XXXX Unified School District

PSYCHOEDUCATIONAL ASSESSMENT REPORT

-CONFIDENTIAL-

Student: XXXX XXXX School: XXX

Date of Birth: XXX Dates of Evaluation: XXX
Age: XXX Date of Report: XXX
Grade: 6th Type of Report: Triennial
Gender: XXX School Psychologist: XXXX, M.S.,
Primary Language: Spanish NCSP

REASON FOR REFERRAL

XXXX XXXX is a XX year, XX month old XX grade male student attending XXX. He
receives Specialized Academic Instruction (SAI) in all academic subjects as well as
Speech and Language services under the eligibility category of Specific Learning
Disability (SLD).

The purpose of this triennial re-evaluation is determine what XXXX’s strengths and
needs are, to help determine if he continues to be eligible for Special Education services
and to aid in the development of Free and Appropriate Public Education (FAPE) in the
Least Restrictive Environment (LRE).

ASSESSMENT PROCEDURES
Observations
Review of Records
Interviews
Health and Developmental Report
Teacher Reports
Woodcock-Mun oz Language Survey-Revised (WMLS-R) Spanish
Woodcock-Mun oz Language Survey-Revised (WMLS-R) English
Woodcock-Johnson III Normative Update Test of Cognitive Abilities (WJ-III COG NU)
Beery-Buktenica Developmental Test of Visual-Motor Integration- Fifth Edition
(Beery VMI)
Test of Auditory Processing Skills - Third Edition (TAPS-3)
Woodcock Johnson III Normative Update Test of Achievement (WJ-III NU) (*administered
by SAI Teacher)
Behavior Assessment System for Children - Second Edition (BASC-2) Parent
Conners 3rd Edition (Conners 3-T) Teacher Form
Conners 3rd Edition (Conners 3SR) Self-Report Form

BACKGROUND INFORMATION
Background information was updated by XXXX’s mother, Ms. XXX and a District Nurse.
For more information please refer to the previous Psychoeducational Report dated XXX.
Family, Language and Environmental Factors
XXXX’s parents are separated. On weekdays, XXXX resides with his Mother, Ms. XXX
and on Friday, Saturday and Sunday he resides with his Father, Mr. XXXX. XXXX
indicates that he attends a Spanish-speaking church on most weekends with his Father.
XXXX has two older siblings that live in Mexico. Ms. XXX’s occupation is XXX and Mr.
XXXX works outside the home. Ms. XXX indicates that XXXX is distractible and
forgetful.

XXXX is classified as an English Language Learner (ELL). XXXX’s primary language is

Spanish. The language of both homes is Spanish. Both his Mother and XXXX indicated
that English is the language that is easiest for him. XXXX mixes both languages when
he speaks. XXXX’s teachers reported that compared to his peers, XXXX displays strong
oral expression skills, but struggles with reading and writing. XXXX’s conversational
skills in English appeared stronger and better developed than his conversation skills in
Spanish. When speaking in Spanish, he would have trouble finding words and would
sometimes use words in English.

XXXX has been receiving instruction in an English Only program with English Language
Development (ELD) support since kindergarten.

California English Language Development Test (CELDT)

3rd 4th 5th 6th

Listening Beginning Intermediate Early Early
Advanced Advanced
Speaking Early Advanced Early Early
Advanced Advanced Advanced
Reading Beginning Beginning Beginning Early
Intermediate
Writing Beginning Beginning Beginning Intermediate

Based on these scores, XXXX has made the most growth in listening and speaking
skills. XXXX is still emerging in his reading and writing skills.

Health, Development, and Medical History

XXXX has been in good general health the last three years. The date of his last health
exam was XXX. The date of last vision exam was on XXX. XXXX is currently taking the
following medications: Focalin, 1 tablet daily. Ms. XXX indicated that he has been taking
this medication for approximately two years. Ms. XXX indicated that he has been
diagnosed attention difficulties. Medical confirmation of a diagnosis was not obtained.
XXXX passed vision and hearing screening performed by a District Nurse on XXX.

XXXX eats well and sleeping patterns were described as normal. He was described as
having a friendly temperament and having good behavior with friends. No frequent
changes in residence were reported. Ms. XXX reported a family history of diabetes. No
other history of major medical problems, surgeries, or hospitalizations was reported.

Educational History
XXXX attended XXX Elementary School in the XXX Unified School District from
kindergarten through 3rd grade. The XXX campus reopened in the fall of 2009 as XXX
Magnet School which XXXX attended from 4th through 5th grade. He had 11 absences

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and 14 tardies in the 4th grade. He had 10 absences and 3 tardies in the 5th grade.
XXXX has been attending XXX Middle School since the 6th grade (8/24/11-present). His
attendance has been consistent.

XXXX has been receiving Speech and Language services since April of 2008. He was
referred for a comprehensive evaluation in the 3rd grade and became eligible under the
eligibility category of Specific Learning Disability (SLD). He began receiving Specialized
Academic Instruction (SAI) in Math and English Language Arts in addition to Speech and
Language services. At an addendum meeting held on 10/21/10, his speech minutes
were reduced. At his annual review Individualized Education Program (IEP) meeting on
12/9/10, SAI minutes increased, while Speech and Language services remained the
same. During his attendance at XXX Middle School, XXXX has been receiving SAI
services in all academic subjects as well as Speech and Language services.

In 4th grade, he earned “C’s” (modified curriculum) in all academic subjects with
satisfactory marks in effort. In the 5th grade, XXXX earned passing grades in all
academic subjects, but needed to improve in working independently, focusing
consistently and staying on-task.

Current Grades
Subject 6th
Grade/Cooperation/Work Habits
Trimester 1 Progress
English *A- E E
Math *C S N
P.E. - - -
Science *C S N
Social Science *A- E E

*Modified Curriculum
- Passing grade

6th grade Teacher comments are as follow: honest and kind, a pleasure to have in class,
work needs improvement, and missing class/lab assignments.

California Modified Assessment (CMA)

A - Advanced
P- Proficient
B- Basic
BB- Below Basic
FBB- Far Below Basic

Grade 3 4 5
English- FBB BB BB
Language 263
Arts
Math BB B BB
281
Science P
359

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XXXX’s current teachers described him as having a sweet disposition, wanting to do well
and having good class participation. In the classroom, XXXX struggles with writing
proficient simple and compound sentences, developing paragraphs, and struggles using
correct grammar, vocabulary and spelling. He is demonstrating adequate addition and
subtraction skills, but is struggling with basic math skills and math problems solving
skills. XXXX also has difficulty focusing and concentrating in class, following directions
and instruction, completing classwork, homework and projects. His binder is
disorganized and has difficulty keeping track of notes and papers.

Previous Assessment Results

XXXX (8-1) Psychoeducational Report- XXX
Nonverbal ability fell within the average range. Adaptive functioning was age-
appropriate. Visual-motor integration fell within the below average range. Phonological
awareness and rapid naming fell within the average range. Phonological memory fell
within the below average range. XXXX displayed significant attention difficulties as well
as restlessness and fidgeting. XXXX displayed difficulty with work completion in class.
Social relations were age-appropriate. Academically, he displayed below average skills
in reading decoding and spelling. He continued to present with articulation error as well
as difficulty with “what” articles, prepositions, past tenses and plurals when creating
sentences.

BEHAVIORAL OBSERVATIONS
Testing
XXXX presented himself as friendly and talkative student. Rapport was easily
established and he appeared comfortable with this examiner. In this quiet, one-to-one
situation, XXXX was attentive, cooperative and put forth good effort. He took care in
responding and generally persisted with difficult tasks.

Classroom
XXXX was observed during his math class of 13 students and one teacher. XXXX was
not wearing his glasses. XXXX was well-behaved. XXXX sat in the second row of the
classroom. The teacher was giving a whole group lesson. Students were to listen and
participate. When XXXX was called on he participated, but his response was not
correct. Students were to work independently and solve problems that were on the
board. XXXX was easily distracted by things going on around him. The teacher
reminded him to circle his answers and to add more space to his responses. XXXX’s
writing was messy. XXXX often fidgeted and moved around in his chair during
independent work time.

CURRENT ASSESSMENT RESULTS AND INTERPRETATION

Each assessment and evaluation was selected and administered so as not be discriminatory
on racial, cultural, or sexual bias. Each assessment was used for the purpose for which it
was designed and is valid and reliable. Each instrument was administered by trained and
knowledgeable personnel. Each assessment was given in accordance with the test
instructions provided by the producer of the assessment, unless otherwise reported. No
single measure was used to determine a present level of performance. This examiner
proficient in both and English and Spanish and therefore no interpreters were needed.

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 Standard Score Scaled Score Qualitative Descriptor
131 and above 17-19 Superior
116-130 14-16 Above Average
85-115 7-13 Average
84-70 4-6 Below Average
69 and below 1-3 Well Below Average

Language Proficiency:
Woodcock-Mun oz Language Survey-Revised (WMLS-R)

Subtest/Cluster Standard Score Standard Score

Spanish English
Picture Vocabulary 61 102
Verbal Analogies 77 92
Oral Language 63 96
Cognitive Academic 2 4
Language Proficiency Very Limited Fluent
(CALP)

When compared to same-aged peers, XXXX demonstrates very limited Spanish oral
language skills. On the task that measured mostly expressive vocabulary, XXXX was
asked to name pictured items. XXXX scored within the well below average range on this
task. On the task that measured his ability to reason using lexical knowledge, XXXX had
to listen to three words of an analogy and complete that analogy with the appropriate
word. On this task, XXXX scored within the below average range.

When compared to same-aged peers, XXXX demonstrates fluent English oral language
skills. On the task that measured mostly expressive vocabulary, XXXX was asked to
name pictured items. XXXX scored within the average range on this task. On the task
that measured his ability to reason using lexical knowledge, XXXX had to listen to three
words of an analogy and complete that analogy with the appropriate word. On this task,
XXXX scored the average range.

Based on background information, parent and teacher interviews & questionnaires,

current test results, and this examiner’s informal observations, XXXX’s has developed
an adequate level of proficiency in academic English oral language skills and is not
fluent in Spanish oral language skills. Therefore, in order to obtain the most valid results
of his skills and abilities at this time, the subsequent cognitive, processing, academic
and social/emotional assessment will be conducted in English, as this appears to be the
language he is most proficient in.

Cognitive Functioning:
Woodcock-Johnson III Normative Update Tests of Cognitive Abilities (WJ III
COG NU)
Clusters Standard Score
General Intellectual Ability 97

Subtests
Verbal Comprehension 99

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Visual-Auditory Learning 73
Spatial Relations 93
Sound Blending 122
Concept Formation 103
Visual Matching 80
Numbers Reversed 97
Visual Auditory Learning Delayed 89
Picture Recognition 104

The Woodcock-Johnson III Normative Update Tests of Cognitive Abilities (WJ

III COG NU) was administered to examine XXXX’s cognitive strengths and
weaknesses. According to the WJ-COG, his overall cognitive ability most probably
lies within the average range.

In regards to verbal tasks, XXXX was required to name pictures, give synonyms and
antonyms and complete verbal analogies. He scored within the average range in
this area.

The verbal-visual associative learning tasks require a student to learn a verbal label
for a visual picture. His score fell within the below average range. On the same task,
presented a few days later, he scored within the lower end of the average range.

For the spatial-relations task, XXXX was required to choose different puzzle pieces
that would combine to make a target figure. He scored within the average range in
this area which shows that he can mentally manipulate and understand part-whole
relationships.

On the task that measures problem solving skills with novel information, he looked at
different groups of shapes and was asked to identify, categorize, and determine the
rules related to the figures using inductive logic. His score on this task fell within the
average range.

On the phonological processing task, XXXX was able to listen to sounds and blend
them together to make words very well and earned standard score within the above
average range. This was an area of strength for XXXX.

Verbal working memory examines a student’s ability to manipulate verbal information

prior to giving a response. For example, he was asked to recall a sequence of
numbers in reverse sequence. XXXX scored within the average range on this
subtest.

The task that measured visual processing speed using paper and pencil, required
him to quickly identify and circle numbers that were the same. He displayed
weakness on this task and scored within the below average range.

The Picture Recognition subtest measured his visual short-term memory skills. The
task required him to look at pictures of objects for 5 seconds and then point them
out. He scored within the average range on this task.

Overall, XXXX’s cognitive ability is within the average range and display strength in
phonemic awareness and weakness in visual perceptual speed. Speech and

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Language:
Based on the Speech and Language Assessment Report, XXXX demonstrates
average receptive and expressive language skills, but continues to display
articulation errors in his speech. Please refer to the Speech and Language
Assessment Report for more detailed information regarding eligibility
recommendation.

Perceptual/Motor:
Test of Auditory Processing Skills (TAPS-3)
Subtests Scaled Scores
Word discrimination 8
Phonological Segmentation 5
Phonological Blending 9
Number Memory Forward 7
Number Memory Reversed 4
Word Memory 6
Sentence Memory 5

Indices Standard Scores

Phonological 87
Memory 77

The Test of Auditory Processing Skills (TAPS-3) was administered to XXXX in order
to measure auditory processing skills in the areas of phonological processing and
auditory memory.

On the Phonological Index, he performed within the lower end of the average range. He
displayed difficulty manipulating sounds within words.

On the Memory Index, XXXX performed within the below average range. XXXX had
difficulty manipulating numbers in his head before reciting them and struggled with
accurately repeating sentences that increased in complexity and length.

The Beery-Buktenica Developmental Test of Visual-Motor Integration- Fifth Edition

(Beery VMI)
Standard Score
Beery VMI 79
Visual Perception 86
Motor Coordination 85

The Beery-Buktenica Developmental Test of Visual-Motor Integration- Fifth Edition

(Beery VMI) is a structured measure of visual-motor coordination and assesses a
student's ability to interpret and integrate what is seen visually and replicate it using
paper and pencil. Skills in this area are associated with the ability to copy information
from near- and far-point and space letters and words appropriately on the lines when
writing. On this test, XXXX achieved a standard score in the below average range.
XXXX performed slightly better when visual perception and motor coordination were
assessed independently and scored within the lower end of the average range in both
areas. In the classroom, his penmanship tends to be messy.

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Gross motor skills are age-appropriate. He participates in a general education physical
education class and is earning a passing grade.

Academic Achievement:
Wechsler Individual Achievement Test – Third Edition (WIAT-3)
Date: 11/15/2011 Age: 10-11
Age-Based Scores Given By: XXXX, SAI Teacher

Standard Score Description

Reading Composite/Subtests
Total Reading Composite 78 Below Average
Reading Comprehension and Fluency 80 Below Average
Reading Comprehension 84 Below Average
Word Reading 73 Below Average
Oral Reading Fluency 84 Below Average
Written Expression
Composites/Subtests
Written Expression Composite 79 Below Average
Sentence Composition 85 Average
Essay Composition 87 Average
Spelling 77 Below Average
Mathematics Composite/Subtests
Mathematics Composite 81 Below Average
Math Fluency Composite 71 Below Average
Math Problem Solving 80 Below Average
Numerical Operations 85 Average
Math Fluency Addition 80 Below Average
Math Fluency Subtraction 77 Below Average
Math Fluency Multiplication 60 Well Below
Average

Based on standardized academic results, XXXX scored within the average range and
displays relative strength in sentence composition, essay composition, and decoding
made-up words. XXXX scored within the below average range in all other areas and in
the well below average range in math fluency with multiplication. XXXX appears to
struggle the most with decoding and quickly solving multiplication problems.

Social/Emotional Functioning:
The Behavior Assessment System for Children - Second Edition (BASC-2) is
behavior rating scale that measures numerous aspects of behavior and personality. A
T score of 41 to 51 is considered to be within the Average range. A T score of 60-69 is
considered to be within the At-Risk range and may indicate a potential or developing
problem that needs to be monitored carefully. A T score of 70 or above is considered to
fall within the Clinically Significant range and may indicate a high level of maladaptive
behavior or absence of adaptive behavior. On the adaptive scales, low scores represent
possible problems areas. The At risk range is a T score of 31-40 and a T score of 30
and below denotes a Clinically Significant problem area. This behavior rating scale is
not being used for the purpose of diagnosing conditions.

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The Behavior Assessment System for Children- Second Edition (BASC-2)
*At Risk
**Clinically Significant

Ms. XXX
Mother
T Score
Externalizing Problems 50
Hyperactivity 56
Aggression 44
Conduct Problems 51
Internalizing Problems 43
Anxiety 42
Depression 45
Somatization 47
School Problems -
Attention Problems 77**
Learning Problems -
Behavioral Symptoms Index 53
Atypicality 46
Withdrawal 44
Adaptive Skills 40
Adaptability 55
Social Skills 52
Leadership 42
Activities of Daily Living 26*
Study Skills -
Functional Communication 33*

On the BASC-2 Parent form, Ms. XXX responses yielded a score in the Clinically
Significant range in the area of Attention. Ms. XXX responses suggest that XXXX
almost always has a short attention span, is easily distracted, makes friend easily, has
trouble following regular routines and can be unclear when presenting ideas.

The Conners 3rd Edition is a behavior rating form that assesses Attention Deficit
Hyperactivity Disorder (ADHD) and related issues like Executive Functioning (planning,
prioritizing and completing tasks), Learning Problems (difficulty reading, learning and
remembering), Aggression, and Peer/Family Relations.

T score of 70 or above is a Very Elevated Score.

T score of 60-69 is an Elevated Score
T score of 40-59 is an Average Score
T score of 40 or below is a Low Score

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Conners 3rd Edition (Conners 3-T) Teacher Form
Completed by SAI Teacher, Ms. XXX
T Score
Inattention 76
Hyperactivity/Impulsivity 46
Learning Problems 60
Executive Functioning 78
Defiance and Aggression 54
Peer Relations 63
Conners 3 Global Index Total 61
Conners 3 GI; Restless-Impulsive 63
Conners 3GI Emotional Lability 45

Ms. XXXX’s responses yielded a very elevated score in the area of inattention and
executive functioning. Elevated scores were also found in learning problems, peer
relations, the total index, as well as the restless impulsive index. Ms. XXX’s responses
suggest that XXXX is having difficulty starting, sustaining focus and completing
classwork and projects; is easily distracted; gives up easily; seems tired; has trouble
concentrating; forgets to turn in work; and is forgetful. The teacher reported that these
characteristics are significantly impacting his academic performance.

Conners 3rd Edition (Conners 3SR) Self-Report Form

Completed by XXXX XXXX
T Score
Inattention 55
Hyperactivity/Impulsivity 41
Learning Problems 58
Defiance and Aggression 46
Family Relations 68

XXXX’s responses yielded elevated scores in the area of family relation. An analysis of
his responses suggests that at home, XXXX feels unjustly punished and that his parents
expect too much from him. He also reported that he has trouble in math and has trouble
concentrating, but is happy.

During the interview, XXXX indicated that he sometimes likes coming to school. His
favorite subject is science and geography and his least favorite subject is math.
Division is difficult for him. XXXX indicates that he has a lot of friends here at school.
His hobbies are skateboarding with his friend. What he likes the most about himself is
that he has a nice family and friends and that he was born healthy. When asked what
worries him, he indicated that he does not tend worry. When asked what he does when
he gets mad, he indicated that he thinks of something else or does something else to
help him cool down. His three wishes are: 1) that Mom and Dad would be together 2)
world peace and 3) to have two thousand million dollars

RELATIONSHIP OF BEHAVIOR TO STUDENT’S ACADEMIC AND SOCIAL

FUNCTIONING
XXXX’s attention difficulties negatively impact his ability to concentrate, stay on-task,
follow class instruction, and complete assignments.

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SUMMARY AND CONCLUSION
XXXX XXXX is a XX year, XX month old XX grade male student attending XXX. He
receives Specialized Academic Instruction (SAI) in all academic subjects as well as
Speech and Language services under the eligibility category of Specific Learning
Disability (SLD). A triennial re-evaluation was conducted in order to investigate what
XXXX’s strengths and needs are, to help determine if he continues to be eligible for
Special Education services and to aid in the development of Free and Appropriate Public
Education (FAPE) in the Least Restrictive Environment (LRE).

XXXX’s is a student who demonstrates an adequate level of proficiency in English

academic oral language skills. His overall cognitive ability lies within the average range.
He displays strength in phonemic awareness and weakness on timed visual perceptual
tasks. Auditory memory skills fell within the below average range. He struggles holding
on to and manipulating verbal information in his short-term memory. He also has
difficulty remembering sentences accurately. Fine motor coordination as well as visual
perception skill fell within the lower end of the average range. Visual-motor integration is
within the below average range. Standardized academic scores reflect below average
scores in most areas of reading, writing and mathematics. XXXX is a kind and
expressive student who displays appropriate peer and adult relations. Rating scales
indicate elevated scores in the area of attention and executive functioning. In class,
XXXX is having significant difficulty with attention. He is easily distracted and is having
difficulty initiating and completing assignments as well as staying on-task. Speech and
language assessment results revealed average language skills and articulation errors.

Educational Implications
Specific Learning Disability (SLD)
At this time, XXXX appears to continue to meet the Special Education eligibility category
of Specific Learning Disability (SLD). Formal and informal measures reflect a severe
discrepancy between XXXX cognitive ability and academic achievement in the areas of
reading decoding, written expression and math reasoning skills. In addition, XXXX
exhibits a psychological processing disorder in the areas of attention, sensory-motor
skills, and auditory processing. These learning problems do not appear to be primarily
due to external factors such as cultural, linguistic or economic disadvantage, limited
school experience, or poor school attendance.

These findings are developed for the IEP team to consider. The IEP team will
determine eligibility, placement, and services based on XXXX’s current abilities
and needs.

Recommendations:

XXXX may likely benefit from:

1. Continued Specialized Academic Instruction and accommodations

2. Wearing his glasses in class on a consistent basis

3. Frequent positive reinforcement when he displays on-task behaviors

4. A visual signal to assist him to re-focus and stay-on task

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 5. Assistance with organizing his school binder

6. Explicit instruction and reinforcement on organizational and project completion

skills

7. Continued home and school collaboration/communication

___________________________ _____________________
XXX XXXXXX, M.S., NCSP Date
School Psychologist

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