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Address Any Town USA
Reason for Referral:
Jane Doe, a nine-year-old Caucasian female in fourth grade, was brought for testing by her parents, Tom and Kate Doe. The parents report uneven performance in school. Jane seems to know something one day and then perform it poorly on the next. They report that Jane struggled to learn both printing and cursive and that she still makes occasional reversals when writing numbers. She is struggling to learn multiplication and division facts, which is making problems for her in arithmetic. Parents also report that the classroom teacher, Mrs. Brown, also has concerns. Parents state that Mrs. Brown says that Jane is often off-task and that Jane requires what the teacher thinks is more help than typical for children her age to get on task and stay on task. Jane often fails to bring homework done or forgets to turn it in and doesn't always know what the homework assignments are.
The father reports that he struggled in school. He often understood the work but got low grades because he would fail to do his homework, or do it but fail to turn it in. He sees Kate making the same mistakes. The father struggled to graduate from high school because of his difficulties and does not want see his daughter have the school problems he had.
The child's medical history is unremarkable according to the parents. She has had occasional colds but no serious illnesses but sometimes has difficulty falling asleep at night. They report that at home she needs frequent reminders to get even the simplest things done and has to be reminded to do such basic things as brush her teeth in the morning. They say she is completely overwhelmed if asked to tidy up her room and are baffled by these things because her six-year-old brother does better in this regard than she does. A nursing evaluation showed height and weight in proportion to each other and normal for Jane's age. She had no apparent hearing or vision problems. A hearing screening done in third grade also showed no nearing problems.
During the parent interview, parents reported that Kate has one sibling, a younger brother who is six years old. Parents report that the two children usually get along well. The father is a driver for UPS. The mother works part-time as a teacher aid in a different elementary school than the one Jane attends, which allows her to be home when her children get home from school. A report from Carol Black, MSW, reports no indications of significant difficulties with the family structure or dynamics. Ms. Black saw no indications that Jane's difficulties might stem from difficulties within the home environment.
The report from Jane's pediatrician notes no significant concerns, and all vaccinations are up-to-date. An occupational screening suggested difficulty with fine-motor tasks.
This psychologist observed Jane in the classroom on two occasions, August 26 and August 31. School had been in session for two weeks and a classroom routine had been established.
Aug. 26, 9AM -- 9:30 AM
Group reading behavior
Jane was judged to be off-task about 40% of the time and frequently blurted out answers before the teacher had finished asking a question and without raising her hand as was expected in that setting.
Typically when Jane was off-task, the teacher was explaining something or asking probing questions, such as why a character might have acted as he did.
No consequences were applied during this period. Typically Jane returned to task when the task returned to reading.
Twice when Jane was off-task, the teacher called on Jane. Each time she had to repeat the question for her, but both times Jane was able to answer the question.
Aug. 31, 1PM -- 1:30 PM
Jane was judged to be off-task about 40% of the time antecedent
There was no pattern observable for when Jane was on and off-task. The work was multiplying numbers by two digits. Sometimes when Jane's attention wandered it was in the middle of a problem. When she got back to work, she would have to start over. She also had to refer to a multiplication facts chart frequently consequence
No consequences were applied during this period.
The teacher periodically walked around checking students' work. If Jane was off-task, seeing the teacher coming got her back on task.
An interview with the teacher, Mrs. Green, revealed that she believes that Jane is capable of doing fourth grade work but that her effort is inconsistent. She has tried requiring Jane to stay in at recess to finish incomplete work, but that this made Jane quite sad. Mrs. Green decided that Jane needed the opportunity to socialize appropriately with her classmates and that maybe she would talk less in class, so she has stopped this practice and instead assigned it as homework, but that Jane often forgets to take it home or bring it back. She likes Jane and does not think Jane is doing this deliberately as Jane seems quite bothered when she realizes she has failed to turn work in. She reports that Jane is stronger in reading than math and that she struggles with written expression, partly because of her handwriting and partly because she has trouble getting her ideas down on paper.
Jane was tested using the WISC-R and The Woodcock Johnson Educational Battery. The results are given below:
10 picture completion
14 picture arrangement
7 block design
14 object assembly
digit span 9
full scale IQ: 103 verbal IQ: 117 performance IQ 93
The behavioral observations suggested that during reading, Jane prefers to just read rather than participated in extended instruction. Her reading skills are strong, and it may be somewhat boring for her to pay attention while the teacher reviews information Jane has already mastered, but Jane also failed to pay attention to discussions that should have increased her understanding and enjoyment of what she was reading. During math there was no observable factors that caused her to become distracted. Her attention seemed to move away from the math assignment with great frequency. Her work appeared to be somewhat impulsive, something the teacher says she sees in all subjects, making frequent erasures. The teacher scored this paper before the observer left. Jane completed about half the assignment with 73% accuracy.
Test results shows a child with an overall average IQ but with marked strengths and weaknesses. When numbers were not involved she scored strongly on the verbal subtests of the WISC-R. Her Arithmetic score of 7 contrasts sharply with the 14's in similarities, vocabulary and comprehension. The Digit Span of 9 was satisfactory. However, she did markedly better when numbers were to be repeated just as heard. When she had to reverse them, she had great difficulty. On the performance subtests, Jane was observed to work in a random manner. On Picture Arrangement she put the pieces down quite rapidly, without putting any observable effort into the task. Her performance on Object Assembly was similar. She rapidly put the pieces down. She rearranged them without any real plan observable, and the result was often unrecognizable. She would shrug her shoulders and say "I'm done with that one," and prompts to work a little longer did not result in a better result. Throughout the testing she fidgeted in her seat and asked several times when she would be done.
On the Woodcock-Johnson, she scored higher on subtests where an immediate response was an advantage, such as word recognition.…[continue]
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