Parent / Caregiver Rating Report

Examinee Information Test Information

Name: NAM, TRAN NHAT Form: Parent / Caregiver Rating

ID Number: 04 Interview Date: 06/19/2021
Birth Date: 03/13/2009 Examiner Name: MINH PHUC TRAN
Age: 12:3 Examiner ID: 3
Sex: Male Respondent: Tran Minh, Phuc
Race/Ethnicity: Relationship to Individual: Other
Highest Completed Grade: K Present Classification/Diagnosis: 6
School/Facility: 1 Reason for Assessment:
Site: hành vi thích ng Other Information:

Intelligence Test Results

Form:
Test Date:
Standard Score:

The Vineland-II Adaptive Behavior Scales assess personal and social sufficiency of individuals from birth through adulthood based on the
report of the individual's parent or caregiver. Results contained herein are confidential, and should only be viewed by those with proper
authorization. This computer-generated report should not be the sole basis for making important decisions related to diagnosis, treatment,
or qualification for program eligibility.

Scores and narrative text are based on the normative data from the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II)
ID#: 04
Vineland-II
Parent / Caregiver
NAM, TRAN NHAT Rating
Report generated by Vineland-II Survey version 1.0
Report printed for: VANDERBILT UNIV
Report Date: 06/21/2021 Page 1 of ©2005 AGS Publishing All rights reserved.
 Test Date: 06/19/2021
Age: 12:3

Score Summary

Score
Raw v-Scale Stand. %ile
Subdomain / Domain 90% CI Adapt. Level Age Eq. Stanine Minus S/W
Score Score Score Rank
Median
Receptive 39 14 ±2 Adequate 11:0 0.0
Expressive 104 12 ±2 Mod. Low 8:7 -2.0 W
Written 50 22 ±2 High 22+ 8.0 S
Communication Sum = 48** 110 ±7 75 Adequate 6 0.0
Personal 82 22 ±3 High 22+ 3.0 S
Domestic 45 18 ±2 Mod. High 15:3 -1.0
Community 72 19 ±2 Mod. High 16:3 0.0
Daily Living Skills Sum = 59** 127 ±8 96 Mod. High 9 17.0 S
Interpers. Rels. 69 14 ±2 Adequate 11:3 -1.0
Play and Leisure Time 57 15 ±3 Adequate 12:0 0.0
Coping Skills 54 15 ±2 Adequate 12:9 0.0
Socialization Sum = 44** 99 ±8 47 Adequate 5 -11.0 W
Gross Motor Skills (Est) 80 16 ±0 Adequate 22+
Fine Motor Skills (Est) 72 20 ±0 Mod. High 22+
Motor Skills (Est) Sum = 36** 121 ±0 92 Mod. High 8
Adapt. Behav. Comp. Sum = 336* 114 ±5 82 Adequate 7

Raw Score v-Scale 90% CI Level

Internalizing
Externalizing
Other 1
Maladaptive Behavior Index
* Represents sum of domain standard scores
** Represents sum of subdomain v-scale scores
*** Caution is required in interpreting this age equivalent

Report printed for: VANDERBILT UNIV Report generated by Vineland-II Survey version 1.0
Report Date: 06/21/2021 Page 2 of ©2005 AGS Publishing All rights reserved.
NAM, TRAN NHAT Age: 12:3
ID#: 04 Test Date: 06/19/2021

Vineland-II Pairwise Comparisons

Domain Comparisons

Standard Score Significance Frequency of

Domain Comparisons
Difference Level Difference
Communication < Daily Living Skills 17 .05 10%
Communication > Socialization 11
Daily Living Skills > Socialization 28 .01 1%
Communication Motor Skills NS
Socialization Motor Skills NS
Daily Living Skills Motor Skills NS

Within-Domain Subdomain Comparisons

v-Scale Score Significance Frequency of

Subdomain Comparisons
Difference Level Difference
Communication
Receptive > Expressive 2
Receptive < Written 8 .01* 1%
Expressive < Written 10 .01* 1%
Daily Living Skills
Personal > Domestic 4
Personal > Community 3
Domestic < Community 1
Socialization
Interpersonal Relationship < Play and Leisure Time 1
Interpersonal Relationship < Coping Skills 1
Play and Leisure Time = Coping Skills 0
Motor Skills
Gross Motor Skills Fine Motor Skills NS
NS = Not Scored
* = Bonferroni-adjusted level for multiple comparisons

Report printed for: VANDERBILT UNIV Report generated by Vineland-II Survey version 1.0
Report Date: 06/21/2021 Page 3 of ©2005 AGS Publishing All rights reserved.
 Vineland-II Pairwise Comparisons

Across-Domain Subdomain Comparisons

v-Scale Score Significance Frequency of

Across-Domain Subdomain Comparisons
Difference Level Difference
Expressive < Interpersonal Relationship 2
Expressive < Coping Skills 3
Fine Motor Skills Written NS
Fine Motor Skills Domestic NS
Fine Motor Skills Personal NS
NS = Not Scored
* = Bonferroni-adjusted level for multiple comparisons
Score Profile
 Narrative Report

The Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) measures the personal and social skills
of individuals from birth through adulthood. Because adaptive behavior refers to an individual's typical
performance of the day-to-day activities required for personal and social sufficiency, these scales assess what a
person actually does, rather than what he or she is able to do. The Vineland-II assesses adaptive behavior in four
domains: Communication, Daily Living Skills, Socialization, and Motor Skills. It also provides a
composite score that summarizes the individual's performance across all four domains.

TRAN NHAT NAM was age 12:3 on the interview date of June 19, 2021. The respondent was Phuc Tran Minh.
Phuc was administered the Vineland-II Parent / Caregiver Rating Form by MINH PHUC TRAN.

TRAN NHAT was previously classified with the following diagnosis: 6.

TRAN NHAT's Adaptive Behavior Composite standard score of 114 summarizes his overall level of adaptive
functioning. The 90 percent confidence level shows that TRAN NHAT's true Adaptive Behavior Composite is
likely to be within the range of 109 to 119 (confidence interval of +/-5). TRAN NHAT's Adaptive Behavior
Composite classifies his general adaptive functioning as adequate; he scores higher than over 82% of similarly
aged individuals in the Vineland-II norm sample.

TRAN NHAT's level of adaptive functioning within the Communication domain is adequate for his age group.
His standard score of 110 results in a confidence interval of +/-7 (103 to 117) at the 90 percent confidence level.
His percentile rank is 75. Thus, his score in this area is higher than or equal to 75 percent of his peers in the
normative sample. He had an adaptive level of adequate for the Receptive subdomain, moderately low for the
Expressive subdomain, and high for the Written subdomain. TRAN NHAT's age equivalents for the
Communication subdomains are 11:0 for the Receptive subdomain, 8:7 for the Expressive subdomain, and 22+
for the Written subdomain.

Comparison of the Communication subdomain v-scores can provide insight into an individual's relative
abilities. In TRAN NHAT's case, significant differences were found between the v-scores of the following
pairs of Communication subdomains: Receptive and Written, with his Written being significantly greater at the
.01 level and the difference occurring only 1% of the time in the general-population norm sample; Expressive
and Written, with his Written being greater at the .01 level and this difference occurring only 1% of the time in
the Vineland-II norm sample. Relative to the other Communication subdomains, TRAN NHAT's Written skills
represent a strength. His Expressive skills represent a weakness compared to his other Communication skills.

TRAN NHAT's standard score for the Daily Living Skills domain is 127 which results in a confidence interval
of +/-8 (119 to 135) at the 90 percent confidence level. This score represents a moderately high level of adaptive
functioning in this area for an individual of his age. His percentile rank for the Daily Living Skills domain is 96.
He had an adaptive level of high for the Personal subdomain, moderately high for the Domestic subdomain, and
moderately high for the Community subdomain. TRAN NHAT's age equivalents for the Daily Living Skills
subdomains are 22+ for the Personal subdomain, 15:3 for the Domestic subdomain, and 16:3 for the
Community subdomain.

Comparison of the Daily Living Skills subdomain v-scores reveal that in TRAN NHAT's case, the differences
between subdomains were not significant or unusual in the frequencies at which they occur in the general-
NAM, TRAN NHAT Age: 12:3
ID#: 04 Test Date: 06/19/2021

population norm sample. Relative to the other Daily Living Skills subdomains, TRAN NHAT's Personal skills
represent a strength.

TRAN NHAT's level of adaptive functioning within the Socialization domain is adequate for his age group.
His standard score is 99 which results in a confidence interval of +/-8 (91 to 107) at the 90 percent confidence
level. His percentile rank is 47. A look at the subdomain scores within the Socialization domain indicates that
TRAN NHAT's adaptive level is adequate for all three subdomains (Interpersonal Relationship, Play and
Leisure Time, and Coping Skills). TRAN NHAT's age equivalents for the Socialization subdomains are 11:3
for the Interpersonal Relationship subdomain, 12:0 for the Play and Leisure Time subdomain, and 12:9 for the
Coping Skills subdomain.

A comparison of TRAN NHAT's Socialization subdomain v-scores indicates that the differences between
subdomains were not significant or unusual in the frequencies at which they occur in the general-population
norm sample.

TRAN NHAT's standard score for the Daily Living Skills domain is significantly higher than the median score
for all of the Vineland-II domains. Such a difference indicates that his day-to-day living skills are a strength
that he may use to compensate for skills in other areas. TRAN NHAT's standard score for the Socialization
domain is significantly lower than the median score for all of the Vineland-II domains. Such a difference
indicates that his social skills are a weakness for TRAN NHAT relative to his skills in the other areas.
Activities that target the development of social skills may therefore be useful. In fact, attention to socialization
may help to raise his overall level of adaptive behavior.

Comparison of Vineland-II domain standard scores also can provide further insight into an individual's relative
abilities. In TRAN NHAT's case, significant differences were found between standard scores of the following
pairs of Vineland-II domains: Communication and Daily Living Skills, with his Daily Living Skills being
significantly greater at the .05 level and the difference occurring only 10% of the time in the general-population
norm sample; Daily Living Skills and Socialization, with his Daily Living Skills being greater at the .01 level
and this difference occurring only 1% of the time in the Vineland-II norm sample.

MR Classification
A determination of whether TRAN NHAT meets the criteria for mental retardation according to professional
guidelines (AAMR expert consensus, DSM-IV, and APA Division 33) cannot be made because no IQ score has
been reported.

Supplemental Security Income (SSI) Eligibility

The Vineland-II ASSIST software may help determine if clients one year or older meet some of the
Supplemental Security Income (SSI) eligibility requirements for a determination of disability due to mental
retardation on the basis of the current, nonprorated Vineland-II findings and intelligence test results provided by
the examiner. The only eligibility requirements that are considered by the ASSIST program are those from
Section 112.05 (Mental Retardation) of the January 2003 edition of the Disability Under Social Security
document. Individuals may qualify for SSI benefits on the basis of other criteria in Section 112.05 that are not
considered by the ASSIST program, or on the basis of criteria for other mental or physical conditions. In order
for the ASSIST program to maximize the eligibility possibilities, the client must have been tested with an IQ
test within the last four years. A determination regarding the likelihood of TRAN NHAT's eligibility for SSI
benefits cannot be made in the absence of a current IQ score.
Report printed for: VANDERBILT UNIV Report generated by Vineland-II Survey version 1.0
Report Date: 06/21/2021 Page 7 of ©2005 AGS Publishing All rights reserved.
 Caregiver Letter

The Vineland Adaptive Behavior Scales, Second Edition (also referred to as the Vineland-II) measures an
individual's adaptive behaviors. Adaptive behaviors are those day-to-day activities that are necessary for
individuals to get along with others and take care of themselves. These activities change as a person grows older
and becomes less dependent on the help of others. But at every age, certain skills are required in the home,
school, and community.

Learning about an individual's adaptive behavior helps us to gain a total picture of that individual. When
adaptive behavior information is combined with information about an individual's intelligence, school
achievement, and physical health, plans can be made to address any special needs that person may have at home
or in school.

In order to determine the level of an individual's adaptive behavior, someone who is familiar with that
individual, such as a parent or caregiver, is asked to describe his activities. Those activities are then compared
to those of other people the same age to determine which areas are average, above average, or in need of special
help.

TRAN NHAT's percentile ranks are reported for Communication, Daily Living, Social Skills and Relationships
and the Adaptive Behavior Composite. The scores indicate how TRAN NHAT's adaptive behavior compares
with a group of typical individuals from across the United States the same age as TRAN NHAT. A percentile
rank indicates the percentage of individuals who had scores lower than TRAN NHAT's score. For example,
TRAN NHAT's percentile rank of 82 on the Adaptive Behavior Composite tells you that 82 percent of the
people TRAN NHAT's age in the norm group had lower scores than TRAN NHAT. This score indicates an
average level of performance overall relative to individuals in the norm group.

More specific areas of adaptive behavior within each of the areas assessed are also reported. For each of these
specific areas TRAN NHAT's score is rated high, above average, average, below average, or low. TRAN
NHAT's abilities in the Communication domain were average for Hearing and Understanding, below average
for Talking, and high for Reading and Writing. In the Daily Living domain, TRAN NHAT's abilities in the
Caring for Self subdomain were high, in Caring for Home they were above average, and in Living in the
Community they were above average. TRAN NHAT's abilities in the Social Skills and Relationships domain
were average for Relating to Others, average for Playing and Using Leisure Time, and average for Adapting.

Sincerely,