Confidential Neuropsychological Assessment

Client Name: AS Sex: Female Date of Birth: 04/10/2012

Age at Testing: 11 years, 11 months Ethnicity: Caucasian Handedness: Right
Date of Evaluation: 03/17/2024 Examiner: STUDENT

Reason for Referral

AS is an 11-year-old, Caucasian, female who was referred by her school psychologist,
REDACTED, for an assessment of IQ and general cognitive ability as she is getting ready to
enter middle school and has shown difficulty in processing information as noted by her
classroom teachers.

Background
Developmental History
AS’s mother reported that she did not have any complications during her pregnancy and AS did
not have any developmental delays and met her developmental milestones timely. AS’s mother
did report that she was of an older maternal age when she had AS, giving birth when she was 40
years old and was monitored closely by her medical team during pregnancy.

Academic History
AS attended preschool and elementary school, and is currently in 5th grade and regularly
attending school. Both AS and her mother reported that AS does well academically and has quite
a few friends at school. AS said she enjoys reading the most at school, and reads outside of
school for fun as well. AS does miss school periodically for horseback riding competitions,
usually towards the end of the school year. AS’s mother reported that she usually brings
schoolwork with her to these competitions and completes her outstanding assignments. AS’s
mother reported that AS has ‘quite a bit of test anxiety’ and is a ‘perfectionist who does not like
making mistakes.’ She also said that AS often under performs on exams but does very well on
projects, homework, and other assignments that are not time limited.

AS’s mother said that at parent-teacher conferences this school year and last, AS’s teachers have
reported her taking longer than other students on her work. AS’s mother said that they were not
concerned about her understanding as she usually performed well on assignments, but they were
concerned about it seeming she needed longer time or more detailed directions than other
students to understand directions. This is a concern for AS’s parents as she is getting ready to
enter middle school the following school year and may not receive the same level of attention
she currently receives at her small elementary school.

Psychiatric and Health History

AS has not previously been diagnosed with a psychiatric disorder and does not have any
diagnosed ongoing health issues. AS’s mother reported that the household got COVID in Winter
2023 and they were all sick for about a month and as a result much of the family, including AS,
have lingering coughs and lethargy but it ‘comes and goes, usually when the weather changes.’
Within her family, her younger brother has combination type ADHD and was diagnosed when he
was in early elementary school. There is no other familial history of psychiatric diagnoses or
learning difficulties.

Family History
AS lives at home in REDACTED, Michigan on a farm with her mother, father, younger brother,
and older half-sister from her mother’s first marriage. She also has an older half-brother from her
mother’s first marriage and an older half-sister from her father’s first marriage that she does not
often see. All of her half-siblings are adult aged. Her mother works for the state government and
her father is a teacher at the middle school she will be attending next school year.

Social/Emotional Functioning
AS is very social, both she and her mother reported that she has many friends through school,
extracurricular activities, and family in the area. AS is very active and spends much of her free
time riding her pony, playing outside with her younger brother, and doing chores around the
family farm. AS’s mother noted that AS gets anxious at times and ‘puts a lot of pressure on
herself’ with her school performance and is very competitive with her horse shows and gets
upset when she makes mistakes. She described her getting upset as a ‘shut down’ and AS will
not talk much and tear up, often not wanting to be comforted and wanting to spend time alone
before responding to comfort after a ‘few minutes’ alone to process.

Behavioral Observations
AS presented as quiet, reserved, and tired during testing. Her mother reported that she had been
over at a friend’s house the night prior and had a sleepover and probably was not well rested.
She wore a t-shirt and riding breeches during testing, as she had just ridden her pony before
testing. As testing progressed, her face would flush and she would fidget with a pop-it toy in her
lap. Her answers also got briefer on subtests requiring verbal responses as testing progressed and
would answer ‘I don’t know’ when prompted to ‘give your best guess’ on these verbal subtests.
When offered breaks, water, or a snack, AS denied these and said ‘I just want to get it over with.’
When testing concluded, she smiled and appeared much happier and less stressed than when the
test was being administered and went to hug her mother once testing concluded.

Psychological Tests Administered

Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V)

Test Results and Interpretation

Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V)
AS was administered the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) to
assess her intellectual ability across several domains. The WISC-V includes 10 subtests which
yield scores such as the Full Scale Intelligence Quotient (FSIQ), which is an overall estimate of
cognitive functioning. Nuanced understandings of performance can be understood by examining
the Verbal Comprehension Index (VCI), Visual Spatial Index (VSI), Fluid Reasoning Index
(FRI), Working Memory Index (WMI), and Processing Speed Index (PSI). The scores AS
received on the WISC-V can be found in Table I of the appendix.

The FSIQ obtained may not be the best summary of AS’s overall intellectual ability due to the
significant variance in index scores. AS obtained a score of 98 (FSIQ = 98; 45th percentile; 95%
confidence interval = 92 - 104), this score is within the Average range but may not be the best
indicator of AS’s intellectual functioning. For the FSIQ to be reliably interpreted, the difference
between the lowest and highest index scores should not be equal to or greater than 1.5 standard
deviations from the mean (23 points). AS’s highest index score was on the Working Memory
Index (WMI), on which she scored a 110 and her lowest score was on the Processing Speed
Index (PSI) on which she scored an 86, representing a broad range indicative of strengths and
weaknesses. The interpretations of index scores individually may be a better indicator of AS’s
intellectual ability, each index will be described below. Within each index, there were not
significant differences in scores between subtests, making these reliable and interpretable
indicators of AS’s intellectual functioning.

AS’s verbal comprehension skills were measured by the Verbal Comprehension Index (VCI).
With scores that put her into the 50th percentile which makes her performance Average on this
index in comparison to same-aged peers (VCI = 100; 50th percentile; 95% confidence interval =
92 - 108). AS received the highest score on the subtest asking her to describe the similarities
between two words (Similarities = 11), in which she was in the 63rdpercentile. AS scored lower
on the remaining subtest asking her to define words (Vocabulary = 9), in which she was in the
37th percentile. For both of these subtests, AS scored within the Average range respectively.

AS’s tact at the visualization and manipulation of objects was measured by the Visual Spatial
Index (VSI). With scores that put her into the 50th percentile which makes her performance
Average on this index in comparison to same-aged peers (VSI = 100; 50th percentile; 95%
confidence interval = 92 -108). AS received the highest score within this index on the subtest
asking her to manipulate blocks and recreate a presented design (Block Design = 11), in which
she was in the 63rd percentile. On the remaining subtest that asked AS to apply reasoning to
multiple visual shapes and recreate a presented design, she received a lower score (Visual
Puzzles = 9), in which she was in the 37th percentile.
AS’s problem solving skills were measured by the Fluid Reasoning Index (FRI). With scores that
put her into the 27th percentile which makes her performance Average on this index in
comparison to same-aged peers (FRI = 91; 27th percentile; 95% confidence interval = 84 - 99).
AS received the highest score within this index on the subtest asking her to assess the weight of
shapes and assign an option into a missing space on a scale (Figure Weights = 9), in which she
was in the 37th percentile. AS received a lower score on the subtest asking her to apply reasoning
to visual stimuli and following an established pattern to fill in a blank (Matrix Reasoning = 8),
putting her into the 25th percentile.

AS’s executive functioning skills were measured by the Working Memory Index (WMI). With
scores that put her into the 75th percentile which makes her performance Average on this index in
comparison to same-aged peers (WMI = 110; 75th percentile; 95% confidence interval = 102 -
117). AS scored higher on a subtest asking her to repeat a string of numbers forward, backward,
and sequentially (Digit Span = 12), in which she was in the 75th percentile. AS scored lower on a
subtest asking her to recall presented images in order from an array (Picture Span = 11), in which
she was in the 63rd percentile.

AS’s processing speed skills were measured by the Processing Speed Index (PSI). With scores
that put her in the 18th percentile which makes her performance Low Average on this index in
comparison to same-aged peers (PSI = 86; 18th percentile; 95% confidence interval = 79 - 97).
AS scored higher on a subtest asking her to translate numbers from an established code within a
time limit (Coding = 8), in which she was in the 25th percentile. AS scored lower on a subtest
asking her to identify a certain symbol within a row of stimuli within a time limit (Symbol
Search = 7), in which she scored in the 16th percentile. Within both of these subtests, AS did not
make any errors.

Interpretations and Conclusions

AS is an 11 year-old, Caucasian, female who resides in REDACTED, Michigan. She is currently
in fifth grade and was referred for psychological assessment by her school psychologist,
REDACTED. She was referred to testing due to her teachers noting that while AS has high
quality work on projects, homework, and other non-timed assignments, she often underperforms
on exams. They also noted that AS often needs extra time to understand directions than her peers
and sometimes needs more detailed clarification before beginning a task. This deficit has caused
concern for AS’s parents as she is going to be entering middle school the following school year.

The results of the psychological assessments administered indicate that AS’s overall intellectual
functioning falls within the Average range. However, as there were significant differences
between the index scores on the WISC-V, the FSIQ may not be a good indicator of AS’s overall
intellectual ability. Additionally, both AS and her mother reported test anxiety which may have
interfered with AS’s performance. AS additionally had been to a sleepover the night prior, and
lack of sleep could have additionally interfered with the results obtained. Due to the FSIQ not
being a reliable indicator of intellectual functioning, the individual indexes are a better indication
of AS’s functioning. On four of the indexes, AS obtained scores within the Average range, on
the one remaining index, Processing Speed (PSI), AS scored in the Low Average range.

This Low Average score on the Processing Speed Index (PSI) is consistent with the reason for
referral and educational history. AS’s classroom teachers reported that AS underperforms on
timed tasks like examinations and needing more detailed and clearer instructions before
beginning a task. This additional time needed to understand presented information could have
also impacted the scores on other indexes and their subtests, as all subtests required AS to hear
verbalized instructions and apply that information to a novel task. On average, AS received
higher scaled scores on subtests that were untimed compared to subtests that were timed. The test
anxiety AS is experiencing could be a result of the deficits in processing speed.

While AS’s psychological testing and academic performance is not indicative of any cognitive
deficits or learning disorders, she is experiencing notable test anxiety. This test anxiety is
impacting her performance on examinations as noted by her classroom teachers. It is likely that
AS’s below average processing speed capabilities are impacting her performance which is the
cause of her anxiety around test taking and other timed assignments.

Recommendations
The following recommendations are provided to assist AS with her continued functioning

1. AS would benefit from testing accommodations that allow her to have extended time on
examinations to alleviate some of the stress she has around test taking and allow for more
time to process directions given for the assignment.
2. AS would benefit from continued monitoring of anxiety symptoms and school
performance as she enters middle school next year and transitions to different types of
schoolwork and classes, as well as an increase in life changes that often come with early
adolescence.
 Appendix
Table I
Results of the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V)

Index (M = 100, SD = 15) 95% Confidence Percentile Descriptive

Subtest (M = 10, SD = 3) Score Interval Rank Category

92-108 50 Average
Verbal Comprehension (VCI) 100

Similarities 11 63 Average

Vocabulary 9 37 Average

100 92 - 108 50 Average

Visual Spatial (VSI)

Block Design 11 63 Average

Visual Puzzles 9 37 Average

91 84 - 99 27 Average
Fluid Reasoning (FRI)

Matrix Reasoning 8 25 Average

Figure Weights 9 37 Average

110 102 - 117 75 Average

Working Memory (WMI)

Digit Span 12 75 Average

Picture Span 11 63 Average

86 79 - 97 18 Low Average
Processing Speed (PSI)

Coding 8 25 Average

Symbol Search 7 16 Low Average

 98 92 - 104 45 Average
Full Scale IQ (FSIQ)

- END OF REPORT -