THE PSYCHOLOGICAL REPORT

The case of Anna S.

DATE OF BIRTH: 21/05/99
GENDER: Female
DATES OF ASSESSMENT: July 17, 21, 22, 24, 2011
DATE OF REPORT: August 4, 2011
Anna is a 12-year, bilingual, Hispanic female who is currently residing in a foster home due to
parental abuse, neglect, and abandonment. Anna presents with irritability, anxiety, and poor
peer relations. Additionally, Annas foster parents indicate that Anna is having problems in
school because of interpersonal difficulties with her classmates and problems adjusting to
their home (e.g., seeks constant attention, argues with foster siblings). Annas therapist, Mary
Smith, LCSW, requested this psychological evaluation to assist in assessing her current level
of cognitive and emotional functioning, clarify her diagnosis, identify her strengths, and
provide suggestions that may be useful in helping her to adjust to school.
Evaluation Procedures/Sources of Information
Clinical interview with Anna.
Review of social service/family court documents.
Review of current case file.
Consultation with Annas social worker, therapist, teacher, and foster parents.
Wechsler Intelligence Scale for Children-III (WISC-III ).
Wechsler Individual Achievement TestScreener (WIAT).
Trauma Symptom Checklist for Children (TSCC).
Personality Inventory for Youth (PIY).
Childrens Apperceptive Test.
Draw-a-House-Tree-Person.
Child Self-Report and Projective Inventory (Color How You Feel, Critical Items,
Color How Others Make You Feel, Perceived Competence, Draw a Child in the
Rain, Sentence Completion, Kinetic Family Drawing).
During the initial testing session, Anna presented as a pleasant and engaging youth
who was casually dressed and appropriately groomed. She appeared to be of average
size and weight for her gender and chronological age. She willingly accompanied this
examiner and appeared eager for individualized attention. Anna remained cooperative,
maintained good eye contact, and readily responded to questions with descriptive
details. She was clearly oriented to person, place, time, and situation. Her mood was
somewhat depressed and her affect was generally constricted. She indicated that the
reason for this evaluation is to see how Im doing. Anna demonstrated fair insight regarding
her current situation, identifying her mothers abandonment of her as the reason
for her current foster care placement and her associated feelings of distress. Her
responses to hypothetical situations requiring decision-making skills suggest somewhat
compromised judgment. Thought content was appropriate to the situation and
thought processes were lucid, concrete, and coherent. There was no evidence of perceptual
disturbances, flight of ideas, circumstantiality, or loose associations. Cognitive
abilities appeared to be within the average range. Although not formally assessed,
her conversational English skills were apparently proficient. When responding to direct
questions, Anna typically responded in grammatically correct English. At times,
she responded in Spanish but quickly restated her response in English, switching between
both languages with apparent ease. During subsequent testing sessions, Annas
test-taking behaviors continued to be cooperative. Her approach to each task was
marked by diligence, good effort, eagerness to please the examiner, and heightened
performance anxiety (e.g., Am I doing a good job?). Although Anna exhibited good
attention and concentration with the majority of testing activities, she also worked

rapidly when given written tasks. Anna reported that she is good at writing fast and
stated that she wanted this examiner to see how quickly she can work.
Even though Anna appeared to give her best efforts to the tasks presented to her, she
is a bilingual youth whose first language is Spanish. Given that the tests administered
were not specifically normed on this population, the assessment results should be
treated with caution. In addition, she may have somewhat overreported her current
level of emotional difficulties.
Information obtained from family court documents, consultation with Annas therapist,
her social worker, her current foster parents, and interview with Anna indicates
that Anna has experienced multiple disruptions in her home life events throughout her
childhood. These events include physical/emotional abuse, neglect, and abandonment.
Anna lived with her biological mother, Lupe S., until she was approximately 6 years
old. At that time, Anna and Ms. S. moved in with Juan F., whom Anna refers to as her
stepfather. Anna continued to reside primarily with her mother, stepfather, and their
two children, Roberto and Juanita, until March 2011.
After moving in with her stepfather, Anna reported that her mother repeatedly
stated, I wish you [Anna] were never born, and that her parents frequently yelled at
her, hit her, and did not provide adequate clothing or care for her. Furthermore, Anna
reported that she and her mother frequently left her stepfathers home to live with other
relatives or in homeless shelters because of her stepfathers mean behaviors but that
her mother always returned to him. Family court documents indicate that there were
five substantiated reports of physical/emotional abuse and neglect of Anna and/or her
siblings by both her mother and stepfather. Annas parents reportedly did not comply
with family supervision plans as mandated by Child Protective Services. Additionally,
Anna explained that over the past several years her mother exhibited weird behaviors
such as rummaging through garbage cans, forgetting to wash clothes, and most pertinent
to the child, witnessing her mothers attempt to choke herself. Anna also reported that
her mother has been hospitalized at least 4 to 5 times for attempting to kill herself. In
the past year, Anna was temporarily placed at the local childrens shelter after running
away from her home and when her stepfather attempted to abandon her at this facility.
Subsequently, Anna resided with a maternal aunt for an undetermined amount of time
before returning to her mothers care in the spring of this year.
During the spring of 2011, Anna and Ms. S. resided intermittently with relatives,
Ms. S.s employer, and then in a homeless shelter. Ms. S. then requested that acquaintances
from church care for Anna. The acquaintances agreed to this on a temporary
basis. However, they reported that Anna began having significant problems at school
(e.g., suspended for fighting). Furthermore, these caretakers stated that Anna appeared
to have significant emotional problems and were, therefore, unwilling to care for her
any longer. They contacted Social Services and explained Annas situation, clarifying
that her mother was not available to care for her. As a result, Anna has been a ward of
the state since May 2011, and has been placed in the foster home of Mr. and Mrs. G.
Annas social worker referred Anna for mental health services given her history of
neglect and abuse, physical aggression in school, and her excessive irritability. On
placement in her current foster home, Anna initially appeared very sad and had difficulties
interacting with her foster siblings. Annas foster parents indicated that Anna
has not exhibited overt behavioral problems but does appear to be immature (e.g., excessive
teasing, difficulty sharing), needs a considerable amount of individual attention,
and displays excessive moodiness.
Cognitive Functioning. On the WISC-III, Anna achieved a Full Scale IQ of 85; Verbal
IQ of 87; and Performance IQ of 86. Overall, this places her in the Low Average range or
16th percentile ( lower 16% of the population) when compared to her age-related peers.

A close examination of Annas relative strengths indicates relatively intact

visualspatial/mechanical skills (Perceptual Organization Index = 91) as well as good verbal
expression/conceptualization skills associated with school-related learning (Verbal
Comprehension Index = 89). She is likely to do particularly well in tasks requiring her
to understand social norms and follow the meaning of nonverbal social situations. This
was consistent with this examiners observations of Anna during the interview in
which she responded appropriately and answered all questions clearly.
In contrast to these strengths, Annas responses to tasks that required her to respond
quickly and accurately to nonverbal information were quite low (Processing
Speed = 67). This suggests that even though she can understand what might be expected
of her in school, she will do poorly when she is required to perform under
time constraints. In these conditions, she would be likely to sacrifice speed for accuracy.
In addition, she may have a difficult time concentrating, especially when dealing
with numerical information presented to her verbally (e.g., recalling phone
numbers, making arithmetical calculations).
In comparison to her low average global cognitive potential (WISC-III FSIQ = 85),
Annas composite academic achievement skills (WIAT Screener; Total SS = 93) is
within the average range. Annas scores on the Spelling (SS = 102) and Basic Reading
(SS = 98) subtests suggest that these are relative strengths while her Mathematical
Reasoning (SS = 81) skills are considerably weaker. However, Annas solid average
performance in Spelling and Basic Reading, which actually exceed her global cognitive
potential, suggests that Annas scores on the WISC-III may be an underestimate of her
true cognitive potential. This is likely because of her bilingualism and the absence of
normative data pertaining to this specific populations performance on standardized
intellectual assessment measures. Her lower scores on the IQ tests are also likely to result
from her difficulties working under time constraints.
Emotional Functioning. Annas reports of multiple and atypically severe intrapersonal
discomfort is associated with her traumatic and disruptive childhood experiences. She
is experiencing heightened levels of internal anxiety, depression, and uncertainty as
well as low self-esteem. For example, she frequently provided self-deprecating remarks
about her drawings (e.g., its ugly), and the colors she used to represent her feelings
depicted her emotional states as overwhelmingly sad and worried. She seems to harbor
feelings of anger but has difficulty expressing these appropriately and, thus, may have a
propensity to act out. However, it also appears that she attempts to mask her internal
distress by presenting herself as outwardly happy and content. Furthermore, Anna depicts
her life experiences as extremely stressful and has significant difficulty coping
with such experiences. Her perceptions of her family and others indicate significant
ambivalence, isolation, and alienation. For example, when prompted to draw a picture
of her family, Anna did not include herself and depicted all family members enjoying
activities independent of each other. However, she also incorporated symbols of warmth
and closeness in her house drawings. Thus, Anna appears to hold conflictual feelings
about her family while she also hopes for safety and support.
In response to questions eliciting Annas experience of critical life events, she
identified three specific traumatic experiences that appear to be associated with her current
worries, fears, nightmares, and sadness. Anna reported that when she was about 8
years old, a homeless man attempted to take her while she was walking by herself in
the evening but that she never shared this experience with her parents because she felt
that it would not be important to them. Additionally, Anna explained that when she was
about 10 years old, she witnessed her mother attempting to choke herself and subsequently
worries that her mother will kill herself. Most recently, Anna reported that her
mother left her with people that she did not know and has been feeling very sad and
worried since that time. Anna indicated that she has difficulty staying asleep throughout
the night as she has bad dreams about these scary events. She also admitted to
having considerable difficulty concentrating at school because of intrusive thoughts

about her past experiences and worries about her future.

Annas interpretation of story cards was representative of overwhelmingly negative
outcomes for the child figure. Themes included betrayal by mother, excessive worries
and fears, abandonment and rejection by others, lack of caring and attention from
mother, foreshortened future, harm inflicted by others, and inability to obtain wishes
and desires such as reunification with family. Thus, it appears that Anna experiences
her world as generally unsafe, unpredictable, and lacking emotional warmth. However,
in one story, Anna projected a positive resolution for the child, in which the parents
comforted and cared for the child when she needed them. This suggests that Anna
has a strong desire to be nurtured and accepted by caregivers.
In spite of these traumatic and stressful life experiences, Anna is able to identify
positive self-attributes related to her academic skills (e.g., spelling, handwriting), personal
appearance, and athleticism. It appears that these strengths and perceived competencies
bolster Annas self-esteem and promote her ability to function on a
day-to-day basis and hope for positive changes in her life.
Interpersonal Functioning. Anna typically responds to people with the hopes of
obtaining attention and acceptance. This has been evident in her interactions with adults,
which have been characterized by a strong eagerness to please, requests for individual
attention, and gift-giving. However, Annas negative experiences with her parents have
likely bolstered her defenses against continued rejection. Therefore, Anna may respond
by rejecting others first. This has been exemplified in her history of aggressive
peer interactions, which have led to persistent teasing and fighting at school as well as
her own reports of not having any true friends. While such behaviors have not been
problematic at her current placement, Annas foster parents have reported that her social
interactions with peers have been immature (e.g., whining, teasing, difficulty
sharing). Yet, when provided with support and nurturing, Anna has become increasingly
able to verbalize her difficulties and share painful experiences with adults (e.g.,
therapist, foster mother).
Behavioral Functioning. Assessment of Annas overt behavior did not reveal high
levels of acting out (e.g., aggression, delinquency). In contrast, she is likely to internalize
her distress by becoming anxious and depressed. Annas foster mother, Mrs. G., described
Anna as initially very argumentative and oppositional but said that these behaviors
subsided within the first several weeks in the new home. Overall, Mrs. G.s
ratings of Annas current functioning suggest that Anna is not displaying significant
behavioral concerns but that she does demonstrate symptoms of emotional distress at
this time. It appears that Anna is responding positively to the structure, consistency,
and nurturing provided by her foster parents although concerns associated with Annas
internal turmoil are evident.
Diagnostic impressions
AXIS I 309.81 Posttraumatic Stress Disorder
995.5 Neglect /Physical Abuse of Child
AXIS II v71.09 No Diagnosis on AXIS II
AXIS III None known/reported
AXIS IV Abandonment by mother
AXIS V Current GAF: 60
Highest GAF past year: 50
Findings from this psychological evaluation indicate that: (a) Annas academic skills in
reading and spelling exceed her measured cognitive abilities, (b) she does not currently
exhibit overt behavioral difficulties although peer/adult interactions have been strained,
and (c) she is demonstrating and experiencing significant signs of emotional distress.
While Annas global cognitive ability score is within the low average range, it is likely

an underestimate of her true ability level given her higher than expected scores on
spelling and reading skills. This suggests that Annas bilingualism and slowed performance
may have inhibited her ability to demonstrate her optimal cognitive ability on the
WISC-III. It is also quite possible that Annas exposure to early and persistent abuse/neglect
may have impeded the development of her optimal cognitive functioning, which is
likely to be in the average range. Annas experience of multiple traumatic events, including
the threat of an abduction by a stranger, witnessing her mothers suicide attempts,
and abandonment, have further exacerbated her feelings of fear/uncertainty associated
with persistent maltreatment by her parents. It is evident that Annas worries, sadness,
difficulty concentrating, and recurring nightmares are associated with these traumatic
experiences. Subsequently, Annas internal turmoil has been increasingly evident in her
interpersonal relationships. With adults, Anna exhibits a strong desire to please and
seeks constant individual attention. With peers, her attempts to be recognized have included
a large repertoire of negative attention-seeking behaviors. Although obstructive,
these patterns of relating to others appear to represent Annas attempts to obtain any
type of personal acknowledgment, albeit negative, in a world that she perceives as
largely unsafe and threatening.
However, it is also important to highlight Annas resiliency in the face of immense
risk factors in her young life. Annas ability to acquire new knowledge (e.g., proficiency
in English) and her attempts to initiate relationships with others suggest that
she possesses the capability to succeed in academic settings and is receptive to building
social support networks outside of her family of origin. In spite of her current and
expected difficulties associated with trauma, Anna presents as a likeable youth who
desires acceptance from others. Ensuring placement in a loving, consistent, and structured
home environment that provides unconditional acceptance is absolutely crucial in
supporting Annas cognitive and socioemotional development and long-term stability.
This is also likely to improve her cognitive level of functioning and enhance her academic
performance.
Given the previous findings, the following recommendations seem appropriate:
1. Ensure regular attendance at school to bolster Annas academic skills. Providing
extra assistance/tutoring for mathematics and strategies on how best to work with timed
tasks would be particularly helpful.
2. Provide Anna with opportunities to participate in structured community activities of
interest to her (e.g., sports team) to promote her sense of self-efficacy and enable her to
develop positive peer relationships in natural settings.
3. Provide Annas foster parents with ongoing parenting education and parenting skills
training to promote their understanding of Annas needs (e.g., supportive structure, limit
setting, explanations, consistency, acceptance) and use of specific strategies to promote
Annas positive adjustment to her new placement, as well as school.
4. Reevaluate Annas cognitive and academic functioning, including language
proficiency in English and Spanish, after stable home and academic placements are
secured, to determine if a need for additional educational interventions are warranted.
5. Provide Anna with individual therapy that uses supportive as well as
cognitivebehavioral strategies to enhance her ability to further process her thoughts/feelings
about her situation, promote her self-esteem, facilitate her use of positive coping strategies
when distressed, and alleviate her trauma-related symptoms.
As therapy progresses, it would be important to help Anna understand and process
her experience of her family, her abandonment, and abuse. Integrating and resolving these
issues will be essential in assisting her to become a well-adapted adolescent and young
adult.