COGNITIVE-ACADEMIC ASSESSMENT CASE CONCEPTUALIZATION WORKSHEET

FOR CHILDREN AND ADOLESCENTS

Clients Name: R.
Grade: 4

DOB: 04/12/2002
School: CCCS

Age: 10.9
Date: March 15, 2013

PROBLEM LIST FROM INTAKE

1.

Transferred to new school because of low skills overall, parents unsure if low skills are possible LD

2.

R is coming home and saying that school is hard for her and that she needs extra help and quiet
space to work (the class is too loud)

3.

Teacher has concerns with low confidence and whether or not R will be well prepared for middle
school. She would like to know what she can do to help prep her.

4.

Inconsistent school history with home schooling and non-traditional school setting

5.

Parents would like R to obtain more individualized support and attention due to concerns with her
academic skills

SPECIFIC REFERRAL QUESTION

Are there any underlying deficits that may be impacting Rs success? Would R. benefit from a full
psychoeducational assessment to determine her learning strengths and needs. Is her struggle with the
curriculum and low confidence based on lack of exposure or potential LD?

RELEVANT DEVELOPMENTAL HISTORY

Complications during pregnancy and at birth (Mom had TTTS syndrome and twin sibling died shortly
after birth). Was in neonatal intensive care unit for 2 weeks.
Hospitalized twice for long periods of time for asthma in grade 3 and 4
Transient facial and vocal tics (parents would not elaborate on how long for some reason avoided
discussing tics)
Hearing and vision screened with no concerns
RELEVANT ENVIRONMENTAL INFORMATION (HOME, SCHOOL, SOCIAL)
Series of emotional events in younger years (diagnosis of cancer to aunt and 2 deaths)
Attended public school in Kindergarten, home-schooled grades 1 and 2, attended very tiny school (5
kids in her class) with a focus on meditation for grades 3 and 4. Parents transferred her as they felt
CCCS would provide a better education.
Parents are both very kind, but also very mellow individuals.
Peers adore R, but she will state at home that she doesnt have a lot of friends. She has missed an
extensive amount of schooling this year, and this has likely affected peer relationships.
WORKING HYPOTHESIS
Anxiety?
Undiagnosed LD?
Parenting support?
AD/HD inattentive (teachers suggestion)

G. Wilcox 2013

COGNITIVE-ACADEMIC ASSESSMENT CASE CONCEPTUALIZATION WORKSHEET

FOR CHILDREN AND ADOLESCENTS
RULE OUTS
ADD in attentive was ruled out right away with observations and when working with R. She does appear
a bit dreamy at times. However, this appears to be more linked to personality or perhaps anxiety.

STRENGTHS
Cognitive
Neuropsychological
N/A

Academic
Delayed story recall
(only sig. strength)
Oral Language (relative
to her personal scores)
Within Average range:
Oral language
Reading
Writing
Application of academic
skills

Behavioral
Observation
Hard working

Parent/Teacher Report

Wants to please adults

Kind and thoughtful

Thoughtful at times
hesitant

Empathetic, highly in
tune with other people

Aware of weaknesses

Artistic

Hard working

STRENGTHS REAL LIFE IMPLICATIONS: R. MAY BE STRUGGLING WITH WRITTEN OUTPUT NOT MATCHING HER
ORAL LANGUAGE ABILITIES. DELAYED STORY RECALL STRENGTH MAY BE DUE TO PROCESSING TIME OR MEMORY
(LONG TERM AND TIME BETTER THAN SHORT TERM AND FAST RESPOSES- WHICH IS IN-LINE WITH PERSONALITY
DESCRIBED BY TEACHER, PARENTS AND OBSERVED BY ME. ADULTS AND PEERS ALL LOVE SPENDING TIME WITH
RUBY- EASY TO WORK WITH AND LOVES THE HELP
NEEDS
Cognitive
Neuropsychological
N/A

Academic
Academic Needs:
Math calculation skills
Editing skills
Spelling of non-words
Academic Fluency
Needs:
Math fluency
Reading fluency
Spelling of soundsphonological and
orthographic coding
skills
Math fluency
Story recall (immediate)

Behavioral
Observation
Facial tics (pursing lips
during areas of struggle)

Parent/Teacher Report

Looking for a lot of eye

contact (seeking
reassurance)

Gaps in academic areas

Hesitant

Struggles with
homework- takes a long
time

Sensitive

Aware of weaknesses

NEEDS REAL LIFE IMPLICATIONS:

FLUENCY (PROCESSING SPEED AND MEMORY) MAY BE IMPACTING HER ACADEMICS. ALTHOUGH SHE DIDNT
APPEAR OVERLY ANXIOUS, SHE MAY BE IN A DIFFERENT SETTING. THIS WAS 1:1 AND PERHAPS SHE PERFORMED
HIGHER THAN SHE DOES IN THE CLASSROOM

WORKING HYPOTHESIS ANALYSIS

G. Wilcox 2013

COGNITIVE-ACADEMIC ASSESSMENT CASE CONCEPTUALIZATION WORKSHEET

FOR CHILDREN AND ADOLESCENTS
Hypothesis
Undiagnosed LD or Low
academic skill areas
due to lack of exposure

Supporting Data
WJIII scores
inconsistent schoolinghard to determine at this
time
first year she has ever
really attended school

anxiety

Non-Supporting Data
Wonder about
processing speed and
memory
If she doesnt respond
to interventions, then
will need to be referred
for full assessment

overall in the average

range, with some weak
areas
Inconsistent attendance
High awareness of
challenges

Parenting needs

High level of parent

contact

Confirmed Y/N; Why?

N- might require full
assessment

No direct conversation

Anxiety noted during

meetings
Mother very tearful
several times
Teacher also has
concerns

N- would require
social/emotional
testing/more thorough
assessment, but I have
referred the parents to a
Pediatrician
N- not really my place
However, I did open up
the conversation and
have since sent them
some parenting
workshop information as
well as some articles on
school refusal and they
have both identified that
is an area that they need
to look at

DIAGNOSTIC IMPRESSIONS/EDUCATIONAL CLASSIFICATION

Not at this time- waiting to hear from Pediatrician regarding anxiety

INTERVENTION PLAN
Goals:
1.

Academic interventions to work on low skill areas. If she responds well, fantastic.if not, then
referral on for a full assessment

2.

Math computation skills and fluency- direct instruction and explicit teaching, computer based
intervention, drill and practice, visual aids

3.

Writing support- direct instruction and explicitly teaching capitalization and punctuation results, how
to recognize and write complete sentence, visual aids, support with editing, checklists to support
editing, extended time, reduced quantity if needed, possible voice recognition software or
keyboarding

G. Wilcox 2013

COGNITIVE-ACADEMIC ASSESSMENT CASE CONCEPTUALIZATION WORKSHEET

FOR CHILDREN AND ADOLESCENTS
Spelling support- direct instruction in spelling rules, prefixes and suffixes, word bank
4.

Support with coping skills- directly teach anxiety management/stress reduction strategies,
determine what the triggers for Rs anxiety are, advance notice of changes, check-ins, referral to
school counselor, alternate environment to work, stress reduction tools

5.

Referral to Pediatrician to explore possible anxiety

6.

Parenting support- referral to some community supports for parenting

G. Wilcox 2013