Emily Part 2

Impressions:

Emily presented as a very friendly and engaging girl who was extremely cooperative and invested in her performance throughout the testing. She appeared at ease during the assessment, her mood was generally cheerful, and she displayed a good sense of humor. Emily's receptive language skills were intact and she exhibited well developed linguistic pragmatic skills (the ability to use language for social purposes). Expressively, she was easily able to initiate conversation and respond to questions from the examiner , although she was observed to have some word finding difficulties and would frequently use "filler" phrases such as "that's cool." In addition, consistent with her ADHD diagnosis, Emily's arousal and attention levels were variable and she exhibited some impulsive behavior, such as interrupting with tangential comments. Nevertheless, given Emily's level of motivation and hard work, the results of this evaluation are considered valid indicators of her present levels of functioning.

Results of intellectual assessment reveal that Emily is performing at or above age expectations. Her overall verbal reasoning skills measured in the High Average range, while her visual - spatial reasoning and perceptual reasoning skills measured solidly in the Average range. Emily's working memory was also assessed in the Average range, although her performance was noted to be inconsistent on these task due to variations in her level of attention. On contrast, Emily performed relatively lower on tests of processing speed, scoring at the low end of the Average range in this regard. Specifically, Emily displayed difficulties on tests of "mechanical skills" such as speed of visual scanning and graphomotor output. Due to the discrepancy among Emily's index scores, a General Ability Index was calculated to provide comparable approximation of her overall intellectual functioning. results of this find Emily to measure in the High Average range.


on standardized tests to assess Emily's academic skills, Emily generally performed at or above grade level expectations. For example, Emily's math calculation skills measured solidly in the Average range. In addition, on tests of reading comprehension, Emily performed above grade level, although on a timed single word decoding and phonemic awareness test, Emily performed relatively lower ( but within grade level expectations). With regard to writing, Emily exhibited Superior Range single word spelling skills. However, despite Emily's strong single word spelling skills, when asked to write a story, her writing contained multiple spelling, punctuation and capitalization errors. In addition, although Emily experienced Superior range vocabulary, her story contained simplistic vocabulary and awkward sentence structure.

From a diagnostic standpoint, the results of the present evaluation highlight the continued presence of ADHD, a neurologically based disorder involving difficulties with he regulation of mood, attention, behavior and energy level. In addition, current neuropshychological assessment was notable for a learning disability characterized by significant difficulties in executive functioning including the areas of organization and processing speed, and for weakness in graphomotor control. Notably, many children with Epilepsy have significant problems with attention, arousal and executive functioning. Further, based on the discrepancy between Emily's intellect and diminished written expression skills, she meets the criteria for a specific learning disability in written expression.

During the testing Emily's behavior was notable for decreased behavioral control, impulsivity, and trouble organizing information. In addition, compared to her strong verbal cognitive abilities, Emily's processing speed is relatively weak. This profile is very common among individuals diagnosed with ADHD. Further, qualification of a standardized questionnaire, found Emily's parents to indicate symptoms of ADHD at a clinically significant level (99th percentile) while Emily's teacher noted that Emily often appears disorganized in class. the discrepancy between the home and school attentional issues is likely related to the structure inherently provided during the school day, one that is not always feasible in the home.

Results of current neuropsychological testing were also notable for executive functioning vulnerabilities including reduced behavioral regulation and difficulty inhibiting responses, both aspects of executive control.

Executive functioning also encompasses problems with cognitive organization. On several tasks, Emily displayed difficulty organizing large amounts of both complex visual and verbal information. For example, Emily's approach to copying a complex design was less organized then expected for a student of her age. While Emily was able to appreciate the overall "gestalt" of the design, she had difficulty recognizing the organizational components of the design and integrating the details. Similarly, while Emily could readily organize some verbally presented information, such as repeating orally present complex stories, when presented with a long list of unrelated words, Emily was relatively unsuccessful at independently generating an organizational strategy, therefore displaying difficulty initially learning and then retaining the information over time.

Difficulties with cognitive organization frequently lead to problems with efficient information retrieval. On a task of naming picture, Emily often required cueing of the first word sound in order to retrieve the vocabulary that she knew. One way that this weakness in cognitive organization manifests in school is that students will know information and understand concepts, but struggle to retrieve what they know under the pressure of a class discussion or in testing situations.

Emily also presented with significant fine motor difficulties. her handwriting was extremely messy, her graphomotor speed on a timed task measured in the Low Average range, and her ability to manipulate pegs in a pegboard measured below age expectations for both hands.

Fortunately, Emily presents with many strengths in her profile. Nevertheless, despite her many strengths, Emily presents with a neurologically based attention disorder. In addition, she displays executive functioning vulnerabilities that are significantly undermining her development of written expression. With this profile, I view Emily as a student who is at risk for being undermined academically by increasing writing and organizational demands. As such, she will need support in order to help her capitalize on her strengths and compensate for the areas in which she performs less efficiently.