Courtney Hope Willson

 XXXX Psychological Assessment *Confidential* For Professional Use Only Student Name: XXXX Date of Birth: XXXX School and District: XXXX Grade: 12th (Post- Secondary) Evaluator: XXXX, LSSP Date of report: 3/8/2019 Reason for Referral: Due to current emotional difficulty and diagnoses, XXXX was referred for additional assessment by her ARD committee in order to gather information related to her current functioning and to assess whether or not additional disability eligibilities, program modifications, and/or emotional/behavioral supports and accommodations are needed at this time. Sources of Information: SOURCES OF DATA (formal and informal) EVALUATION DATES Review of Educational Records 1/28/2019 Comprehensive Vocational and Psychological evaluation 4/11/2017 Behavior Assessment System for Children, 3nd Edition (BASC-3) Self-Report- XXXX Parent Rating Scale – XXXX Teacher Rating Scale- XXXX Teacher Rating Scale – XXXX Parent/Caretaker Rating Scale- XXXX 1/25/19 1/28/19 1/25/19 1/28/19 1/25/19 HAAK Sentence Completion – Secondary Form 1/25/19 Beck Anxiety Inventory Self-Report 1/25/19 Beck Depression Inventory, 2nd Edition Self-Report 1/25/19 Adaptive Behavior Assessment System, 3rd Edition Parent Rating Scale – XXXX Teacher Rating Scale- XXXX Teacher Rating Scale – XXXX Parent/Caretaker Rating Scale- XXXX Self-Report – XXXX Berry 1/25/19 1/25/19 1/28/19 1/25/19 1/25/19 Scales of Independent Behavior-Revised XXXX, Parent XXXX, Teacher XXXX, Teaching Assistant XXXX, Residential Instructor 1/28/19 1/24/19 1/24/19 1/25/19 Woodcock-Johnson, Tests of Cognitive Abilities, 4th Edition 1/25/19 Student Information 1/23/19;1/25/19 Teacher/Staff Information 1/30/19 Parent Information 1/28/19 Online Student Incident Reports 9/18/18 – 1/11/19 Background and Sociological Information: XXXX is a 21-year-old female referred to XXXX from XXXX, in XXXX, Texas. She was initially referred during her 7th grade year, and has attended XXXX for the remaining years of her education. When not attending XXXX, XXXX lives at home with her mother and step-father. XXXX also has two older brothers, as well as a half-brother and half-sister, who no longer live at home. XXXX sees her biological father infrequently but does communicate with him on a regular basis. XXXX began reporting increased anxiety during the summer of 2018, and additional medical support was sought. Reported symptoms included difficulty eating, decreased appetite, and difficulty sleeping. On 7/9/18, XXXX saw XXXX, FNP-C of XXXX in XXXX, TX, and received a diagnosis of Generalized Anxiety Disorder. She began taking Citalopram and increased her dosage 1 x prior to the December of 2018. In December of 2018, XXXX reported an increase in her anxiety and her Citalopram was discontinued. At this time, she began taking Buspirone (7.5 mg) in support of her anxiety. Since December, her dose has increased two additional times. Currently, she takes 30mg daily. In addition, XXXX takes daily medication in support of her allergies and digestion. At this time, XXXX does not receive any outside therapy or behavioral support services. On 1/14/19, XXXX saw XXXX, FNP-C for a follow-up appointment and Dysphagia (difficulty swallowing) was also identified as a concern. XXXX reported that this may be correlated with XXXX’s Generalized Anxiety Disorder diagnosis. A screening for depression was also completed at this time, and scores indicated that XXXX may be experiencing Moderate levels of depression and sadness. In January of 2019, XXXX and her family dog, Buddy, enrolled in an training program to pursue certification for service animals. The goal for this certification is that Buddy will be able to identified as a therapeutic service animal in support of XXXX’s anxiety. Prior January of 2019, XXXX was a residential student in the XXXX program and only returned home on school holidays/closings. A trial period was granted that allowed for XXXX and her dog to live on the XXXX dorm in order to explore if the required schedule and routine would be sustainable. XXXX reported that she did not feel that she could manage both her program responsibilities and care for her dog at this time. Currently, XXXX has moved to an apartment off-campus in order to provide the necessary care for Buddy, complete his certification, and continue with her transition program at XXXX as a day student. Physical Information: Currently, XXXX receives special education services as a student with a Visual Impairment (VI) and Speech Impairment (SI). She has a visual diagnosis of chorioretinal and iris colobomas (congenital gap within the structure of the eye), microphthalmia (congenital condition where one or both of the eyeballs are moderately to severely reduced in size), Nystagmus (an involuntary, rhythmic, side-to-side or up and down/oscillating eye movement that is faster in one direction than the other) and aphakia (absence of the lens in the eye). XXXX’s most recent FVE/LMA (3/26/18) indicates noted distance acuities of 10/200 O.D. (right eye) and 10/60 O.S. (left eye). Information from her most recent Low Vision Evaluation (4-22-14, XXXX, O.D.) indicates superior field restrictions (similar to wearing a baseball cap), some central field acuity problems related to the colobomas and photosensitivity (sensitivity to outdoor light and indoor lighting at night). XXXX’s visual prognosis is permanent and is considered to be a significant vision loss. Previous Evaluation Information XXXX has undergone previous assessment conducted by XXXX, XXXX, and XXXX, LSSP, in correlation with Vocational Rehabilitation Services and Texas Workforce Commission. A Full and Individual Evaluation was most recently completed on 5/3/18. Evaluation information indicated that XXXX continues to meet eligibility as a student with a visual impairment and speech impairment due to an expressive/receptive language disorder. A counseling evaluation was also requested by XXXX’s mother, XXXX, and completed by XXXX on 3/20/2014. Information from this counseling evaluation indicated that XXXX did not meet eligibility for related service counseling at that time due to inconsistent demonstration of behaviors and successful access and participation within her school program. A comprehensive vocational and psychological evaluation was also completed on 4/11/2017 by XXXX, LSSP. This evaluation was requested by the Texas Workforce Commission, Vocational Diagnostic Unit. Information from this evaluation indicates an Emotional Factor score within the borderline range (based on the evaluator’s observations and the customer’s report of functioning) and screening measures for depression and anxiety were not significant. Testing Observations: XXXX was generally appropriate and fully participatory during testing sessions. She appeared well-groomed and appropriately dressed. Throughout the assessment process XXXX was very verbal and gave expansive answers to most questions asked by the examiner. On several occasions, XXXX required redirection back to the topic being discussed. She also benefited from additional clarification and information in order to understand the context and purpose of questions asked. Overall, XXXX’s demeanor appeared cheerful and pleasant. Emotional/Behavioral Information: Student Interview and HAAK Sentence Completion: XXXX was interviewed by XXXX, LSSP, on 1/23/19 for approximately one hour. When asked about her emotional/behavioral history, XXXX reported that she feels as though she has experienced anxiety for several years, beginning when she was in Junior High. Recently, she described increased anxiety over the past month and reported that she feels “antsy” and “ready to be done with school”. XXXX also reported several recent panic attacks, and stated that she occasionally has experiences where her “mind goes somewhere else, her heart beats quickly, and she can feel her face get heated and flushed.” XXXX reported that when she feels anxious, she benefits from time with her dog, Buddy, and that she prefers to not be around anyone else. She also stated that she enjoys watching TV or movies, playing video games, and listening to music to help distract her from how she is feeling. When asked about her relationships with family and friends, and whether or not these are helpful to her when she is feeling anxious, XXXX reported that she feels as though talking to others is not a good option for her. She identified herself as more of an “animal” person vs. a “people” person, as “animals can’t talk back to you.” XXXX also emphasized that she doesn’t like thinking about other people and how they are feeling and that therefore she doesn’t enjoy communicating with others about how she is feeling. She shared “I don’t get along with other people. I’ve always been like that. I don’t trust them. They have to earn my trust.” XXXX described having a handful of close friends, but none who are currently at XXXX. She reported that most of her friends live other places outside of Austin and her home community, but that she texts them to keep in communication. While XXXX identified these friends and was able to define the value that they bring to her life, she stated that she “doesn’t care if people like” her, and that she “isn’t at XXXX to make friends.” She reiterated that she prefers to be alone and that being around others, especially more than 1-2 people, can be difficult for her. When asked about her personal goals for her future, XXXX reported that she hopes to live independently in an apartment with her dog, and to work full-time with animals. She stated that she does not want to get married or have a family, as she feels she wouldn’t enjoy being around people in such a close proximity for such a long time. XXXX acknowledged that she is “quick-tempered” and described herself as being someone “you don’t want to mess with.” When asked about the kinds of things that can trigger her anger, XXXX reported that she can easily become angry if she is hungry, tired, needs a break, and/or if someone doesn’t give her space when she needs it. She described herself as expressing her anger most frequently by swearing, as it makes her feel better, and by walking away from the situation. When asked about activities and hobbies that she enjoys, XXXX stated that she loves playing with her family animals, playing video games, listening to music, and watching true crime and mystery television shows. When asked to describe what she would wish for if she was granted three wishes, XXXX reported that she would want to have her dream job (animal trainer), live in an apartment by herself, with only people she likes nearby, and have a self-driving car. XXXX was also administered items from the HAAK Sentence Completion- Secondary Form orally, and was asked to respond orally. In this activity, she was asked to fill in the secondary parts of sentences regarding topics such as school, authority, peers, locus of control, relationships, self-concept, emotions, aspirations, social values, and openness to help. Information from XXXX indicated common themes having to do with interpersonal relationships and self-dependence. The following sentences were completed: If I were king, I would… let people do whatever they want. When it comes to making friends, … it is harder for me. Other students always expect me to… be respectful. Students at this school are… annoying- I’m not a fan of other people and want them to leave me alone. I could achieve more if… I knew what I was doing. I can never… sit still. If I need help, the person who helps me best is… myself. To a teenager, a family is…annoying. In my family, I… don’t get along with people. The people in my class think I am… annoying. Being “left out” happens a lot to… I don’t know. I never feel left out. I like myself when… all of the time. A lot of smart people cannot… I don’t know. I don’t like to think about other people. The one thing that people need to understand about me is… that I like to be alone. I hardly ever feel… sad. Nothing feels better than… being alone. I could be happy if… I got my own space. I need to change… I don’t need to change anything. What I most look forward to is… getting out of school. It’s no use to… read. What I need most of all is… space. I can’t stand… being with a lot of people. I really get mad when… there are too many people. My biggest problem is… I don’t have a problem. I hope that I never… get really, really mad because I’m not sure what would happen. I do not like to think about… school. I often daydream about… I don’t daydream. I feel proud when… I do work on my own. The world needs more people who… don’t talk a lot. Talking over problems with a counselor is... not my favorite thing to do. Parent Information: XXXX, XXXX’s mother, met with XXXX, LSSP, for approximately two hours on 11/28/2019. When asked about her most significant concerns regarding XXXX, XXXX reported that XXXX often has big, emotional responses to small, every day conflicts and that she can easily get “stuck” when trying to problem-solve these issues. She described XXXX as having experienced anxiety since she was younger, but that she has observed an increase in anxiety over the past several months. She stated that XXXX often appears to have difficulty knowing how to manage her emotions, and that this can be a significant hurdle for her when interacting with others. XXXX also reported that XXXX consistently seeks to please others and that she can become anxious if she feels as though she might disappoint those around her. However, she noted that XXXX has very strong preferences, and reported that when XXXX doesn’t like something or want to do something, that she can escalate quickly. Often, this escalation will reinforce XXXX’s concerns that she is disappointing those around her or not doing something correctly. When asked to describe XXXX’s relationship with both peers and adults, XXXX shared that XXXX generally treats others similarly, no matter their age. She emphasized that XXXX is very wary of trusting others, and that she can take a long time to build a relationship with someone. Because XXXX has very clear ideas on individuals that she “likes” and “dislikes”, she can form opinions about others quickly, and these opinions can be hard to change. XXXX stated that XXXX works best with preferred peers and staff and that she generally works to actively avoid those who she does not like or get along with. When asked about XXXX’s school history, XXXX reported that XXXX has historically had a small group of friends at XXXX, but that she does not have any close friends within her home community. She stated that XXXX has historically been most successful working independently, or one-on-one with preferred teachers who fully understand XXXX’s needs and preferences. She described XXXX as being able to sustain attention only on ideas and topics that she is interested in, and noted that XXXX has never enjoyed reading. In regards to how XXXX demonstrates her emotions, XXXX described XXXX as experiencing frustration frequently, and that this typically looks like XXXX swearing, yelling (but not necessarily at someone, just about the situation), and/or seeking isolation from her environment. When XXXX is sad, XXXX reported that she will cry and/or retreat to her room to be by herself. When asked about XXXX’s coping strategies, XXXX described her as greatly benefiting from time with the family animals, specifically her dog, Buddy, and time alone to play video games and/or decompress away from others. XXXX also emphasized the importance of “down time” for XXXX, stating that she can become more anxious if she feels that her whole day is filled with scheduled places and responsibilities. When asked about XXXX’s strengths, XXXX described XXXX as a strong advocate for the things she wants, and a hard worker who is focused on her preferred goals. She reported that XXXX has wonderful skills working with animals, and that she demonstrates a lot of independence in her travel and navigation. Staff/Teacher Information: Information regarding XXXX’s current strengths, needs, and areas of concern were reported by her XXXX staff during weekly team meetings on 1/23/19 and 1/30/19. Staff included XXXX (Classroom teacher and CTVI), XXXX (Teaching Assistant), XXXX (Residential Instructor), XXXX (Residential Manager), and XXXX (Job Coach). When asked about XXXX’s strengths, staff reported that she demonstrates strong preferences in regards to her likes/dislikes and that she is often a good advocate for thee preferences. Staff described XXXX as very willing to help other students in the area of technology, and stated that she typically is most successful working within small groups (1-2 people) of preferred students and staff. When asked about emotional/behavioral observations, XXXX’s staff reported that she has demonstrated significant difficulty participating in her program since beginning the spring semester, and that she has been observed to consistently avoid and/or refuse to participate in both her residential and school-day routines. Staff report that XXXX has repeatedly voiced her frustrations over the requirements and responsibilities of the EXIT program and that there has been a significant increase in “shut-down” behaviors over the past several weeks. These behaviors typically occur when XXXX is prompted to do something she does not want to do and/or does not agree with what is being asked of her. XXXX has also demonstrated consistent difficulty with her interpersonal relationships. Staff report that since November of 2018, XXXX has reported increased conflicts with both non-preferred peers and staff, and that she often requires extensive support to problem-solve and communicate with others appropriately. When angry or frustrated, staff report that XXXX has been observed to communicate her emotions by swearing, shouting, throwing items, and/or abruptly leaving the room. When escalated, XXXX is typically not able to identify appropriate steps to take to resolve the situation and often requires support from her mother in order to de-escalate. Staff also report that XXXX can have a difficult time identifying her own role in conflicts and she can be rigid in her ability to take other’s perspectives. When asked about XXXX’s greatest need areas, staff reiterated concerns regarding XXXX’s ability to communicate her needs and emotions in ways that are appropriate to people, person, and place. They also identified XXXX as having a strong temper and stated that, at times, she can have significant difficulty managing her anger. While her school program is able to provide accommodations to support her needs regarding anger management, her staff stated that they are concerned about how her emotional management might impact her future employment, etc. On 1/23/19, XXXX’s schedule was amended in order to align with her post-secondary goals and change in day-student status. This schedule included two days spent on-campus at XXXX participating in related services as well as working with a job coach, and two days spent off-campus participating in Dog Alliance training. Due to varying circumstances, XXXX’s participation in her on-campus programming has been inconsistent. Current staff indicate that XXXX’s communication regarding whether or not she will be attending related-service sessions has also been inconsistent. General Observations: XXXX, LSSP, attempted to observe XXXX participating in her amended schedule on 2/5/19, 2/19/19, and 3/6/19. XXXX was absent each of these days and/or did not participate in her scheduled related service and/or class and therefore observational data is not noted. Functional Behavior Information: Data taken from XXXX's Online Student Incident Reporting System indicates 23 behavior-based incidents since 8/21/18. 17 of these incidents have occurred since 11/11/18. Of these incidents: Refusal to participate/Shut-down behaviors: (9 incidents) Skipping class/activities without communicating to staff: (6 incidents) Emotional outbursts (crying, swearing, shouting, slamming doors, etc.: (5 incidents) Making disparaging remarks about peers and/or staff: (2 incidents) Reported panic attack: (1 incident) All reported behaviors have been observed in both the classroom and residential settings, as well as in the community. Behaviors typically increase when around non-preferred staff and peers, when provided feedback and or instruction by staff, and when provided prompts or redirected by staff. Strategies that have been utilized by staff in order to support behaviors include decreasing expectations and increasing accommodations as needed, providing space and time to decompress, exploring alternative ways to communicate a need for a break, reinforcing appropriate communication of sadness, frustration, and anxiety, and exploring additional coping strategies. XXXX also had a behavioral contract in place in order to help support her understanding of expectations. These strategies have been inconsistently effective. A Behavior Intervention Plan is recommended in order to provide continued support for XXXX’s behavioral needs, as well as to help provide staff with appropriate strategies in support of XXXX’s difficulty with emotional management. Please see attached. BAI: The Beck Anxiety Inventory (BAI) is a 21-question multiple-choice self-report inventory that is used for measuring the severity of anxiety in children and adults. The questions used in the measure ask about common symptoms of anxiety that the rater has experienced during the past week, such as numbness and tingling, sweating not due to heat, fear of the worst happening, etc. It is designed for individuals who are 7 years of age or older. The BAI was orally administered to XXXX by XXXX, LSSP, on 1/25/19. Results are as follows: BAI Score Ranges: Classifications: 0-7 Minimal 8-15 Mild 16-25 Moderate 26-63 Severe Date of Administration: Score: Classification: 1/25/19 8 Mild BDI-II: The Beck Depression Inventory, Second Edition (BDI-II) is a 21-item self-report instrument intended to assess the existence and severity of symptoms of depression in individuals ages 13 and older, as listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – 4th Edition. When presented with the BDI-II, the rater is asked to consider each statement as It relates to the way they have felt for the past two weeks. The BDI-II can be a useful tool in assessing an individual’s emotional progression from one week to the next. The BDI-II was orally administered to XXXX by XXXX, LSSP, on 1/25/19. Results are as follows: BDI-II Score Ranges: Classifications: 0-13 Minimal 14-19 Mild 20-28 Moderate 29-63 Severe Date of Administration: Score: Classification: 1/25/19 6 Minimal BASC-3: The Behavior Assessment System for Children, Third Edition, 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. In addition to evaluating personality and behavioral concerns, the BASC-3 identifies positive behaviors associated with school success. Results should be interpreted with caution due to lack of normative data for individuals with visual impairments. XXXX, along with her mother, teacher, teaching assistant, and residential instructor, completed a BASC-3 form, rating XXXX’s behavior in multiple areas. At-risk and Clinically Significant responses are marked below. At-risk typically refers to elevated levels of behaviors that require monitoring and would likely benefit from targeted interventions. Clinically Significant behaviors typically require immediate intervention. Results are as follows: All reporters returned BASC-3 profiles with validity indexes within the acceptable range. It should be noted that differences between raters are not unusual and may be explained by differences in subject matter, time of day, level of demands placed on XXXX, presence/absence of comparison peers, environmental structure, rater experience with XXXX, etc. The Externalizing Problems Composite (acting out behavior) examines the areas of hyperactivity, aggression, and conduct problems. The hyperactivity scale measures the tendency to be overly active or act without thinking, the aggression scale measures the tendency to act in a hostile manner that may appear threatening to others, and the conduct problems scale measures the tendency to engage in anti-social rule-breaking behavior. One rater indicated At-Risk scores in the area of Hyperactivity. Two raters indicated At-Risk scores in the area of Aggression, while one rater indicated Clinically Significant scores in this area. In addition, two raters indicated At-Risk scores in the area of Conduct Problems. Overall, three out of four raters indicated At-Risk scores in the composite area of Externalizing Problems. The Internalizing Problems Composite (acting in behavior) examines the areas of anxiety, depression, and somatization. The anxiety scale measures the tendency to be nervous or worried about real/imagined problems, the depression scale measures the tendency to have feelings of unhappiness and sadness that may result in the inability to carry out everyday activities, and the somatization scale examines the tendency to be overly sensitive to relatively minor physical problems/discomforts. One rater indicated At-Risk levels of concern in the area of Depression, and one rater indicated Clinically Significant scores in this same domain. Overall, one rater indicated At-Risk scores in the composite area of Internalizing Problems. The School Problems Composite examines the areas of attention problems and learning problems. The attention problems scale measures the tendency to be easily distracted and the inability to concentrate. The learning problems scale measures the presence of academic difficulties. Two raters indicated At-Risk levels of concern in the area of Attention, while one indicated Clinically Significant scores in this area. One rater also indicated Clinically Significant scores in the area of Learning Problems. Overall, one rater indicated At-Risk scores in the composite area of School Problems, while another rater indicated Clinically-Significant scores. There are two scales which do not contribute to a composite - atypicality and withdrawal. The atypicality scale examines the tendency to think or behave in an odd or unusual manner. The withdrawal scale examines the tendency to avoid social contact. Two raters indicated Clinically Significant scores in the area of Atypicality. In the area of withdrawal, two raters indicated At-Risk levels of concern, while one indicated scores within the Clinically Significant range. The Adaptive Skills Composite examines pro-social, desirable behaviors, including adaptability, social skills, leadership skills, study skills, functional communication skills, and activities of daily living. Three raters indicated At-Risk levels of concern in the area of Adaptability. In the area of Social Skills, two raters indicated scores within the At-Risk range, while one rater indicated scores that were Clinically Significant. In the area of Leadership, three raters indicated scores within the At-Risk range, while one indicated scores within the Clinically Significant range. Two raters indicated scores within the At-Risk range in the area of Study Skills. In the area of Functional Communication, two raters indicated scores within the Clinically Significant range, and one rater scored within the At-risk range. In the area of Activities of Daily Living, one rater indicated scores within the Clinically Significant range. Overall, one rater indicated scores within the At-Risk range in the area of Adaptive skills, while two raters indicated scores within the Clinically Significant range. The BASC-3 index also provides specific content scales in the areas of Anger Control, Bullying, Developmental Social Disorders, Emotional Self-Control, Executive Functioning, Negative Emotionality, and Resiliency. One raters reported at-risk levels of concern in the area of Anger Control, while two raters indicated Clinically Significant scores. This indicates that XXXX may have a tendency to become irritable quickly and have difficulty maintaining self-control when faced with adversity. Two raters reported At-Risk levels of concern in the areas of Bullying, while one rater indicated Clinically Significant scores in this domain. In the area of Developmental Social Disorders, one rater indicated At-Risk levels of concern, while two raters indicated scores within the Clinically Significant range. Elevated scores in these domains indicates that XXXX may have difficulty engaging with and communicating appropriately with peers. Three out of four raters indicated Clinically Significant scores in the areas of Emotional Self-Control, while one rater indicated At-Risk levels of concern in the area of Negative Emotionality, and two raters indicated Clinically Significant scores in this same domain. These scores indicate that XXXX may have difficulty regulating and expressing her negative emotions appropriately. Three raters also reported clinically significant levels of concern in the area of Executive Functioning. This indicates that XXXX may demonstrate difficulty controlling and maintaining her behavior and mood. Overall, one rater indicated At-risk levels of concern in the area of ADHD probability, and another rater indicated Clinically Significant scores in this same domain. Two raters indicated At-Risk scores in the area of Functional Impairment, while one rater indicated Clinically Significant scores in the same domain. Three raters indicated Clinically Significant scores in the area of Emotional Behavioral Disturbance. In addition, XXXX also completed a BASC-3 Self- Report Form on 1/25/19.These scales are used to provide insight into a student’s thoughts and feelings. This assessment was orally administered by XXXX, LSSP. All validity scales fell within the acceptable range, indicating that XXXX appeared to answer the questions consistently and honestly. Results are as follows: XXXX self-reported At-Risk levels of concern in the areas of Attitude to School and Inattention/Hyperactivity. Clinically Significant concerns were self-reported in the areas Attitude to Teachers, Sensation Seeking, School Problems, and Hyperactivity. Information from scores on the Content Scales indicate that XXXX self-reported At-Risk levels of concern in the areas of Mania and Test Anxiety. Intellectual/Adaptive Behavior Information: Previous Evaluation Information: XXXX’s cognitive abilities were most recently evaluated as a part a comprehensive neuropsychological and vocational assessment completed by XXXX, LSSP, on 4/11/17, as contracted through Texas Workforce Solutions. XXXX was administered selected sub-tests from both the Cognitive Test for the Blind (CTB) and the Wechsler Adult Intelligence Scale, 4th Edition (WAIS-IV). The results were as follows: Cognitive Test for the Blind Verbal Subtests Scaled Score Performance Subtests Scaled Score Auditory Analysis 8 Category Learning 8 Immediate Digit Recall 4 Category Memory 8 Language Comprehension 6 Memory Recognition 11 Letter-Number Learning 4 Pattern Recall 8 Vocabulary 5 Spatial Analysis 5 *Average Range is 8 – 13 Factor Standard Score Descriptor Total 79 Borderline Verbal 80 Below Average Performance 88 Below Average *Average Range is 85 - 115 WAIS-IV Subtests Scaled/Standard Scores Score Range Descriptors Verbal Subtests Similarities 4 Borderline Vocabulary 5 Borderline Information 6 Low Average Verbal Comprehension Index (VCI) 72 Borderline Working Memory Subtests Digit Span 4 Borderline Arithmetic 5 Borderline Working Memory Index (WMI) 74 Borderline *Average Scaled Score range is 8 – 13 *Average Standard Score range is 85 - 115 Current Evaluation Information: XXXX’s cognitive abilities were assessed using selected sub-tests from the Woodcock-Johnson Tests of Cognitive Ability, 4th Edition (WJ-IV COG). Any test items requiring vision were not administered. Deviations from standard procedure occurred, as appropriate. Frequent breaks were offered. No time limits were enforced and directions/questions were repeated as often as necessary (as appropriate to the sub-test). Due to a lack of normative data for individuals with visual impairment for the WJ-IV COG, as well as deviations from standard procedure, results should be interpreted with significant caution. Additional information regarding XXXX’s cognitive functioning was also taken from observations, reports, and rating scales completed by her multi-disciplinary team. Testing observations: XXXX was notified in advance that she would be working with the examiner and participated willingly. Testing lasted approximately two hours over one testing session. Frequent breaks were offered, and multiple fidget toys and accommodations were provided to assist XXXX in her focus and participation. While XXXX appeared to put forth consistent effort, she did demonstrate mild frustration with certain test items that were deemed difficult. If XXXX did not know the answer to the question, she consistently chose to move to the next item quickly, rather than attempt to guess or answer the previous question fully. Due to XXXX’s quick pace of assessment and demonstrated frustration, scores should be interpreted with caution as they may be an under-representation of her current abilities. Scores are as follows: Ability Area/Subtest Standard Score SS Range Gc Crystalized Intelligence 64 Very Low WJ-IV: General Information 63 Very Low WJ-IV: Oral Vocabulary 67 Very Low Ga Auditory Processing 69 Very Low WJ-IV: Phonological Processing 62 Very Low WJ-IV: Non-word Repetition 80 Low Average Gwm Short Term Memory 56 Very Low WJ-IV: Memory for Words 65 Very Low WJ-IV: Verbal Attention 82 Low Average WJ-IV: Object-Number Sequencing 46 Very Low WJ-IV: Numbers Reversed 64 Very Low WJ-IV: Story Recall 56 Very Low *Average Standard Score range is 90 - 110 The Comprehensive Knowledge Index (Gc) is a measure of crystalized knowledge, which is an individual’s acquired knowledge of a culture and the effective application of this knowledge through formal schooling and general life experience. The General Information subtest asks questions such as “Where would you find… (an object)?” and “What would you do with… (an object)” The initial items involve objects that appear commonly in a person’s environment, and later items become more difficult and unusual. XXXX demonstrated difficulty identifying items that are typically recognized by an individual her age. The Oral Vocabulary subtest asked XXXX to provide synonyms and antonyms for common words. She was able to identify initial items but demonstrated difficulty with more difficult, age appropriate words. Testing in this area suggests a weakness in her cognitive development as evidenced by her limited vocabulary and difficulty negotiating abstract concepts. The Short Term-Working Memory Index (Gsm) is a measure of working memory abilities, which is the ability to perceive, analyze, synthesize, manipulate, transform, and think with given stimuli and produce correct output within a few seconds. XXXX’s scores in this area fell within the very low range, indicating that her functioning in this area is significantly below age-level expectations. The Verbal Attention subtest asked XXXX to listen to a list of named numbers and animals and then repeat the items in the order as directed. XXXX performed within the Low Average range on this subtest. The Numbers Reversed subtest was a challenge for XXXX, as it was difficult for her to hold a span of numbers in her immediate awareness (memory) while performing a mental operation utilizing these numbers (reversing the sequence). The Object Number Sequencing subtest asked XXXX to listen to a series of objects and numbers, remember and name the objects in the sequence, and then name the numbers in the exact sequence. XXXX was able to hold and utilize two pieces of information when she was asked to manipulate it, but struggled to hold and utilize three or more pieces of information (containing both numbers and objects). XXXX’s memory span or her ability to recall ordered elements in the correct order after one presentation appears to range from 3-4 items. When asked to recall items while performing an additional set of cognitive operations, XXXX was able to do so within a range of 2-3 items. Testing in this area suggests a weakness in cognitive development as evidenced by her difficulty in synthesizing and manipulating object/number stimuli. The Auditory Processing Index (Ga) is a measure of sound discrimination and measures a student’s ability to notice, compare, discriminate, and separate sounds. The Non-word Repetition subtest was a relative strength for XXXX as she was asked to listen to listen to and then reproduce letter combinations that are phonetically consistent, or reproduce regular patterns in English orthography that are non-words. The Phonological Processing subtest consists of three smaller subtests. On the Word Access subtest, XXXX was given an alphabet sound and was then asked to state a word that starts, ends or has that particular sound in the middle. XXXX was able to correctly identify words that started with particular sounds; however, she struggled to produce words with sounds in the middle and end. On the Word Fluency subset, XXXX was asked to name as many words that she could recall that began with a certain sound. The Substitution subtest asked XXXX to substitute a word, a word ending, or a letter sound to create a new word. Overall, XXXX performed within the Very Low range on this cluster. XXXX was also administered additional subtests from the WJ-IV COG. Deviations from standard procedures are noted above. XXXX obtained a standard score within the very low range on both the Story Recall and Memory for Words subtests. These scores indicate that XXXX demonstrated difficulty recalling information when provided contextual cues and information that challenged her rote recall. Scores from the Story Recall subtest can also provide information in relation to Long-Term Retrieval. Retrieval fluency is an additional skill area that is considered to be highly correlated to academic success and is defined by the ability to automatically recall learn information associated with most learning tasks. XXXX’s score in this area indicates skills that fall within the very low range. Adaptive Behavior: XXXX’s adaptive behavior was assessed formally using the Adaptive Behavior Assessment System, 3rd Edition (ABAS– III) and the Scales for Independent Behavior-Revised Short Form for the Visually Impaired (SIB-R). The ABAS-III and SIB-R are standardized behavioral checklists for individuals from birth through adulthood. Adaptive Behavior refers to one’s ability to display personal independence and social responsibility in coping with natural and social demands of one’s environment. Both the ABAS-III and SIB-R were completed by XXXX’s mother, XXXX, her teacher, XXXX, her Teaching Assistant, XXXX, and her Residential Instructor, XXXX. XXXX also completed a Self-report ABAS-III form. Scores from the ABAS-III compare XXXX to other same-age peers and should be interpreted with caution due to a lack of individuals with visual impairments represented in the norming sample. It should be noted that differences between raters are not unusual and may be explained by differences in subject matter, time of day, level of demands placed on XXXX, presence/absence of comparison peers, environmental structure, rater experience with XXXX, etc. Scores from the SIB-R also compare XXXX to same-age peers but include individuals with visual impairment in the norming sample. It is designed to assess skills needed to function independently in home, social, school, work, and community settings. XXXX’s results are as follows: ABAS-III Skill Areas and Composites XXXX, CTVI Scaled Score/Standard Scores and Descriptor XXXX, TA Scaled Score/Standard Scores and Descriptor XXXX, Residential Instructor Scaled Score/Standard Scores and Descriptor XXXX XXXX, Mother Scaled Score/Standard Scores and Descriptor Communication 5 Low 5 Low 2 Extremely Low 10 Average Functional Academics 6 Below Average 3 Extremely Low 4 Low 7 Below Average Self-Direction 3 Extremely Low 1 Extremely Low 2 Extremely Low 8 Average Conceptual 68 Extremely Low 59 Extremely Low 62 Extremely Low 89 Below Average Leisure 4 Low 4 Low 1 Extremely Low 4 Low Social 5 Low 3 Extremely Low 1 Extremely Low 9 Average Social 73 Low 68 Extremely Low 62 Extremely Low 85 Below Average Community Use 9 Average 6 Below Average 8 Average 10 Average Home/School Living 5 Low 4 Low 5 Low 8 Average Health and Safety 7 Below Average 9 Average 6 Below Average 12 Average Self-Care 6 Below Average 4 Low 5 Low 9 Average Practical 79 Low 74 Low 75 Low 94 Average General Adaptive Composite 73 Low 66 Extremely Low 65 Extremely Low 90 Average Average range = Standard Scores (90 – 110) Average range = Scaled Scores (8-12) ABAS-III Self-Report Skill Areas and Composites: Scaled/Standard Score and Descriptor: Communication 9 Average Functional Academics 7 Below Average Self-Direction 9 Average Conceptual 89 Below Average Leisure 7 Below Average Social 5 Low Social 78 Low Community Use 6 Below Average Home Living 6 Below Average Health and Safety 9 Average Self-Care 6 Below Average Practical 81 Below Average General Adaptive Composite 81 Below Average Average range = Standard Scores (90 – 110) Average range = Scaled Scores (8-12) Conceptual Domain The Conceptual Domain is a measure of XXXX’s functional communication, basic academic skills needed for daily independent functioning, and her skills as applied to age-appropriate independence, responsibility, and self-control. Additional skills clustered in this domain include starting and completing tasks, keeping a schedule, following time limits, following directions, and making choices. Three of four raters indicated scores within the Extremely Low range, while parent scores indicated skills within the Below Average range. XXXX’s self-ratings indicated scores within the Below Average range. Social Domain The Social Domain is comprised of items from the social and leisure scales. The Social scale focuses on skills needed to interact socially and to get along with other people such as maintaining friendships, showing and recognizing emotions, assisting others, and using manners. The Leisure scale involves skills needed to engage in and plan leisure and recreational activities, including engaging with others, engaging in recreation at home, and following rules in games. Scores on this composite ranged from Extremely Low to Below Average. XXXX’s self-ratings indicated scores within the Low range. Practical Domain The Practical Domain is a measure of XXXX’s functioning and behavior within the community, daily living skills, personal hygiene, and ability to ensure personal safety and respond to illness. Three of four raters indicated Low scores in this domain, while parent scores indicated skills within the average range. XXXX’s self-ratings indicated scores within the Low Average range. General Adaptive Composite Overall, composite scores varied extensively, ranging from Extremely Low to Average. Information from both XXXX’s daytime and residential staff indicated general scores within the Extremely Low to Low range, while parent information indicates much higher scores that fell within the Average range. XXXX’s self-rating scores fell within the Low Average range. The significant in variability of scores is most likely due to the difference in demands, expectations, and structure between environments (home vs. school) as well as the frequency in which XXXX demonstrates her abilities in these environments. While XXXX often verbalizes her ability to complete tasks within the school setting, she does not always demonstrate these abilities, and therefore her emotional/behavioral needs may be reflected in her lower adaptive behavior scores in the school environment. Scales of Independent Behavior (SIB-R)- Short Form for the Visually Impaired: The Scales of Independent Behavior-Revised (SIB-R) is a comprehensive, norm-referenced assessment of adaptive and maladaptive behaviors used to determine an individual’s level of functioning in key behavior areas. The scores reported below are age equivalents. Norms are based on XXXX’s age at the time of assessment (21 years, 0 months.) Raters reported support level scores that ranged from Infrequent to Frequent. Scores from XXXX’s residential staff were the lowest. This is most likely due to the increase in emotional/behavioral needs observed within this setting. Broad Independence Score: Rater: Standard Score: Range (95% CI): Percentile: Student Skill Level: Estimated Support Level: XXXX, CTVI, Classroom teacher 63 (56 – 70) 1% Limited Intermittent XXXX, Teaching Assistant 61 (54 – 68) 0.4% Limited Intermittent XXXX, Parent 92 (85 – 99) 30% Manageable Infrequent XXXX, Residential Instructor 47 (40 – 54) 0.1% Limited to Very Limited Frequent Adaptive and Maladaptive behavior is based on an average of eight Problem Behavior Scales: Hurtful to Self, Hurtful to Others, Destructive to Property, Disruptive Behavior, Unusual or Repetitive Habits, Socially Offensive Behavior, Withdrawal or Inattentive Behavior and Uncooperative Behavior. Maladaptive behaviors refer to types of behavior that inhibit a person’s ability to adjust to a particular situation. This type of behavior is often used to reduce one’s anxiety, but the result is dysfunctional and non-productive. These behavior scales translate to a corresponding Support Score, indicating an overall level of support ranging from Pervasive to Infrequent. Overall, raters indicated the lowest scores on the Internalized Behaviors and Externalized Behaviors index. The Internalized Behaviors index has to do with behaviors such as withdrawal, inattention, unusual or repetitive behavior, and self-harm. The Externalized Behaviors Index is related to more observable behaviors related to distress such as disruptive behaviors, destruction to property, and being hurtful to others. Information from XXXX’s school staff and parent indicates that, at this time, XXXX appears to be functioning within the Normal to Marginally Serious range when compared to same-age, visually-impaired individuals. The Asocial Behaviors Index received elevated scores by all raters. This index is related to patterns of asocial behavior such as socially offensive and uncooperative behaviors. Raters indicated that this area appears to be a Marginally to Very Serious concern for both XXXX’s school staff and parent. This information is consistent with previous BASC-IV data, as well as student, staff, and parent input. Maladaptive Behavior Indexes Profile: ___________________________ Maladaptive Behavior Indices: XXXX, CTVI XXXX, TA XXXX XXXX, Parent XXXX, RI Support Score and Range (including Standard Error of Measurement) Descriptor Support Score and Range (including Standard Error of Measurement) Descriptor Support Score and Range (including Standard Error of Measurement) Descriptor Support Score and Range (including Standard Error of Measurement Descriptor Internalized Behaviors Index 2 (-1 to 5) Normal 2 (-1 to 5) Normal 2 (-1 to 5) Normal -14 (-11 to -17) Marginally Serious Asocial Behaviors Index -32 (-36 to -28) Moderately Serious to Serious -21 (-25 to -17) Marginally Serious to Moderately Serious -14 (-18 to -10) Marginally Serious -41 (-37 to -45) Serious to Very Serious Externalized Behaviors Index -3 (-6 to 0) Normal -4 (-7 to -1) Normal 3 (0 to 6) Normal -17 (-14 to -20) Marginally Serious General Behaviors Index - 14 (-16 to -12) Marginally Serious -9 (-11 to -7) Marginally Serious to Normal -4 (-6 to -2) Normal -30 (-28 to -32) Moderately Serious Summary and Recommendations: Summary: XXXX is a 21-year-old female attending the XXXX program at XXXX. She meets eligibility as a student with a visual impairment and speech language impairment. She was referred for assessment in order to gather more information related to her psychological and behavioral functioning. Current assessment indicates that XXXX reports significant difficulty with her interpersonal relationships, emotional management, and functional communication. In addition, XXXX has an outside medical diagnosis indicating Generalized Anxiety Disorder. On the BASC-3, XXXX self-reported elevated scores in her attitude to school and Inattention/Hyperactivity and Clinically Significant scores in her attitude towards teachers, sensation seeking behaviors, school problems, and hyperactivity. Two of four raters indicated elevated scores on the BASC-3 in the areas of Aggression, Conduct Problems, Externalizing Problems, Depression, Attention Problems, School Problems, Atypicality, Withdrawal, Adaptability, Social Skills, Leadership, Study Skills, Functional Communication, and overall Adaptive Skills. Scores on the Content scales from the BASC-3 indicate that at least two out of the four raters reported elevated scores in the areas of Anger Control, Bullying, Emotional Self-Control, Executive Functioning, Negative Emotionality, Emotional Behavioral Disorder, and Functional Impairment. Behavior information is consistent with rating scale data, indicating need areas related to inattention, emotional management, withdrawal, functional communication skills, and externalizing behaviors. Information from XXXX’s educational team indicates that these behaviors may be impacting her ability to access and fully participate in the EXIT program. Previous assessment indicates that XXXX’s cognitive abilities fall within the Borderline Range, while current cognitive scores demonstrate more depressed skills. These lower scores are most likely due to XXXX’s frustration level and difficulty sustaining effort when test items became more difficult and may not be an accurate reflection of her current abilities. Current adaptive behavior information also indicates lower scores; While XXXX often verbalizes her ability to complete tasks within the school setting, she does not always demonstrate these abilities, and therefore her emotional/behavioral needs may be reflected in her current lower adaptive behavior scores within the school environment. Adaptive Behavior scores within her home environment ranged from Low to Average. When considering whether or not a student meets eligibility as having an Emotional Disturbance, there are five characteristics that are considered. One or more of these characteristics must have been exhibited over a long period of time and to a marked degree that the student’s educational performance has been impacted. The five characteristics are as follows: An inability to learn that cannot be explained by intellectual, sensory, or health factors An inability to build or maintain satisfactory interpersonal relations with peers and teachers Inappropriate types of behavior or feelings under normal circumstances General pervasive mood of unhappiness or depression Tendency to develop physical symptoms or fears associated with personal or school problems It is the opinion of the evaluator, based on the whole of evaluation data, including her recent diagnosis of Generalized Anxiety Disorder, that XXXX currently meets eligibility as a student with an Emotional Disturbance based on her sustained difficulty maintaining interpersonal relations with peers and teachers as well as her consistent demonstration of inappropriate types of behavior or feelings under normal circumstances. The ARDC should consider the addition of this eligibility as well as the following recommendations: Recommended school-based supports: A Behavior Intervention Plan should be considered as a part of XXXX’s IEP in order to provide support to behaviors of concern. Please see attached for proposed BIP. It is recommended that XXXX continue to receive social work services as an IEP support in order to provide her with the necessary time and resources to identify potential community and adult services. Psychological services are recommended in order to provide consultative support to XXXX’s educational team. Recommended community-based supports: XXXX may benefit from continued community-based behavioral health support and/or psychiatric services in order to provide consistent management for her mental health needs. See attached information regarding resources available within the Austin area. Recommendations to support XXXX’s communication: Current speech and language information indicates that XXXX’s comprehension of spoken language is below average. She benefits from shortened, concrete instructions, repetition, and information about context in order be most successful. For example, a job supervisor might say, “It is important that this area be cleaned every day after the last customer has left. Cleaning supplies are in the cabinet to the left of the sink. You’ll find rags, disinfectant in a spray bottle, and fresh boxes of tissues in the cabinet to the left of the sink. Please be sure to use those cleaning supplies to clean every day before you go home.” XXXX has strong technology skills and benefits from utilizing her personal technology to support her communication. Developing formulaic statements (to use in emails, interviews, problem-solving discussions, etc.) and saving them on her One Note device for use within a professional environment may be a helpful tool. XXXX may become overwhelmed if too much information is given. Avoid verbal overload and instead strive to use clear and simple language when communicating. XXXX may have a limited understanding of how the words she chooses are perceived by others. When expressing complex information, she benefits from support to restate main ideas in order to ensure her communication is clear and understood. When interacting with unfamiliar adults, XXXX benefits from sentence starters and increased support (i.e. reminders to begin the conversation and/or ideas to help the conversation continue). Once XXXX is comfortable and has interacted multiple times with someone, she is more successful in initiating and continuing conversation. XXXX may have difficulty communicating about her emotions in the midst of escalated frustration or anxiety. Attempting to discuss her feelings when she is escalated will only serve to increase her frustration. Instead, provide her with time and space to decompress. Once her frustration and/or anxiety has decreased, allow her the opportunity to share how she was feeling in the moment and ideas for what can be done differently the next time a similar situation occurs. Recommendations to support XXXX’s emotional and behavioral health: XXXX is most successful when she feels as though she has choices and control within her environment. When possible, she benefits from having multiple options for ways to engage, participate, and/or contribute within any given setting. XXXX benefits from having time alone to decompress. When possible, remind her of upcoming opportunities in which she can take a break and experience minimal expectations. When experiencing anxiety, XXXX may completely withdrawal and/or shut down. During these times, it may be difficult for her to communicate and/or accept support from others. Provide her with the opportunity to take breaks, as needed. Recommendations to support XXXX’s skill acquisition and participation within a work setting: When learning new tasks, XXXX benefits from clearly communicated expectations and significant repetition. If tasks have multiple steps and/or if the demands of the task change unexpectedly, she can become frustrated. XXXX is most successful when working independently and/or in very small groups (1-2 people). When possible, minimize the expectation to work in large groups, as this can contribute to increased anxiety. XXXX benefits from consistent and predictable routines and expectations. Sudden increases in responsibility or expectations may contribute to increased anxiety and frustration. When providing feedback to XXXX, it should be clear, concise, and respectful. Avoid critical language or verbiage that may be perceived as shaming. Look for opportunities to provide feedback privately rather than in front of others. Modifications to supervision methods may be helpful in supporting XXXX’s levels of stress and anxiety. These modifications could include: meeting with XXXX or less frequently to discuss daily/weekly job tasks, providing instructions auditorily and in writing, using remote communication options when appropriate, and using goal-oriented management methods. Additional accommodations within the work setting may include: checklists, color-coded systems, modified break schedule, recorded directives, messages, and/or materials, use of timers, and the use of noise-cancelling technology, when appropriate. Preview helpful coping strategies with XXXX prior to new or challenging tasks/activities. Remind her of how she can communicate her needs and what her options are if she begins to feel overwhelmed. Point out places that she can go to take a break if needed. Signature Redacted.