District of Residence: Any USD

Home School:

District of Attendance: Any USD

School of Attendance:

Any District
Address
City, St, Zip
Phone
PSYCHO-EDUCATIONAL ASSESSMENT REPORT
LEGAL NAME
BIRTHDATE
CHRONOLOGICAL AGE
GRADE
PARENT/GUARDIAN
ADDRESS
PHONE
GENDER
ETHNICITY
ENGLISH LANGUAGE LEARNER
SCHOOL OF ATTENDANCE
DATES OF ASSESSMENT
DATE AP SENT
DATE AP RECEIVED
REASON FOR REFERRAL:
@ was referred for an initial psycho-educational evaluation in compliance with the requirements of IDEA and the
California Education Code, to ascertain eligibility as an individual with exceptional needs. The request for
evaluation came via a written parent request. Parent noted concerns in the areas of ____________
When a student is eligible for and receiving special education services, a comprehensive re-assessment of the
pupil is conducted by the Local Educational Agency at least once every three years, unless the parent and LEA
agree in writing such a reassessment is unnecessary (EC 56381 (a) (2).
Testing was conducted as part of a triennial evaluation to determine eligibility for continuation of Specialized
Academic Instruction (SAI) within the most appropriate, least restrictive placement.
RELEVANT HISTORY:
Educational:
Socio/Cultural:
The primary language spoken in the home is LANGUAGE. Parent reports @s preferred language is
LANGUAGE. A translator was/was not needed for this assessment.
Medical:
Hearing Screening: Date:
Vision Screening: Date:
Developmental History:
EV-20, Section III-A, Page 1 of 26 (Rev. 9/11/02)

Results:
Results:

Social Communication Questionnaire:

(SCQ)
*Score > 15 = Developmental history typical of ASD
Total Scored Behaviors:
Significant/Not Significant
Autistic Spectrum Disorder (ASD) is developmental in nature. Because the cause of Autism Spectrum Disorders
is not yet known, ASD diagnoses are based purely on observations or reports of behaviors. ASDs are defined by
difficulty in three areas of behaviors:
1) Reciprocal social interaction,
2) Communication
3) Repetition and insistence on sameness.
Exactly how an individual is impacted across these three areas varies greatly.
The Social Communication Questionnaire is a screening tool used to identify symptoms associated with Autism
with consideration of early development. Parent completed the Lifetime Social Communication Questionnaire
(SCQ). Total score on this rating scale was a __, where a score of 15 or higher can be an indication of a possible
autism spectrum disorder.
NAME OF CURRENT ASSESSMENTS:
The testing and assessment materials and procedures used for this assessment were selected and administered so
as not to be racially, culturally, or sexually discriminatory. The tests and other evaluation materials were
administered by trained personnel in conformance with the instructions provided by their producers. The tests
and other assessment materials have been validated for the specific purpose for which they were used, and were
administered in conformance with the instructions for the test or other assessment materials. The tests and other
assessment materials include those tailored to assess specific areas of educational need. A child will not be
determined a child with a disability if the determinant factor is lack of instruction in reading or math or limited
English proficiency. No single procedure was used to determine @s eligibility for special education and/or
determine appropriate educational programming. Test scores are estimates of the attributes measured by the test.
Results are felt to be a valid estimate of @s current functioning except where specifically stated otherwise.
WISC-IV
WASI
CAS
KABC-2
WJ-III Cog
KBIT-2
WIAT-II
WRAT
VMI-5
TONI-III
TAPS-3
TVPS-3
BRIEF
ADOS-2
KTEA-II
TOWL-3

Wechsler Intelligence Scale for Children Fourth Edition

Wechsler Abbreviated Scale of Intelligence
Cognitive Assessment System
Kaufman Assessment Battery for Children Second Edition
Woodcock-Johnson Tests of Cognitive Abilities Third Edition
Kaufman Brief Intelligence Test Second Edition
Wechsler Individual Achievement Test Second Edition
Wide Range Achievement Test
The Beery-Buktenica Developmental Test of Visual-Motor Integration 5
Test of Nonverbal Intelligence III
Test of Auditory Perceptual Skills Third Edition
Test of Visual Perceptual Skills Third Edition
Behavior Rating Inventory of Executive Functioning
Autism Diagnostic Observation Schedule - 2
Kaufman Test of Educational Achievement Second Edition
Test of Written Language Third Edition

Page 2 of 26 (Rev. 12/11/15)

PPVT-III
BASC-2
SAED-2
WJ-III Ach
LET-II
CTOPP
ABAS-II
SCQ
SRS
VADPRS
VADTRS
DP-3

Peabody Picture Vocabulary Test Third Edition

Behavior Assessment System for Children, Second Edition
Scale for Assessing Emotional Disturbance Second Edition
Woodcock-Johnson Tests of Achievement
Learning Efficiency Test Second Edition
Comprehensive Test of Phonological Processing
Adaptive Behavior Assessment System Second Edition
Social Communication Questionnaire
Social Responsiveness Scale
Vanderbilt ADHD Diagnostic Parent Rating Scale
Vanderbilt ADHD Diagnostic Teacher Rating Scale
Developmental Profile 3
Bender-Gestalt Test of Visual Motor Integration Second Edition
Conners Rating Scale Revised: Short Version
Sentence Completion
Records Review
Teacher Observation
Classroom Observation
Pre-Assessment Interview
Educational Evaluation

DEFINITION OF ASSESSMENT TERMS:

Standard Scores and Scaled Scores are referenced to a childs age.

o Standard Scores have a mean of 100 and a standard deviation of 15. Average range would include scores from 85
to 115, using these end points as extremes. A score of 2 or more standard deviations, or roughly 30 points or
more below 100 would indicate a significant delay. (Note: certain tests, for example the Gillian Autism Rating
Scale, report Standard Scores that have a different statistical basis.)
o Scaled scores have a mean of 10 and a standard deviation of about 3. Average would be indicated by scores of
about 8 to 12. Scores 6 or more points below 10 represent significant delay.
The Grade Equivalent score is the grade of a child who would attain the same number of items correct as this child on a
specific measure.
A Percentile represents the percentage of children of the same age in the norm sample who scored below this student on
this test.
A Confidence Interval (e.g.90-110) represents the range of scores between which this students true score falls, with a
90 or 95 percentage of certainty.
T Scores- A T-Score is a standard score with a mean of 50 and a standard deviation of 10.

Unless otherwise specified, the following descriptors will be used:

Ability Classification
Very Superior/Gifted
Superior
High Average
Average
Low Average
Borderline/Below Average
Page 3 of 26 (Rev. 12/11/15)

Standard
Scores
130+
120-129
110-119
90-109
80-89
70-79

Scaled Scores

Percentiles

17+
14-16
13
8-12
7
4-6

98+
91-97
75-90
25-74
9-24
2-8
3

Extremely Low/Deficit

<69

<3

<2

TEST BEHAVIOR OBSERVATION:

Motivation/Effort
Rapport
Response Time
Attention
Activity Level

___ Good
___ Easily attained
___ Average
___ Good
___ Normal

___ Fair
___ Slowly attained
___ Impulsive
___Fair
___ Fair

___ Minimal Effort

___ Limited
___ Inconsistent
___ Short
___ Fidgets in seat

___ Inconsistent
___ Not attained
___ Delayed
___ Distractible
___ Excessively active

Other testing behavior observations:

____
Good self-confidence
____
Poor self-confidence
____
Cooperative/compliant
____
Easily frustrated
____
Resistant to testing
____
Frequently off-task
____
Frequently off-topic
____
Impulsive
____
Perseverated
____
Frequent inappropriate responses
____
Needed prompts
____
Frequently requested clarification/repetition
____
Failed to ask for clarification

SUMMARY OF ASSESSMENT FINDINGS

COGNITIVE FUNCTIONING:
In compliance with State mandates, no formal standardized IQ tests were administered due to @s AfricanAmerican ethnicity.

A note regarding intelligence test scores:

Intelligence tests measure only a portion of the competencies involved with human intelligence. The intelligence
results are best seen as predicting performance in school and reflecting the degree to which children have
mastered predominant cultural values and symbols.
Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV): The WISC IV is a widely used
measure of childrens intelligence. The test is divided into four parts, a Verbal Comprehension Index (VCI),
Working Memory Index (WMI), Perceptual Reasoning Index (PRI) and a Processing Speed Index (PSI). These
four measures are then combined to create a Full-Scale Intelligent Quotient (FSIQ), which is thought to
represent the childs overall intellectual functioning. All IQs and Indexes yield an average score of 100 and a
standard deviation of 15.
Standard Score
130 and above
120 to 129
110 to 119
90 to 109
80 to 89
Page 4 of 26 (Rev. 12/11/15)

Wechsler Tests
Percentile Range
98 to 99.99
91 to 97
75 to 90
25 to 73
9 to 23

Classification
Very Superior
Superior
High Average
Average
Low Average
4

70 to 79
69 and below

Intelligence Quotient (IQ)

Full Scale IQ
Index
Verbal Comprehension Index (VCI)
Perceptual Reasoning Index (PRI)
Working Memory Index (WMI)
Processing Speed Index (PSI)
Subtests

2 to 8
.01 to 2
WISC-IV
Standard
Score
Standard
Score

Age-Scaled
Score

Borderline
Extremely Low

%ile

Classification

%ile

Classification

Classification

Verbal Comprehension
Similarities
Vocabulary
Comprehension
Perceptual Reasoning
Block Design
Picture Concepts
Matrix Reasoning
Working Memory
Digit Span
Letter-Number Sequencing
Processing Speed
Coding
Symbol Search

For the Verbal Comprehension Index (VCI) subtests, children are assessed based on their ability to listen to a
question, draw upon learned information from both formal and informal education, reason through an answer,
and express their thoughts aloud. @s overall verbal reasoning abilities fell within the ____ range (VCI = SS;
%ile). @ performed in the ____ range when asked to define a range of words (Vocabulary, ss = ) and when asked
to find similarities between abstract concepts (Similarities, ss = ). @ demonstrated a relative strength in his/her
ability to understand general principles and social situations (Comprehension, ss = ), within the ___ range.
The Perceptual Reasoning Index (PRI) measures non-verbal and fluid reasoningthe ability to perform mental
operations, such as the manipulation of abstract symbols. @s abilities in this area fell in the ____ range (PRI =
SS; %ile) as a cognitive weakness. Performance on a test requiring that he/she manipulate colored blocks to
match a design fell within the ____ range (Block Design, ss = ). On tests requiring him/her to visually perceive
meaningful stimuli (Picture Concepts, ss = ), @ tested within the ____ range as a significant weakness. When
asked to find visual relationships (Matrix Reasoning, ss = ), @s performance fell within the ____ range.
In the Working Memory Index (WMI) children are assessed based on their ability to memorize new information,
hold it in short-term memory, concentrate, and manipulate that information to produce some result or reasoning
processes. Results can tap a child's level of concentration, planning ability, cognitive flexibility, and sequencing
skill. @ tested within the ___ range (SS; %ile).
The Processing Speed Index (PSI) assesses children based on their ability to focus attention and quickly scan,
discriminate between, and sequentially order visual information. Persistence and planning ability is required here
and is related to reading performance and development. @s ability fell in the ___ range (SS; %ile).
Page 5 of 26 (Rev. 12/11/15)

Wechsler Abbreviated Scale of Intelligence (WASI)

Subtest
Vocabulary
Block Design
Similarities
Matrix Reasoning
Verbal IQ
Performance IQ
Full-Scale Abbreviated IQ

Standard Score
86
103
94

T-Score

Percentile
18
58
34

Descriptor
Low Average
Average
Average

The WASI is a brief intelligence test based upon the Wechsler Intelligence scales. The test produces scores
comparable to longer tests like the Wechsler Intelligence Scale for Children - IV. Results are reported in terms of
Intelligence Quotients or IQ scores. An IQ of 100 indicates average ability with higher scores reflecting greater
ability. This test produces an overall measure of a childs academic aptitude called the Full-4 IQ. This overall
score is then divided into Verbal and Performance IQ scores. The Verbal IQ measures a students facility with
language and the Performance IQ measures their visual-motor coordination and non-verbal problem solving.
@ obtained a Full-4 IQ score of ____ which places him/her in the ______ range of intelligence. @ obtained a
Verbal IQ of ________ which is also in the _______ range and a Performance IQ of _________ which is in the
_______ range.

Cognitive Assessment System (CAS)

Standard
Score
>130
120-129
110-119
90-109
80-89
70-79
<69

Classification
Very Superior
Superior
High Average
Average
Low Average
Below Average
Well Below Average

@ was administered the Cognitive Assessment System (CAS), which is designed to assess and provide scores in
four subscales which include: Planning, Attention, Simultaneous, and Successive Processing (PASS). Each of
these cognitive processing areas can be used to describe how people think, learn, and solve problems. The CAS
utilizes a Standard Score with a mean of 100 and a standard deviation of 15. @s Full Scale on the CAS was a
standard score of __, at the __%ile, which is classified within the ____ range.
Page 6 of 26 (Rev. 12/11/15)

Planning: Mental process by which the individual determines, selects, applies and evaluates solutions to
problems. Planning subtests require the use of strategies for efficient performance and the application of these
strategies to novel tasks of relatively reduced complexity.
Subtests

Scaled Scores

Matching Numbers
Planned Codes

Simultaneous Processing: Mental process by which the individual integrates separate stimuli into a single whole
or group. Simultaneous processing subtests require integration of parts into a single whole and understanding of
logical and grammatical relationships.
Subtests

Scaled Scores

Nonverbal Matrices
Verbal-Spatial Relations

Attention: A mental process by which the individual selectively focuses on particular stimuli while inhibiting
responses to competing stimuli presented over time. CAS subtests present children with competing demands on
their attention and sustained focus.
Subtests

Scaled Scores

Expressive Attention
Number Attention

Successive Processing: A mental process by which the individual integrates stimuli into a specific serial order
that forms a chain-like progression. Successive processing subtests require the reproduction of the serial
dimension of stimuli through understanding of sentences on the basis of syntactic relationships, and the
articulation of words in series or the repetition of words or a series of words in series.
Subtests

Scaled Scores

Word Series
Sentence Repetition
PASS Scales
Domain
Planning
Simultaneous Processing
Attention
Successive Processing

Standard Score

Percentile

Classification

@s Planning processing scale reflects his/her ability to make decisions about how to best complete the tests, use
of good strategies, control of behavior, self-monitoring, and self-correction. @ earned a CAS Planning scale
standard score of __, which is within the ______ classification and is ranked at the __%ile rank.
@s Simultaneous processing score reflects his/her ability to relate parts into a group or whole, understand
relationships among pictures and words, and work with spatial relationships. @ earned a CAS Simultaneous
scale standard score of ___, which is within the ____ classification and is ranked at the ___ percentile.
@s Attention was measured by tests that required him/her to focus on specific features of the material and resist
reacting to distracting parts of the tests. @ earned a CAS Attention scale standard score of __ which is within the
_______ classification and is ranked at the ___ percentile.
Page 7 of 26 (Rev. 12/11/15)

@s performance on the Successive Scale reflects his/her ability to work with information in a specific linear
order. For example, the tests required him/her to remember the order of words spoken by the examiner and
comprehend information that is based on ordering of words. @ earned a CAS Successive scale standard score of
__, which is within the _____ classification at the ___ percentile rank.
Kaufman Brief Intelligence Test-II
KAUFMAN BRIEF INTELLIGENCE TEST II
Subtest
Standard Score
%ile
Verbal Scale
Nonverbal Scale
IQ Composite

Range

Kaufman Tests
131 or greater
Upper Extreme
116-130
Above Average
85-115
Average
70-84
Below Average
69 or less
Lower Extreme

@ was administered the Kaufman Brief Intelligence Test, 2 nd Edition (KBIT-2), which is a brief, individually
administered measure of verbal and nonverbal cognitive ability. The verbal score measures verbal, school-related
skills by assessing a persons word knowledge, range of general information, verbal concept formation, and
reasoning ability. The nonverbal score measures the ability to solve new problems by assessing an individuals
ability to perceive relationships and complete visual analogies. @ scored within the __________ on the Verbal
domain (SS; %ile rank) and within the _______ range on the Nonverbal domain (SS; %ile). The results of this
assessment indicate.
Test of Nonverbal Intelligence Third Edition (TONI-3)
>130
121-130
111-120
90-110
80-89
70-79
<70

Very Superior
Superior
Above Average
Average
Below Average
Poor
Very Poor

Nonverbal Quotient:
Descriptor:
Percentile:
Universal Nonverbal Intelligence Test - UNIT
UNIVERSAL NONVERBAL INTELLIGENCE TEST (UNIT)
Subtest
Standard Score
%ile
Range
Memory Quotient
Reasoning Quotient
Symbolic Quotient
Non-symbolic Quotient
Page 8 of 26 (Rev. 12/11/15)
Full Scale IQ

Standard
Score
>129
120-129
110-119
90-109
80-89
70-79
69 and below

Performance
Very Superior
Superior
High Average
Average
Low Average
Delayed
Very Delayed

Due to @s primary language being Spanish, he/she was administered the Universal Nonverbal Intelligence Test
(UNIT). The Universal Nonverbal Intelligence Test is a set of individually administered specialized tasks. The
UNIT is a standardized, norm-referenced measure intended to provide a fair assessment of intelligence for
children and adolescents who have speech, language, or hearing impairments; color vision deficiencies; different
cultural or language backgrounds; and those who are verbally uncommunicative. The UNIT also provides
diagnostic information relevant to educational exceptionalities and psychiatric disorders. Description of UNIT
scales is below:
The MEMORY QUOTIENT is an index of complex memory functioning involving short-term recall and
recognition of both meaningful and abstract materials. The Memory Quotient is a measure of memory for
content, location, and sequence.
SS
The REASONING QUOTIENT is an index of thinking and problem-solving abilities, for both familiar and
unfamiliar situations. The Reasoning Quotient is a measure of pattern processing, understanding of relationships,
and planning abilities.
SS
The SYMBOLIC QUOTIENT is an index of an individuals ability to solve problems that involve meaningful
materials and whose solutions lend themselves to internal verbal mediation, including labeling, organizing, and
categorizing.
SS
The NONSYMBOLIC QUOTIENT is an index of an individuals ability to solve problems involving abstract
materials that is not very meaningful and whose solutions are not conducive to verbal mediation.
SS
On the UNIT, @ achieved a Memory Quotient of ____, a Reasoning Quotient of ____, a Symbolic Quotient of
_______, and a Nonsymbolic Quotient of ______. @s Full Scale IQ, which is a combination of all subtest
scores, was an __, which is in the _________ range.
Developmental Profile 3
Standard Score
range
>130
116-130
85-115
70-84
<70
Page 9 of 26 (Rev. 12/11/15)

Descriptive
Category
Well Above Average
Above Average
Average
Below Average
Delayed
9

Teacher
Scale
Physical
Adaptive Behavior
Social-Emotional
Cognitive
Communication
Parent
Scale
Physical
Adaptive Behavior
Social-Emotional
Cognitive
Communication

Raw Score

Standard Score

Descriptive Category

Raw Score

Standard Score

Descriptive Category

The developmental profile three was completed by_. This tool provides five skills, each within 34 to 38 items,
designed to assess the development and functioning of children from birth through age 12. The developmental
profile measures developmental skills across five domains; physical, adaptive, social emotional and cognitive and
communication.
The 35 items on the Physical scale reflect the development of gross and fine motor skills, muscle coordination,
strength, stamina, flexibility, and sequential motor abilities. Gross-motor skills are those that employ the largest
muscles of the body and are involved positioning the body in space; these skills include balance and movement of
the limbs. Fine-motor skills are those involving the smaller muscles that perform the movements of the hands and
fingers, and include eye-hand coordination. Gross and fine motor skills are useful for both assessment and
instructional purposes. @ scored in the average range on the Physical domain indicating normal functioning.
The Adaptive Behavior Scale reflects the acquisition of self-care and survival behaviors. With very young
children, these behaviors include eating, using the toilet, and dressing; with older children, they involve
independent functioning and competency in everyday life. Adequate Adaptive behavior skills may be an indication
that the individual is able to respond to the expectations or practices of the parents or teacher. @ scored in the
average range on the Adaptive Behavior scale indicating normal functioning.
The Social-Emotional Scale is concerned with interpersonal behaviors that reflect social and emotional
competence. Facets of social competence include the childs various expressions of needs and feelings,
interactions with others, a sense of identity, and adherence to the mores of his or her society. Social-emotional
functioning is a combination of innate characteristics, personality predisposition, and environmentally imposed
socialization experiences. @ scored in the average range on the Social-Emotional scale.
The Cognitive scale assesses a childs level of cognitive functioning, as described by the parent or teacher.
Cognitive functioning encompasses skills such as perception, concept development, number relations, reasoning,
memory, classification, time concepts, and related mental acuity skills. @s Cognitive functioning appears to be in
the average range according ___
The Communication scale reflects the childs ability to understand spoken and written language as well as use
both verbal and nonverabal skills to communicate. The scale is divided between receptive language and
expressive language skills. Receptive language involves comprehension of verbal or written information, while
Page 10 of 26 (Rev. 12/11/15)

10

expressive language skills involve expression of thoughts in verbal or nonverbal form. @ scored in the average
range on the Communication domain.
EXECUTIVE FUNCTIONING:
Behavior Rating Inventory of Executive Function
Parent/Teacher Form (Completed by: )
BRIEF Score Summary Table
Index/Scale

T Score

Percentile

Inhibit
Shift
Emotional Control
Behavioral Regulation Index (BRI)
Initiate
Working Memory
Plan/Organize
Organization of Materials
Monitor
Metacognition Index (MI)
Global Executive Composite (GEC)
Scale
Negativity
Inconsistency

Raw Score
0

Cumulative Percentile

Protocol Classification
Acceptable

Acceptable

The Behavior Rating Inventory of Executive Function (BRIEF) is a questionnaire completed by parent and
teachers of school-aged children. It is designed to provide a better understanding of a childs self-control and
problem-solving skills by measuring eight aspects of executive functioning. Executive functions are mental
processes that direct a childs thought, action, and emotion, particularly during active problem solving. Specific
skills include: (a) selecting appropriate goals for a particular task, (b) planning and organizing an approach to
problem solving, (c) initiating a plan, (d) inhibiting (blocking out) distractions, (e) holding a goal and plan in
mind, (f) flexibly trying a new approach when necessary, and (g) checking to see that the goal is achieved. The
executive functions are also responsible for controlling a childs emotional responses, thereby allowing for more
effective problem solving. According to the manual, a T-score of 50 represents the mean of the T distribution.
The horizontal rule at a T-score of 65 represents the 1.5 standard deviation above the mean, which is the
recommended threshold for interpretation of a score as abnormally elevated; this is the area of potential
clinical significance
ACADEMIC FUNCTIONING:
Woodcock-Johnson Tests
Standard Score
Percentile Rank
131 and above
98 to 99.9
121 to 130
92 to 97
111 to 120
76 to 91
90 to 110
25 to 75
80 to 89
9 to 24
Page 11 of 26 (Rev. 12/11/15)

Classification
Very Superior
Superior
High Average
Average
Low Average
11

70 to 79
69 and below

3 to 8
0.1 to

Low
Very Low

The WJ-3 consists of a series of achievement tests administered to the individual student. These tests are
intended to assess the level of academic accomplishment of the student.
On the WJ-3, the Reading Composite includes reading identification, comprehension of short passages, and
phonemic awareness. @s ability to read words and apply knowledge of phonetics to sound out unfamiliar words
scored within the ___ range (SS: ). To assess reading comprehension, the examinee reads a sentence and
provides the missing word (cloze activity). @ tested within the ____ range (SS: ). Reading Fluency tested ___.
The Math Composite includes analysis and solving of practical problems in mathematics using addition,
subtraction, multiplication, and division. Calculation assesses the ability to solve written calculation problems
and simple equations. Applied Problems is a measure of ones ability to identify the proper procedure (i.e., add,
subtract, multiply, or divide) necessary to solve problems read aloud to them and then perform the calculation.
Math fluency tests automaticity of basic math facts.
Spelling tested within the ___. Writing Samples measure skill in writing responses to a variety of demands. The
student must produce written sentences that are evaluated with respect to the quality of expression and is not
penalized for errors in basic writing skills such as spelling or punctuation. Writing Fluency measures skill in
formulating and writing simple sentences quickly. The words are provided and sentences are not penalized for
errors in contextual conventions.
Kaufman Test of Educational Achievement (KTEA-II)
(AGE BASED NORMS)
Subject

Standard
Score

Reading Composite
Letter & Word Recognition
Reading Comprehension
Mathematics Composite
Mathematics Concepts & Applications
Mathematics Computation

Percentile

Grade Equivalent
-

The KTEA-II consists of a series of achievement tests administered to the individual student. These tests are
intended to assess the level of academic accomplishment of the student.
Letter & Word Recognition assesses word recognition and decoding skills. Reading Comprehension assesses the
types of reading comprehension skills taught in the classroom or used in everyday life. The examinee reads
different types of passages and answers questions involving the comprehension of content, such as identifying the
main idea and specific details and making inferences.
Mathematics Computation assesses the ability to solve written calculation problems and simple equations
involving the basic operations of addition, subtraction, multiplication, and division. Math Concepts &
Applications presents a series of math problems with both verbal and visual prompts that assess the ability to
reason mathematically.
Test of Written Language Third Edition (TOWL-3)
Page 12 of 26 (Rev. 12/11/15)

12

131-165
121-130
111-120
90-110
80-89
70-79
35-69
Spontaneous Writing
Contextual Conventions
Contextual Language
Story Construction
Spontaneous Writing Quotient

Very Superior
Superior
Above Average
Average
Below Average
Poor
Very Poor
Standard Score

Grade Equivalent

Wechsler Individual Achievement Test Second Edition (WIAT-II)

(AGE BASED NORMS)
Subject
Reading Composite
Word Reading
Reading Comprehension
Pseudoword Decoding
Mathematics Composite
Numerical Operations
Math Reasoning
Written Lang. Composite
Spelling
Written Expression
Oral Expression
Listening Comprehension

Standard Score

Percentile

Age Equivalent

The WIAT-II consists of a series of achievement tests administered to the individual student. These tests are
intended to assess the level of academic accomplishment of the student.
Letter & Word Recognition assesses word recognition and decoding skills. Reading Comprehension assesses the
types of reading comprehension skills taught in the classroom or used in everyday life. The examinee reads
different types of passages and answers questions involving the comprehension of content, such as identifying the
main idea and specific details, making inferences, and defining vocabulary by using context cues.
Numerical Operations assesses the ability to solve written calculation problems and simple equations involving
the basic operations of addition, subtraction, multiplication, and division. Math Reasoning presents a series of
math problems with both verbal and visual prompts that assess the ability to reason mathematically.
Written Expression on the WIAT-II assesses the writing process. Word fluency assesses the ability to generate
and write a list of words that match a prescribed category. Sentences evaluate the ability to combine multiple
sentences into one meaningful sentence or the ability to generate a sentence from visual or verbal cues. Essay
assesses the mechanics, organization, theme development, and vocabulary of writing.
Wechsler Individual Achievement Test-Third Edition
The WIAT-III is an individually administered clinical instrument designed to measure the achievement of students
who are in PK-12, or ages 4 years 0 months through 19 years 11 months. The subtests are used to evaluate
Page 13 of 26 (Rev. 12/11/15)

13

listening, speaking, reading, writing, and math skills. Administration time and number of subtests administered
varies depending on grade level.
Subject
Total Reading Composite
Word Reading
Reading Comprehension
Pseudoword Decoding
Oral Reading Fluency
Mathematics Composite
Numerical Operations
Math Problem Solving
Math Fluency Composite

Standard Score

Percentile

Age Equivalent

Standard Score

Percentile

Qualitative
Description

Percentile

Age Equivalent

Math Fluency-Addition
Math Fluency-Subtraction
Math Fluency-Multiplication

Written Exp. Composite

Spelling
Sentence Composition
Essay Composition
Oral Language Composite

Listening Comprehension
Oral Expression

Subtest Components
Listening Comprehension
Receptive Vocabulary
Oral Discourse Comp.
Oral Expression
Expressive Vocabulary
Oral Word Fluency
Sentence Repetition
Sentence Composition
Sentence Combing
Sentence Building

Essay Composition
Word Count
Theme Development and Text
Organization

Supplemental Subtest Components

Reading
Oral Reading Accuracy
Oral Reading Rate

Standard Score

To assess reading comprehension on the WIAT-III, @ is required to read a passage and answer questions about
the main idea, specific details, or the order of events. He/she is also asked to make inferences, draw conclusions,
or define unfamiliar words by using context clues.
SOCIAL/EMOTIONAL FUNCTIONING:
Social emotional indicators were taken from parent, teacher report, and observation. @ does not provide any
indicators that require further exploration of emotional disturbance.
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14

To address social/emotional functioning, the BASC-2 was administered. The Behavior Assessment System for
Children-2 is a multi-method, multi-dimensional approach to evaluating the behavior and self-perceptions of
children. The BASC-2 was designed to facilitate the differential diagnosis and educational classification of a
variety of emotional and behavioral disorders. The analysis and scale classifications are based on T-scores
obtained using norms. Scale scores in the Clinically Significant range (T= 70 and above) suggest a high level of
maladjustment. Scores in the At-Risk range (T=60-69) may identify a significant problem that may not be severe
enough to require formal treatment, but may need to be monitored.
BASC-2 Clinical Scale Classifications
Clinical Scales
Classification
70
Clinically Significant
61-69
At-Risk
40-60
Average
30-39
Low
29
Very Low

BASC-2 Adaptive Scale Classifications

Adaptive Scales
Classification
70
Very High
61-69
High
40-60
Average
30-39
At-Risk
29
Clinically Significant

The Behavioral Symptoms Index reflects the overall level of problem behavior and is composed of six scales:
hyperactivity, aggression, depression, attention problems, atypicality and withdrawal.
The scales on Externalizing Problems Composite include hyperactivity, aggression and conduct problems. A
central characteristic of the Externalizing Problems Composite is behavior that is disruptive to the activities of
both peers and adults and that is often unresponsive to adult direction.
The Internalizing Problems Composite can be characterized as a broad index of inwardly directed distress that
reflects internalizing problems a child may be experiencing and consists of three scales: anxiety, depression and
somatization.
The Adaptive Skills Composite consists of six scales: adaptability, social skills, leadership, activities of daily
living/study skills, and functional communication. This composite summarizes appropriate emotional expression
and control, daily living skills inside and outside the home, and communication skills, as well as prosocial,
organizational, study and other adaptive skills.
Scale for Assessing Emotional Disturbance - 2
*Non-ED norms used
*Subscale Scores: 17-20 Very Likely Child has Emotional Disturbance
14-16 Likely Child has Emotional Disturbance
1-13 Unlikely Child has Emotional Disturbance

SAED-2
Domain
Inability to Learn
Relationship Problems
Inappropriate Behavior
Unhappiness or Depression
Physical Symptoms or Fears
SAED-2 Quotient

Page 15 of 26 (Rev. 12/11/15)

Teacher
Scaled Score
14 (Likely)
16 (Likely)
15 (Likely)
14 (Likely)
19 (Very Likely)
138

Parent
Scaled Score
16 (Likely)
15 (Likely)
14 (Likely)
10 (Unlikely)
16 (Likely)
128

15

_______ also completed a Scale for Assessing Emotional Disturbance (SAED-2) rating scale. The SAED is a
standardized, norm-referenced scale that is based on the federal terminology and definition of emotional
disturbance. Results indicate ____________. The Overall Competence subscale focuses on the positive skills or
strengths that are related to a students overall adjustment, while the Social Maladjustment subscale measures the
presence of antisocial or delinquent behaviors out of school.

Autism Diagnostic Observation Schedule- 2:

(ADOS-2)

ADOS-2 MOD # 4
Stereotyped Behaviors & Restricted Interests
Imagination/Creativity
A. Communication
B. Reciprocal Social Interaction
Classification A+B
Spectrum =7
Autism >10

Total Score

4
Non-significant

The Autism Diagnostic Observations Schedule-2nd version was administered to @ on 00/00/12. The ADOS-2 is a
standardized assessment of communication, social interaction, and play or imaginative use of materials
administered in a semi-structured environment. The ADOS-2 activities allow the examiner to observe behaviors
that have been identified as important to the diagnosis of persons suspected of exemplifying possible Pervasive
Developmental Disorders. The diagnostic algorithms provide a distinction between a broader category of autism
spectrum disorder (ASD), and a narrower classification of autism.
Social Responsiveness Scale (SRS)
This 65 item rating scale measures the severity of autism spectrum symptoms as they occur in natural social
settings. The SRS provides a clear picture of a child's social impairments, assessing social awareness, social
information processing, capacity for reciprocal social communication, social anxiety/avoidance, and autistic
preoccupations and traits. Total T-scores of 76T or higher profile in the severe range, and are strongly associated
with a clinical diagnosis of Autistic Disorder, Aspergers Disorder or more severe cases of PDD-NOS. They
suggest a severe interference in everyday social interactions. T-scores of 60 through 75 indicate clinically
significant deficiencies in reciprocal social behavior resulting in mild to moderate interference in everyday social
situations.
T-scores <59: within normal limits
*T-scores of 60-75: Mild to moderate range interference in everyday social interactions
** T-scores > 76: Severe range of scores, suggest a severe interference in everyday social interactions
Teacher Rating Scale

Subscale
Social Awareness
Social Cognition
Social Communication
Social Motivation
Autistic Mannerisms
SRS TOTAL
Page 16 of 26 (Rev. 12/11/15)

T-Scores

Designation

65

Mild to Moderate

79

Moderate to Severe

72

Mild to Moderate

58

Normal Range

71

Mild to Moderate

71

Mild to Moderate
16

Parent Rating Scale

Subscale
Social Awareness
Social Cognition
Social Communication
Social Motivation
Autistic Mannerisms
SRS TOTAL

T-Scores

Designation

62

Mild to Moderate

79

Severe

84

Severe

80

Severe

87

Severe

84

Severe

Childhood Autism Rating Scale Second Edition (High Functioning Version)

The CARS-2 is a 15 item behavior rating scale to help identify children with autism and distinguish them from
developmentally handicapped children who are autistic. In addition, it distinguishes mild to moderate from severe
autism. It is suitable for use with any child over 2 years of age. The High Functioning Version of the test was
chosen due to @s current level of functioning.
Total Raw Score

T-score

Severity Classification

28.5

43

Mild to Moderate

Based on this examiner filling out the CARS-2 form, revealed that @s behavior is consistent with an individual
with mild to moderate social impairments.
LANGUAGE FUNCTIONING (Expressive/Receptive):
Receptive language indicates a persons ability to comprehend spoken language, and expressive language
indicates the ability to verbally express oneself. @ engaged in appropriate reciprocal conversation with the
examiner during the assessment process, and was able to express his/her wants and needs adequately. Case
carrier reports that language skills are adequate compared to peers within the classroom setting.
Test of Auditory-Processing Skills: Third Edition
Subject
Word Discrimination (Students ability to discern
phonological differences and similarities within
word pairs)
Phonological Segmentation (Students ability to
manipulate phonemes within words.)
Phonological Blending (Students ability to
synthesize a word given the individual
phonemes.)
Phonologic Quotient

Scaled Score

Percentile

Number Memory Forward (Students ability to

retain simple sequences of numbers)
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17

Number Memory Reversed (Students ability to

retain and manipulate a simple sequence of
numbers.)
Word Memory (Students ability to retain a
simple sequence of words)
Sentence Memory (Students ability to retain
details in sentences of increasing length and
grammatical complexity.)
Memory Quotient
Auditory Comprehension (Students ability to
understand passages that are read to them with
increasing length and complexity.)
Auditory Reasoning (Students ability to
understand implied meanings, make inferences,
or come to logical conclusions given the
information in the sentences presented.)
Cohesion Quotient
Auditory Quotient

@ was administered the Test of Auditory Perceptual Skills: Third Edition. This is an assessment tool developed
to measure functioning in various areas of auditory perception. Auditory perception, while not measuring hearing
(physical), does measure what a subject does with what is heard. Therefore, the term auditory perception in a
broad sense is the ability of the brain to understand and interpret what the ears hear; and, based on the
understanding and interpretation, the ability to express the meaning.
PSYCHO-MOTOR FUNCTIONING (Perception/Memory/Motor):
Developmental Test of Visual-Motor Integration Fifth Edition
Standard Score
>129
120-129
110-119
90-109
80-89
70-79
<70

Performance
Very High
High
Above Average
Average
Below Average
Low
Very Low

VMI Standard Score

Descriptor
Percentile
Visual Perception SS

The Beery Developmental Test of Visual-Motor Integration Fifth Edition was utilized to assess @s ability to
judge size, shape, angulations, spatial orientation, and integration of variously presented Gestalts, and to use
his/her fine motor skills in reproducing them. This test is designed to assess the extent to which individuals can
integrate their visual and motor abilities. Self-correction is not permitted. @s abilities fall within the ______
range (SS= ___), which does/does not suggest a processing disorder in this area.

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18

Bender Gestalt II
Standard Score
145-160
130-144
120-121
110-119
90-109
80-89
70-79
55-69
40-54

Percentile Rank
99.87-99.99
97.72-99.83
90.88-97.34
74.75-89.74
25.25-72.75
9.12-23.17
2.28-8.08
0.13-1.94
0.00-0.11

Classification
Extremely High
Very High
High
High Average
Average
Low Average
Low
Very Low
Extremely Low

Standard Score
Percentile
Descriptor

The Bender-Gestalt Test of Visual Motor Integration Second Edition was utilized to assess @s ability to judge
size, shape, angulations, spatial orientation, and integration of variously presented Gestalts, and to use his/her
fine motor skills in reproducing them. This test is designed to assess the extent to which individuals can integrate
their visual and motor abilities. Self-correction is permitted. @s abilities fall within the ____ range (SS= ___),
which does/does not suggest a processing disorder in this area.

Test of Visual-Perceptual Skills: Third Edition

Subject
Visual Discrimination (student is shown a design and
asked to point to a matching design among the
choices given)
Visual Memory (student is shown a design on one
page and then asked to remember that design in order
to choose that one from a list of options on another
page)
Spatial Relations (student is shown a series of designs
on a page and then asked to choose the one that is
different from the rest; it may differ in detail or
rotation of all or part of the design)
Form Constancy (student is asked to find one design
among others on the page; the design can be larger,
smaller, or rotated)
Basic Processes
Sequential Memory (student is shown design
sequences comprising increasing number of elements,
the page is turned, and student is asked to choose the
matching design from among the choices on the
following page)
Sequencing
Figure Ground (student is asked to find one design
among many within a complex background)
Visual Closure (student is shown a completed design
on the page and is asked to match it to one of the
incomplete patterns shown on the page)
Page 19 of 26 (Rev. 12/11/15)

Scaled Score

Percentile

19

Complex Processes
Overall Quotient

@ was administered the Test of Visual-Perceptual Skills- Third Edition (TVPS-3). The TVPS-3 is a battery of
seven subtests that measure different but interrelated visual perceptual and visual-motor abilities. Each of the
seven subtests measures a type of visual perceptual ability that is classified as position in space, form constancy,
spatial relations, or figure-ground. @ obtained a standard score of ___ on his/her overall visual-perceptual
quotient, which is ranked at the __%ile. These results do/do not indicate the presence of a visual processing
disorder.

Comprehensive Test of Phonological Processing (CTOPP)

Standard Score
131-165
121 to 130
111 to 120
90 to 110
80 to 89
70 to 79
35-69

Scaled Scores
17-20
15-16
13-14
8-12
6-7
4-5
1-3

Core Subtests

Classification
Very Superior
Superior
Above Average
Average
Below Average
Poor
Very Poor

Standard Scores

Elision
Blending Words
Memory for Digits
Rapid Digit Naming
Nonword Repetition
Rapid Letter Naming

Composites

Percentile

Index
Score

Phonological Awareness
Phonological Memory
Rapid Naming

The Comprehensive Test of Phonological Processing (CTOPP) is an instrument designed to assess phonological
processing, which refers to the use of phonological information, especially the sound structure of one's oral
language. The subtests yield composite scores in three areas of phonological processing which appear to be
especially relevant for the mastery of written languagephonological awareness, phonological memory, and
rapid naming.

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20

Phonological Awareness refers to @s awareness of and access to the sound structure of oral language. On the
Phonological Awareness Index, @ obtained a score of ___ at the __%ile which is within the ___ range.
Phonological Memory refers to coding information phonologically for temporary storage in working or shortterm memory. Delays in phonological memory may impact ones ability to learn new written and spoken
vocabulary. @s Phonological Memory Index score is in the _____ range (SS ; %ile).
The Rapid Naming composite measures @s speed in naming digits and letters. The subtests require efficient
retrieval of phonological information from long-term memory. Delays in rapid naming may impact reading
fluency. @s Rapid Naming Index was currently assessed in the ______ range (SS ; %ile).
Learning Efficiency Test Second Edition (LET-2)
Ordered
Imm STM LTM
Imm
Visual
7
7
7
12
Auditory
10
5
5
9

Unordered
STM LTM
6
6
8
9

Visual Memory SS:

Auditory Memory SS:
Global Memory SS:
The Learning Efficiency Test 2nd edition was administered. This test examines how efficiently and effectively a
student processes and retains information immediately and with short term and long-term interference through
the visual and auditory sensory modalities. Results on this instrument indicate that _________
Vanderbilt Diagnostic ADHD Rating Scales
The Vanderbilt ADHD rating scales were completed by teacher and parent to address reported diagnosis of
ADHD. According to the results of the Vanderbilt ADHD teacher rating scale, @ does/does not demonstrate a
sufficient number of symptoms which correlates to a diagnosis of ADHD-Inattentive type represented within the
rating scale.
Vanderbilt ADHD Diagnostic Teacher Rating Scale
Teacher Rating
Disorder (# of criteria needed for
diagnosis)

# of criteria
met

ADHD-inattention (6+)
ADHD-hyperactivity/impulsivity
(6+)
ADHD-combined (6+ from each
subtype)
Oppositional Defiant
Conduct Disorder (3+)

NS

Disorder/

Anxiety or Depression symptoms

(3+)

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21

Vanderbilt ADHD Diagnostic Parent Rating Scale

Parent Rating
Disorder (# of criteria needed for
diagnosis)

# of criteria
met

ADHD-inattentve (6+)
ADHD-hyperactive/impulsive (6+)
ADHD-combined (6+ from each
subtype)

NS

Oppositional Defiant Disorder (4+)

Conduct Disorder (3+)
Anxiety or Depression (3+)

Conners Rating Scale -Three

* t-score of

>70
65-69
60-64
40-59
< 40

Very Elevated Score (Many more concerns than are typically reported)
Elevated Score (More concerns than are typically reported)
High Average Score (Slightly more concerns than are typically reported)
Average Score (Typical levels of concern)
Low Score (Fewer concerns than are typically reported)

SUBSCALES-TEACHER

Teacher

Parent

Teacher

Inattention
Hyperactivity/Impulsivity
Learning Problems/Executive Functioning
Aggression/Defiance
Peer Relations
SUBSCALES-Parent
Inattention
Hyperactivity/Impulsivity
Learning Problems
Executive Functioning
Aggression/Defiance
Peer Relations

SUBSCALES

Parent

Inattention
Hyperactivity/Impulsivity
Learning Problems
Executive Functioning
Aggression/Defiance
Peer Relations
Conners 3 Global Index: Total

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22

CLINICAL SCALES
DSM-IV TR ADHD Inattentive
DSM-IV TR ADHD Hyperactive-Impulsive

DSM-IV TR Conduct Disorder

DSM-IV TR Oppositional Defiant Disorder

CAREER VOCATIONAL/PRE-VOCATIONAL:

ADAPTIVE BEHAVIOR (Self-help):

@ presented himself/herself appropriately dressed, groomed, and appears to have sufficient self-help skills as
measured by the pre-assessment interview.
Adaptive Behavior Assessment Scale Second Edition (ABAS II)
Scaled scores of 7, 8, 9, 10, 11, 12, &13 are considered average

SCALES
Communication
Community Use
Functional Academics
Home/School Living
Health & Safety
Leisure
Self-Care
Self-Direction
Social
(Work)

Scaled/Standard Scores
Parent

Scaled/Standard Scores
Teacher

Conceptual Domain
Social Domain
Practical Domain
Global Adaptive Composite

The Adaptive Behavior Assessment System, Second Edition provides a comprehensive norm-referenced
assessment of the adaptive skills of individuals ages birth to 89 years. The ABAS is divided up into three domains
as well as an overall score for Adaptive Behavior. The three domains are Conceptual, Social and Practical. The
conceptual domain includes the skill areas of communication, functional academics, self-direction, and health and
safety. The social domain includes the social and leisure skill areas. The practical domain includes the skill areas
of self-care, home living, community use, health and safety, and work.
The Vineland Adaptive Behavior Scales, Second Edition
The Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) measures the personal and social skills of
individuals from birth through adulthood utilizing a structured interview. Since adaptive behavior refers to an
individual's typical performance of their day-to-day activities required for personal and social sufficiency, these
scales assess what a person actually does, rather than what he is able to do. The Vineland-II is organized around
four behavior domains: Communication, Daily Living Skills, Socialization, and Motor Skills.
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23

Parent Vineland II Summary of Scores

Category
Communication
Daily Living Skills
Socialization
Motor Skills
Adaptive Behavior Composite

Standard Score

Qualitative Description

Teacher Vineland II Summary of Scores

Category
Communication
Daily Living Skills
Socialization
Motor Skills
Adaptive Behavior Composite

Standard Score

Qualitative Description

CONCLUSIONS REGARDING THE EFFECTS OF ENVIRONMENTAL, CULTURAL, OR

ECONOMIC DISADVANTAGE, WHERE APPROPRIATE- E.C.56327(g)
Do not appear to be primary.
OR
Cultural, linguistic, or experiential factors which may influence this childs ability to profit from the education
process include:
___ Coming from a non-English speaking home or geographic area.
___ The childs/familys recent immigration to the United States.
___ The familys high mobility or migrant status.
___ Lack of early childhood education
___Turbulent environmental history during early developmental years
___High number of documented absences cannot be ruled out as having an effect on academic performance level.
Student was assessed in all areas of suspected disability EC 56320(f).
In the opinion of the examiner, test results are considered valid: Yes
Comment:

No

An interpreter was used: Yes No If yes, describe effect on validity of the Assessment.
For pupils suspected of having a specific learning disability, evidence of a severe discrepancy between
intellectual ability and achievement. E.C. 56337 (a)

SPECIALIZED NEEDS [30 EC 56327(h)]

Student currently has: Specialized Services
Yes No If yes, specify ________________
Specialized Materials Yes No If yes, specify ________________
Specialized Equipment Yes No If yes, specify ________________
Serious Emotional Disturbance Eligibility
34 CFR Section 300.8(c)(4)(i): Because of a serious emotional disturbance, a pupil exhibits one or more of the
Page 24 of 26 (Rev. 12/11/15)

24

following characteristics over a long period of time and to a marked degree, which
adversely affects educational performance:
Mark X if Specific Criterion
applies
(A) An inability to learn that cannot be explained by intellectual, sensory or health factors.
(B) An inability to build or maintain satisfactory interpersonal relationships with peers and
teachers.
(C) Inappropriate types of behavior or feelings under normal circumstances.
(D) A general pervasive mood of unhappiness or depression.
(E) A tendency to develop physical symptoms or fears associated with personal or school
problems.
Autistic-Like Behaviors Eligibility
34 CFR Section 300.8 (c)(4)(g) A pupil exhibits any combination of the following autistic-like
behaviors, to include but not limited to:
Mark X if Specific Criterion
applies
(1) An inability to use oral language for appropriate communication.
(2) A history of extreme withdrawal or relating to people inappropriately and continued
impairment in social interaction from infancy through early childhood.
(3) An obsession to maintain sameness.
(4) Extreme preoccupation with objects or inappropriate use of objects or both.
(5) Extreme resistance to controls.
(6) Displays peculiar motoric mannerisms and motility patterns.
(7) Self-stimulating, ritualistic behavior.
SUMMARY

@ demonstrates a profile consistent with a Specific Learning Disability at this time. The results of this assessment
will be shared with the IEP team. It is important to note that it is the students area(s) of need that drives special
education supports and services rather than the specific category of Specialized Academic Instruction. Because
the focus of educational programs varies according to the degree of the students need, the team should take into
consideration the amount of support services required for @ to make meaningful gains. The IEP team should
consider which disabling category, if any, under IDEA best depicts @s conditions. The final decision in
determining eligibility, educational goals, and least restrictive placement will be determined by the Individualized
Educational Plan team.
It is recommended that these assessment results be shared with the Redlands Unified School District IEP team
for final determination of eligibility for specialized academic instruction with consideration of Specific Learning
Disability and Other Health Impairment.

________________________________
Name
Page 25 of 26 (Rev. 12/11/15)

DATE:
25

School Psychologist
Any Unified School District

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26