Anda di halaman 1dari 11


April 19, 2004

STUDENT: John Waters

D.O.B. January 5, 1989
GRADE: 9th
PARENTS: Sally and Mark Waters
ADDRESS: 1234 Riverview Place
St. Paul, MN 55349
PHONE: (651) 482-1989

EVALUATORS: Elizabeth Stacey, School Psychologist

Marcia Green, School Social Worker
Robert Zomero, EBD Teacher
Kathy Manning, LD Teacher
Ardis Ambon, School Nurse


Reason for Evaluation:

John was referred to the assessment team for behavioral concerns that were interfering with his
performance at school. John’s attendance and grades had been going down over the last two
years, while his negative behaviors towards learning and towards his teachers had been
increasing. The assessment team, including John’s parents, decided to include academic and
intellectual assessments, as well as a functional behavioral assessment (FBA).

Background Information Including Review of Educational Records & Pre-referral Interventions:

John is a Caucasian student who lives with his parents and two younger siblings in an urban setting.
He is currently in 9th grade at Crestview Middle School, and has a job at McDonalds. John has a
history of school concerns in the areas of social and behavioral skills, consisting of a high activity
level, difficulty sitting still, impulsive behavior, and some resistance to following directions. There
have also been concerns about John’s social interaction skills with peers, but after some informal
social skills group participation in the intermediate grades, his peer interaction skills improved. John
had one previous school evaluation in 5th grade, but was judged not to qualify since his behaviors were
not adversely affecting his academic performance at school. John’s parents have considered taking
him in for a medical evaluation looking at a possible ADHD, but have decided not to unless it
becomes educationally necessary.

There have been renewed concerns about John’s behavior during the last year, as his educational
performance has been ‘slipping’. He was a B/C student through most of 6th grade, after which his
grades began slipping down to Cs and Ds. During the last year he has even begun to receive some
failing grades. John has also had attendance issues during his 9th grade year, especially in the areas of
tardiness, leaving school early, unexcused absences and truancy. As an intervention, John was placed
in the STEPS to SUCCESS Program, which is a small group, general education based program
designed to help students improve their grades. When John was not responding to the STEPS to
SUCCESS Program, an additional intervention consisting of weekly meetings with the school
councilor was added. While John reported he liked the counseling sessions as it gave him tme to ‘tell
his side of the story’, neither intervention had a significant affect on improving his grades, attendance,
or negative behaviors. At the time of this assessment, John’s class rank was 502 out of 537, while his
BST scores were comparably higher, with passing scores in both reading and math.

John had begun breaking more school rules in January 2004, in the areas of tobacco use, yelling at
teachers, profanity, and cafeteria rules. The referral for evaluation was already in process when John
began to exhibit unsafe behavior by fighting with his peers, which resulted in use of the emergency
behavioral intervention of use of the lockable quiet room being implemented two or more times within
a 30 day period.

Information Provided by Parent/Guardian:

History and Development:

The following information was received in an interview with Sally Johnson, Johnny's mother. Sally
reported that there were no complications during Johnny's birth. Sally stated that, except for Johnny's
allergies, Johnny was a very healthy child. During Johnny's time at the Elementary and Middle School
settings, Sally reported that Johnny was a very good student, and that school seemed to be relatively
easy for Johnny. Sally also reported that Johnny's behavior in middle school was fairly good, despite a
few physical altercations with other students. When Johnny entered the High School, Sally reports a
drastic change in Johnny's grades, attitude, and behavior.

Sally reports that Johnny currently lives at home with his mother and his father. Sally stated that
Johnny spends most of his time in his room which is the basement of the house that they live in.
Johnny has his own TV and computer in his room, and since Johnny sleeps in the basement, she
cannot report on the amount of sleep Johnny receives each night. Sally also reported that there are
times when she does not know where Johnny is when he is not at home. She stated that she does not
know many of Johnny's friends, and only knows that many of them are older than Johnny. Sally
reported that she has set a curfew for Johnny, and that if he breaks his curfew he is grounded for at
least one night. Sally also reported that Johnny has been in trouble with the police recently. On two
occasions the police had to bring Johnny home due to toilet papering and egging a house. Sally stated
that she also found cigarettes in Johnny's room on one occasion and is worried about Johnny smoking.
Sally also reported she is not sure about Johnny using drugs, and that she might have found some drug
paraphernalia at one point.

Strengths, Skills, and Concerns:

Sally reports that Johnny is a very intelligent person. She also stated that she feels Johnny will be an
excellent lawyer some day. Sally also commented on Johnny's superior communication skills
including his excellent vocabulary and verbal skills. Sally reported that Johnny is also an excellent
leader, and knows that this skill will help him in the future.

Sally reports that her main concern with Johnny is about his failing grades. Sally is concerned that if
Johnny does not receive better grades, he will not be able to enter college. Sally is also concerned
about Johnny graduating from High School, and wants to ensure that Johnny will receive the credits
necessary to receive his diploma. Sally also stated that she is currently holding Johnny's drivers
permit as motivation for him to improve his grades.

Sally also has some concerns with regard to Johnny's behavior. She reports that Johnny can often be
argumentative, and will rarely take "no" for an answer. She also reported that Johnny "knows better"
than to argue with his Father, and that Johnny looks up to his Father. Sally also stated that Johnny
does not communicate much with her or his Father, and that his behavior has become unpredictable.

List of all Tests/Procedures:

Review of Records
Review of Health Records, Including Hearing and Vision
Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV)
Woodcock-Johnson Tests of Achievement-Third Edition (WJ-III)
Classroom Observations
Middle School and High School Organizational and Independent Work Skills Checklist
Information Processing Checklist
Behavior Assessment System for Children - 2nd Edition (BASC-2)
Connors Teacher Questionnaire
Enderle-Severson Transition Rating Scale-Form J-Revised
Beginning the Transition Planning Process-Informal Student Survey
Functional Behavioral Assessment


Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV)

The WISC-IV is designed to measure a student’s overall level of intellectual functioning, and a score of 100 is average. The WISC-IV
consists of four scales, Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed.

Date: March 14, 2004 by Elizabeth Stacey, School Psychologist

During the testing, John was cooperative and attended to each of the tasks presented. Testing behavior
indicates that John becomes frustrated when tasks become mildly challenging, suggesting a very low
threshold for frustration. Additionally, throughout testing, John’s level of frustration rose quickly,
which limited his attention, effort, and performance on tasks. The results, indicated below are
believed to be close to an accurate reflection of his current level of intellectual ability, with the caution
of taking into consideration his frustration and stress level during the testing.

Domain IQ Score Level

Verbal Comprehension 102 Average
Perceptual Reasoning 106 Average
Working Memory 120 High-Average to Superior
Processing Speed 106 Average
Full Scale 110 Average to High-Average

John’s overall performance on the WISC-IV indicates that he exceeds approximately 75% of the
individuals his age in the standardized group. There is a 95% probability that John’s true IQ score is
between 105 and 115.

When analyzing the four indexes, there was not a significant discrepancy between John’s Verbal,
Performance, and Processing Speed index scores, suggesting that these abilities are uniformly
developed. He will most likely experience similar success on tasks that are presented in both
language-based and visual formats. With uniformly developed cognitive skills, John’s Full Scale IQ
score is a good reflection of his general ability.
There was significant discrepancy, however, between these index scores and the Working Memory
Index. John’s superior score on the Arithmetic subtest brought an otherwise average performance on
the Working Memory Index into the superior range. John’s auditory memory,, facility with arithmetic,
and powers of concentration allowed him to obtain a superior score on the Arithmetic subtest. It is
interesting to note that throughout testing, John appeared motivated to do well; frustration, however,
seemed to hold him back from giving full mental effort. Twice during testing, John was able to break
away from the self-imposed limits, putting forth the mental and emotional effort necessary to obtain
above average scores.

Information Processing Checklist March 7, 2004,

(administered to 3 of John’s teachers by Elizabeth Stacey, School Psychologist)

Domains Concerns .
Storage following 2-3 step directions
Organization planning skills, organizing desk, etc, completing & handing in assignments
Acquisition obtaining information by touching, or by multisensory approach
Retrieval developing strategies to help recall information, and counting and
calculating automatically
Expression responding appropriately to nonverbal communication
Manipulation applying learned information to new situations

While there are various concerns noted on this checklist, the only area with more than two concerns
was the area of Organization.


Woodcock-Johnson III Tests of Achievement – Form A

The Woodcock-Johnson III is a broad=based nationally normed achievement test. It provides information about reading, math, and
written language. The test is individually administered. Achievement is reported in standard scores with and average score of 100
(average range 85-115).

Date: March 10, 2004 by Kathy Manning, LD Teacher

During the testing, John was attentive and put forth effort on each task. While John did demonstrate
frustration quickly at difficult tasks, he maintained his effort and appeared to be completing tasks to
the best of his ability. John was given this assessment over the period of two days, and was able to
stay on task and maintain effort if given periodic short breaks. The following scores are perceived to
be an accurate reflection of John’s academic abilities at the time of this test.

The Woodcock-Johnson III Tests of Achievement, Form A, is divided into four broad areas, which test
skills in reading, math, written language, and general knowledge. The test is standardized, based on
scores compiled from an age-based norm group of the student's peers. These scores are reported in
standard score form (90 to 110 is average), and are acquired from individually administered subtests,
which are combined to form the broad categorical areas listed below.

(Norms based on grade 9.7)

Cluster/Test Standard Score Percentile
Oral Language 124 95
Total Achievement 115 84

Broad Reading: 116 85

Broad Mathematics: 110 76
Broad Written Language 128 97

Math Calc Skills 108 71

Written Expression 128 97

Academic Skills 102 56

Academic Fluency 118 89
Academic APPS 116 85

John’s scores on all the academic cluster tests were in the average to high-average range, with the
exception of the oral language and written expression scores which were in the superior range.
While John’s cluster test scores were relatively uniform, there were some significant discrepancies in
the individual test sections. John showed exemplary skills in the Writing Sample section, obtaining a
standard score of 155, which is in the gifted range. On the other hand, John had greatest difficulty in
the Story Recall and Understanding Directions sections, with standard scores of 67 and 58
respectively, which are in the significantly low range. These test results indicate that John has
significant difficulty when auditory information is given without visual cues.

Organizational and Indepenent Work Skills Checklist

(Filled out by John’s English Teacher, and interpreted by Kathy Manning, LD Teacher

On this checklist, John’s teacher reported numerous concerns in the area of organizational skills
including transitioning, following class schedule, using a planner, completing assignments, listening
and working without distraction, and using independent time appropriately. There were also two
Motor concerns involving managing school materials in a timely manner, and operating a computer


March 12, 2004 by Ardis Ambon, School Nurse

A review of John’s health records indicates that he has had no significant health concerns other than
allergies, which he takes over-the-counter medication for. John has consistently passed his hearing
and vision screenings at school.


Three Classroom Observations

by Elizabeth Stacey, School Psychologist & Marcia Green, School Social Worker
Observation #1
John was observed on Tuesday, March 21 in Social Studies class. Upon entering the room he talked
with his friends and after the bell rang all of the other students sat down, while John needed to be
reminded to take his seat. The teacher began to talk about the three branches of government. John
appeared to make eye contact with the teacher, but I could not be sure if he was truly listening or not.
He began to doodle on his folder as the teacher continued. Several other students were engaged in this
same behavior. After 12 minutes, the teacher showed a film about the branches of government. The
film was not of high interest. After the film when the lights came on, I observed that John appeared to
be sleeping. When the teacher called his name to pay attention, he glared at the teacher, sat up,
mumbled something, and slouched down in his desk. Class was almost over and John remained in this
posture until the kids got up to stand by the door.

Observation #2
John was observed on Friday, March 24 in his STAR Language Arts class. It is a small class with
only 12 students, most of them boys. On this day the class was studying "Romeo and Juliet". The
class was reading one scene from the play. The teacher began the lesson by making sure everyone
remembered what had happened previously in the play. Then she reviewed some of the vocabulary.
John sat quietly but did not write down the vocabulary as the class instructed. Neither did the boy who
sat across from John. The class began to read the scene aloud as a play. John was assigned the part of
Tybolt. He clearly enjoyed the reading aloud and read with inflection. When the other students were
reading their parts however, he became off task and began distracting the rest of the class. The teacher
redirected him twice and then told him to sit down. He swore at the teacher and left the room,
slamming the door as he left. I later saw him at the counselor’s office. He told her it was a baby class.

Observation #3
John was observed in his gym class on February 27. It is a large class with 32 students. The class
requires the students to wear exercising clothes and John was dressed appropriately. The class began
with the teacher having the students do some warm-up exercises. John did the warm-up fine. He did
talk quietly to the three boys around him while stretching but it did not interfere with the exercise.
Next the teacher gave the directions for the three games the entire class would be playing. He still
chatted quietly as did other students but it was not disrupting. John and the boys he was with the
entire class played the first two games enthusiastically and there were no problems. John followed the
rules and appeared to be having a great time. In the third game there was a disputed call about
whether he was in bounds. He did not agree with the call and argued with the teacher with an average
tone at first. When she would not change the call he started shouting and became agitated. The
teacher then told him he was done for the day. He quietly went and sat down on the sidelines and
watched the last ten minutes of class. At the end when his buddies came over he was still complaining
about the call, but he was not as highly agitated as he had been before.

Conners Teacher Questionnaire Date 3/8/04

This teacher questionnaire has been used successfully over the past 18 years to identify children who might have Attention Deficit
Disorder. A score of 40 or greater often indicates Attention Deficit Disorder might be present.

After compiling the results of 4 of John’s teachers, John received a score of 43, which indicates he is a
student who may have Attention Deficit Disorder. His most significant areas of concern on this rating
scale were: easily frustrated & demands must be met immediately, sensitive to criticism, quarrelsome,
temper outbursts, and submissive.
Behavior Assessment System For Children (BASC) (Scored by Marcia Green, School Social Worker)
The BASC is an integrated system designed to facilitate the differential diagnosis and classification of a variety of emotional and
behavioral disorders of children and to aid in the design of treatment plans. This instrument should not be the sole basis for making
important diagnostic or treatment decisions.

The teacher, parent, and students versions of the BASC were given. The Behavior System Index is
reported with a T score where 50 is average. The following are the ranges and T scores:

Range T-Score
Acceptable 20-59
At Risk 60-69
Clinically Significant 70 and above

John obtained the following composite scores:

Teacher Form (scores listed as teacher 1/ teacher 2) March 14, 2004

Composite T-Score %ile Rank Classification .
Externalizing Problems 61/87 87/99 At Risk/Clinically Significant
Internalizing Problems 41/71 16/95 Acceptable/Clinically Significant
School Problems 52/74 61/98 Acceptable/Clinically Significant
Behavior Symptoms Index 49/75 56/97 Acceptable/Clinically Significant
Adaptive Skills 44/30 30/28 Acceptable

Parent Form (filled out by John’s mother, Sally) March 4, 2004

Composite T-Score %ile Rank Classification .
Externalizing Problems 100 99 Clinically Significant
Internalizing Problems 43 24 Acceptable
Behavior Symptoms Index 65 92 Clinically Significant
Adaptive Skills 38 13 ?Acceptable

Student Form March 13, 2004

Composite T-Score %ile Rank Classification .
School Maladjustment 50 56 Acceptable
Clinical Maladjustment 37 8 ?Acceptable
Personal Adjustment 40 15 ?Acceptable
Emotional Symptoms Index 41 18 ?Acceptable

While John rated himself in the acceptable range on all measures, There was agreement on the parent
and teacher forms that John has clinically significant behaviors in the categories of Externalizing
Problems and Behavior Symptoms Index. Of note is that while one teacher rated John as clinically
significant in all areas of behavior on this assessment form, the other teacher rated him as ‘acceptable’
in all areas except Externalizing Problems. This difference may indicate that John reacts quite
differently to different teachers or styles, or that he is reacting differently to varying school subjects.

Functional Behavior Assessment Date: 3-18-2007

1. Introduction/Purpose of Evaluation
The Functional Behavior Assessment Summary Report was compiled by the school psychologist,
Elizabeth Stacey. A Functional Behavior Assessment is the process of looking at relationships
between behavior and the environment, external and internal. It acknowledges that the student's
behavior has a function. The behavior continues because it works in some way or has served some
specific function. The purpose of this assessment is to gain information so that we can teach and
encourage effective alternatives.

The purpose of this assessment being written is because at this time, John's behavior warrants a
Functional Behavior Assessment.

2. Parent Input

John's mother reports that the behaviors he exhibits in school rarely occur at home and never with his
father. He has had some difficulties but most of the behaviors have been minor. He stays out late
quite often but does come home and get up for school. “Every once in awhile he argues with me or his
sister.” “Generally speaking, I don't know why his grades have been slipping.”

3. Student Input

John has stated that his teachers criticize him and that is why his behavior sometimes gets "out of
hand". He tries to get his work done but with all of the teachers reminders he can't handle it. He
stated that if his teachers would "mellow out" every thing would be fine. He admitted when the
teachers do keep on him to get his work done and get to class he does argue with them. He said he
likes to tell his side of the story. He also stated that many days he is tired. John does not seem to have
awareness of why he has anger or why he is habitually late for his classes. He seems to think it is the
teachers fault that he doesn't get his school work completed and in on time.

4. Challenging Behaviors

John's challenging behaviors include anger outbursts where he calls out or argues loudly with the
teacher and many times leaves the room. Secondly, he actively refuses to follow directions, finish
assignments, and sometimes even acts bored. Lastly, he is habitually late for his classes, many times
missing half of the class.

The possible antecedents to these behaviors are the authority of the teacher directing him and John
wants to control the situation. Most of his outbursts occur after a teacher or person of authority is
telling John to do something and he challenges their right to direct him. He also cannot stay focused
for more than a few minutes, then when directed he lashes out at the teacher with a defiant attitude.
The tardies possibly occur to avoid the work and the emotional upsets, anger, and boredom, when he
does attend class. In his gym class these behaviors are less likely to occur because he is physically
active and he enjoys this class. If John is engaged in the learning, like reading aloud to the class, he
can participate for longer periods of time.

The consequences and reinforcers are possibly the attention, socializing, and self-expression he gets.
He also gets power and control of the situation. Often he is directed to the counselor's office and then
he avoids the work altogether and can calm himself down after the emotional highs and lows of
attending class. The pressure and frustration, that has been building, and the guilt he may feel for not
meeting classroom expectations is alleviated. His slow triggers seem to be the group social setting, the
nature of the instruction, and his mood in terms of frustration. His stress builds up as he loses focus,
which he then stuffs until the blowing point. The fast trigger is the high pressure (anxiety), and he
blows up. He is least likely to display these behaviors in the segments of class where he is engaged in
the class and feels in control and in gym class, which he likes, and is physically active.

5. Student Strengths

John is a caring person. He takes the side of the underdog and is very loyal to those he considers his
friends. He is very protective of those whom he feels need protection. John is very popular with his
peers and well liked along with being a caring person, John is also a sensitive person. He is almost
hypersensitive to the facial expressions and tone of voice of others. This is being noted here as a
strength but it is a strength that needs to be developed. It also can be a detriment as he sometimes has
difficulty reading and understanding facial expression and voice tone. John has a great sense of
humor. He is intelligent and can pretty much achieve all he wants to in academic endeavors. He is an
avid motorcyclist and works very hard at marinating his bikes and competing in races all over the
country. He loves all things about racing motor bikes.

6. Interventions and Replacement Behaviors

- Place where John can go to calm down
- Behavior and attendance contract with clear expectations
- Weekly monitoring sheet to track assignments and grades
- Study skills class to learn organizational skills and get help staying on top of school work and
make-up missing work
- Daily attendance check with a staff member who monitors and befriends

The replacement behaviors the staff believe John needs involve learning to disagree appropriately and
learning to manage his stress. Learning to manage anger, to problem solve, and to make good
decisions may alleviate his stress and boost his self esteem as he manages his own life. Working on
developing these skills would help improve healthy decision making to complete schoolwork, stay on
top of assignments, and attend class regularly.


Beginning the Transition Planning Process-Informal Student Survey Employment:

(completed by John on March 1, 2004)

John reported:

Home Living: He cleans his room, makes pizza, and helps with grocery shopping.
Community Participation: He had a drivers permit, does not use the bus, and has a savings account.
Recreation and Leisure: He engaged in active outdoor sports, read the comics in the newspaper,
belonged to the American Motorcycle Association, and went on vacation with his family.
He also reported that he enjoyed being with others, and went to his friends’ houses for fun.
Jobs and Job Training: He had filled out job applications, did lawn work, and worked at
Post-Secondary Training: His favorite class at school was shop, he did not like math, gym, and
science, and he planned to attend technical college after highschool.
Enderle-Severson Transition Rating Scale-Form J-Revised March 11, 2004
The goal of this assessment is to gather information that accurately and comprehensively states the learner’s present level of performance
in the area of transition to post-secondary settings.

This form was filled out by Marcia Green, the social worker during a joint interview of John’s mother
and two of his teachers. Following is a summary of John’s strengths and needs in each area:

Strengths: hygiene and grooming, understanding of purpose of working, job training, and job
retention, how to search for jobs, interpersonal skills, able to fill out job application, and current
successful job experience.
Needs: attendance, punctuality, interviewing skills.

Recreation and Leisure:

Strengths: participation in community sports, communicates effectively.
Needs: use of freetime, and acting appropriately in public.

Home Living:
Strengths: use of telephone, dressing appropriately, household cleaning and laundry, sexual awareness,
understanding of checking and savings accounts, writing skills, planning and preparing balanced
meals, and understanding of basic parenting skills.
Needs: citizenship skills, first aid and preventative medical care, and response to household

Community Participation:
Strengths: use of community resources, cost saving techniques & purchasing options, and awareness
of transportation and insurance.
Needs: social behaviors in public, and realistic plan for housing needs.

Post Secondary Education and Training:

Strengths: awareness of post-secondary options, and had participated in a vocational assessment.
Needs: self-awareness.

F. ASSISTIVE TECHNOLOGY: At this time, John is able to use typical school materials, and
assistive technology is not indicated as a need.


The evaluation team concluded that John does not meet the criteria for eligibility under the category of
Specific Learning Disability since he did not demonstrate a significant discrepancy of -1.75 or greater
between his ability and achievenment. Even though John’s grades had been below average, as of this
assessment, his academic knowledge and skills were still in the average to above average range.

The evaluation team also concluded that John did meet eligibility and demonstrates need for special
education and related services under the category of Emotional and Behavioral Disorders (EBD).

The team concluded that John met the EBD criteria in the following areas:
John was eligible and in need of special education and related services for an emotional and behavioral
disorder due to meeting the criteria in items A to C.

A) John demonstrated an established pattern of emotional and behavioral responses that is described
in part 3, and which represents a significant difference from peers:

3) aggressive, hyperactive, or impulsive behaviors that were developmentally inappropriate, for

example: physically or verbally abusive behaviors; impulsive or violent, destructive, or
intimidating behaviors; or behaviors that are threatening to others or excessively antagonistic. The
pattern was not be the result of cultural factors, and was based on evaluation data.

B) John’s pattern of emotional and behavioral responses adversely affects educational performance
and results in:

a pattern of unsatisfactory educational progress that is not primarily a result of intellectual,

sensory, physical health, cultural, or linguistic factors; illegal chemical use; autism spectrum
disorders under part 3525.1325; or inconsistent educational programming.

C) The combined results of prior documented interventions and the evaluation data for John
established significant impairments in academic and social skills. The data must documented that
the impairment:

severely interfered with the student’s or other students’ educational performance;

and was consistently exhibited by occurrences in at least three different settings, including two
educational settings, one of which is the classroom, except for children not yet enrolled in
kindergarten, and either the home, child care, or community settings;

and has been occurring throughout a minimum of six months.

D) The evaluation findings were supported by current or existing data from:

three systematic observations in the classroom or other learning environment;

record review;
interviews with parent, student, and teacher;
and a functional behavioral assessment.


John needs to have the following adaptations, and interventions:

- Place where John can go to calm down

- Behavior and attendance contract with clear expectations
- Weekly monitoring sheet to track assignments and grades
- Study skills class to learn organizational skills and get help staying on top of school work and
make-up missing work
- Daily attendance check with a staff member who monitors and befriends