Psychodiagnostics Psychological Assessment Report

PSYCHOLOGICAL ASSESSMENT REPORT 2

Personalia
Name Erika
Gender Female
Age 14 years and 2 months old
Family Mother Gera, 45 years old, housewife (former accountant)
Father Henry 50 years old, stockbroker
School History Currently in High School grade 2 (HAVO), 3 months long absence from
school, dropout history due to medically unexplained complaints, follows
classes online due to short attention span and tiredness, misunderstood and
rejected by her peers, lacks social contact because of her school absences,
first symptoms in 4th grade (age 8), starting with stomachaches, then
paralysis and fatigue.
Setting Psychological Practice Boyer & De Jong
Validity of Report 2 years

Reason for referral

The primary reason for referral reported by the family physician is the recognition of physical
symptoms that are not medically explainable and might have an underlying psychological cause.
Erika suffers from physical symptoms, including stomachaches, leg paralysis, and fatigue, which
hinder her from attending school for longer periods of time. Given that when her symptoms pass
and she goes back to school they return even worse, her mother leaves it up to her to decide when
she feels well enough to go back to class. Despite seeing numerous specialists, no medical
explanation has been found, which is why the general practitioner deems her to a psychologist to
investigate the psychological reasons behind her physical aches. Her physical impairment is causing
an impact on her academic achievements due to missing classes and being too tired to pay attention
for more than an hour in class, or through webcam. She also stopped socializing in and outside of
class and has lost contact with her old friends from school. In addition, her staying at home prevents
her mother from going to work, which has caused her to lose her previous job by taking too many
days off to take care of her, consequently making her feel worthless and unwanted. Erika’s physical
complaints have affected too many other areas of her, and her family’s lives, including her parents’
relationship struggles because of their different viewpoints of Erika’s illness. While her mother is
willing to stay at home and take care of Erika, her father thinks she should go to school anyway and
be tougher.
Her mother just wants her daughter to feel better, and additionally to cut back all the consequences
previously mentioned that her illness has had on herself and her family, besides the obvious physical
pain, she comes to the psychologist’s clinic to get a second opinion. Even though her IQ is not
questioned or related to her physical complaints, her struggle to maintain a longer attention span
could be related to it somehow and is checked just to discard low IQ being the problem.

Assessment

Hypothesis 1: Erika is expected to have an average IQ score.

Instrument: The Wechsler Intelligence Scale for Children (WISC) is used primarily by
psychologists and educators to measure the Intelligence Quotient (IQ) of children aged 6-16. This
test has been developed since 1949 and since 2014, the fifth edition is in force (WISC-V). The WISC-
V consists of 5 subscales. Verbal comprehension measures verbal reasoning and general

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 knowledge and understanding of vocabulary. Visuospatial skills are the ability to understand and
integrate visual-spatial information. Fluid reasoning is, broadly, logical thinking and encapsulates
skills from problem-solving to abstract thinking. Working memory is the ability to use short-term
information to solve tasks. Lastly, processing speed is the time one takes to process visual
information. The wide variety of tested components contributes to the WISC being a more
accurate assessor of intelligence, rather than traditional definitions scientists used to describe
intelligence. (Wechsler, 2014).
Expectation: The primary reason for referral doesn’t target the client’s IQ directly, given that her
apparent physical and attention disorders do not relate to her intelligence. Therefore, we expect
an average IQ score, ranging from 84 to 100. If anything, her school absence and short attention
span could make her score lower on the test due to potentially impaired cognitive abilities, for
example, working memory, which could reflect a below-average IQ.
Result: As expected, Erika scores an average IQ score of 92, which lies within the 95%
interval. Even though all her subtests’ scores are average, there’s a notorious difference between
them. While she scores 8-12 in verbal comprehension, visuospatial skills, and fluid reasoning, for
working memory and processing speed it ranges only 5-7.
Conclusion: These results concur with the theory that her possible attention challenges interfere
with some cognitive abilities, in this case, working memory and processing speed. Nevertheless,
not to a clinical or subclinical extent, where it could suppose a problem for her academic
achievements.

Hypothesis 2: Erika is expected to have subclinical and clinical results in physical, social, and
attention disorders, in addition to possible anxious and depressive symptoms.
Instrument: The Child Behavior Checklist (CBCL) is a diagnostic tool to quantify problematic
behaviors and skills of children and adolescents in a standardized manner. It is divided into 2 age
ranges, namely 1,5-5 and 6-18 years old. (Achenbach, 1999).
Expectation: Given the primary reason for Erika’s referral, we expect clinical results for at least
physical symptoms. In addition, her fatigue makes it hard for her to pay attention for long, which is
why attention problems may arise as well. Social problems may be taken into consideration as well,
due to her loss of contact and socialization with her friends from school and ultimately being
isolated at home, only having a relationship with her parents. All these problems could easily make
Erika feel depressed and hopeless for not finding a medically plausible reason for her symptoms.
Her social difficulties may also be related to anxiety or stress, so Erika’s results in anxiety,
withdrawal, and depression are most likely clinical too.
Result: Erika’s Total Problem Score is 51, supposing a normal or average score. However, as
expected, her T-scores are clinical for physical problems (86), withdrawn/depressed (79), social
problems (79), and stress problems (80), and subclinical for anxious/depressed (66) and attention
problems (67). She scores 69 for internalizing behavior (border area) but 50 (normal) for
externalizing behavior. On the Diagnostic and Statistical Manual for Mental Disorders (DSM) scale,
she is clinical for Physical Problems (86) and subclinical for Depressive Problems (68), Anxiety
Problems (69) and Attention Deficit/ Hyperactivity Problems (67). She scores normally for slow
thinking pace (50) and thinking problems (50).
Conclusion: Erika’s test scores go along with the hypothesis, since according to the DSM scales,
she probably suffers from Depression, Anxiety, and Attention Deficit (Hyperactivity) Disorder
(ADHD or ADD). In addition to her WISC-V result, given that both of her thinking scores, more
related to her IQ, are normal, the theory of a low IQ score remains discarded. The reason for her
lack of attention in class is most likely explained by her possible ADHD. Her social problems, caused
by her school absence, are related to anxiety, and her hopelessness because of a lack of a physical
diagnosis results in depression and withdrawal. However, given that the CBCL is not a diagnostic
tool, she should be properly assessed and diagnosed by a professional.

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Conclusions and advice (max ½ A4)

The reason for referral was Erika’s physical symptoms with no medical explanation, to assess a
possible psychological cause and make her feel better. Given Erika’s scores, she should get further
tested for DSM diagnoses of Physical Problems, Depression, Anxiety, and ADHD, given that CBCL
does not suffice to diagnose, and more tests and assessments should be held. It is not sure whether
the physical symptoms or the mental distress came first, but they seem to feed each other. There is
a possibility that in the 4 th grade when Erika started to experience the physical symptoms, she
developed school refusal, and her symptoms were psychological indications of her anxiety. Given
that her mom was so understanding and caring, there is also a possibility that her symptoms worsen
whenever she goes back to school because she became dependent on her and also developed
separation anxiety. These are just theories based on her results, which should be looked into deeper.
The first recommendation would be to get treatment to correct her attention problems. Her
difficulty in catching up on her schoolwork is her fatigue, but if she was able to follow online classes
with a longer attention span, this could be solved. Once her schoolwork was not so tiring anymore,
because she could concentrate better, she would feel less stress and fatigue and could maybe try
going to school more regularly. If she got treatment for her anxiety as well, she would have less
difficulty in socializing with her peers, which could simultaneously help her withdrawn and
depressed symptoms. If her mental health slowly recovers, her physical health will most likely
follow. If her dad understood that what Erika needs is more comprehension and empathy toward
her physical struggles, maybe he and his wife would fight less. However, the mother also needs to
understand that she cannot hover over her daughter too much, to avoid possible separation anxiety,
and try to care for her daughter in a less self-consuming way than losing job opportunities
overstaying at home with her. Erika needs to know that the mother is not at her 24/7 disposition
because that will make it more likely for psychosomatic symptoms to appear because it is easier and
more comfortable to stay home than going to school.

Reference List

Achenbach, T. M. (1999). The Child Behavior Checklist and related instruments. In M. E. Maruish
(Ed.), The use of psychological testing for treatment planning and outcomes assessment (pp.
429–466). Lawrence Erlbaum Associates Publishers.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
ed.). https://doi.org/10.1176/appi.books.9780890425596

Wechsler, D. (2014). Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V). Pearson.