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Case Study One

CLIENT NAME: AGE: GRADE: Key Clinician(s): Marko, Cain 19 years 1 month 12 Rhonda Williams

REASON FOR REFERRAL: Cain was referred for a psychoeducational assessment following concerns identified by Cains school and parents. Specifically, Cain has been identified as having difficulties in many subject areas in school, especially with reading, mathematics and written expression. Cain is also presenting with social and emotional difficulties both at school and at home. This assessment was requested to determine his current level of cognitive and academic functioning as well as his current social-emotional functioning to determine how to best support him in his final year of high school. This assessment will also give a better understanding of how to support Cains transition from school at the end of the year into adulthood. BACKGROUND INFORMATION: The following information was obtained from interviews with Cain and his mother, Cain, a 19-year-old young adult, currently lives with his mother and father and younger brother. Mrs. Marko noted that Cain does not seem to enjoy family life and prefers to spend the majority of his time playing online computer games. This activity is interfering in his ability to engage in family activities and is disrupting his sleep patterns. Mrs. Marko reported experiencing high blood pressure during her third trimester of pregnancy with Cain but that there were no other significant issues. Cain was born healthy and had no significant medical complications early in life. Mrs. Marko reported that Cain achieved most developmental milestones (e.g., sitting, talking, and walking) within the expected timeframe. She did note that Cains speech development and articulation were slightly delayed. When looking through his cumulative file and interviewing his mother, Cain has been described as a young man experiencing academic, social and emotional difficulties. He is often angry or sad, demonstrating labile mood fluctuations. When frustrated, Cain can become physically aggressive.. Mrs. Marko reported that Cain has had difficulty with school since Grade One. Reading, mathematics, and written expression have all proven challenging. His teachers describe him as a beginning reader who has great difficulty decoding words. This in turn affects his written expression skills. Moreover, Cains mathematical skills are poorly developed and he has little understanding of mathematical concepts. Throughout Cains school history since entering school he has received Special Education services

Case Study One Rhonda Williams 2 and assistance. Goals on Cains current Individual Program Plan (IPP) focus on self-identification of learning needs and development of self-advocacy skills, improvement of mathematical skills, improvement of reading skills and strategies, and improvement of written expression skills. As well, Cain is provided special provisions for academic assessment such as additional time for test writing, access to exams on CD, the use of a word processor for written examinations, and the use of a calculator for mathematics examinations.


Parent/Child interview Although some information has been provided that has been obtained from both his cumulative file and interviews with Cain and his mother, there are a few more areas I would like to explore: Academic and cognitive histories for Cains parents and younger brother -Have any of them had similar struggles/strengths Is there a family history of mental health concerns? Does Cain spend any time with friends? What are Cains strengths? Areas of interest? Has he had any previous assessments? If so, what were the outcomes? When was his hearing and vision last assessed? Results? What classes has Cain taken in high school? What does Cain want to do after finishing high school? Are the accommodations currently in place effective? Who made the referral? This will provide a stronger basis for the historical and current factors that contribute to Cains overall cognitive, academic, social-emotional and adaptive functioning levels. COGNITIVE ASSESSMENTS: Wechsler Adult Intelligence Scale Fourth edition: Canadian (WAIS-IV) One of the referral inquiries is gaining an understanding of Cains cognitive functioning levels. Because Cain is 19 years of age, The WAIS-IV should be used as one of the tools to get a basic assessment of Cains cognitive level. The WAIS-IV assesses individuals between the ages of 16-90 and comes with Canadian norms. Information on verbal comprehension, perceptual reasoning, working memory and processing speed can be gathered to give a measurement of Cains overall cognitive functioning. Although his language skills have been reported by his teachers to be at the level of a beginning reader, I still think I would start with the WAIS-IV to see how he does. Sometimes the results can surprise you and could be different from what you expect. If Cains scores are extremely low in language-based areas during the assessment and seem to be a barrier to accurately assessing Cains abilities, I would then administer a non-verbal measure to assess his cognitive functioning level. Please see suggestion below.

Case Study One Rhonda Williams 3 Wechsler Nonverbal Scale of Ability: Canadian (WNV) If after administering the WIAS-IV it was observed that the language components become a barrier to assessing Cains cognitive functioning skills, I would administer a nonverbal cognitive assessment such as the Wechsler Nonverbal Scale of Ability- IV. Instructions for the subtests are administered through pictorial directions and the test can be administered for individuals between the ages of 4-21. The subtests for the full battery that would be administered include matrices, coding, spatial span and picture arrangement. Delis-Kaplan Executive Function System (D-KEFS) Because it is his last year of high school, Cain and his parents want to start planning for his transition from school. I think understanding his executive functioning skills is an important to understand Cains strengths and areas of struggle. This information could be useful when planning for additional supports and also potential job prospects. The tests can be administered to individuals from the ages of 8-89 and assess vital executive functions such as flexibility of thinking, inhibition, problem solving, planning, impulse control, concept formation, abstract thinking, and creativity in both verbal and spatial modalities. Because of the game-like format, Cain would most likely find the tasks engaging while measuring both verbal and nonverbal skills. The tests also measure the fundamental skills required to complete the executive functioning tasks, providing further information around Cains skill set. This information will also help plan coping strategies that utilize Cains strengths in everyday living situations. MEMORY ASSESSMENT: Wechsler Memory Scale- Fourth edition (WMS-IV) To address both the cognitive and academic functioning questions within the referral, a memory assessment such as the Wechsler Memory Scale- Fourth edition (WMS-IV) should be administered to understand Cains working, short term and long term memory. It will also provide information around verbal and spatial memory as well as whether information within a context is easier to remember than non-meaningful information. The WMS-IV can be administered to individuals ranging in age from 16-90 years old and provides scores subtests regarding immediate, delayed, visual and auditory memory indexes. ACADEMIC/ACHIEVEMENT ASSESSMENTS: Wechsler Individual Achievement Test Third edition: Canadian (WIAT-III) Because the referral questions would like an understanding of Cains academic functioning, I would first administer the WIAT-III to get a basic understanding of Cains academic knowledge in areas such as reading, mathematics, written expression and oral language. Unlike previous versions of the WIAT, the WIAT III has five new subtests including oral reading fluency, math fluency (addition, subtraction, and multiplication) and early reading skills. The early reading skills may

Case Study One Rhonda Williams 4 help capture Cains reading ability with more detail. The WIAT III also provides specific instructional goals and recommendations that can be used in Cains IPP. Because Cain has experienced ongoing deficits in reading, mathematics and written expression, I suspect I would need to complete more assessments in the areas of reading and mathematics to get a better understanding of his skill level. Please see below assessments to enhance information in these areas. KeyMath- Third edition: Canadian Administering the KeyMath 3 will allow for an in-depth measure of essential mathematical concepts and skills ranging from early experiences with rote and rational counting to factoring polynomials and solving linear equations. This test can be administered to individuals ranging in age from 4:6 to 21:11. This will provide the range needed to capture Cains mathematical ability providing measures within 10 subtests representing three general content areas: basic concepts (numeration, algebra, geometry, measurement and data analysis & probability), operations (mental computation & estimation, written computation: addition & subtraction and multiplication and division) and applications (foundations of problem solving and applied problem solving). Comprehensive Test of Phonological Processing (CTOPP) Because Cain has an extensive history of reading difficulty, specifically in decoding words, it would be beneficial to administer the Comprehensive Test of Phonological Processing (CTOPP) to get a better understanding of the specific strengths and deficits of Cains phonological abilities. The CTOPP can be administered to individuals ranging in age from 5-24 years old. The CTOPP provides information around phonological awareness which would measure Cains awareness and access to phonological structure of oral language. It would also provide information around Cains phonological memory, measuring his ability to code information phonologically for temporary storage in his working and short-term memory. The rapid naming portion of the CTOPP would measure Cains ability to efficiently retrieve phonological information from long term memory as well as executing a sequence of operations quickly and repeatedly. This information from the CTOPP may help guide intervention programs, strengthening Cains reading ability. SOCIAL-EMOTIONAL and BEHAVIOURAL ASSESSMENTS: Behavioral Assessment System for Children 2nd edition (BASC-2): parent, teacher, & self report scales With Cains referral for assessment, an idea of his current social-emotional functioning level was requested. Cain is reported to often be sad or angry and exhibits mood fluctuations. He can also respond to frustration aggressively. Because of these concerns, the first socialemotional/behavioural assessment I would administer is the Behavioral Assessment System for Children -2 (BASC-2). This assessment can be used with individuals ranging in age from 2-21 years old. Because of Cains reading level, I would most likely complete the self report with him to make sure he can read and understand each question. I would also ask that at least one of his

Case Study One Rhonda Williams 5 teachers and both parents complete the inventory to get a wider range of perspectives regarding Cains interactions and coping strategies. The BASC-2 provides a broad range of content coverage that assesses both strengths and weaknesses and can also detect various response patterns to the questions. Because of the wide range of areas addressed within the BASC-2, it is a great tool to first screen, allowing for further exploration of issues that may arise in the clinical or at-risk areas of the assessment. I suspect that Cain may have an at-risk or clinical level arise on the BASC-2 around depression according to the information gathered. If this was indeed the case, I would also administer the Beck Depression Inventory to get a better assessment around his potential depression. Please read more about this assessment below. Beck Depression Inventory II (BDI-II) If depression rated high on the BASC-2, I would administer the Beck Depression Inventory-II (BDI-II) to help understand Cains depression indicators and diagnose if required. This inventory can be completed by individuals ranging in age from 13-80 years of age and can assess the intensity of depression, guiding recommendations and interventions used to support Cain in his socialemotional well-being. BarOn Emotional Quotient Inventory (BarOn EQ-I) Because part of the referral focuses on preparing Cain for the transition from school into adulthood, I may also administer the BarOn Emotional QuotientInventory (BarOn EQI) to get more of an idea about Cains emotional intelligence and psychological well-being by examining his emotional and social strengths and weaknesses. This can provide important information for the workplace, home or school settings. It can be administered to individuals ages 16 and older and provides information regarding the following areas: Emotional Self-Awareness, Assertiveness, Self-Regard, Self-Actualization, Independence, Empathy, Interpersonal Relationship, Social Responsibility, Problem Solving, Flexibility, Reality Testing, Stress Tolerance, Impulse Control, Optimism, and Happiness. ADAPTIVE FUNCTIONING ASSESSMENT: Adaptive Behavior Assessment System- Second edition (ABAS-II) Since Cain is in his last year of high school and transitioning to adulthood, it is important to have a deeper understanding of his adaptive functioning skill level to support fostering independence and self-reliance as he gets older. In his school placement, some of these skills are being addressed on his IPP (self-advocacy and self-identification of his learning needs). Understanding Cains strengths and areas for development will provide direction for intervention and supports to help Cain mature and become more independent. It may also provide valuable information regarding potential funding for programs to support Cain as an adult if required. The Adaptive Behavior Assessment SystemSecond Edition (ABASII) can be used from birth to 89 years of age and provides composite norms for three general areas of adaptive behaviour (conceptual, social and practical). It can also gather information from multiple information sources such as self-reports,

Case Study One Rhonda Williams 6 parents and teachers. The areas assessed by the ABAS-II include: communication, health and safety, social, community use, leisure, work, functional academics, self-care, home living and selfdirection.

SUMMARY: Here is a chart that summarizes what assessments would be in my initial battery and what assessments would provide additional supportive information to provide depth to the current cognitive, academic and social-emotional functioning level of Cain. This list of assessments is by no means exhaustive. When the assessment is underway, there may be areas of strength or weakness that come up unexpectedly and require further exploration. For example, more exploration may be required in the areas such as visuo-spatial or sensorimotor functioning as indicated by his performance on some of the primary assessments I have planned to administer. The person assessing Cain needs to be flexible and adapt the assessment schedule to provide the information required to best support and assist Cain in his daily life experiences. It is important that the assessments selected compliment and combine with each other to give a well-rounded representation of Cains strengths and weaknesses. This will provide information to best support him and provide areas to focus intervention and support while fostering resiliency and skill development in already existing adaptive functions for Cain. Primary WAIS-IV (cognitive) WIAT-III (academic) WMS-IV (memory) BASC-2 (behavioural, social-emotional) D-KEFS (cognitive-executive functioning) ABAS-II (adaptive functioning) Additional Information WNV (cognitive) KeyMath 3 (academic) CTOPP (academic) BDI-II (social-emotional) BarOn EQ-I (social-emotional)