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Name
Date of Birth
Age
Sex
Ethnicity
Education
Handedness
Date of Assessment
Date of Report
Diagnoses, usually cognition-related, including:
Educational and vocational accomodations
1. Psychosocial History.
2. Educational History.
3. Work history.
4. Medical History.
5. Current Illnesses.
6. Current Medications.
7. Psychological and Cognitive Symptoms Reported.
8. Previous Evaluations.
9. Motivational Factors.
1. Appearance
2. Orientation
3. Behavior
4. Level of Cooperation
5. Level of Motivation
6. Mood and Affect
7. Speech
8. Thought Process
9. Thought Content
10. Sensory and Motor Functioning
11. Insight
12. Judgment
13. Suicidality/Homicidality
14. Testing Procedure Accommodations
15. Validity
Test results will be reported in terms of ranges and percentiles. Ranges indicate whether the client performed within expectations for his age, below or above expectations. Percentiles indicate how the client performed in comparison with people of the same age group in the normative sample. For example, 60th percentile indicates that the client performed as well as or better than 60 percent of the normative sample, but worse than 40 percent.
Wechsler Adult Intelligence Scale – III (WAIS-III) was administered in order to evaluate Client's intellectual functioning. WAIS-III is a battery of tests assessing intellectual functioning in a variety of domains and providing an estimate of overall intellectual ability, ability in specific cognitive domains, as well as performance on specific cognitive tasks.
IQ Scores
Index Scores
Subtest Scores
Rey Auditory-Verbal Learning Test (AVLT) and Rey-Osterreith Complex Figure Test (CFT) were administered to evaluate Client's verbal and visual memory and learning, respectively. Incidental Learning (IL) scores from the Digit Symbol subtest of WAIS-III are also reported here.
AVLT
IL
CFT
Trails A and B as well as informal screening procedures and the results of previously reported tests were utilized to screen for neuropsychological impairment. This is a screening administered in order to determine if further evaluation is necessary and does not provide a comprehensive assessment of neuropsychological functioning.
Trails A and B (this is a neuropsychological screening test involving a variety of functions and highly sensitive to neurological problems)
Summary of Neuropsycological Functioning by Domain:
Wide Range Achievement Test-4 (WRAT-4) was administered to evaluate Client's academic achievement. In addition to percentiles, school grade level equivalents will be reported for this test.
WRAT-3 Results
Vocational interests were measured by a self-report questionnaire. The occupations are divided into six categories:
The report includes number of activities relevant to the type of occupation one enjoys (out of 11), number of skills one reports to have (out of 11), number of occupations belonging to that category one reports to would have liked (out of 14), and self-estimate on ability and skills as compared to other people of the same age (on the scale from 1 to 7). The three-letter code provided at the end can be used with the Dictionary of Holland Occupational Codes, which provides a listing of various occupations. Possible sample occupations based on obtained code are also listed below.
Vineland Adaptive Behavior Scales-II Interview Form was administered to evaluate Client’s adaptive skills, since Mental Retardation was suspected and the diagnosis of Mental Retardation requires a finding of significant limitations in adaptive functioning in addition to a low IQ score. The domain scores will be reported in terms of adaptive levels and percentiles and subdomain scores in terms of adaptive levels and age equivalents.
Domain Scores
Subdomain Scores
Justification of diagnostic impressions or eligibility determination.
Concrete recommendations for procedures and accomodations based on test results.
For example, let's consider recommendations for ADHD, ATTENTION AND CONCENTRATION:
1. X be referred to the students with disabilities office at his school to receive appropriate accommodation and support services.
2. X be provided with individual tutoring to help him concentrate on and organize information for future recall because of his concentration and organizational deficit.
3. X be allowed double time in quiet environment without distractions for tests and exams because of concentration deficit and slowed processing speed.
4. X use tape recorder to record lectures and be given all assignments in written form because of difficulties in processing complex or extensive auditory instructions.
5. X supplement written materials with multimodal input (such as computerized courses combining visual and auditory input).
6. X has already developed good compensation strategies for his attention deficit and difficulties with organization. However, he may benefit from reviewing available resources for students with ADHD and learning disabilities. Some helpful websites include: www.ncld.org,www.ldonline.org, and www.schwablearning.org
7. In terms of organizational difficulties, X's learning is likely to improve if he forces himself to organize information as early as possible in the learning process. Taking notes and creating tables is likely to be helpful.
8. Intentionally slowing down, backtracking, and acquiring a habit of checking one's work may allow X to compensate for difficulties with attention and concentration. For example, when X is solving math problems, he can verbalize steps required to solve the problem, which would slow him down and ensure that he does not miss steps while calculating the answer (e.g. to add two three-digit numbers, I need to add the third digits, if the result is more then ten I write one over the second digits and the remainder in the third space under the line, then I add the second digits plus one if there is a one over the second digits, etc.). If X's tutor can help him to write out step-by-step instructions for solving this type of problem, it would be helpful. After completing the problem, X can repeat the solution. If the results are identical, they are probably correct. This is a slow and cumbersome process, but it would benefit X in the long run, since he will train himself to concentrate. Circling the computational sign or key words in instructions before attempting the problem may also be helpful to focus X's attention.
9. A similar strategy can be employed for language-related tasks. X can use repetition, rephrasing, and summarizing to improve his understanding of lecture material. For example, when he reads or listens to the tape recorder, he can repeat and then rephrase each sentence for himself to make sure he attended to it and understood its meaning. Once he completed a paragraph, he can type a brief summary for that paragraph. Once he read or listened to an article or a chapter or a part of lecture in this way, he can re-read his summary notes and summarize the main ideas and important points he will need to remember and understand for the class. For maximum effectiveness, this process should be started with a tutor, who can go through it step-by-step with X and provide a concrete example of its application.
10. Quiet and uncluttered work environment that is empty of distractions is likely to improve Mr. X's concentration while he is studying. Having a set period of study time every day may also help him organize himself.
11. For complex tasks, a written checklist with each task being checked off as it is accomplished is likely to be very helpful.
12. Finally, external organizational tools, such as day planer or an electronic organizer or palm pilot, including scheduler with alarm, is likely to be very helpful to Mr. X.