Case Study #1

Barbie
EDPS 660
Presented by: Amanda Medland & Lindsay Birchall

Agenda
Review assessments

Referral Question
Family and Background History
Relevant medical history
Behavioural Observations
Outcome scores
Critique

Questions?
Case Discussion

Timeline of Ax

6 yrs 3 mths

6 yrs 11 mths

11 yrs 11 mths

13 yrs

March 2009
June 2003

February 2004

August 2010

Timeline of Ax

6 yrs 3 mths

6 yrs 11 mths

11 yrs 11 mths

13 yrs

March 2009
June 2003

February 2004

August 2010

Ax #1 -Referral
6 yrs 3 mths
- June 2003
Referral:

Current level of
cognitive functioning
Areas of strength
and weakness

Ax#1 - Relevant History

Developmental delays as a result of an
undetermined genetic disorder
Currently enrolled in Kindergarten for the
second time

Ax #1 - Behaviour Observations
Willingly went with examiner
Keen interest in test materials
Friendly and pleasant
Enjoyed talking about her interests
(Barbies, movies and doll clothes)
Sighed & Rolled eyes - easy activities
Help immediately - lack of persistence
Did not want to guess
Responded well to tangible R+ (stickers and erasers)

Ax #1 - Results - WPPSI-R
FSIQ

Delayed

Performance (PIQ)

Borderline

Verbal (VIQ)

Delayed

Subtests - WPPSI-Performance IQ
Subtest

Range

Age Equiv.

Geometric Design

Delayed

4.5 yrs

Block Design

Delayed

3.75 yrs

Object Assembly

Average

6.75 yrs

Mazes

Borderline

4 yrs

Picture Completion

Delayed

3.5 yrs

Animal Pegs

Low Average

5 yrs

Subtests - WPPSI-Verbal IQ
Subtest

Range

Age Equiv.

Information

Borderline

4.5 yrs

Comprehension

Delayed

4 yrs

Arithmetic

Delayed

3.75 yrs

Vocabulary

Delayed

3 yrs

Similarities

Delayed

4 yrs

Sentences

Delayed

3.25 yrs

Achievement
Task

Outcome

Foam Letters

Identified all capital letters

Lower case - difficulties with visual processing
(mislabeled b, d, p, q & u, n)

Foam
Numbers 120

Correctly identified 1-9

10 forty zero
10+ forty something

Summary and Conclusions of Ax #1

Cognitive functioning - Delayed range
Strengths
Carry on a conversation
Academic Achievement
Early readiness - literacy
Tasks involving manipulatives,
pictures or visual prompts

Weaknesses
Verbal reasoning
Problem solving
Language development
Categorizing and Comparing
Question answering - lacks
complete sentences

Relevant Recommendations

Reassess in 1 - 2 years
Access SLP consultation
Visual and Tactile aids
Repetition to learn new
concepts

Ax #1 - Critique
Background information
No family history
No medical history
No School history
No Percentiles (subtests, PIQ, VIQ, FSIQ)
Age equivalents presented
Insufficient Academic Achievement Ax and info. (i.e. no
school information)

Timeline of Ax

6 yrs 3 mths

6 yrs 11 mths

11 yrs 11 mths

13 yrs

March 2009
June 2003

February 2004

August 2010

Ax #2 - Referral
Report states 9 years old in background
Report dated Feb 2004 - 6 years 11 mths
Referral:

To determine cognitive functioning

Assist with program planning

How old is Barbie?

6 years old?
Report date Feb 2004 (6 yrs
11 mths)
2001-2002-K
2002-2003 - K 2nd time
Sept 2003 Barbie entered
the Grade 1 program
Psych did WPPSI
Summary states she is 6 yrs

9 years old?
Barbie is a 9 year old
who lives with her mother
and older brother
Barbie is currently in her
third year at ____ school

Ax #2 Relevant History
Family:

Barbie lives with her mother and older brother

Dad has no involvement with family
Barbie & brother - diagnosed with an X-linked recessive disorder associated cognitive, language, social skill and motor delays

Services Received:

Genetics Dept. ACH

CHADS (Medicine Hat)
SLP - Early Intervention Program (2000-01)
REACH (OT, PT, Psychology)
Vision & Hearing - no concerns

Ax #2 - Relevant History
Education:

Has an educational assistant (1:1 25% of her time)

Modified program
Pleasant, friendly, can be shy
Loves to color, draw and print
Some defiance (Math) - refuse to work
Prefers to play with brother - showing increased peer interaction social defectis ongoing

Ax #2 - Relevant History
Previous Assessments:
On the WPPSI-R, Barbie was found to score in the mild
range at the 1st percentile (FSIQ =66). Barbie obtained a
score at the 1st percentile on the Verbal Scale (VIQ=66) and
at the 3rd percentile on the Performance Scale (PIQ=71).
Ax in April, 2003, concerns were expressed regarding the
accuracy of the results and a reassessment was requested

Ax #2 - Behavioural Observations

Friendly & Pleasant-Comfortable with examiner

Good conversational skills - interest in communicating with examiner
Cooperative during testing
Easily Distracted (active, difficulty sitting in chair) Very active
Difficulty Listening and following directions
Attention to task - inconsistent
Problem solving - impulsive, trial & error, disorganized, did not attend to visual
cues, ineffective strategies
Frequent self-talk - good persistence
Sequencing-confusion, planning difficulties, skip items, did not evaluate work for
errors, overlook important detail
Limited Comprehension
Responded well to testing the limits - corrected errors when cued
Verbal items - guessing - I dont know

Ax #2 - Results - WPPSI-III
FSIQ

77

6th %ile

Borderline

Performance
(VIQ)

75

5th %ile

Low Average

4 yrs 4 m

Verbal (VIQ)

80

9th %ile

Borderline

4 yrs 10 m

Processing
Speed (PSQ)

91 27th %ile

Average

Subtests - WPPSI-Performance IQ
Subtest

% ile

Age Equiv.

Block Design

2nd

3 yrs 10 m

Object Assembly

2nd

4 yrs 4 m

Picture
Completion

1st

4 yrs 1 m

Picture Concepts

25th

5 yrs 10 m

Matrix Reasoning

Subtests - WPPSI-III-Verbal IQ
Subtest

%ile

Information
Receptive Vocabulary
Vocabulary

16th

Similarities

25th

Word Reasoning
Comprehension
Picture Naming

WPPSI-III-Processing Speed
Subtest

%ile

Range

Symbol
Search

25th

5 yrs 10 m

Coding

37th

6 yrs 6 m

Ax #2 Results - Scales of Independent

Behaviour-Revised (SIB-R)
Included in the list of
Test Administered
No results reported in
any subsection of the
report

Ax #2 - Summary and Conclusions

Difficulties planning and organizing
Often more active, distractible, responded impulsively
Difficulties with analysis and attention to detail noted
on performance tasks
Better performance on rote tasks
Strengths - verbal abstract reasoning (Sim) and word
knowledge (Vocab)
Difficulty with social judgment (Comp)

Ax #2 - Critique
Discrepancy in Age info - 6 or 9?
Recency Effects

WPPSI testing 8 months apart - psychologist knew - reported

previous scores
Psych reports FSIQ at the 6th percentile (77)
Verbal abstract reasoning - strength Ax #2 - Language
development - weakness Ax #1

Background - Only parent sourced (mother)

No academic testing

Timeline of Ax

6 yrs 3 mths

6 yrs 11 mths

11 yrs 11 mths

13 yrs

March 2009
June 2003

February 2004

August 2010

Ax #3 -Referral
Report Dated: March 2009, 11yrs 11mo.
Referral:

to determine her mental abilities

provide suggestions for programing

Ax#3 - Relevant History

Family:
Barbie lives with her mother, step father, older brother and younger
brother
Barbie & brother - diagnosed with an X-linked developmental
disability of cerebral creatine deficiency

Ax #3 - Relevant History
Education:
Grade 4-6 at new school on a modified program
In school has been making progress but behaves immaturely and is
easily distracted
Engages in whining and crying when does not want to follow
instruction, demands are placed, new or unfamiliar work
Prefers to colour pictures which has been used as a motivator
gets along with peers and has made friends.

Ax #3 - Relevant History
Previous Assessments:
Assessment in 2004 with WPPSI
mental abilities fell within borderline
FSIQ 77, 6th percentile

Ax #3 - Behavioural Observations

Willing, comfortable and at ease, friendly

Low expressive language, speak in brief phrases
Inconsistent eye contact but appeared to be listening
Likes school, art particularly, and hockey
Needed instructions repeated, misinterpreted directions or
questions
Learned best from visuals
Impulsive responding
Trial and Error problem solving, easily discouraged
Gave up easily and lacked confidence
Increase in difficult lead to avoidance behaviour and
discouragement

Ax #3 - Results - WISC IV
FSIQ

Mild Mental Disability

55 (1st percentile)

VCI

Mild Mental Disability

63 (1st percentile)

PSI

70 (2nd percentile)

WMI

74 (4th percentile)

PRI

50 (less than 1st

percentile)

Ax #3 - Results - Vineland-II
Adaptive Behaviour
Composite

Low range 68 (4th

percentile)

Daily Living Skills

Mild 62 (1st
percentile)

Communication

76 (5th percentile)

Socialization

74 (4th percentile)

Summary of AX #3
Cognitive functioning in Mild range of
mental disability (FSIQ = 55)
better performance on memory and
processing tasks
significant difference between VCI (63) and
PRI (50)
Low (68) range with Vineland-II
consistent with mild mental disability

Relevant Recommendations
Continue to make program modifications
Guidance with self confidence and
independence
Help develop visual-spatial skills
Encourage her to attend to the environment
Focus on basic teachings of math concepts

Critique of Ax 3
95% confidence interval for WISC results
listed
ability to reason using her verbal skills was
significantly better than her ability to
reason using nonverbal. VCI (63)- 1st
percentile, PRI (50) - 1st percentile
previous test results indicate struggles in
math. No academic testing.

Timeline of Ax

6 yrs 3 mths

6 yrs 11 mths

11 yrs 11 mths

13 yrs

March 2009
June 2003

February 2004

August 2010

Ax #4 -Referral
follow-up psychological assessment after 1
year treatment with L-Arginine.

Ax #4 - Relevant History
13 year old girl
Lives with other brother (15) and mother
Immediately prior assessment moved. Were living with
moms partner and 2 step siblings (11 & 12). Stressful
move
Family history of cerebral creatine deficiency
secondary to a creatine transporter defect. Description
of CTD.
Referral to June 15, 2009 report for history
Starting Grade 8 at a new school

Ax #4 - Behavioural Observations
pleasant, cooperative, engaged in
conversation
brief responses
required questions to be repeated and
required prompting as the assessment went
on
missed critical details, showed a hasty
approach to tasks

Ax #4 - Results - WISC IV
FSIQ

Not listed - was not best

description of abilities

VCI

Mild Mental Disability

(1st percentile)

Approximate 7 years

PSI

7th percentile

6 year and yr 6 mo

WMI

Below the 1st percentile

Approximate 6 yr

PRI

Below the 0.1st

percentile

6 years and below

Ax. #4 Results
Expressive One-Word Picture Vocabulary
9 yr 3 mo age level (10th percentile)

Peabody Picture Vocabulary Test (4th Ed.)

9 yr 6 mo age level (8th percentile)

Ax. #4 Results
Beery Developmental Test of Visual
Perception, Visual Motor Integration and
Motor Coordination
VP - 6 year 6 month age level (2nd percentile)
VMI - 7 year 1 month age level (3rd percentile)
MC - 8 year age level (7th percentile)

Ax. #4 Results
WRAML- 2nd Ed.

consistent with WMI (1st percentile)

recognition memory (13th percentile)

Behavior Rating Inventory of Executive Functions

Metacognitive Abilities - 92nd percentile
significant difficulties
Behavioural Regulations - 93rd percentile
significant

Ax. #4 Results
Test of Everyday Attention for Children

Selective Attention - 10 yr 6 mo (20th percentile)

Other domains (below 5th percentile)

Conners Continuous Performance Test - 2

slower and contained more errors, clinically
significant problem with attention

Ax. #4 Results
BASC - 2

significant levels of concern for hyperactivity,

impulsivity and attention problems, consistent with
DSM-IV diagnosis of ADHD-I

Social Communication Questionnaire

consistent, do not suggest concerns

Ax. #4 Results
ABAS-II

Conceptual and Practical Daily Living Skills:

Extremely Low (below 3rd percentile)
Social Skills: Borderline Range (5th percentile)

Ax. #4 Summary
Functioning level continues to be in the
range of Mild Cognitive Disability.
Non-verbal reasoning in realm of Moderate
Cognitive Disability
Symptoms consistent with ADHD-I
Axis IV - educational problems

Ax. 4 Recommendations
(Code 51) Mild - tailored programming,
individualized curriculum
Special education strategies in Jan 2009 &
June 15, 2009 reports
Memory aid strategies
Attention & focus strategies
Social Skills development

Ax. #4 Critique

Just over 1 year between assessments

a LOT of assessment measures!
Most assessments: percentiles and age equivalents
mentions June 15, 2009 ax, then claims to compare
results of #4 with results from May 2009.
WRAML, TEA-CH & Conners results compared to last
assessment ??
BASC only parent - ADHD in 1 setting?
No academic achievement - how is her academic
abilities actually affected?

Missing Ax????
- ACH Baseline 16 months prior 2010 ax.
- September 2008

Your thoughts?