PSYCHOLOGICAL SERVICESElizabeth SSS, ASSESSMENT REPORT

Name: Elizabeth SSS DOB: 2001/07/XX Age: 9 years XX months Reason for Referral: Elizabeth was referred for psychological assessment and intervention to address socio-emotional and executive functioning concerns. Relevant Background Information: The following information was obtained from a review of Elizabeth SSSs OSR, including minutes from PDT meetings attended by Elizabeths mother, Petra SSS. School: ZZZ ZZZZ French Immersion School Grade: 4 Date Assessed: 2011/05/XX Examiner: Ms. Monique Janssen, Supervised by Dr. P.R.

Educational History: Elizabeth attended ZZZ Public School for JK before moving to ZZZ ZZZZ French Immersion, which she continues to attend. In JK Elizabeth was described has having a happy disposition at school, being eager to learn, and enjoying playing with one or two other children. Elizabeth consistently obtains As and Bs on her report cards but is reported to have difficulty with mathematics specifically in the areas of number sense and numeration and time. Current concerns noted on Elizabeths report card are bringing needed items to and from school and asking for help when needed. On her grade 3 EQAO testing Elizabeth was at the provincial standard in math and on the Otis-Lennon School Ability Test 7th Edition Elizabeths verbal and nonverbal skills were in the average range. In the 2009-2010 school year Elizabeth was late for school 21 times and absent on 13 and a half days. This represents an increase in the number of late arrivals from previous years. Elizabeth was first brought to the attention of the Program Development Team (PDT) in December 2009 due to school concerns with focusing in mathematics and anxious behaviours and parent concerns with a lack of emotional control, anxiety, and school avoidance. At this time Elizabeth would hide in the closet before school or say that she wished she were dead. Elizabeth told her mother that she felt scared over conflicts with other students both at school and on the bus. The PD team recommended that Elizabeth have someone to check in with at school, have one recess in which to do her homework and that Petra should assure Elizabeth that she is safe at school and keep an eye on Elizabeths state of mind and concerns. This team met again in March 2011 due to parent concerns with social problems and applying learned conflict resolution strategies when problems arise. Elizabeths teacher agreed that Elizabeth struggles with conflict resolution. At this meeting it was decided that Elizabeth would receive 6 weeks of Collaborative Problem Solving training from Monique Janssen and that Elizabeths parents may want to enroll her in a conflict resolution group at Merrymount Childrens Centre or Vanier Childrens Services. Developmental History: Developmental milestones were met at the expected ages. Medical History: No concerns with Elizabeths medical history were noted in the OSR; however, when problems arise at school Elizabeth sometimes complains about stomachaches and asks to go home. Family History: Elizabeth lives with her adoptive mother and father (she was adopted at X weeks of age from CAS) and her adopted younger sister. Petra SSS reports that Elizabeth has always been sensitive toward being adopted.

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Previous Assessments and Interventions: In the past Elizabeth saw XXXXX, a play therapist at Vanier Childrens Centre, XXXX a counselor at the Child and Adolescent Centre for art therapy, and a private counselor. Mr. and Mrs. SSS had Elizabeth privately assessed by Dr. XXX in October 2009 for clinical depression. Dr. XXXX noted that Petra SSS had long standing concerns regarding times when Elizabeth was very distressed, had difficulty managing negative emotions and made statements reflecting self harm and a desire to be dead. Dr. XXXX concluded that these statements reflected Elizabeths low capacity to deal with strong negative emotion and that Elizabeth had perfectionist tendencies and had developed an avoidant coping style. Dr. XXXX recommended exploration of skills based teaching in relation to developing adaptive coping with negative emotions and social conflict and parent training on how best to respond to Elizabeths expressions of distress. It was suggested that the family ask Mr. XXXX if Elizabeth was eligible to participate in a childrens group on anxiety, which would involve a parental educational component. If this was not available it could be arranged through her office. Assessment Methods Given the referral concerns an evaluation of executive and socio-emotional functioning was conducted. This included: OBSERVATIONS In Class During one-on-one Meetings May XX, 2011 May XX, XX and June X, X, X, and XX, 2011 QUESTIONNAIRES Assessment of Lagging Skills & Unsolved Problems Completed by Mrs. Jones Bar-On Emotional Intelligence Inventory: Youth Version (Bar-On EQ-i:YV) completed by Elizabeth SSS Behavior Rating Inventory of Executive Function (BRIEF): Parent Form completed by Petra SSS Behavior Rating Inventory of Executive Function (BRIEF): Teacher Form completed by Mrs. Jones Child Behavior Checklist for Ages 6-18 (CBCL): Parent Form completed by Petra SSS Child Behavior Checklist for Ages 6-18 (CBCL): Teacher Form completed by Mrs. Jones Multidimensional Anxiety Scale for Children (MASC) Completed by Elizabeth SSS Piers-Harris Childrens Self Concept Scale, 2nd Edition (Piers-Harris 2) completed by Elizabeth SSS May XX, 2011 May XX, 2011 May XX, 2011 May XX, 2011 May XX, 2011 May XX, 2011 May XX and June XX, 2011 May XX, 2011

Observations: On May XX, 2011 I observed Elizabeth for several minutes during her mathematics lesson immediately following the first nutrition break. It took Elizabeth several minutes longer than her classmates to

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transition from recess to the lesson and the lesson had already begun before Elizabeth had her indoor shoes on. During the lesson Elizabeth appeared to pay attention and occasionally played with her hair. Elizabeth was also observed during the indoor play portion of the second nutrition break on May XX, 2011. She spent this time playing, smiling, and talking animatedly with two other girls in her grade. Observations from One-on-One Meetings: On May XX, 2011 Elizabeth and I met for our first individual meeting in the Learning Support Teachers office. Elizabeth was a happy, kind and articulate girl. She expressed enjoyment in her after school activities including participating in plays, swimming, and martial arts. She also reported that she likes to play with her younger sister on the weekends and is looking forward to playing at the cottage in the summer. Elizabeth and I spent several minutes discussing her social relationships at school and she reported that she has three close friends, one of whom has been her friend since grade one while the other two have been her friends since September. Elizabeth appeared upset when describing a former friend and detailing their falling out in February of this year. She reported that she does not want to be friends with this girl again, but feels hurt that two of her friends will play with her former friend instead of her. When asked what she would like help problem solving she requested help with standing up for herself. This meeting ended with Elizabeth carefully completing three questionnaires about her socio-emotional functioning. During our second meeting on May XX, 2011 Elizabeth and I agreed that we would work on four goals over the course of our meetings: (1) accurately expressing emotions, (2) self-advocacy, (3) problem solving in social situations, and (4) improving organization. During this meeting Elizabeth described a social problem and thought of three practical ways to solve this problem in the future. We also discussed her feelings and some things she can try when frustrated in class. Elizabeth and I met briefly on June X, 2011 and she reported that she was in an excellent mood, had received good grades on tests that week, was having no social problems, and is good at multiplication (the math the class was working on). Elizabeth requested that the meeting end so that she could return to class. On June X Elizabeth was doing well. She had slept in that morning, had a fun weekend, and at lunch went to a friends house. When asked about something that had happened in the past week that was not good she said she was upset that she forgot her agenda at school. We problem solved remembering her agenda and Elizabeth suggested a checklist to remind her of the end of the day routine. She dictated the steps that she would need to take and a checklist was written. Elizabeth was once again in a good mood during the June XX meeting and reported that things were great. She was excited about a sleepover with her friends on the previous weekend and was enjoying the new math unit. She briefly mentioned a fight with her younger sister that made her feel upset. However, reported that her mother had helped her solve the problem and she was happy with the resolution. Elizabeth said that when she gets upset at home she likes to go to her room to cool off and then talk to her mother about how she is feeling. I spoke to Mrs. SSS later on June XX and she reported that Elizabeth did not seem less anxious at home. She said that Elizabeth had said she did not feel safe at school, that her former friend had called her names, and another student had been saying rude things about Elizabeths sister. To alleviate the concern that taking Elizabeth out of class may be causing her discomfort I agreed to meet Elizabeth over her break. On June XX when Elizabeth forgot to meet me in the office I found her on the yard and we had a thirty minute meeting. Elizabeth completed the MASC first and told me that she felt happy. She reported no problems in the past week. I asked her about some of the issues her mother had mentioned and Elizabeth denied or minimized all of them. She said that no one had been mean to her at school and that she was remembering being called names in February. We discussed her reaction to the names and how Elizabeth was feeling about it now and she reported that when she thinks about it she feels angry. Elizabeth rated her progress on the four goals from May XX. She felt she was doing a pretty good job of

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telling people how she feels and said she has not felt sick recently. She said that asking for help was going really well because another boy at her table often had the same questions as her so the teacher responds quickly. Elizabeth described problem solving with friends as going really good and was excited about the checklist to help her stay organized. Of the four areas Elizabeth thought she was best at problem solving with friends and still needs to work on getting help when needed. When asked if she thought meeting with someone was helpful she said yes but that she would rather work with her mom than go for counseling. Once the bell rang Elizabeth was eager to return to class. Assessment Validity: Valid Questionable Validity

Questionnaire Results: Mrs. SSS, Mme. Jones, and Elizabeth each completed standardized questionnaires describing their observations or beliefs about Elizabeths socio-emotional and executive functioning. The results of the questionnaires reflect their perceptions and observations of Elizabeth compared to other children of a similar age. Consistency and negativity scales on all questionnaires indicated that all raters were reliable. Detailed results are presented in a table at the end of this report where Clinically Significant indicates Elizabeth has much greater difficulty with that issue than other children, At Risk indicates she has slightly more difficulty than others, and Average means that she has no more difficulty than expected. Executive Function Executive functioning refers to skills such as planning, problem solving, and monitoring appropriate behavioural and emotional responses. Mrs. SSS and Mme. Jones completed the BRIEF, which provides a measure of Elizabeths executive functioning abilities in daily activities. Elizabeths mother and teacher reported somewhat different levels of executive functioning with Mme. Jones observing problems with all areas at school and Mrs. SSS observing problems with some areas at home. Both raters agreed that compared to other 9 year old girls Elizabeth is having more difficulty with executive functioning overall. They also agreed that Elizabeth struggles with modulating her emotional responses, planning for and organizing her materials, and developing appropriate sequential steps ahead of time as evidenced by scores that are in the Clinically Significant range. Socio-Emotional Function Elizabeth, her mother, and her teacher completed standardized questionnaires reflecting their observations and knowledge of Elizabeths socio-emotional functioning. Mrs. SSS and Mme. Jones completed the CBCL and agreed the Elizabeth was experiencing many more affective problems (Clinically Significant) than other children similar to her in age and gender. Both raters also noted problems with anxiety and somaticism; however, Mrs. SSS (Clinically Significant) rated these problems as more severe than Mme. Jones (At Risk). Mrs. SSS rated Elizabeth as Clinically Significant for conduct problems while Mme. Jones sees Elizabeth as well behaved at school (Average). Mme. Jones also completed the Assessment of Lagging Skills & Unsolved Problems and the areas that Elizabeth often experienced difficulties with tended to rely on executive functioning and emotional regulation. The only unsolved problem that Elizabeth was reported to often encounter at school was bullying issues with a classmate. Elizabeth completed the Bar-On EQ-i:YV, MASC, and Piers-Harris 2 to provide her perspective on her socio-emotional functioning. On the Bar-On EQ-i:YV and Piers-Harris 2 Elizabeth reported few problems and was in the Average range for interpersonal, stress management, adaptability, general mood, behavior adjustment, intellectual and school, physical appearance, freedom from anxiety, popularity, and happiness and satisfaction perceptions. She rated herself in the At Risk range on the Bar-On EQ-i:YV interpersonal scale indicating that she perceives herself as having some problems with social relationships. Despite rating herself as generally free from anxiety on the Piers-Harris 2, Elizabeth reported experiencing anxiety in several areas on the MASC on May XX. Both the MASC Total and Anxiety Disorder Index were in the Clinically Significant range on that date. She described herself as having the most difficulty with experiencing physical symptoms of anxiety and feeling scared when alone or separated from those who make her feel safe. She rated herself in the At Risk range for harm avoidance where her score

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indicates she worries more about doing everything right than being called on in class, and social anxiety where she was more worried about being rejected by other people than performing in front of others. Since Elizabeth indicated that she was feeling happier and less anxious in June she was asked to complete the MASC again. This time she rated herself in the At Risk range on the Anxiety Disorder Index and Average range on the MASC Total. She indicated that she was no longer experiencing problems with physical symptoms of anxiety or social anxiety. She continued to rate herself as in the At Risk range on perfectionism. Summary/Formulation: Elizabeth is a kind and friendly girl who takes pride in her accomplishments and was referred for a psychological assessment and intervention to address concerns with socio-emotional and executive functioning. Elizabeths mother and teacher reported that Elizabeth experiences significant difficulties with her executive functioning. At school Elizabeth struggles in all areas of executive functioning while at home she struggles most with controlling her emotions, developing appropriate sequential steps ahead of time, and planning for and organizing her materials. However, no concerns with attention were reported on the CBCL. This indicates that Elizabeth requires support on tasks that involve executive functioning such as transitioning from one activity to another, controlling her emotions, starting tasks, figuring out the steps she needs to take, remembering these steps or instructions, organizing her materials, and monitoring her performance and how her actions are perceived by others but is able to sustain attention where needed and ignore irrelevant information in her environment. The Assessment of Lagging Skills and Unsolved Problems also indicated that Elizabeth experiences difficulties with executive functioning and requires support to interpret social cues, seek attention appropriately, think rationally when upset, and consider a range of solutions to a problem. Questionnaire measures of Elizabeths socio-emotional functioning further supported the notion that Elizabeth was having difficulty controlling her emotions as both her teacher and mother reported affective problems and some problems with anxiety and physical experiences of feelings of sadness or worry. Mrs. SSS reported some conduct problems at home that were not present at school. On the MASC Elizabeth initially described herself as having slightly more problems with social relationships than other children and many more problems with anxiety including feeling physically sick when worried, wanting to do everything perfectly, and feeling scared when alone. In October 2009 Dr. XXXX had Elizabeth complete the MASC and she found significantly elevated responses in the areas of perfectionism and avoidant coping responses to worries or fears. This means that in May 2011 she was having less avoidant coping responses to worries or fears, but was having more physical feelings of her emotions, and fears of being alone than October 2009. To find out whether Elizabeths June reports of having no problems and feeling happy represented a decrease in her feelings of anxiety or not wanting to engage in collaborative problem solving at school she was asked to complete the MASC again. On June XX she reported that she continued to worry about doing things perfectly and had some concerns with being alone; however, these ratings decreased from Clinically Significant to At Risk. This indicates that Elizabeth is currently feeling less anxious than she was in May. Given Elizabeths difficulty with emotional regulation it is probable that the falling out with a former friend and subsequent bullying issues in February increased Elizabeths overall levels of anxiety. Since Elizabeth reports that these problems have resolved it makes sense that she feels less anxious and happier overall. Recommendations: Elizabeth has difficulty developing an organized plan for how she is going to achieve a goal or execute a task. Interventions that may help her develop this skill include reviewing the plan for the day over breakfast, parent modeling of how to plan multi-step activities through the day, setting goals and planning how to achieve them with fading adult support, and encouraging Elizabeth to break down difficult tasks into steps and create a list for future reference.

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Since Elizabeth experiences difficulty with organization she will benefit from working in environments that are well organized and predictably structured. To prevent problems with forgetting necessary materials for homework her parents may want to request an extra set of books. Elizabeth will also require assistance in managing long-term tasks such as being assigned only one task at a time or breaking down a large task into several smaller tasks with more frequent due dates. Elizabeth shows a stable tendency towards perfectionism and may benefit from reinforcement at home and school that she is capable and that no one expects her to be perfect. If she becomes worried about her performance on an upcoming task she should be encouraged to look at things in perspective and discuss possible outcomes of her best effort not being perfect. Elizabeth experiences difficulty controlling her emotions and experiences more feelings of anxiety than most children at least some of the time. Elizabeth may find discussing upcoming situations that may provoke an outburst beneficial as this can help her modulate her emotions more effectively in the moment. Additionally, discussing situations that led to an outburst in a non-threatening setting and manner once she is calm can make her more aware or her reactions and plan more desirable ways to react in the future. Her parents and teachers may also want to reinforce Elizabeths ability to use coping skills and reinforce her when she identifies stressful situations ahead of time, uses relaxation methods, or finds other ways to control her emotions. Since Elizabeth is not currently experiencing significant problems with anxiety and has expressed a preference for working with her parents over a counselor it is recommended that her parents continue to help her work through her feelings and reinforce Elizabeths ability to solve her problems.

SSS, Elizabeth Indices BRIEF General Executive Composite Behavior Regulation Index Inhibit Shift Emotional Control Metacognitive Index Initiate Working Memory Plan/ Organize Organ. of Materials Monitor CBCL DSM-Oriented Scales Affective Problems Anxiety Problems Somatic Problems ADHD Problems Oppositional Defiant Problems Conduct Problems Bar-On EQ-i:YV Intrapersonal Scale Interpersonal Scale Stress Management Scale Adaptability Scale General Mood Scale Total EQ MASC MASC Total Total Physical Symptoms Tense Restless Somatic Total Harm Avoidance Perfectionism Anxious Coping Total Social Anxiety Humiliation/ Rejection Performance Fears Separation/ Panic Anxiety Disorder Index Piers-Harris 2 Total Score Behavioural Adjustment Intellectual & School Physical Appearance & Attributes Freedom from Anxiety Popularity Happiness & Satisfaction Mother (Mrs. Petra SSS) Clinically Significant Clinically Significant At Risk At Risk Clinically Significant Clinically Significant At Risk At Risk Clinically Significant Clinically Significant At Risk Clinically Significant Clinically Significant Clinically Significant Average Average Clinically Significant Teacher (Mrs. Mrs. Jones) Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant At Risk At Risk Average Average Average Average At Risk Average Average Average Average Clinically Significant Clinically Significant At Risk Clinically Significant At Risk At Risk Average At Risk At Risk Average Clinically Significant Clinically Significant Average Average Average Average Average Average Average Average Average Average Average Average Average At Risk Average Average Average Average At Risk At Risk Self (Elizabeth SSS) May 24, 2011

Self (Elizabeth SSS) June 21, 2011