Report Writing Format

PSYCHODIAGNOSTIC REPORT

Name:

Father’s Name:

Date of Birth: Nov 15th, 2000

Age: 15 years

Date of Assessment: Sep 10, 11, 12 & 15, 2020

Examiner:

REFERRAL SOURCE AND PRESENTING PROBLEMS

Name of referral purpose of referral (psychotherapy, assessment, both), presenting complaint (as
written on intake card or as reported by client).

CLINICAL INTERVIEW (Only in In-report)

Mr. _________reported that ---------. History of problem, duration (problem started since or for),
symptoms, condition, suicidal attempts, delusion/hallucinations or any specific details related to
problem.

History of consultation, prior testing, medications, side effects, changes in consultation, changes
in medications, reasons for changes, present medication doses etc.

History of other medical problems (if the patient is suffer from other medical illness, past &
present both) surgeries, accidents, substance/alcohol use.

History of consultation, prior testing, medications, side effects, changes in consultation, changes
in medications, reasons for changes, present medication doses etc.

History of other medical problems (if the patient is suffer from other medical illness, past &
present both) surgeries, accidents, substance/alcohol use.

School history, age of admission, change in school grades, relationships with peers, teachers,
participation in extracurricular activities or not, social problem related to school etc.
Work history, age of starting work, duration of job, changes in jobs or business/work, reasons for
it, job related stress, relationship with coworkers etc.

History of friendships, nature of friendships, no. of friends, (girl/boy friends), sharing activities
with friends, recreational activities, religiosity.

Sexual history, (homosexual/heterosexual relations), premarital, marital, extra marital relations.

Sleeping habits, (insomnia, hypersomnia, dreams)

Orientation, perception, mannerisms (if significant).

Overall behavior, personality traits, thought patterns, aims ad goals of life (if significant).
Strength and weakness of client (if significant).

TESTS ADMINISTERED

• Neuropsychological Screening Tests (BG, SVMPT, QNST, SDCT)

• Intelligence Tests (WAIS, WISC, TONI, SIT)

• Adaptive Tests (VSMS, VABS)

• Achievement Test (WRAT)

• Objective Tests (SPS, Beck Inventories, IPAT-D, IPAT-A)

• Screening Tests (CARS, Corner Rating Scale)

• Objective Personality Tests (MMPI, EPPI, EPPS, PAI)

Projective Personality Tests (HFD, TAT, CAT, ROR)

BEHAVIOR DURING ASSESSMENT

Specific and overall behavior observed during clinical interview and the administration of test (in
detail).

PSYCHOLOGICAL EVALUATION (Adult)

Write the evaluation of different tests in a sequence which has written above. For example

Neuropsychological screening test indicates that Ali’s visual motor perceptual capacity fall at
normal range.
Results of Intelligence testing, Adaptive testing and Achievement testing (correlate with
interview information).

Results of projective testing e.g. (it seems that/it indicates that)

Overall personality of the client (impulsive, dependent, immature, mature, aggressive or well
functioning personality).

Dominant Needs (HFD, TAT, ROR) whether satisfied or not

Main Conflicts (between which need)

Nature of Anxieties (HFD, TAT, ROR)

Overall perception of the world (TAT, ROR)

Handling of anxieties, defenses, stresses, relationships (TAT, ROR)

Creative and intellectual potentials (ROR)

Reality contact (ROR, TAT, correlate with interviewing information)

Prediction about the problem areas (on the basis of assessment and clinical interview).

PSYCHOLOGICAL EVALUATION (Children)

Neuropsychological screening test indicates that Ali’s visual motor perceptual capacity fall at
normal range.

Results of Intelligence testing, Achievement testing (correlate with interview information e.g.
milestones).

Social Maturity and Social Adaptive functioning (VABS), discuss age equivalents, each domain.

Results of tests for learning disabilities, or any other indication.

Results of projective testing e.g. (it seems that/it indicates that)

Overall personality of the client (impulsive, dependent, immature, mature, aggressive or well
functioning personality).

Dominant Needs (HFD, CAT, ROR) whether satisfied or not

Main Conflicts (between which need)

Nature of Anxieties (HFD, CAT, ROR)

Overall perception of the world (CAT, ROR)

Handling of anxieties, defenses, stresses, relationships (CAT, ROR)

Creative and intellectual potentials (ROR)

• Reality contact (ROR, CAT, correlate with interviewing information)

• Prediction about the problem areas (on the basis of assessment and clinical interview).

CONCLUSION

Through clinical interview, formal assessment and clinician observation, it may be concluded
that client reveals no signs of Autism. He might have neuropsychological impairment. His
Intellectual Functioning IQ is average as well as adaptive functioning is adequate but needs
consideration on aspects of Communication and Socialization. Moreover, client’s achievement
level for Reading and Spelling is according to his age group where as for mathematics his
achievement level is lagging behind his age group. In addition, the personality assessment
revealed that he might have emotional issues in his life. He seemed to be maladjusted in social
and emotional areas of his life. Furthermore, his environment seems to be in-congenial and
interpersonal relationships appears to be disturbed. Considering the whole record, it could be
concluded that he might have Attention Deficit Hyperactivity Disorder and might have
oppositional trends as well.

RECOMMENDATIONS (Adult)

• What type of treatment would be provided to the client?

• (e.g. whether he would be refer to some other professional or psychotherapy should be

provided?)

• Which psychotherapy (different techniques if psychotherapies according to the client

problem) should be provided.

RECOMMENDATIONS (Children)

• Parental counseling, if needed (details).

• What type of treatment would be provided to the client?

 • Whether he/she would be refer to some other professional (psychiatrist, neurologist,
speech therapist, physiotherapist or psychotherapy should be provided?)

• Whether he/she would be admitted in special school?

• What type of home/school environment would be provided to the child for his/her
improvement?

• Whether psychotherapy would be provided?

• Which psychotherapy (different techniques if psychotherapies according to the client

problem) should be provided.

Examiner’s Name Supervisor’s Name

Director’s Name (If outside report)