Case Study: Bobby Smith

Dr. Darlene Brackenreed

Part 1 Bobby’s Pre-referral and referral

Identifying information

Name of Student: Bobby Smith

Age: 13 years, 8 months

Current placement: Grade 8 General education eighth grade class

Pre-referral Information and Activities

Bobby’s eighth grade teacher, Derek Miller, requested a pre-referral for him. In his request, Mr. Miller reported that Bobby passed only 2 subjects on his first report card of grade 8. The subjects that Bobby passed were Physical Education and Art. When working on class assignments Bobby appears to be unable to get started, as if he does not understand what he is to do. He becomes distracted by other activities going on in the classroom and does not complete his work. When Mr. Miller checks for understanding Bobby is non-responsive and will not discuss the problem he is having with the assignment. Bobby never engages in conversations with Mr. Miller and rarely asks questions in class or of him personally. From observations during school breaks and lunch hour Bobby spends most of his time alone and does not join in group activities. Bobby does not recognize words when he is reading and has difficulty comprehending what he has read. If asked to read out loud in class Bobby has become visibly upset with outbursts and swearing at the teacher. On the day that Mr. Miller made the pre-referral request, Bobby’s total morning’s work consisted of answering 4 multiplication questions. Mr. Miller did note that in Bobby’s school records his first-grade teacher had described him as inquisitive, but he showed no sign of that quality in grade eight.

The pre-referral team consisted of Mr. Miller, the resource teacher, and the school principal. The team discussed Bobby’s daily classroom work and decided that the work may be too difficult for him. The team made several suggestions. It was decided that Bobby should be given materials to read that were at the grade seven reading level and given individualized assignments using these materials. Bobby should be placed at the front of the classroom so that Mr. Miller could keep a closer eye on him. Mr. Miller should meet with the seventh grade teacher to discuss Bobby’s work last year. High-interest, low-vocabulary books from the library should be provided for Bobby to use. On a daily basis Mr. Miller should check Bobby’s agenda and make notes to the parents where applicable. Bobby should be reminded of daily homework, upcoming assignment due dates and tests.

Mr. Miller followed up on these suggestions for four weeks. Bobby refused to participate in assignments that were different from his peers. He did not exhibit any interest in the library books. He lost his daily agenda and began to purposely break his pencils or pen when doing homework. Mr. Miller was unable to contact Bobby’s grade seven teacher as she had moved out of town. Bobby’s schoolwork worsened; he no longer demonstrated interest in Physical Education and Art. Mr. Miller decided it was time to discuss an educational evaluation with Bobby’s parents.

Referral and Initial Planning

Mr. Miller met with Bobby’s mother to discuss her son’s difficulties at school. Mrs. Smith said she was getting worried as the problem was becoming significant. Bobby kept saying that he was dumb and that he hated school. It was getting more and more difficult to get him out of bed in the morning to go to school. He complained of headaches and stomach aches in the morning and begged to stay home. Mr. Miller and Mrs. Smith agreed to refer Bobby for an educational evaluation with the intent of providing information to build an appropriate educational plan for him. Mrs. Smith signed the consent form so that the evaluation could proceed.

Mr. Miller discussed Bobby’s situation with the resource teacher and handed in the referral. It was decided that Bobby’s evaluation would consist of the following kinds of assessment information: classroom observations, auditory and visual acuteness, a relevant developmental and educational history, measures of intellectual functioning, current levels of achievement, a measure of adaptive behaviour, learning strengths and weaknesses, and an interest inventory.

Part 11 Bobby’s Multidisciplinary Evaluation

The multidisciplinary team for Bobby’s case consisted of the school psychologist, and resource teacher. Each member of the team was responsible for assessment and gathering of information.

The Classroom Observation

The resource teacher observed Bobby in his eighth grade class mathematics class. Mr. Miller was giving the class practice in solving word problems in two-digit multiplication and division, using place value. He read a problem to the class. Students were expected to visualize the problem and then do the calculations on paper to find the answer. The students then were to practice on five similar problems from a hand-out. Bobby did not volunteer any answers to the oral problems and did not write any calculations to solve the problems during the lesson. From the hand-out Bobby attempted the first question and then sat and looked out the classroom window. His work sample showed that he did not line up the numbers in the appropriate columns in the multiplication problems and made several erasures and cross-outs. During a ten-minute period of free time, none of Bobby’s classmates interacted with him and he continued to stare out the window for the fifteen minutes.

Auditory and Visual Acuteness The resource teacher tested Bobby for hearing and visual acuteness.

Hearing: The audiometer hearing screening test results were within normal range.

Vision: The Vision Screening test results were within normal range

Developmental and Educational History

The school psychologist interviewed Mrs. Smith to obtain the case history information. Bobby is the older brother of an 11-year old sister in an English-speaking household. His father is a farmer and his mother a homemaker. Father grew up in (town) and mother reports he had no difficulty with school. Mother grew up in (nearby city) and states that she had to work hard in school. In the early elementary years Mother was diagnosed with epilepsy and has been on anti-convulsant medication since that time. No other medical or psychiatric concerns are present in either family.

Mother was hospitalized during the final stages of her pregnancy with Bobby as he had stopped gaining weight and the Doctor felt he might be under stress. After two unsuccessful attempts to induce labour, a cesarean section was performed. Mother describes Bobby as being quite happy as a baby. As he grew older he began to engage in temper tantrum behaviour (as a toddler he would bang his head on the wall, as he got older he would kick the wall). Bobby reached all developmental milestones on time with the exception of being toilet trained (4 years old).

Bobby enjoys farm work and being outside with the animals. He is not interested in joining clubs or organizations. One of Bobby’s peers died this summer and Mother is not sure if he understands the performance of death. Bobby does not talk much. Discipline usually consists of removal of privileges and this seems effective. Overall, Bobby’s health is good but he does experience intense headaches. When he has the headaches he needs to be put in a quiet, dark room until it subsides. Mother reports that Bobby enjoys cooking and baking and that he is a loving but not overly affectionate child. There are still some concerns with his swearing behaviour.

Mother states that Bobby’s school difficulties began in Grade 2 when he was having trouble with phonetics. She feels that because he is not a talker he may have gotten very discouraged and frustrated with the schoolwork and then lost interest. His own level of appraisal of his performance is very different from his parents (i.e., two passed subjects on report card and Bobby states that these marks are okay). Mother sees Bobby’s current difficulties as being the result of a lack of motivation.

Measures of Intellectual Aptitude

Bobby came to the assessment easily and indicated he knew the school psychologist would be meeting with him today. Although he did not appear nervous or anxious, Bobby was quiet throughout our session. He answered questions with one-word responses if possible (both informal and formal assessment questions). Bobby states that he does not experience any problems in school, but that it was his mother who had a problem with his schoolwork. Success and failure did not appear to have an influence on his overall motivational level. He approached all tasks with the same amount of effort. Bobby sustained attention throughout the three-hour assessment. No unusual problems were apparent and affect appeared level.

BEHAVIOUR OBSERVATIONS:

TESTS ADMINISTERED:

Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV)

RESULTS:

Intellectual Assessment:

The Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV) was administered to assess Bobby’s level of intellectual functioning. The test comprises ten core subtests and five supplemental ones. The supplemental subtests are used to accommodate children in certain rare cases, or to make up for spoiled results which may occur from interruptions or other circumstances. Testers are allowed no more than two substitutions in any FSIQ test, or no more than one per index. These subtests then generate a Full Scale score (FSIQ,) and four composite scores known as indices: Verbal Comprehension (VCI,) Perceptual Reasoning (PRI,) Processing Speed (PSI) and Working Memory (WMI.)

On the WISC-IV, Bobby obtained a Verbal Comprehension Index (VCI) score in the Borderline range, a Perceptual Reasoning Index (PRI) score in the Below Average range, a Processing Speed Index (PSI) score in the average range and a Working Memory Index (WMI) score in the Average range. His Full Scale (FSIQ) score of intellectual functioning is in the Low Average range (FSIQ: 16th percentile). (The mean for the IQ scores on the WISC-IV is 100; the mean for the subtest scores on the WISC-IV is 10). Bobby’s Full Scale I.Q. score indicates that he is functioning at a level equal to or better than approximately 16 percent of his same aged peers. The difference between his Verbal Comprehension Index score (2nd percentile) and his Perceptual Reasoning Index score (66th percentile) was highly significant. These results are within a 95% confidence interval (the chances are 95 out of 100 that the results are correct.

The Working Memory Index (WMI) requires working memory processes applied to the manipulation of orally presented verbal sequences. Bobby achieved a relative strength on a subtest measuring short-term auditory memory and attention (Digit Span: 50th percentile) and letter-number sequencing (53rd percentile). The Arithmetic subtest yielded a score in computational skills at the 9th percentile (Arithmetic: 9th percentile).

Within the Verbal Comprehension Index weaknesses relative both to Bobby’s own performance and the performance of same aged peers were found on the following subtests: judgment and common sense (Comprehension: 1st percentile); range of factual information (Information: 2nd percentile); abstract and categorical thinking (Similarities: 2nd percentile); language development and vocabulary (Vocabulary: 9th percentile) and Word Reasoning at the 2nd percentile.

Within the Perceptual Reasoning Index, Bobby exhibited a strength relative to both his own and same aged peers performance on a subtest measuring visual alertness and long-term visual memory (Picture Completion: 95th percentile). Other subtests within the PRI yielded: Block Design 75th percentile, Picture Concepts 82nd percentile, Matrix Reasoning 86th percentile. Bobby exhibited strength within this Index. This level of discrepancy between his ability as measured by the VCI and the PRI is significant and reflects a high probability that skill level in verbal and nonverbal intellectual functioning are different.

The Processing Speed Index (PSI) requires visual perception and organization, visual scanning, and the ability to use eyes/hands together in an efficient manner. Results from the (PSI) indicate an average level of ability for Bobby in this area: Coding: 52nd percentile and Symbol Search 61st percentile.

Specifically, the Verbal Comprehension Index is a measure of verbal concept formation, verbal reasoning, and knowledge acquired from one’s environment. This includes the application of verbal skills and information to the solution of new problems, ability to process verbal information, and the ability to think with words. The VCI provides information about language processing, reasoning, attention, and verbal learning and memory. It can be used to evaluate receptive and expressive language. The Perceptual Reasoning Index is a measure of perceptual organization, spatial processing, and visual-motor integration. This includes the ability to think in visual images and to manipulate these images with fluency and relative speed, to reason without the use of words, and to interpret visual material quickly. The PRI provides information about visual processing, planning, organizational ability, attention, and nonverbal learning and memory. The VCI is dependent on the child’s accumulated experience whereas the PRI is more dependent on the child’s immediate problem-solving ability.