UNIVERSITY • 340 MCKB • PROVO, UTAH 84602-5093

(801) 422-3857 / FAX (801) 422-0198 • email: cpsesec@byu.edu • web: http://education.byu.edu/cpse