Case Study #6

Tasha

Assessment #1
December 2005

Age 8:0

Grade 3

Referral Question: What factors potentially underlie Tashas difficulties in managing daily school
responsibilities/demands? What interventions would support Tasha?

Background Information:
-

requires much assistance to remain focused and work production is limited

struggles to work independently
experiences episodes of frustration, outbursts, or will shut down
confident, outgoing, enjoys social aspect of school
positive interactions with peers are a challenge
argumentative, disrespectful, disrupts the learning of others
one in-school suspension in November 2005 (reason not provided)
requiring constant redirection in classroom setting
behavior escalates during unstructured times
school team concerned Tasha doesnt seem to take behavior or consequences seriously

Assessment #1 - Grade 3
Academic Information:
-

Tasha has received intensive literacy support - 1:1 assistance with reading and writing
Modified programming in place
Frequent communication between home and school
School provided a letter in April 2005 for the physician outlining Tashas difficulties and
encouraged parents to seek medical consultation regarding her difficulties (attention,
impulsivity, distractibility)
Behavior incentives being used

September 2005 level of academic functioning:

-

Word Reading - Instructional Grade 1 (San Diego Graded Word List)

Reading Comprehension - Frustration Grade 1 (Alberta Diagnostic Reading Inventory)
Spelling - Grade Equivalency - 2.0 (Edmonton Spelling Test)
Math - Skill Estimate - Beginning Grade 2 (No assessment)

Family Background - None provided

Classroom Behavior
Classroom Observation:
-

50 minutes on one occasion - 2:40-3:30

presented as highly distractible
engaged in self-distracting behaviors or responding to environment
off-task unless specifically redirected by the teacher 1:1
responded appropriately but unable to maintain focus
desktop disorganized
experienced difficulty locating materials required for tasks
seemed unable to follow step-by-step instructions unless provided to her 1:1, one step at a time

Assessment Behavior
Cognitive Assessment (December 1, 2005)
-

appropriately engaged
physically restless (kneeling on chair, laying body on work table)
maintained focus
demonstrated memory strategies and mental control
self talk
required reminders to continue on paper-pencil tasks after finishing a line
appeared to approach tasks very systematically or very randomly

Academic Assessment (December 5, 2005)

-

testing completed in room off gymnasium

commented tasks were hard, I dont think I can
defiant during Sentence Combining - I know what Im doing but Im changing it!
impatient with instructions, defensive
announcement about a change in routine because of weather sent her into a total flap
assessor speculated academic tasks may have contributed to her behavior

WISC IV
Scale

Composite Score

95% Confidence
Interval

Percentile Rank

Descriptive
Category

Verbal
Comprehension

87

81-95

19

Low Average

Perceptual
Reasoning

81

75-91

10

Low Average

Working Memory

80

74-90

Low Average

Processing
Speed

85

78-95

16

Low Average

Full Scale

79

74-85

Borderline

Verbal Comprehension

Standard Score

Percentile

Working Memory

Standard Score

Percentile

Similarities

Digit Span

25

Vocabulary

10

50

Letter-Number

Comprehension

16

(Arithmetic)

10

50

(Information)

25

(Word Reasoning)

37

Perceptual Reasoning

Standard Score

Percentile

Processing Speed

Standard Score

Percentile

Block Design

Coding

37

Picture Concepts

11

63

Symbol Search

Matrix Reasoning

(Cancellation)

10

50

(Picture Completion)

25

Bender-Gestalt II
Visual Motor Skills:
Standard score of 95 (87-103 at 95%
confidence level)
37th percentile - Average

Visual Motor Memory:

Standard Score of 103 (91-113 at 95%
confidence level)
58th percentile- Average

WIAT-II
Subtests/Composites

Standard Scores

Percentile Rank

Reading Composite

81

10

Word Reading

79

Reading Comprehension

78

Pseudoword

81

37

Mathematics Composite

89

23

Numerical Operations

99

47

Math Reasoning

84

14

Spelling

88

21

Written Expression

Not Scored

BASC-2
Self-Report of Personality (SRP-C)
-

unusual thoughts and perceptions

having little control over events/blamed for things she
didnt do
difficulty establishing and maintaining close
relationships
feeling lonely/isolated
worry/nervousness/inability to relax
feeling sad/misunderstood
dissatisfied with performance despite effort
engaging in restless/disruptive behaviors

Examiner suggested generalized anxiety, depressive

affect, and negative self-image to be potentially
affecting her performance at school.

Teacher Rating Scales (TRS-C)

-

overall level of problem behavior exceeding most

children her age
frequent episodes of aggression, hyperactivity, rule
defiance, engaging in behaviors that affect others,
difficulty with self-control
significant difficulties sustaining attention
unusual difficulty comprehending and completing
schoolwork
appears disconnected from surroundings
engages in behaviors that are strange/odd
seems alone, difficulty making friends, difficulty joining
group activities

BASC-2
Parent Rating Scales (PRS-C)
-

engages in many disruptive, impulsive,

uncontrolled behaviors,
can be aggressive, argumentative, defiant,
threatening,
engages in rule-breaking behavior
tendency to become irritable quickly, difficulty
maintaining self control when faced with
adversity
poor expressive/receptive communication
difficulty seeking information independently

able to adapt to new situations

possesses appropriate social skills
able to overcome stress and adversity

Summary
Recommendations:

modification to grade level curriculum, direct teaching, concrete and structured assignments
strategy instruction for memory and retention
develop confidence in herself as a learner, encourage her to take academic risks
purposeful engineering of her environment
social skills instruction
involvement of pediatrician to rule out an attentional disorder
close monitoring and reassessment at a future date

Critique
Pros

report describes Tashas behavior during testing in detail

interpretation of assessment results offered
Educational/classroom interventions were appropriate

Cons

no background information about the family - only school-based information

recommendations are not written in a teacher or parent friendly way
no score summary page for the BASC-2
classroom observation done at the end of the day, didnt provide context
use of terminology such as total flap could be better described as became
agitated and upset
no recommendation for involvement of mental health, counseling, pediatric
neurological intervention

Assessment #2
October 2007
Referral Question:

Age 9

Grade 5

Does Tasha meet diagnostic requirements for severe disabilities

categorization? What recommendations can be made for intervention?

Family Background Information

-

lives with her mother and stepfather

has 2 older brothers - one lives with father in B.C., other lives independently
Tasha and her brother were apparently exposed to some sexualized behaviors by a babysitter
when Tasha was 3
both children acted out some of the behaviors
Tasha apprehended CFS and brother moved to B.C. to live with father
Tasha was in foster care from September 2006 - December 22 2006
Tasha and her brother see one another and have had therapy
family received in home support
mom feels Tasha is doing fine, would like her to return to her community school in Grade 6
mom reported no behavior problems at home and is most concerned about academics

School Background Information

-

attended community school until Grade 3

history of physical aggression, impulsivity, defiance
received both in school and formal suspensions
involved in significant bullying incidents
sexually inappropriate with younger children
Short Term Observation Program (STOP) from September 5 - October 27 2006 (while in foster
care)
home schooled briefly after discharge while waiting for a placement in Bridges Program

Bridges Program Interventions

-

closely monitored and escorted to the bathroom

receives positive reinforcement
time out and problem solving are used to her benefit
social skills are taught
receives individual assistance
peer tutoring is used
participates in a morning sharing circle, extra time, preferential seating, support if frustrated

Behavioral Concerns
impulsive

sly

many conflicts with peers

hurts others

doesnt take responsibility

manipulative

verbally and physically aggressive

sold treats for money
manipulated younger children to share food on bus
made a mess in the bathroom
wrote swear words on the computer and printed them
hidden under swings with a little boy
hidden under the slides
disrespectful tone of voice and attitude
has yelled when upset
argumentative

BASC-2

Summary
- Tasha displays chronic, extreme, pervasive behaviors and requires high level
of structure and services.
- Requires close supervision and support
- continued sneaky and manipulative behavior despite high levels of support
and supervision in Bridges Program.
- Tasha is unhappy with herself
Diagnosis: Conduct Disorder, Childhood-Onset Type
Tasha meets the Alberta Education eligibility requirement for a Severe Emotional/Behavioral Disability

Recommendations
- Placement in a program with structure, predictability, and consistency
- To ensure Tasha and other students safety
- Develop a plan so that Tasha can be trusted in school without posing a risk
to other students
- To help Tasha feel better about herself
- To give Tasha the opportunity to make new friends
- Long term planning and monitoring

Critique
PROS

Some parent input from mom is reported in the background information for this assessment
Some insight is provided into a traumatic experience in Tashas life that may help explain some of her behavior

CONS

Parent input is incomplete in the background information

No school input is provided on background information
No explanation as to why Tasha is placed in foster care
Inappropriate reporting of Tashas behavior (no clarification of who provided the information):
She was described as sly, manipulative, and argumentative
Her tone of voice and attitude communicate a disrespectful attitude

Some reported behavioral concerns need clarification (i.e. sharing food, hiding under the slide, etc.)
In the clinical interview with Tasha, she reported that someone else controls her thoughts. She noted that she has
a devil voice that tells her to do things and an angel voice that tells her not to listen. No more information or follow
up is provided after this statement.
Summary is very short with no explanation or rationale for a Conduct Disorder diagnosis

Assessment #3
June 2009
Reason for Referral:

Age 11:5

Grade 6

The DSM-IV diagnosis which supported Tashas identification with a Severe

Emotional/Behavioral Disability has become outdated. A reassessment is requested to confirm that
she meets diagnostic eligibility for Alberta Education. Her current cognitive and academic profile also
needs to be updated.

Assessment Techniques

Consultation with School Principal and Classroom Teacher

Review of Student Record
Student Interview
Classroom Observation
Behavior Assessment System for Children - Structured Developmental Questionnaire
BASC-2
Parent Rating Scale - Child (PRS-C)
Teacher Rating Scale - Child (TRS-C)
Self-Report - Child (SRP-C)
WISC-IV
WIAT-II
Childrens Interview for Psychiatric Symptoms (ChIPS)
Parent Form

Assessment #3 Grade 6
Family Background Information:
- She lives with her mother and stepfather in Calgary and reports a positive
home environment
- One older brother lives with her dad in British Columbia and the other older
brother lives independently
- Nothing unusual during moms pregnancy with Tasha. She was born full
term and her developmental milestones were met appropriately.
- She was prescribed glasses one year ago and infrequently wears them to
school.
- Mom described Tasha as an outgoing young girl with a great sense of
humor and a charming personality

Assessment #3 Grade 6
Previous Assessments
- December 2005 psycho-educational assessment:
- met diagnostic criteria as a student with Mild/Moderate Emotional/Behavioral
Disability
- overall cognitive ability in the Borderline range
- academic skills were below grade level expectations
- September 2007 psychoeducational assessment:
-

history of defiance and aggression were reported

significant bullying behaviors, which resulted in a suspension from school
described as sly, manipulative, and argumentative
met appropriate criteria for a diagnosis of Conduct Disorder - Childhood Onset

Educational History and Current Functioning at

School
Past and Current Interventions at School:

Enrolled in STOP
Enrolled in BEST
Currently enrolled in Bridges II Program
Regular support provided by COMPASS
Classroom privilege system
Behaviour Log
Behavior Support Plan

Strengths:

Positive attitude towards learning

Appears to enjoy reading
Is able to successfully manage transitions
between classroom activities
Can be a positive mentor for younger peers

Difficulties:

Difficulties with peer interaction and

engaging in appropriate, prosocial
behavior
Difficulties riding the bus to and from
school
Difficult time appropriately accepting
feedback
Requires reminders of school routines
At times, displays a defiant and
argumentative attitude towards adults
Additional areas of concern include: selfesteem, self-image, and academic
difficulties

Current reports of her behavior in the Bridges II

Program have been positive but attempts at
reintegration have not been successful.

Classroom Observation
-

63 minutes from 8:55 - 9:58 a.m.

Tasha was working on an art project in a class of five students during the first half of
the observation
seemed pleasant while interacting with her peers
was argumentative on several occasions when she was given feedback and
direction from adults
workplace was disorganized
failed to return materials to their proper place when not prompted
Tasha was in the music room preparing for a school concert during the second half
of the observation
was mature and polite when she had to share her instrument with a student sitting
beside her
Demonstrated some inattentiveness and had difficulty following along with the rest
of the class

Clinical Impression
-

Tasha continues to exhibit some disruptive behaviors within the school environment
She continues to require daily support within the classroom
Continues to struggle with positive peer interaction and demonstrating prosocial
behavior
Poor self esteem
Continues to struggle with academic content in class
Acknowledgement that Tashas past history of trauma may underlie difficulties in
emotional regulation and transition as well as contributing to a state of hyperarousal
Based on results from this assessment, she continues to exhibit behaviors that
interfere with her own learning, as well as the learning of other students
These behaviors include: difficulty accepting personal responsibility and
accountability, difficulties riding the bus, defiant and argumentative attitude, and
poor self-esteem.

Assessment Behavior
-

Testing was completed in a quiet room that was relatively free from distraction and
interruptions
Generally, Tasha was cooperative throughout the assessment and was positive, friendly
and outgoing
She experienced more difficulty completing the academic tasks
Her approach to some tasks was impulsive
She responded well to verbal cueing and redirection
She demonstrated age appropriate attention and concentration on each of the tasks.
She stated that she likes going to school and her favourite subject is math and likes writing
in her journal.
She hopes to someday work with at-risk youth in a school environment

WISC-IV
Scale

Composite Score

95% Confidence
Interval

Percentile Rank

Descriptive
Category

Verbal
Comprehension

91

84-99

27

Average

Perceptual
Reasoning

78

72-89

Borderline

Working Memory

91

84-100

27

Average

Processing
Speed

85

78-95

16

Low Average

Full Scale

83

78-89

13

Low Average

WISC-IV Subtest Scaled Scores

Average scores fall between 8 and 12

WIAT-II Summary of Subtest Scores

Subtest

Standard Score

95% Confidence
Range

Percentile Rank

Qualitative Description

Word Reading

68

62-74

Extremely Low

Reading
Comprehension

87

80-94

19

Low Average

Pseudo Word
Decoding

69

64-74

Extremely Low

Reading Composite

85

67-75

Borderline

Numerical Operations

74

66-82

Borderline

Math Reasoning

72

62-82

Borderline

Math Composite

70

63-77

Borderline

Spelling

75

67-83

Borderline

Written Expression

62

49-75

Extremely Low

Written Language
Composite

55

47-63

0.1

Extremely Low

Recommendations
Behavior and self-esteem:

IPP goals and accommodations

reflecting emotional and
behavioral needs that address
self-regulation, prosocial
behavior, building social skills,
developing appropriate ways to
express frustration

Positive reinforcement on
prosocial behavior and
compliance

Monitor Tashas well-being and

learning needs

High expectations for behavior

standards at home and at school

Regular communication with

Tashas parents

Encourage Tasha to practice

positive thinking

Reading
Individual or small group
instruction focusing on word level
reading skills
Encourage Tasha to read (reading
program at home, reading group at
school, parent volunteers)
Assign reading that is appropriate
for her instructional reading level
Writing
Extra time in the classroom to
complete writing tasks
Allow the use of a computer where
appropriate
Review basic sentence structure
and proper punctuation
Provide support in helping her plan
and organize her ideas for writing

Math
Look and say the math
operations out loud before
solving the question
Break problem solving
process into stages
Learn how to identify
extraneous information
Reinforce previously
learned math facts and
apply these skills to
applications in the current
curriculum
Verbalize rules for solving
math problems and have
Tasha explain them in her
own words

Recommendations and Summary

Supports Recommended:
- Additional time to complete assignments
- Allow Tasha to utilize alternative modes of demonstrating and communicating her
ideas
- Access to assistive technology
- Strategy instruction in the areas of reading, writing, and math
- One-on-one instruction with a tutor along with individual tutorials from the teacher
Conclusion:
Tasha meets the diagnostic criteria for identification as a student with a Mild/Moderate
Emotional/Behavioral Disability as outlined by Alberta Education
A reassessment in junior high school will help direct appropriate programming for Tasha when she enters into senior high school.

Critique
PROS

Clarification that Tashas first diagnosis in Dec. 2005 is Mild/Moderate Emotional/Behavioral Disability
Explanation of why she was suspended from school in grade 3 (Nov. 2005)
Recognition that Tasha had experienced trauma which may attribute to her current behavior
Some developmental and medical history was provided

CONS

No BASC-2 or ChIPS results were reported (only mentioned in the Summary section), page 12 is missing in the
report
No mention of the babysitter incident in the background information
No clarification of why Tasha was placed in foster care in 2006
No school input was included in the background information
No clarification of who is reporting specific behavior descriptors of Tasha:
A history of defiance and aggression was reported, in addition to significant bullying behaviors
Tasha was described as sly, manipulative, and argumentative

Any questions?