Learning Diagnostic Clinic Missouri State University Alumni Center Suite 502 Springfield, Missouri 65897 (417) 836-4787 Fax # (417) 836-5475 CONFIDENTIAL PSYCHOEDUCATIONAL EVALUATION ______________________________________________________________________ Client Name: Woman39 Referred by: Greene County Drug Social Security Number: xxx Court Date of Birth (Age): xx/xx/xxxx (39y) Phone Number: (417) xxx-xxxx (Jane Race: Caucasian Doe, Social Worker) Gender: Female Phone: (417) xxx-xxxx Handedness: Right Examiner: Lindsey H Steding, B.A. Dates of Evaluation: 06/xx-xx/10 Supervisors: Steve Capps, Ph.D Report Date: 06/xx/2010 Paul Deal, Ph.D. _________________________________________________________________________ This report is based upon the integration of information obtained in a clinical interview, behavioral observations, and the results of psychological testing. PRESENTING PROBLEM/REASON FOR REFERRAL: Woman39 is a 39-year-old Caucasian female. Mrs. Woman39 presents to the Learning Diagnostic Clinic for a diagnostic impression and treatment recommendations upon referral from the Greene County Drug Court. According to her case worker, she has been involved in the program for nearly three years, and has not shown adequate progress in reaching her goals. Mrs. Woman39 reports severe psychological and emotional distress from numerous head injuries, several accounts of trauma, and a family history of mental illness. She explains that these problems have complicated her substance abuse recovery. HISTORY OF PRESENTING COMPLAINTS: Mrs. Woman39 stated that she has ³issues´ that are limiting her ability to succeed in Drug Court. To elaborate, she used a variety of specific examples to highlight problems with memory, concentration, hallucinations, difficulty recognizing loved ones, and feeling that she is ³becoming crazy." These symptoms are affecting her relationships with family, her daily functioning, and her motivation to cope with emotions and improve her condition. Mrs. Woman39 had difficulty identifying clear onset periods as well as current frequency of her troubles with memory, and her "strange" perceptual experiences. She expressed some insight that traumatic events and her harmful behaviors have continued to worsen her symptoms over time. She stated, "I used to blame all that stuff on the drugs, but then I couldn't pretend anymore," acknowledging that some of these symptoms began to occur while she was frequently intoxicated, but they also occurred during months of reported abstinence, have continued to impair her functioning, after several months in controlled settings and parole. FAMILY BACKGROUND & EARLY CHILDHOOD SETTING Mrs. Woman39 recalled a highly volatile and unsafe home environment during her childhood. She described her father as an alcoholic "monster," from whom she experienced extensive abuse. At the age of five, Mrs. Woman39 and her mother were in a traumatic car accident that resulted in the death of her mother. Although Mrs. Woman39 claims that she was

Her work history was varied and sporadic. she was in a car accident when her boyfriend crashed the car into a telephone pole. Mrs. according to Mrs. Her past jobs included working in fast food restaurants and factories. Woman39. and other substances while pregnant with her. She endorsed receiving a high school diploma. Woman39¶s early schooling was in a special education program within the public school near her home. Although she reported being an avid reader and being able to ³pass any test. She has never been hospitalized for any physical illness. she was not severely injured. The only ongoing health complaint she reported was migraine headaches. Woman39 recalled receiving ³straight F¶s. In 1990. She does not hold a job at the present. The only common illnesses in her family were those related to alcohol use. suffered a Traumatic Brain Injury (TBI). She described a close relationship with one of her brothers throughout childhood as well as in her adult years.´ Mrs. cooking. ACADEMIC & OCCUPATIONAL HISTORY: Mrs. when she was in the car with her mother and her mother was killed. and craft-making as hobbies that she enjoys. and kids with behavior problems. She does not take any prescription medication for this condition.i. as discussed earlier. although some were half-siblings and others were stepsiblings. After her mother's death.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 2 sitting on her mother's lap during the accident. but explained that she finished some of her schooling through an Adult Education program due to her pregnancy at age 15. which. She could not remember any injuries from that accident. Another head injury was sustained when Mrs. She no longer uses this medication. Woman39 endorsed her mother's use of alcohol. KS she re-enrolled in school there. She explained that she had a total of six brothers and six sisters. but scattered anecdotes of her siblings and highlighted several accounts of family psychopathology: two biological sisters were described as ³schizophrenic and paranoid. cigarettes.d.. She reported that she quit these jobs when she was ³bored or empty.´ or was fired due to not making some of her shifts. dosage unknown) while at XXX Recovery Center for Women. She did not complete the full term of prescribed rehabilitation therapy. It was unclear whether her vague memories were due to trauma or simply trying to remember events of such a young age. She explained that this class was designated for the "deaf. which began after a major car accident at the age of 28 (described below). as well as co-owning an antique business. which she explained was likely due to her drug use. However. but could not recall anything immediately after the event through several months later. The first incident was when she was five years old. When she ran away from home at the age of 13 to live with her sister in XXX. Woman39 discussed three major accidents for which she was hospitalized. their medical history was unremarkable. Woman39 was . Woman39 reportedly. and she admitted that most of her past income came from manufacturing and selling illegal substances.´ and always getting in trouble for her behavior and defiance for not completing school work. and Mrs. primarily due to malnutrition and lack of resources.´ She was in this class because she stopped talking from the time immediately following her mother's death through the fourth grade. She denied being a healthy child. In May of 2010. mentally retarded.´ two brothers committed suicide. Mrs.´ MEDICAL HISTORY: Mrs. She told numerous colorful. although she has not had interest or motivation to engage in these activities ³for several years. and numerous other family members were reported as having substance abuse disorders. Woman39 mentioned sewing. she continued to live with her father. she was prescribed Depakote (t. Compared with her family¶s psychological health history. was to help her cope with her Bipolar symptoms. She has vivid memories of events of that day prior to the accident.

" feeling severely depressed. Woman39 recalled neither of those accounts. going blind.´ She elaborated that often times she has trouble falling asleep as well as waking up too early because of racing thoughts. LEGAL HISTORY: Although she did not appear nervous or unwilling to divulge this information. and after she failed to appear for trial she was sentenced to serve 90 days in the county jail followed by two years of unsupervised probation. passing out.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 3 beaten with a baseball bat by an ex-boyfriend at the age of 34. She claimed that the physicians at the hospital released her when an x-ray showed her skull was not fractured. Mrs. Typical drug usage was detailed as several times a day and ³as much as we could get. including methamphetamines. she was issued a warrant. INTERPERSONAL HISTORY & SOCIAL SUPPORT: A pervasive pattern of unstable interpersonal relationships was described involving handful of family members. but claimed that she ³really found drugs´ when she began to use cocaine at the age of 19. Woman39 had a relationship with a man whom she estimated to be in his late 40s. During her time in Drug Court. in late 2009 she was arrested for manufacturing with intent to distribute an illegal substance. This sentence marks the beginning of her involvement in the Drug Court program. Woman39 received a misdemeanor conviction in August 2008 for operating a motor vehicle while her driver¶s license was revoked. The only long-term effect of her use that Mrs.´ because every time she used she was striving to get a larger effect than the previous time. Mrs. several abusive boyfriends. she received her first violation as a landlord complaint. She endorsed needing more each time to obtain the previous effect. and she even described the amount as ³near suicidal. This was the most recent time she has seen a doctor. Woman39 explained that she either sleeps ³all the time or hardly at all. Consistent with documentation and Mrs. she told a story of staying up for 45 days straight during which her psychotic symptoms were especially prevalent. which is driven by her motivation to be a better mother and grandmother. she has made a commitment to stop using substances. She recalled a few periods where she tried to ³get clean´ for her daughters. and she recalled her last physical examination to be at least 10 years ago. seeing "shadow people. According to Missouri Court documentation. Mrs. As she described a period of heavy drug use at approximately 29 years old. Mrs. Woman39¶s report. and alcohol. Woman39 identified was a decline in intelligence." and feeling empowered. These records then indicate that Mrs. Woman39 described some early exposure to alcohol and marijuana. marijuana. Mrs. Her eating habits were also reported to be sporadic and unhealthy. She recalled her first incident to be a traffic violation and arrest around 1996. which lasted from the time she was 15 to 18 years old.´ Mrs. cocaine. Woman39¶s memories of the dates and charges of her various legal problems were vague and not very consistent with judicial documentation. and gaining weight. and some ³business acquaintances. a foaming mouth. In 2009. she was heavily abusing numerous substances. for which she was sentenced 30 days in jail and 5 years of supervised probation. Withdrawal effects included sleeping "all the time. She estimated this use to be nearly continuous from about 19 to 34 years old. Woman39 declared. Some of the effects she experienced while intoxicated included shaking. opiates.´ While living with one of her sisters in Kansas. SUBSTANCE ABUSE HISTORY: Mrs. having many headaches and seizures. Woman39 endorsed that by 28-29 years old. She . which typically lasted ³a few months to a few years´ long. which was served satisfactorily.

while he was ³running away from federal parole´ and they lived on a farm ³to hide. Mrs. she discussed the laughing as a coping mechanism. Her response to the abuse was to assume that there was something she needed to change about herself and then she would be loved. Woman39 was married for the first time about 4 months ago. usually a baggy t-shirt and blue jeans. CURRENT LIVING SITUATION: Mrs. but her hair was unkempt and she did not appear to be wearing any makeup. Several times throughout the evaluation process. She looks her age.´ They stayed in contact while they were ³locked up´ in separate facilities. and described herself as "a social butterfly." and explained that she does not have any true friends. Her hygiene was adequate. She has a tattoo of a flower (approximately 1 ½ inches) on the inside of her wrist. She does not drive. which allowed rapport to be easily established. MO. easygoing woman throughout the assessment process. revealing insight that she often "laughed off" events that were traumatic or "too deep" rather than cry about them. Woman39 presented herself as a cooperative. Mrs. after which she will return to her home in Springfield.´ This relationship began approximately two years ago. When this relationship ended. The only manifestation of anxiety was excessive laughing at times when she seemed hesitant to reveal feelings or beliefs that may appear "crazy. she also expressed that she does not trust people "one-on-one. with sandals. Mrs. Woman39 also reported that she often babysits for her youngest daughter's 2-year-old child. She described her husband as a ³knucklehead´ who ³really loves me«and perhaps the only person who ever has. She also explained the majority of these to be emotionally and/or physically abusive." However. Mrs. Woman39 denied difficulties in social situations. Woman39 was dressed in very casual attire. Mrs.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 4 recalled spending a significant amount of her time with this man. Woman39 recounted several intense dating relationships. Woman39 described her mood as "pretty good. and then explained that people call her "crazy" precisely because she is often seen as "happier than most. She related to the examiner in a respectful and friendly manner. She began her 30-day stay on XXX.´ She expressed significant guilt that she ³missed a lot´ of their childhood due to her drug-related activities. without overt signs of aging or exhaustion. however. Throughout the evaluation process. At times. Woman39 is presently residing at the XXX residential substance abuse treatment facility. in XXX. Mrs. so she gets around by bus or by means of her husband or brother. Woman39 moved back to Springfield. 2010. MENTAL STATUS & BEHAVIORAL OBSERVATIONS: Mrs. and reunited when they were both released. she appeared overly chatty and uninhibited. Mrs. and resume living with her husband. both times giving the children up for adoption.´ Approximately one year ago. and ³got caught. speaking openly." most of the time. Mrs. and during this time she became pregnant twice. Woman39 was on time or early for most scheduled appointments. She cancelled one appointment 10 minutes prior to the scheduled time. they returned to Springfield. claiming that she needed to watch her sick granddaughter." She claimed her happy disposition is sometimes a "cover up" for feelings she does not want to . she emotionally expressed her daughters and grandchild as being her motivation to ³get better. she evidenced a low amount of social support as she continued to describe herself as feeling "empty. in her narrative accounts she described numerous "neurotic" fears and a considerable amount of self-doubt and feelings of worthlessness. She reports ³good´ relationships and frequent contact with her two daughters (ages 16 and 18)." On later testing sessions." and frequently articulating distrust of others.

Mrs. Some psychotic symptoms were suggested based on her disclosure of abnormal thoughts and her endorsement of visual and auditory hallucinations. Mrs. There were several phone call interruptions during the clinical interview. However. Mrs. For example. However.´ but with slight encouragement.´ providing examples of compulsive behaviors. RELIABILITY AND VALIDITY: Mrs. Bizarre thoughts and paranoid ideation were also endorsed. the phone calls she received during testing were ignored. with the most recent account being December 2009. and she often provided indirect responses to the examiner's prompts or questions. There was some evidence of self-doubt when the examiner queried to clarify her responses. person. Overall. however her affect appeared to vary with the topic of discussion. but her affect would abruptly shift to tearfulness at times when she discussed current distress and fear of abandonment regarding her daughters or husband. She admitted numerous past suicide attempts. In light of her scores that indicate a tendency to over-report distress. she appeared alert and her attention span and concentration was adequate. by promptly beginning to respond or work out problems. she tended to engage in tasks with significantly more confidence than was reflected in her negative self-talk during discussions of her history or ability to function on a daily basis. It will be noted when various assessments are not valid or should be interpreted with caution. Woman39 was hesitant to reveal the content of her idiosyncratic beliefs for which she claims others call her ³crazy. At times there was evidence of illogical thoughts. and tone. At first. She denied ruminations or obsessions. However. and rituals in her home. she denied currents suicidal ideation or plans as well as homicidal ideation. straightening. Woman39 spoke in an animated manner as she relayed information through anecdotes. and purpose. detailed theories about the AIDS epidemic. and the recent oil spill. which she stated are ³based on valid facts. The relevance and sequence of these stories were sometimes difficult to understand.´ She also articulated that in the last five years she has become ³neurotic. but with increased difficulty. and another time having a face-to-face discussion with her daughter who was not actually present. she calmly accepted her inability to accomplish tasks. an overall picture of her mental health and cognitive functioning can still be provided with some accuracy. . Woman39 was oriented to time. with the depth and breadth of instruments utilized in this evaluation. Standardization procedures were adhered for all administration procedures. the severity of her problems should be considered with caution when evaluating these results. including checking. terrorists. almost impulsive manner. She remained on task throughout the assessment process and declined breaks. She demonstrated interest and effort towards most tasks. volume. There was clearly a baseline buoyant presentation. place. she used a high level of vocabulary fluently and appropriately. Although her baseline speech was of a typical rate. However. although she made it clear when she was becoming fatigued and the examiner varied tasks frequently which was effective in maintaining effort. She initiated tasks in a confident. such as when she explained that her ex-boyfriend taught her to stand up for herself. She affirmed that the second mentioned example was validated in a phone call with her daughter after the experience. as well as her observed dramatic storytelling. and then she concluded by saying that she would do anything this boyfriend told her to do. she recalled hearing her name when no one else is home. she shared complex. No further interruptions were encountered. Her story-telling tended to be long-winded and tangential. Woman39 was cooperative throughout the evaluation and appeared to put forth her best effort.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 5 acknowledge.

Third Edition (MCMI-III) Minnesota Multiphasic Personality Inventory-Second Edition-Restructured Form (MMPI-2-RF) Structured Interview of Reported Symptoms (SIRS) Spatial Span in Wechsler Memory Scale-III Test of Variable Attention (TOVA) Test of Written Language (TOWL) Trail Making Test (A & B) Wechsler Adult Intelligence Scale.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 6 ADMINISTRATION PROCEDURES:                  Beck Anxiety Inventory (BAI) Beck Depression Inventory .Fourth Edition (WAIS-IV) Woodcock-Johnson III Tests of Achievement (WJ-III) TEST RESULTS: INTELLECTUAL FUNCTIONING: WECHSLER ADULT INTELLIGENCE SCALE ± IV (WAIS-IV) Scaled or S/W Scaled or Verbal Subtests Standard or Performance Subtests Standard and INDICES Score %ile and INDICES Score Similarities 9 37 Block Design 9 Vocabulary 12 75 Matrix Reasoning 7 Information 10 50 Visual Puzzles 8 Comprehension (12) (75) Figure Weights 8 Picture Completion 10 Verbal Comprehension 102 55 Perceptual Reasoning 88 Digit Span 7 Symbol Search 9 Arithmetic 7 Coding 8 Letter Number Sequencing 9 37 Cancellation (9) Working Memory 83 13 Processing Speed 92 *Note: subtests in parentheses are supplemental and not included in FSIQ calculation.Second Edition (BDI . SCALE Full Scale IQ Score 90 Description Low Average %ile 25 S/W or %ile 37 25 (25) (50) 21 37 25 (37) 30 To determine Mrs.II) Clinical Interview Conners¶ Adult ADHD Rating Scale (CAARS) Controlled Oral Word Association Test (COWA) Finger Tapping Test Green¶s Word Memory Test Grooved Pegboard Test Millon Clinical Multiaxial Inventory. Woman39¶s overall cognitive abilities she was administered the Wechsler Adult Intelligence Scale. Fourth Edition (WAIS-IV) from which her composite scores were .

On the subtest that required her to assemble blocks to re-create a three-dimensional model identical to a two-dimensional image. This strength likely comes from the extensive amount of reading she recounted.. and hold numerical information accessible in her memory long enough to manipulate it and state it aloud. Both visual discrimination and visual motor coordination influence performance in this area. 95% confidence level = 77-91). Woman39¶s speed of processing abilities. Her lowest score was on working memory tasks that required her to sustain attention while listening. and above those of 21% of her peers (WMI = 83. Her general cognitive ability is within the Low Average range (FSIQ = 90. I don't know. As she attempted to solve tasks that involved recognizing and synthesizing relationships among . The client¶s performances on the subtests that contribute to the PRI show these skills to be equally developed. Woman39 demonstrated personal strengths on two activities that relied on her knowledge of vocabulary and general facts. and Mrs.. The abilities to sustain attention. This index is an indication of the rapidity with which she can mentally process simple or routine information without making mistakes. This also represents a normative weakness. Intelligence is often considered to be comprised of a combination of verbal functioning (the ability to think using words) and nonverbal functioning (the ability to reason without words). 95% confidence level= 84-101). this appeared create to self-doubt as evidenced in a hesitant tone and frequent expressions of "Well. learning. Woman39 initially approached the task with confidence.. 95% confidence level = 82-95). Woman39¶s verbal abilities are in the Average range and significantly exceed her nonverbal abilities." Mrs. When the examiner queried for more information. Mrs. The Perceptual Reasoning Index is designed to measure nonverbal concept formation." Mrs.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 7 derived. verbal reasoning. as she scored lower than the average for the comparison sample of individuals her age. I used books as an escape from all the bad stuff going on.. visual motor coordination. as measured by the Perceptual Reasoning Index. Mrs. simultaneous processing. Woman39¶s nonverbal reasoning abilities. concentration. expressed through a few separated but related words or 3-4 word phrases. are in the Low Average range and above approximately 21% of her peers (PRI= 88. Woman39 achieved her best among the tasks that relied on her ability to think in words and reason with verbal information. Woman39's performances indicated that these abilities are equally developed. 95% confidence level = 96-108). as her scores were lower than her average score for all areas. The Verbal Comprehension Index is designed to measure verbal retrieval. Mrs. Woman39¶s impulsive approach style was clearly helpful in getting her to begin timed tasks efficiently. Her working memory abilities as measured by the Working Memory Index are in the Low Average range. Mrs. Her responses tended to be brief. are in the Average range and above those of approximately 30% of her peers (PSI= 92. and she appeared to enjoy the challenge of completing tasks as fast as possible. "I was always a really good and fast reader. but quickly became frustrated with her inability to complete the task with ease. visual perception and organization. 95% confidence interval = 86-94) of intellectual functioning as measured by the Full Scale IQ (FSIQ). and concept formation. as measured by the Processing Speed Index. Mrs. and her skills in these appear to be equally developed. and exert mental control make up the WMI. Woman39¶s verbal reasoning abilities as measured by the Verbal Comprehension Index are in the Average range and above those of approximately 55% of her peers (VCI=102. A personal strength indicates that she scored significantly higher than her average score on each subtest. In this subtest. Mrs. which are in the Below Average range. and the ability to separate figure and ground in visual stimuli. her performance demonstrated the ability to analyze and synthesize visual-spatial material to be a personal weakness.

PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 8 visual-spatial stimuli. and remembering the location of the correct sequence of blocks to tap. Life experiences such as substance abuse. Woman39¶s scores on this subtest ranged from Low to Average ability level. that requires reasoning and interacting with information as opposed to the crystallized. but difficult to follow plot. At the beginning she appeared confused about following the directions. Woman39 constructed a creative. MEMORY. head injuries. This subtest requires both attention and working memory skills. This may be a factor that contributed to her lower scores in these tasks. The story was difficult to read. they were phonetically decodable. Mrs. illness. Furthermore. She performed similarly when given letters or categories as prompts. suggesting she was changing her mind and/or her thoughts were interrupting the flow of her writing process. which tended to be complex or even run-ons.7 Category 17 21. fact based knowledge that she demonstrated in her best performances.5 z Score -0. AND CONCENTRATION: SPATIAL SPAN SUBTEST ± WECHSLER MEMORY SCALE-III Mrs. Although all sentences revolved around the same theme and characters. and the examiner had to explain directions twice and provide . The number of sentences is significantly less than the average of 20 sentences within 15 minutes. Her performance appeared to improve over the course of the tasks. An informal analysis of her story is provided. Woman39 was administered the Controlled Oral Word Association (COWA) test as a measure of verbal knowledge and abstract mental operations. Her story had 6 sentences. Woman39's history. Although there were eight spelling errors. Woman39 was administered the story portion of the Test of Written Language-Third Edition (TOWL-3) as an assessment of written expression. there were many areas in which Mrs. or hold information in her short-term memory long enough to manipulate it. and a lack of intellectually stimulating environments are common causes for declining abilities with fluid cognitive skills. LANGUAGE AND ACHIEVEMENT: CONTROLLED ORAL WORD ASSOCIATION Task # of Words Mean SD F 12 A 10 S 10 Total 32 40. Mrs. ATTENTION. but frequent capitalization errors. maintaining focus. TEST of WRITTEN LANGUAGE ± 3 (TOWL-3) (informally scored) Mrs. due to a tangential flow. Woman39 had scratched out words.82 Mrs.5 10. The story had minimal punctuation errors.79 -0. In addition. Her overall performance was Average based on normative groups of women her age with her education level. there were numerous phrases that were awkward to the sequence of the narrative. Woman39 was administered the Spatial Span subtest from the Wechsler Memory Scale ± Third Edition.5 5. she appeared to have difficulty focusing on the immediate goal long enough without mental distractions. these latter tasks depend on a fluid form of knowledge. This appears to fit with Mrs.

80 (more positive) is not. These results are suggestive of an attentional disorder. CONNERS¶ ADULT ADHD RATING SCALE (CAARS. Mrs. This is typically suggestive of difficulty controlling impulsivity after 15 minutes on task and /or after 5 minutes of a highly stimulating task. which is not within normal limits.24. Test scores may underestimate her abilities. often losing objects necessary for tasks.80 or less (more negative) is suggestive of ADHD while a score more than -1. . problems keeping attention focused while working. and making careless mistakes. TEST OF VARIABLE OF ATTENTION (TOVA) The Test of Variable of Attention (TOVA) is an individually administered computerized test developed to assess attention and impulse control in comparison to established norms. Mrs. Her highest elevations suggest trouble with concentrating. her performance shifted toward an impulsive approach during the final subtest. the extreme severity suggested by the TOVA score should be viewed with caution. trouble listening to others. Individuals who are administered the TOVA are given an ADHD score that summarizes their performance on this task. Errors are calculated with respect to both attention and impulse control. Errors of omission occur when one does not respond to the designated target and are a measure of overall attention.Woman39¶s ADHD score was -7. Woman39¶s performance on the various memory tasks of Green¶s Word Memory Test indicate that caution is needed in interpreting her scores on this assessment as well as other measures requiring conscious effort.S:L) Subscale T-Score Subscale A ± Inattention/Memory 83 E ± DSM-IV Inattention Symptoms Problems F ± DSM-IV Hyperactive-Impulsive B ± Hyperactivity/Restlessness 70 Symptoms C ± Impulsivity/Emotional 79 G ± DSM-IV Symptoms Total Lability D ± Problems with Self-Concept 68 H ± ADHD Index T-score 87 68 83 83 The Conners¶ Adult ADHD Rating Scale ± Self Report: Long Version (CAARS ± S:L) is a self-report measure designed to assess symptomatology and behaviors in adults which are consistent with a diagnosis Attention Deficit Hyperactivity Disorder (ADHD). GREEN¶S WORD MEMORY TEST Mrs. A review of her performance revealed that omission errors significantly worsened from the first quarter to the second quarter. as suggested by scores that reflect a tendency to overreport symptoms and tendency to undermine full effort. The DSM-IV Inattentive Symptoms & ADHD Index scale elevations support a diagnosis of ADHD of the inattentive subtype. Woman39¶s attentional difficulties were sometimes observed as problematic during other tests. suggesting difficulty maintaining attention after 5-6 minutes of a monotonous or unstimulating task. Then. Although Mrs. An ADHD score of -1.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 9 corrective feedback on both practice trials. This is consistent with the difficulties she demonstrated on other tasks that required focused attention and working memory. Errors of commission occur when one fails to inhibit responding and incorrectly responds to a non-target.Woman39 had several significant elevations.

It requires complex scanning.4 23. and Below Average (slower than her peers) for her left hand. EXECUTIVE FUNCTIONING: BOOKLET CATEGORY TEST IV V VI VII Total T score 2 15 4 5 57 41 Subtest Errors I 0 II 0 III 31 Interpretation Below Average Executive functioning refers to the ability to control one¶s own thinking processes and one¶s behavior. Woman39¶s performance was in the Average range for her right hand.) Mean 28 30. Her difficulty with planning was observed several times when she was told that she made an error and then appeared to guess at the next item rather than using the error to plan a strategy that would help her discover the underlying theme of the subtest's designs.3 SD 5. as compared to other tasks which generally assess simple sensory-motor skills.6 44. .7 8.4 z Score -. it provides information regarding sustained and altering attention skills along with sequence and motor skills. GROOVED PEGBOARD Hand # of Drops Time (Sec.84 The Grooved Pegboard Test measures one¶s complex visual-motor-tactile integration and psychomotor speed. and to plan ahead. The Booklet Category Test was administered as a test of reasoning. Mrs.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 10 MOTOR ABILITIES: FINGER TAPPING TEST Hand Average Left 46 Right 54. Mrs.4 Mean 40. and her performance with her right (dominant) hand fell within the Above Average range of ability (faster tapping than her peers). It also requires the executive functions of planning and initiation of behavior. and motivation.2 71 64 Task Trails A Trails B # of Errors 0 0 SD 10. visual tracking.74 Finger tapping is primarily a test of simple motor speed. coordination. attention. and flexibility. as compared to other women her age.6 5. being able to sequence.8 SD 10. In addition.9 z Score 1.14 .21 .8 62. Woman39¶s performance with her left (nondominant) hand fell within the Average range.96 1. Woman39 performed within the Below Average range based on the number of errors she committed throughout the test.30 The Trail Making Test serves as a measure of mental activities. Mrs. Woman39¶s performance was in the Average range for both versions of this assessment.8 z Score 0.) Left 0 79 Right 0 70 Mean 66. and speed of information processing. speed. to alternate between ideas. TRAIL MAKING TEST Time (sec. problem solving. Mrs. It includes being flexible in thinking.

Woman39 was overly willing to share problems. Woman39 was likely over-reporting psychological dysfunction. MILLON CLINICAL MULTIAXIAL INVENTORY . Fs:120. thus invalidating this assessment. An examination of the validity scales suggest that Mrs. and also that she responded in a manner to highlight and possibly exaggerate her symptoms. Woman39¶s presentation of herself is at least slightly skewed in terms of the severity of her symptoms. Her inconsistent responding. given her scores on other measures that demonstrate the same bias.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 11 EMOTION AND BEHAVIOR: MINNESOTA MULTIPHASIC PERSONALITY INVENTORY-2-RESTRUCTURED FORM (MMPI-2-RF) Mrs. Woman39 was administered the MCMI-III to aid in diagnostic decisions and to gain further insight to her current level of psychological functioning. the elevations on the Borderline and Schizotypal Severe Personality Scales provided support for further investigating evidence for a personality disorder by means of additional clinical interviewing. A review of the validity scales (TRIN-r: 80T. Woman39 was administered the MMPI-2-RF. and assertion of a considerably larger than average number of psychopathological and somatic symptoms all reflect a strong likelihood of over-reporting. FBS-r: 99) suggests that Mrs. excessive number of infrequent responses.III Base Rate Scores Disclosure Desirability Debasement 78 Schizoid Clinical Personality Patterns Severe Personality Pathology Clinical Syndromes 101 Severe Clinical Syndromes Thought Disorder 83 71 Major Depression 107 90 Antisocial 80 Schizotypal 82 Anxiety 25 Avoidant 70 Sadistic 66 Borderline 91 Somatoform 81 Depressive 86 Compulsive 25 Paranoid 62 Bipolar: Manic 98 Delusional Disorder 70 Dependent 84 Negativistic 63 Histrionic 17 Masochistic 84 Narcissistic 49 Category Modifying Indices Dysthymia PostAlcohol Drug Traumatic Dependence Dependence Stress 113 101 83 103 The Millon Clinical Multiaxial Inventory ± Third Edition (MCMI-III) is a standardized. an objective measure of emotional functioning. . Ms. F-r:120. Fp-r:119. it is most likely that Mrs. Although this may be a reflection of severe psychopathology. selfreport questionnaire designed to assess characteristics of a client's personality structure and emotional adjustment. Although the overall profile is not an accurate representation of her personality structure.

Mrs. combined with her perception of legal implications that may result from the present evaluation." and feeling "nervous´ over the past week. her scores on the MMPI-2-RF. indicating that she is experiencing severe symptoms of anxiety. which is indicative of severe symptoms of depression. and changes in sleeping. Although mood symptoms are likely to be contributing to Mrs. which suggest inconsistent responding and a high likelihood of over-reporting. STRUCTURED INTERVIEW OF REPORTED SYMPTOMS (SIRS) Primary Scales Scaled Scores Category of Response Rare Symptoms 6 Probable Feigning Symptom Combinations 2 Honest Improbable or Absurd Symptoms 2 Honest Blatant Symptoms 13 Probable Feigning Subtle Symptoms 27 Definite Feigning Selectivity of Symptoms 25 Probable Feigning Severity of Symptoms 15 Probable Feigning Reported vs. loss of energy. indecisiveness. She specifically endorsed feeling severely bothered by symptoms of having a "fear of the worst happening." and a "fear of losing control. and is likely suggestive of an Anxiety Disorder. loss of pleasure. This is consistent with reported worries and intrusive thoughts. The most prominent symptoms she endorsed included loss of interest. Woman39 obtained a score of 41. Woman39¶s dramatic presentation of many distressing symptoms and a complex history. the subjective magnitude of these problems is likely exaggerated. Given that anxiety and depression often coexist. BECK ANXIETY INVENTORY (BAI) The BAI measures severity of anxiety in adults. In addition. the BAI is constructed to measure symptoms of anxiety which are minimally shared with those of depression. It provides an assessment of symptoms corresponding to criteria for diagnosing depressive disorders.Woman39's overall distress and functional impairment. Mrs. It should be noted that both the BDI-II and BAI are sensitive to response style on the MMPI-2-RF. Mrs. suggested a need to evaluate the likelihood of deliberate misrepresentation. support the possibility . Observed Symptoms 6 Indeterminate Supplementary Scales Scaled Scores Category of Response Direct Appraisal of Honesty 6 Honest Defensive Symptoms 24 Indeterminate Overly Specified Symptoms 0 Honest Symptom Onset 2 Honest Inconsistency of Symptoms 5 Honest The Structured Interview of Reported Symptoms (SIRS) is a systematic assessment of deliberate distortions in self-reports of symptoms. Scores of this magnitude are above the typical degree of depressive symptoms endorsed by people with Major Depressive Disorder. Woman39 obtained a score of 25.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 12 BECK DEPRESSION INVENTORY ± Second Edition (BDI-II) The BDI-II is a self-report instrument used to measure the severity of depressive symptoms in adults and adolescents.

. and withdrawal effects Mrs. and Selectivity Subscales. Mrs. She witnessed the traumatic death of her mother in a car accident at the age of five. She also showed an elevated score on the Rare Symptoms. Mrs. as well as several attempts to run away and/or commit suicide. these two substances predominated at particular time periods. Although numerous other substances were reported to be used on occasion in conjunction with these drugs. malingering) or merely to assume a patient role (i. it is most likely that she is overreporting but not completing malingering. but considered her use to be ³suicidal´ in frequency and amount.´ It is unclear what she believed may come of this evaluation. A family history of mental illness included two accounts of sisters with symptoms resembling Schizophrenia. Outcomes from the SIRS revealed four scores in the ³Probable Feigning´ range and one score in the ³Definite Feigning´ range. Woman39¶s markedly elevated score on the Subtle Symptoms scale indicates that she has a very atypical presentation and a tendency to endorse symptoms that untrained individuals would typically associate with everyday problems or minor maladjustment rather than mental illness. and receive recommendations for treatment. dependency. Factitious Disorder with Psychological Symptoms). married. Mrs. another sibling with depression. Woman39 is currently residing at XXX Behavior Healthcare facility for substance abuse rehabilitation. She reported migraines and seizures after these hospitalizations. and then continued to live with an alcoholic abusive father who abused her physically and emotionally. An important clinical distinction is whether Mrs. Mrs. and being hit on the head with a baseball bat when she was 34 years old.e. except that it can ³help the court understand her problems.. and several others with substance-related disorders. opiates.e. and alcohol. She was unable to provide estimate measures. concentration. and appeared to revolve around her substance use. traumatic events. cocaine. She was referred by the Greene County Drug Court for a psychological evaluation to clarify her level of psychological functioning. Woman39¶s elevated scores overall denote a need to use caution in interpreting her selfreports. Mrs. Woman39 endorsed long-term use of numerous substances. This included a TBI when she was about 29 years old. Woman39¶s childhood was scattered with abuse. Her interpersonal history also revealed instability. The maladaptive pattern of impairment. She recalled countless difficulties at school. and demonstrates at least to some degree. interpersonal relations. and psychotic symptoms. SUMMARY AND DIFFERENTIAL DIAGNOSIS: Woman39 is a 39-year-old. All medical conditions endorsed were caused by severe injuries incurred through car accidents or abusive situations. and her use clearly meets the criteria for cannabis and methamphetamine independently rather than as a diagnosis of . including methamphetamines. cannabis. Severity. concerning mood. Mrs. even to a severe degree. Caucasian female. Woman39 was administered the SIRS to gain further information about the nature of her response style. obtain a diagnosis. Woman39 depicted on a timeline meet the criteria for Substance Dependence for cannabis and methamphetamine. A lack of social support was evidenced in her described mistrust of others and feelings of being ³empty´ and unlovable.´ With the variety of difficulties she reports. indicating an overall measure of symptom endorsement utilized to identify an indiscriminate endorsement pattern. Mrs. and many actingout behaviors. Woman39¶s behavior is motivated by an external incentive (i. Woman39 spoke frequently about acting ³like her sisters´ who she refers to as ³crazy´ and ³Schizophrenic.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 13 of deliberate distortion of her symptoms.

´ she reflected. Thus. Mrs. Although her tendency to over-report distress indicates caution in interpreting this elevated score. yet unstable relationships in Mrs. Then on the Wechsler Memory Scale. On the Working Memory Index of the WAIS-IV. thus limiting the accuracy of the profile produced. She endorsed experiences that meet the . Mrs. her functional impairments seem to be resulting more from cognitive distractions when she is not fully engaged in a stimulating activity or needs to perform calculations or manipulate information in her mind. and frequent careless mistakes resulting from poor concentration. Mrs. she performed in the Low Average range.´ Accompanying these changes were behaviors and facial expressions that clearly evidenced a reactive affect. Woman39¶s general cognitive ability is in the Average range of intellectual functioning (FSIQ: 90) as measured by the Wechsler Adult Intelligence ScaleFourth Edition (WAIS-IV). while admiring that he ³is all heart. as well as to detect the presence of a personality disorder. Woman39¶s performance suggests difficulties with maintaining attention on the task at hand. a limited attention span. For example. but instead are symptoms accounted for by her other diagnoses regarding dysregulated mood problems and psychotic symptoms. Attentional difficulties were assessed using a self-report questionnaire (The Conners¶ Adult ADHD Rating Scale ± Self Report: Long Version. TOVA). indicating severe symptoms of depression. to her frequent disappointments at ³letting people down´ for ³not being good enough. Her responses on the MMPI-2-RF demonstrated a pattern of over-reporting so excessive that the protocol was considered invalid.Second Edition (BDI-II). the clinical scales could not be interpreted and additional measures (especially the BAI and BDI-II) may be overestimates of her current symptoms. Woman39¶s performance on memory tasks was similarly poor. Her responses again demonstrated a tendency to exaggerate or magnify symptomatology. shifting from confidence about not having any fears. However. it seems most likely that these attentional and concentration difficulties do not warrant any additional diagnosis.´ She justified her fear of him leaving by talking about other lies he has told. The pattern of intense. Woman39 was also administered the Millon Clinical Multiaxial Inventory ± Third Edition (MCMI-III) as another means to assess emotional adjustment. Mrs. ³I often wonder how valid his love is« I¶m like waiting for the ball to drop. In sum. Mrs. CAARS ± S:L). and an objective attentional task (The Test of Variable of Attention.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 14 Polysubstance Dependence. Based on observations and the client¶s reported history. The reported dates of her last use were used to determine remission specifiers. Based on this evaluation. Further supporting a diagnosis for Borderline Personality disorder was her endorsement of various paranoid ideation and the impulsivity characterized by her history of acting-out behaviors. However. Woman39 obtained a score of 41 on the Beck Depression Inventory.Fourth Edition (WMS-IV) her performance ranged from Low to Average. difficulties regulating her mood were evident in both her presentation and reported accounts. Woman39 was assessed to determine her current social-emotional functioning. The way she spoke about her husband and their marriage displayed frequent fluctuations from adoring him to angry statements that revealed fears of his abandonment or disloyalty. the elevations on the Borderline and Schizotypal Severe Personality Scales provided support for further investigating evidence for a personality disorder by means of additional clinical interviewing. Her self-image was similarly labile. on the Trail Making test and several other brief motor tasks she performed in the Average range. A personal strength was revealed during her performance with tasks that required verbal reasoning and knowledge of vocabulary. Woman39¶s history was an indicator of Borderline Personality Disorder. Mrs. Her performance on The Booklet Categories Test was in the Low Average range due to difficulties with both short-term memory and planning skills.

Woman39. Marital Discord Axis II: 301.70 304. DIAGNOSTIC IMPRESSION: Axis I: 295. Bipolar Type. However. On the Beck Anxiety Inventory (BAI) she obtained a score of 25. changes in sleeping. her reported compulsive behaviors do not appear to be time consuming or significantly interfering with her daily functioning. thus qualifying a diagnosis of Schizoaffective Disorder. or increased goal-directed behavior. Mrs." "fear of losing control´). Substance use can produce symptoms that resemble the mood. In light of the primarily cognitive nature of her anxiety complaints (i. A similar process was used to determine whether her symptoms should be attributed to her head injuries. Various expressions of anxiety were endorsed. An . it was decided that the presence of her psychotic symptoms described earlier (hallucinations and delusions) were sometimes concurrent with these Mixed Episodes and other times occurred in the absence of the mood symptoms. indicating moderate symptoms of anxiety. it is recommended that Mrs. were reported to be present in various combinations the majority of the time. the DSM-IV-TR specifies that the persistence of symptoms a month or more after the end of use are more likely to be better accounted for by a primary disorder. Although Mrs. evidence is lacking to substantiate a Disorder Due to a General Medical Condition. it is likely that these are accounted for by the paranoia and delusions within the Schizoaffective diagnosis. Bipolar Type Methamphetamine Dependence. However. However. anxiety. Woman39 did not meet the full criteria for this diagnosis.83 Axis III: Axis IV: Axis V: GAF= 50 (current) TREATMENT RECOMMENDATIONS:  Due to the accidents she suffered as well as her long-term drug usage. Early Full Remission Cannabis Dependence. Reviewing the timeline she created with the examiner.30 Schizoaffective Disorder. particularly methamphetamine.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 15 criteria of a Mixed Episode. as well as the instability experienced as a result of her Borderline Personality Disorder. including loss of pleasure. Woman39 endorsed her psychotic and mood symptoms as beginning during a period of time when she was using drugs. they have remained at a level of significant impairment much longer than would be expected by a Substance-Induced Disorder. Although a diagnosis of Obsessive-Compulsive Disorder was considered. and perceptual abnormalities described by Mrs.. can result in structural changes to the brain that can lead to psychotic symptoms.e. Ruling out a substance-induced etiology based on Mrs. and thus Mrs. the mood symptoms. Furthermore. research suggests that long-term use of substances. but in the absence of medical records. Early Partial Remission Borderline Personality Disorder Migraines Problems with the legal system. Woman39 consult a physician for a comprehensive evaluation of her physical condition. Woman39 should visit a medical doctor to have a complete physical examination conducted. Woman39¶s reported history was difficult. "fear of the worst happening.40 304.

D. This may bode well when surrounded by people supporting treatment. Woman39 may interpret therapist behaviors as indicative of rejection or look for signs of trust betrayal. Ph.  After her inpatient stay. Woman39 appears to strive to present herself in a positive manner. Date Licensed Psychologist/ Supervisor .A. identity. Woman39¶s strengths in vocabulary and verbal reasoning can be utilized with bibliotherapy techniques. This can be accomplished with a variety of cognitive-behavioral and/or dialectical-behavioral techniques.  Considering the way Mrs. Woman39 tends to relate to others. ____________________________________________ Lindsey Steding. A group setting is recommended to provide an opportunity for her to experience social support and learn interpersonal skills.PRIVILEGED AND CONFIDENTIAL   DO NOT DISCLOSE ž Woman39 16 evaluation will allow a doctor to assist her in developing steps she should take to improve her health. which suggests a need for a long duration of treatment. She identified family members who may not believe she is committed to quitting. Ph. and this treatment should focus on resolving long standing conflicts by altering the way she relates to others.  Mrs. and desires to be accepted by others. but benefits of treatment will likely fade quickly if she is reintegrated in a social network with individuals who condone her substance use. Individual psychotherapy is recommended. by encouraging her to read texts related to her treatment goals. B. Mrs. Date Licensed Psychologist/ Supervisor ___________________________________________ Paul Deal. Effective efforts to counter her fears of disappointment in therapy or lack of success in treatment will allow her to build confidence in herself and trust in others.  Mrs. She is experiencing a high level of functional impairment. Woman39¶s mental health problems is suggested by the recurring themes of instability in her relationships.D.  The complexity of Mrs. and mood. Woman39 should continue to participate in substance abuse treatment. Mrs. Date Psychological Trainee ___________________________________________ Steve Capps. It may be beneficial for positive role models or counselor to assist her with articulating boundaries to these people and with creating distance from past cues for substance use. those involved in her treatment plan should anticipate problems with compliance.