CASE STUDY #1 – Attention and sensory-motor skills
STUDENT: Steve SCHOOL: Jack Tripper Elementary School
DATE OF BIRTH: XXX GRADE: 3
AGE: 9-2 LANGUAGE: English
GENDER: Male ETHNICITY: Hispanic
IEP/REPORT DATE: XXX ASSESSMENT DATES: XXX
BACKGROUND INFORMATION / HEALTH AND DEVELOPMENT
Family: Steve currently lives with his mother, father, three sisters, and two brothers. Primary child care is provided by his mother. Steve has resided with his parents continuously since birth. The language spoken in the home is English. A familial history of delays in learning to speak (sister), difficulties learning to read (sister and brothers), speech problems (sister and brothers), and attention/concentration problems (brother) was reported. No current environmental or familial stressors were reported at the time of the evaluation.
Developmental, Medical, and Health: Steve was the product of a full term pregnancy. Special problems or abnormalities were not noted during the pregnancy. During delivery, parent noted that the umbilical cord was wrapped around Steve’s neck. Developmental milestones occurred as follows: he first rolled over at 3-4 months, crawled at 6-7 months, and walked at 14 months. Toilet training began at the age of 1 year and was completed by age 2 years. Steve first began speaking at the age of 1.5 years, and used three word sentences/phrases at 2.5 years. Parent reported he was difficult to understand as he would not say his words correctly. Sleeping difficulties were noted. These difficulties included sleepwalking and talking in his sleep from age 7 years until the present. Eating difficulties were not noted. A history of speech problems (noted at age five years and treated at second grade) and visual problems (noted at age eight years and corrected with glasses) was indicated. The health history was insignificant for frequent colds, high fevers, ear infections, concussions, seizures, and allergies. No serious accidents were reported. Steve has never been hospitalized. Parent reports Steve has been diagnosed with ADHD. No additional mental health or medical diagnoses were noted by the parent. No other educationally relevant medical findings were reported.
Educational: Steve is currently enrolled in a general education fourth grade program at Jack Tripper Elementary with specialized academic instructional support services as indicated on his IEP. Current designated instructional services include speech and language. School attendance has been regular. Parent reports that Steve was retained in kindergarten. He did attend preschool.
OBSERVATIONS
Classroom Behavior
At the start of the observation, Steve and the class were completing standards practices. Steve was noted to be off task and out of his desk. He required about three redirections during the first five minutes of the observation as Steve was out of his seat. After the third prompt for him to return to his desk, Steve went to retrieve papers from a file cabinet. He was slow to return to his desk and paused nearby to look at papers in a file. He removed one paper and put it on his desk before returning the file to the cabinet. At this time, the phone in the classroom wrong and Steve offered to answer it. He appropriately answered the phone and then relayed the information to the teacher.
Steve continued to walk around the classroom looking at work being completed by his peers and checking to see what others were doing. At this point, the observation had been ongoing for about five to eight minutes and Steve had not been observed to sit in his desk and do any work. He approached the teacher’s desk to look at papers and then was prompted by a teacher’s assistant to get to work. Steve indicated he needed a pencil with an erasure. The instructional assistant directed him towards a pencil and then asked him to sit appropriately.
Steve sat his desk, however, about thirty seconds later, he informed the instructional assistant that there was an issue with the paper he selected from the file cabinet and needed to return it for another one. This time, Steve was able to exchange the paper and return to his desk quickly. Once he sat in his desk, he started to drum on it and look around the room.
While in his desk, Steve took about thirty seconds to write his name on the paper before putting the pencil down and watching other students in the classroom. He then jumped out of his seat to write his name on the AR test section of the white board. He then sat at his desk again and started to look around the room. After a short delay, it appeared that he started to draw a line on his paper. He jumped out of his desk as he saw a student erase his name from the board. At this time, he was directed to sit back down.
Overall, during the fifteen minute observation, Steve had completed next to no work. He circled one answer choice, wrote the solution to a math problem, but then erased that answer. These answers were provided in the last few minute of the observation.
Overall, Steve did demonstrate an appropriate affect. No frustration was noted. Attention to task was considered poor and the amount of work completed during the observation was considered less than the amount of work completed by other boys in the class. Behavioral problems were not noted aside from difficulties staying on task. With this exception, Steve’s behavior appeared to be age-appropriate and was not considered to interfere with his academic and/or social functioning.
Testing Observations
Steve presented himself appropriately dressed and was cooperative during testing. Rapport was easily established and maintained. Steve’s degree of eye contact was considered good. He was confident in each response, and no signs of frustration were noted. He demonstrated an appropriate degree of cooperation during the assessment, but often answered impulsively. During the assessment, Steve demonstrated an unusually high degree of motor activity. He often stood up and leaned in to the table, shifted back and forth, and tapped his hands on the table. In addition, frequent oral-motor activity was noted (eg popping his lips and making raspberries. He struggled to pay attention and required multiple prompts to look at the testing materials. It was noted that he was responsive to these prompts. Because no significantly unusual circumstances intervened with testing, this assessment appears to be an accurate reflection of his abilities at this present time unless otherwise noted.
TESTING RESULTS
Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V)
Verbal Comprehension Index SS: 91
Perceptual Reasoning Index SS: 94
Working Memory Index SS: 75
Visual Spatial Index SS: 92
Processing Speed Index SS: 80
Full Scale IQ SS: 86
Developmental Test of Visual-Motor Integration (VMI)
SS: 90
Developmental Test of Visual Perception (VMI-VP)
SS: 104
Developmental Test of Motor Coordination (VMI-MC)
SS: 82
Wide Range Assessment of Memory and Learning, Second Edition (WRAML2)
Verbal Memory Index SS: 90
Visual Memory Index SS: 91
Attention/Concentration Index SS: 78
Working Memory Index SS: 72
Test of Visual-Perceptual Skills, Third Edition (TVPS-3)
Overall Index Score SS: 101
Comprehensive Test of Phonological Processing (CTOPP)
Phonological Awareness SS: 62
Phonological Memory SS: 67
Rapid Naming SS: 99
NEPSY-II: A Neuropsychological Test (measures of attention/executive functioning)
Auditory Attention S: 6
Auditory Response S: 4
Inhibition: Naming S: 10
Inhibition: Inhibition S: 4
Inhibition: Switching S: 5
NEPSY-II: A Neuropsychological Test (measures of Sensorimotor Processing)
Finger Taping: Repetition’s S: 10
Finger Taping: Sequences S: 11
Finger Taping: Dominate Hand S: 6
Finger Taping: Nondominant Hand S: 14
Visuomotor Precision S: 8
Visuomotor Precision: Time S: 14
Visuomotor Precision: Accuracy PR: <2
Attention Deficit Disorder Evaluation Scale, Fourth Edition (ADDES-4) PARENT
ADHD INDEX SS: 77
-inattention S: 5
-hyperactive/impulsive S: 6
Attention Deficit Disorder Evaluation Scale, Fourth Edition (ADDES-4) TEACHER
ADHD INDEX SS: 74
-inattention S: 5
-hyperactive/impulsive S: 5
Woodcock-Johnson Tests of Achievement – Third Edition (WJ-III)
Broad Reading SS: 70
Broad Math SS: 88
Broad Written Language SS: 62
Dean-Woodcock Sensory Tests
Test
R/L
WNL Mild to
WNL
Mild
Moderate
Severe
Near Point Visual Acuity Right
Left
Visual Confrontation Right X
Left X
Both X
Naming Pictures of Objects
Auditory Acuity Right X
Left X
Both X
Palm Writing Right X
Left X
Object Identification Right X
Left X
Finger Identification Right X
Left X
Dean-Woodcock Motor Tests
Test
R/L
WNL Mild to
WNL
Mild
Moderate
Severe
Gait and Station X
Romberg X
Construction Cross X
Clock X
Coordination Finger-to-nose: Right X
Finger-to-nose: Left X
Finger-to-thigh: Right X
Finger-to-thigh: Left X
Mime Movements X
Left-Right Movements X
Finger Tapping Dominant X
Nondominant X
QUESTIONS
- Discuss the results of the DWSMB. Are there any noticeable patterns in these results?
- Interpret the NEPSY-2 Sensorimotor results (Finger tapping and Visuomotor Precision subtests). Discuss the different scores within each subtest and what these differences suggest.
- Based on the overall testing Profile, what are some reasons that the student’s Processing Speed Index on the WISC-V is low? Be sure to support your answer.
- Describe the student’s selective/focused attention, sustained attention, shifting attention, response inhibition, and attentional capacity. Be sure to include definitions of each area and support your answers with information/scores form the profile.