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NOWHERE COUNTY SCHOOL DISTRICT

Confidential Psychoeducational Evaluation


NAME:
DATE OF BIRTH:
AGE AT TESTING:
SEX:
SCHOOL:
GRADE:
REFERRED BY:
DATE(s) EVALUATED:
EXAMINER (S):

John Taylor
12-28-2003
12 years 1 month
Male
Eagle-Ridge Middle School
6th
n/a
02/18/16- 02/28/16
Sarah Lipman, school psychology practicum student

Educationally Relevant
Medical Findings:

No illness or other medical problems reported

Primary Language of Student:


Primary Language of Home:
Educational Disadvantage:
Racial/ Ethnic Background:

English
Hmong
none known
Hmong

REASON FOR REFERRAL:


John is a 12-year-old boy presently in the 6th grade at Eagle-Ridge Middle School. John
was not referred for evaluation. His family agreed to an assessment to assist graduate
students training for test administration, and as such there were no concerns at the start of
assessment.

FAMILY HISTORY:
John lives with his mother Mary Taylor. The family was reported to be supportive.
Hmong is the primary language spoken in the home.

INSTRUMENTS AND PROCEDURES:


1. Behavior Assessment Scale for Children-2 (BASC-2)
a. Parent-Report Form
b. Self-Report Form
2. Adaptive Behavior Assessment System-II (ABAS-II)
a. Teacher form
3. Child Behavior Checklist (CBCL)
4. Autism Spectrum Rating Scale (ASRS)
5. Sentence Completion Series (SCS)

TEST FINDINGS:
BASC-2 & CBCL
Johns mother Mary Taylor was asked to complete the BASC-2 Parent-Rating Scale and
the Child Behavior Checklist to determine if John demonstrates any behavioral or socioemotional difficulties, atypical of other 12-year-old males.
Ms. Taylors responses to the BASC-2 Parent-Rating Scale were consistent. Her
responses reflected scale elevations in the "at risk" range (i.e. a T-score of 30-39) on the
adaptive skills composite for most clinical scales. Likewise, the only scale on the CBCL
that reached at risk levels was the activities competence scale. All other scales for
behavioral (externalizing and behavioral symptoms) and emotional (internalizing) indices
were rated at average or above average levels. Similarly, responses on the CBCL
reflected scores in the above average range for behavioral (externalizing) and emotional
(internalizing) indices.
This suggests that Ms. Taylor sees John as having social emotional competence. The
results reflect that Ms. Taylor believes John exhibits emotions and behaviors similar to or
better than boys his age. However, Ms. Taylor likely has concerns that John has deficits
in the area of independent and adaptive functioning.
John was also asked to complete the BASC-2 Self-Rating Scale. Johns responses to the
BASC-2 Self-Report Rating Scale were consistent. On the BASC-2, his responses
reflected scale elevations in the "clinically significant range (i.e. a T-Score of 70+) or
the "at risk" range (i.e. a T-Score of 60-69) on all clinical scales for the internalizing
problems composite. Additionally, his scores reflected elevations in the at risk range
(i.e. 30-39) for the relationships with parents and interpersonal relations scales.
This suggest that John perceives that he has little control over the events that occur in his
life, he feels isolated and lonely, and experiences a substantial amount of worrying. John
also reported a general feeling of depression and perceives himself to have a difficult
time concentrating. Additionally, John reports having a strained relationship with his
parents.
ABAS-II
Johns teacher, Ms. Brown, was asked to complete the ABAS-II Teacher Form to
determine if John demonstrates any difficulties more serious than other 12-year-old males
in the area of practical independent functioning. Ms. Browns responses reflected scores
of adaptive functioning that were above average relative to others Johns age across all
composites. This suggests that Ms. Brown views John as more adaptable to his
environment than most boys Johns age.
ASRS
Johns Teacher Ms. Brown also completed the ASRS to determine if John demonstrates
any atypicality in communication, behavior, or self-regulation related to autism spectrum
disorder symptoms. Ms. Browns ratings for all scales showed that her concerns about

John were equal to or less than that of his same age peers. In other words, Ms. Brown
perceives John to have few if any characteristics related to the autism spectrum disorder.
SCS
John was asked to fill out the Sentence Completion Series to determine Johns attitude
and perception about his school and home environments. Considering Johns answers, he
has a fair attitude towards school, and appears to be able to identify goals that he wants to
work towards. John appears to have good peer relationships and considers spending time
with these friends as important to him. From the projective, John does not appear to be
preoccupied with negative emotions.
SUMMARY AND CONCLUSIONS:
John is a 12-year-old 6th grade male who volunteered for psychoeducational evaluation.
John demonstrated normal levels of hyperactivity, aggression and conduct problems.
Overall John has low levels of maladaptive behaviors. This means that he will likely get
along well with others, and can be as independent in self-care as other boys his age. John
has elevated levels of internalizing problems. This means that John may struggle with
feeling sad and/or anxious more often than other boys his age. John expressed feeling as
though his efforts do not match up to his or others expectations of himself, and finds it
hard to concentrate at times. Johns final recommendations regarding classification and
placement will, however, be the joint decision of the IEP team.
RECOMMENDATIONS:
Johns mood and anxiety about his performance make it difficult for him to focus on his
work in the moment. John may benefit from direct instruction on strategies for relaxing,
especially right before a test. Johns view of his own abilities and the high expectations
he places on himself may contribute to his negative mood. John may find it helpful to
reevaluate and put his achievements in perspective. John values his peer relationships,
and perceives himself as more confident when he is with his friends. It might be useful
for John to use this support system and receive verbal feedback from these friends, so that
he can compare his friends perspectives when he is feeling anxious or inadequate.

______________________________
Signature

PSYCHOMETRIC SUMMARY
Name: John Taylor

Date: 02/28/16

Examiner: Sarah Lipman


BEHAVIOR ASSESSMENT SYSTEM FOR CHILDREN-2 (BASC-2)
Informant

Mother

Clinical Scales
Hyperactivity
Aggression
Conduct Problems
Anxiety
Depression
Somatization
Atypicality
Withdrawn
Attention Problems

T Score
45
39
41
40
40
41
50
49
49

Percentile
39
8
12
14
11
19
64
54
47

Adaptability
Social Skills
Leadership
Activities of Daily Living
Functional Communication

57
35
35
36
37

74
6
7
9
11

Composites
Externalizing Problems
Internalizing Problems
Behavior Symptoms Index
Adaptive Skills

41
38
44
38

16
7
30
12

At Risk: Adaptive Skills composite (all scales at risk except adaptability).


Informant

John/self

Clinical Scales
Attitude to School
Attitude to Teachers
Sensation Seeking
Atypicality
Locus of Control
Social Stress
Anxiety
Depression
Sense of Inadequacy
Somatization
Attention Problems
Hyperactivity

T Score
38
44
43
66
71
62
66
77
75
61
60
54

Percentile
10
33
24
92
96
88
93
97
98
84
82
68

Relations with Parents


Interpersonal Relations
Self-Esteem
Self-Reliance

38
40
56
49

13
17
65
42

Composites
School Problems
Internalizing Problems
Inattention/Hyperactivity
Personal Adjustment

39
73
58
44

13
97
80
26

At Risk Scales: Aytpicality, social stress, anxiety, somatization, and relations with
parents; Clinically Significant Composite: internalizing Problems (scales: locust of
control, depression, sense of inadequacy).

CHILD BEHAVIOR CHECKLIST (CBCL)


Informant

Mother

Syndrome Scales
Anxious/Depressed
Withdrawn/Depressed
Somatic Complaints
Social Problems
Thought Problems
Attention Problems
Rule-Breaking Behavior
Aggressive Behavior

T Score
51
52
50
50
55
51
50
50

Competence Scales
Activities
Social
School

31
39
50

Composites
Internalizing
Externalizing
Competence

47
40
34

At risk: Competence Composite (Activities scale)

ADAPTIVE BEHAVIOR ASSESMENT SYSTEM-II (ABAS-II)


Informant

Teacher

Scales
Communication
Community Use
Functional Academics
School Living
Health and Safety
Leisure
Self-Care
Self-Direction
Social

T Score
12
11
12
12
11
12
11
11
12

Composites
Conceptual
Social
Practical
GAC

120
120
119
120

At Risk: none of the scores fall in the at risk range


AUTISM SPECTRUM RATING SCALE (ASRS)
Informant

Teacher

Scales
Social/Communication
Unusual Behavior
Self-Regulation

T Score
39
50
35

DSM-IV-TR

43

24

Composites
Total Score

40

16

At Risk: none of the scores fall in the at risk range

Percentile
14
50
7