ZZZZZ, Steven PSYCHOLOGICAL SERVICES ASSESSMENT REPORT

Name: Steven ZZZZZ DOB: 2004/05/ZZ Age: 7 years 0 months

School: ZZZZZ French Immersion School Grade: 1

Date Assessed: 2011/05/ZZ Examiner: Ms. Monique Janssen, Supervised by Dr. P.R.

Reason for Referral: Steven was referred due to concerns with negative self-statements, zoning out, and deterioration in behaviour and social interaction at home since November 2010 and at school since February 2011. Relevant Background Information: The following information was obtained from a review of Steven ZZZZZs OSR, discussion during a PDT meeting on February ZZ, 2011, interview with Stevens teacher, ZZZZZ, on May ZZ, 2011, and interview with Stevens mother, ZZZZZZ, on May ZZ, 2011. Educational History: Steven is completing his second year at ZZZZZ French Immersion. His OSR indicates that he is doing well academically but that his senior kindergarten teacher had some concerns about his impulsivity and social relationships. Mme. ZZZZ reports that Steven is a good reader but that she has noticed a drastic change in his personality since January 2011. Prior to the Christmas break she describes Steven as a bubbly child but says that he now seems depressed, frustrated, and negative about himself and his abilities. Currently, she describes Steven as zoned out, wandering, and unable to follow directions. Ms. ZZZZZ observation of Steven at home is similar. Prenatal and Developmental History: ZZZZZZ reports that she lived with Stevens father while pregnant and that he would not allow her to eat or buy baby clothes. ZZZZZ had a difficult delivery with Steven as she was in labor for 14 and a half hours before a c-section was performed because the umbilical cord was wrapped around Stevens neck. Steven spent no time in the NICU and was an easy baby who slept and ate well. ZZZZZ reports that Steven met all his developmental milestones at or before the expected time. Medical History: No medical problems were reported. However, Steven eats and sleeps a great deal and asks to go home from school sick when he is not sick. Steven frequently complains of being tired and hungry yet he sleeps 10-12 hours a night and on the weekends will also nap for 3- 4 hours. Family History: Until he was two years old Steven lived with his mother and father. During this time ZZZZZ reported that Stevens father was not involved in his care. When Stevens mother worked nights his father would not feed him or change his diapers. ZZZZZ also reports that Stevens father once pushed him down a flight of stairs. ZZZZZZ separated from Stevens father when Steven was two years old and Steven has only seen his father 3 times since then and not at all since 2009. Currently, Steven lives with his mother and four year old half sister while his sisters father (whom Steven this is his father) occasionally stays in the home. Steven has attended the same day care for 4 years and lived in the same house for the past year. His mother is a ZZZZZ and reports no history of mental illness in her family. Previous Assessments and Interventions: No previous assessments or interventions have been conducted. Assessment Methods Given the referral concerns an evaluation of cognitive, executive, social, and emotional functioning was

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conducted. This included: UNSTRUCTURED INTERVIEWS Teacher on May ZZ, 2011 Mother on May ZZ, 2011 Steven ZZZZZZ on June Z, 2011 OBSERVATIONS Classroom on May ZZ & ZZ, 2011 School Yard on June Z, 2011 DIRECT ASSESSMENT Wechsler Intelligence Scale for Children- Fourth Edition (WISC-IV) on June Z, 2011 OTHER REPORTS Autism Spectrum Rating Scales (6-18 Years) Parent Ratings (ASRS) completed by ZZZZZ on June Z, 2011 Autism Spectrum Rating Scales (6-18 Years) Teacher Ratings (ASRS) completed by ZZZZZZ on June Z, 2011 Stevens Parent Rating Scale- Revised (L) (Stevens) completed by ZZZZ on May Z, 2011 Stevens Teacher Rating Scale- Revised (L) (Stevens) completed by ZZZZ on May Z, 2011 Child Behavior Checklist for Ages 6-18 (CBCL): Parent Form completed by ZZZZZ on May Z, 2011 Child Behavior Checklist for Ages 6-18 (CBCL): Teacher Form completed by ZZZZZZ on May Z, 2011 Personality Inventory for Children, 2nd Edition Behavioral Summary Profile (PIC-2) completed by ZZZZZ on May Z, 2011 Student Behavior Survey (SBS) Completed by ZZZZZZ on May Z, 2011 Interviews: Mme. ZZZZZ expressed concern with Stevens socio-emotional functioning in the classroom as he seems depressed and has been withdrawing from social activities. She reports that he has little frustration tolerance or problem solving ability and frequently throws out his work. He has been observed laughing when other students are hurt, but has also shown compassion and kindness. Steven has shown some strange behaviour such as frequently using the word sexy and looking down female students shirts. The teacher reports that the recess observations were somewhat unusual as Steven usually plays with his cars with another boy who is in grade 2. At school Steven has had incidents where he zones out, shakes, and use sentences that do not make sense. Ms. ZZZZ is most concerned about Stevens negative self-concept, difficult behaviour, and zoning out at home. She reports that Steven does not connect with other children, and she does not believe that he knows how to do this. Steven had one best friend at daycare who recently left. She notices that Steven needs much greater alone time than his sister and physical altercations often occur when his sister wants to spend time with him and he wants to be left alone. Ms. ZZZZ reports that Stevens socio-emotional functioning worsened in November 2010. When Steven becomes upset at home his face turns bright red, his pupils narrow and he will hit his head against a wall, throw himself on the ground, and shake. During these incidents he will yell or talk in another language or in sentences that do not make sense. At home Ms. ZZZZ believes these incidents are precipitated by asking Steven to do something he does not want to do or by not giving him what he wants. When Ms. ZZZZ tries to discipline Steven it often takes four warnings before he complies but he then makes statements such as you hate me, Im bad, or I wish I was dead. At home Stevens emotions shift quickly and he frequently complains of headaches and gets upset about dogs barking, lawn mowers, and childrens television. Previously, Ms. ZZZZ was concerned about Stevens treatment of the family dog as he would pull his tail and ears, kick him, and hit and poke him with sticks. This behaviour has stopped, although Steven will occasionally hit the dog after cuddling with him. Steven has laughed when intentionally hurting his sister or when she is in pain, but will comfort his mother with hugs. One challenge for Ms. ZZZZ is getting Steven to follow instructions as he usually

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completes only the first step of the first instruction. Steven reports being tired at home but sleeps 10-12 hours each night. At some point during the night Steven moves from his own bed to his mothers and she suspects he is having nightmares. Over the weekend Steven will take a 3 hour nap in addition to the 10-12 hours of sleep at night. Additionally, Steven is often hungry. Ms. ZZZZ reports that on June Z, 2011 Steven ate a snack at daycare, came home and had four sandwiches, a bag of chips with dip, and then an hour later ate a box of Kraft dinner. During a break in testing Steven was asked some questions and drew pictures. Steven describes his family as being comprised of his mother, sister, father, dog, and two gerbils. He reported that all members live at his house except his father who lives there sometimes. Steven spoke at length about his gerbil Darien. He said that Darien once escaped from his cage and his mother had to find him. Steven felt sad about this because he thought his mom would yell at Darien and Darien would feel mad. When asked about sleeping Steven says he likes to sleep but that he sometimes has nightmares about a monster coming into his room while he is sleeping and taking him away. During these dreams he screams for his mom but she cannot hear him because she is at work, so the monster takes him in his van to a scary house. Steven reports that he has 6 friends in his class and he does not feel lonely. Behavioural Observations: Steven was observed in several different school situations over three days. In the classroom Steven presented as a student who struggles with transitions and beginning activities. On the first day of observation Steven was observed for half an hour before the second nutrition break. When observation began Steven was supposed to be working on a flower mask but was lying on the classroom floor. He soon went over to students building with Knex and took toys out of another boys hand. When Mme. ZZZZZ prompted him to finish his mask he complied and worked for approximately 1 minute before going to talk to the students on the computers. Mme. ZZZZ had to prompt Steven 4 times over the next 10 minutes to return to his work and each time he would immediately comply, work for less than one minute, and then return to the computers. At one point Steven became upset about misplacing his mask and when it was found he ripped each petal off one at a time. Steven did not comply with Mme. ZZZZs request to stop pulling the petals off his mask, but once she took it from him he was willing to re-attach the petals. When the teacher cued the class for clean up time Steven appeared to be listening to instructions but then continued to work on his mask. Steven looked at the teacher when she provided instructions for the shared reading activity but did not follow them. However, once the teacher provided individualized instructions Steven did sit on his spot on the carpet and participate in the activity. When Stevens turn was over he appeared to switch between looking at the smartboard, looking around the room, and making noises on his arms during the lesson. Immediately preceding the break the students were asked to return to their desks and clean them off for lunch. Steven went to his desk but did not clean it off. Steven was twice observed inappropriately eliciting the teachers attention by standing behind her while she was busy and repeating his request until she gave him attention. May Z, 2011 was a hot and humid day and ZZZZ ZZZZZ has no air conditioning. Steven was observed for one hour during the transition to the auditorium for an assembly, the assembly, and the transition back to class. Steven went to the assembly but while sitting on the gym floor waiting for the assembly to start rocked back and forth with his hands over his ears. He did not interact with the children around him as most of his peers were doing. During the assembly Steven sat on the floor and was usually facing the stage; however, he did not clap or sing at any of the expected times. Towards the end of the assembly Steven clapped at an inappropriate time and made strange faces. While waiting to leave the auditorium Steven wandered away from his class line three times but would return at the request of his teacher. At one point he began climbing on the stage. While his class returned to the classroom Steven walked much slower than the other children, sat outside the office, and walked into other rooms. The third time his teacher asked him to return to class he yelled, Im coming. Steven then walked past his classroom and started to walk out of the school. After the teacher verbally redirected him into the classroom Steven looked upset while telling the teacher that he was hot. Later several students in the class argued about the fan prompting the teacher to turn it off. Steven stood at the front of the carpet with his arms crossed and yelled now because of you Im too hot twice before sitting down on his spot at the teachers request. His peers did not seem to react to Stevens yelling. At this point he began to take out toys, which the teacher would put away. Once the activity was explained, Steven required several prompts to move from

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the carpet but then joined the wrong group. When the teacher redirected Steven he yelled no but returned to the carpet as far away from his group as possible. He sat for about a minute saying its so boring before going and getting a pencil and paper to begin the task. Once he returned to the carpet he sat somewhat close to the other students in his group but did not begin to work. ZZZZZ ZZZZZZ, the school LST, reported concerns about Stevens behaviour during a fire drill on the morning of May Z, 2011. Steven hid in the school while his class evacuated and once outside left the line four times to try to return to the school. Mme. ZZZZZ explained to Steven why he could not go into the school during a fire alarm. On Stevens later attempts at re-entry she asked Steven to explain to her why he could not return to the building. Steven did not seem to understand why he could not re-enter the school and told her the bell is ringing. On June Z, 2011 Steven was observed at recess for 10 minutes. During this time he spent less than 2 minutes interacting with peers and the remainder of the time driving cars along the window ledge. When Steven did interact with peers it was mainly for brief chats with groups of 3- 5 students before they would run away together and Steven would resume playing with his cars. At one point a couple of girls standing near him began shouting and Steven turned and stared at them until they stopped. Steven smiled and danced on his way to the assessment room. He later told his teacher it was fun. Throughout all subtests Steven sat still on his chair and was observed to look at the ceiling and rub his hands on his face when a question was difficult. When Steven was engaged in a task he frequently made different types of rhythmic noises with his mouth (i.e. clicking his tongue against his teeth) or hummed quietly. He appeared to be trying his best and answered questions in a soft voice. Steven became upset with every presentation of an unexpected noise, regardless of volume, and usually covered his ears and would not resume work until the noise was eliminated or explained. Assessment Validity: Valid Questionable Validity

Cognitive Assessment Results: The results of the present assessment document a number of strengths and weaknesses in the development of Stevens cognitive skills. Findings reported in this section will be discussed in terms of percentile rank (PR). PR is used in comparing Stevens score to the scores of other children similar to him (i.e. age, grade) who have taken the test. PR will provide a score denoting the percentage of children achieving a score that is less than or equal to Stevens score. A PR between the 25th and 75th percentile signifies ability in the Average range. A PR above 85 is considered to be a personal strength whereas a PR below 11 is considered to be a relative area in need of support. The following test score descriptions are employed for the purpose of describing Stevens performance on the WISC-IV subtests administered.
Classification Very Superior Superior High Average Average Low Average Borderline Extremely Low Percentile Ranks 98 percentile and above 91st 97th percentile 75th 90th percentile 25th 74th percentile 9th 24th percentile 2nd 8th percentile < 2nd percentile
th

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Intellectual Function Index Verbal Comprehension Perceptual Reasoning Working Memory Processing Speed Full Scale
rd

Percentile

23 27th 9th 27th 16th

Classification Low Average Average Low Average Average Low Average

Stevens overall level of intellectual ability was in the Low Average range (16th percentile). Stevens Perceptional Reasoning, or ability to process and reason with visual information (27th percentile, Average) was slightly stronger than his Verbal Comprehension, or ability to process and reason with verbal information (23rd percentile, Low Average). Stevens Working Memory Index, or ability to mentally manipulate information while holding it in memory was in the Low Average range (9th percentile) while his Processing Speed Index, or ability to visually perceive nonverbal information quickly was in the Average range (27th percentile). Verbal Comprehension: Of the verbal reasoning tasks Steven performed best on an abstract verbal reasoning task that required him to explain how two concepts are similar (50th percentile). Steven had more difficulty on tasks that required him to define words (16th percentile) and demonstrate his understanding of social concepts (16th percentile). Stevens verbal performance appeared to deteriorate as he fatigued. Perceptual Reasoning: Steven performed slightly better when using his ability to reason with visual information. He had difficulty on a measure of his ability to analyze visual patterns and choose the missing piece from the series (16th percentile). Steven performed in the Average range on a measure of his ability to construct designs using colored blocks (25th percentile). Steven showed a relative strength in his ability to identify pictures that share common attributes (63rd percentile). Processing Speed: Steven performed in the Average range (27th percentile) on the Processing Speed Index of the WISC-IV. He performed similarly on measures of his ability to make decisions about whether symbols matched (25th percentile) and on a task requiring him to quickly copy symbols using a key (37th percentile). However, on the latter task, administered at the end of the day, Steven made more errors. This may reflect problems with sustain effort or fatigue. Working Memory: Steven performed within the Low Average range (9th percentile) on the Working Memory Index of the WISC-IV, a measure of his ability to mentally manipulate information while holding it in memory. He performed better on a task requiring him to repeat number sequences in the same or reverse order (25th percentile) than on a task requiring him to mentally manipulate strings of letters and numbers in numerical and alphabetical order (5th percentile). Questionnaire Results: Mother and teacher completed standardized questionnaires to describe their observations of Stevens behavioral, socio-emotional, and attention functioning. The results of the questionnaires reflect their perceptions and observations of Steven compared to other children his age. Consistency and negativity scales on all questionnaires indicated that both raters were reliable. Detailed results are presented in a table at the end of this report. This table indicates that overall Steven displays more problems with his socio-emotional and behavioral functioning at home than at school, although difficulties are evident in both environments. Attention and Executive Function Stevens attention and executive function was assessed due to concerns with his behavior and zoning out in class. Attention and executive functioning includes skills such as tuning into important information, tuning out unnecessary information, planning, problem solving, and monitoring appropriate behavioral and emotional responses. Stevens mother and teacher completed several questionnaires that assessed his

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functioning in these areas including the ASRS, CBCL, Stevens, PIC-2, and SBS. Steven was rated as at risk for or in the clinically significant range on all measures of inattention, hyperactivity, and ADHD by both raters with the exception of the teacher rating of the Cognitive Problems/ Inattention and DSM-IV Inattention scales on the Stevens. Overall, Mme. ZZZZ reported fewer problems with attention, impulsivity, organization, and hyperactivity at school than Ms. ZZZ reported at home. Steven shows more signs of hyperactivity and impulsivity than inattention but overall the CBCL, Stevens, PIC-2, and SBS indicate that he likely meets the criteria for an ADHD diagnosis. Classroom observations and reports from Stevens mother and school staff are consistent with this conclusion. In the classroom Steven required teacher help to start and stay on task and appeared to attend to instructions that he did not enact. Attention problems impact Stevens ability to function in the classroom as evidenced by Mme. ZZZZZs SBS rating of Stevens academic performance as normal but academic habits as problematic. This indicates that Steven is able to perform at school but requires adult help to organize his materials, plan tasks, follow instructions, and stay on task. Social-Emotional Function Stevens emotional function was assessed as both his mother and teacher expressed concerns with his negative self-statements. The results of the CBCL, Stevens, PIC-2, and SBS indicate that Steven is experiencing significant emotional problems, particularly in the composite areas of affective problems and emotional lability. Ms. ZZZZ and Mme. ZZZZZ demonstrated less agreement about Stevens emotional functioning than his attention. Neither rater reported concerns with anxiety, although Mme. ZZZZ (clinically significant) described Steven as more shy than Ms. ZZZZ (at risk). Ms. ZZZZ rated Steven as being in the clinically significant range for perfectionism while Mme. ZZZZ rated him as within normal limits. Ms. ZZZZ reported observing thought problems and reality distortion, which are consistent with concerns about frequent negative self-statements observed at home and school. Ms. ZZZZ sees evidence of somatic problems rating Steven in the clinically significant range on the CBCL and Stevens and at risk on the PIC-2 while Mme. ZZZZZ rated Steven as within normal limits on the CBCL. Due to teacher and parent concerns with withdrawal from social interaction Stevens social functioning was assessed. Stevens mother and teacher reported social problems on the CBCL, Stevens and PIC-2. Once again Mme. ZZZZ observed fewer social problems at school. Social problems at school came out on the CBCL but not the Stevens. Social problems observed by Stevens mother were at risk or clinically significant on the Stevens and PIC-2 but not the CBCL. Children with ADHD can have difficulty with social skills because they struggle with impulsivity, reciprocity, and staying on task. They may also lack problem-solving skills. However, concerns with Stevens lack of interest in social interaction indicated that social problems might be indicative of something separate from attention problems. For this reason the ASRS was completed by Stevens mother and teacher. Stevens mother indicated Steven was clinically significant or at risk in all areas except for sensory sensitivity; whereas, Mme. ZZZZ reported Steven was either at risk or clinically significant in all areas. Stevens mother reported the greatest concern with his social/ communication, peer socialization, social/emotional reciprocity, and stereotypy. Stevens teacher rated social/ communication, peer socialization, self-regulation, and sensory sensitivity as most problematic for Steven. Overall, both Ms. ZZZZ and Mme. ZZZZZ rated Steven in the clinically significant range (99th percentile) on the DSM-IV-TR Scale indicating that Stevens symptoms closely match the DSM-IV-TR criteria for an Autism Spectrum Disorder. Since Steven acquired language and spoke in 3 word sentences by the age of 3 no communication development is suspected. Behavioral Function Both Ms. ZZZZ and Mme. ZZZZZ rated Steven as having clinically significant problems with aggressive behavior on the CBCL. However, Mme. ZZZZZ rated Stevens verbal and physical aggression as within normal limits on the SBS. Ms. ZZZZ rated Steven in the clinically significant range for Oppositional Defiant Problems on the CBCL and Stevens and Delinquency on the PIC-2. Mme. ZZZZZ rated Steven as at risk for Oppositional Defiant Behaviors on the CBCL and within normal limits on the Stevens. Neither rater reported a problem with rule breaking behavior on the CBCL indicating that Stevens behavior problems likely reflect difficulty in complying with instruction and emotional regulation. The inconsistency in Mme.

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ZZZZZs ratings of Stevens behavior among the various questionnaires may reflect the inconsistency in Stevens behavior and they different way these categories are defined. Summary/Formulation: Steven is a sweet and cooperative child who was referred for a psychological assessment due to questions about his attention, socio-emotional, and behavioural functioning. Stevens cognitive functioning was in the Low Average range as assessed by the WISC-IV. There were no significant differences in his performance on any of the tasks. Overall, Stevens Perceptual Reasoning and Processing Speed were in the Average range while his Verbal Comprehension and Working Memory were in the Low Average range. Steven had the most trouble with the working memory tasks, which is not surprising given the attention problems reported by his mother and teacher. Observation, interview, and questionnaire data all indicate that Steven is experiencing significant difficulty in his socio-emotional and behavioral functioning. Stevens teachers have reported difficulty with impulsivity and following instructions since senior kindergarten but his functioning declined between November 2010 and January 2011. Steven currently shows many of the symptoms consistent with an ADHD diagnosis. At this time he is also presenting with problems with oppositional defiance, aggression, social skills, unusual behaviors, thought problems, atypical language, behavioral rigidity, affective problems, emotional lability, and psychosomaticism. Stevens mother reported that he is having more problems at home than at school. Data collected during interviews and observations collaborated questionnaire results that Steven presents with impulsivity, inattention, aggression, social, and oppositional problems to some extent. Steven has also engaged in some unusual behaviors and may not have the knowledge of safety procedures expected of a child his age. Stevens mother and teacher were both concerned about social withdrawal. During observation Steven rarely interacted with his peers during typical social times (i.e. recess and waiting for an assembly to begin) and tended to interact with his peers when it interested him (i.e. talking to those using the computers). Steven was observed playing with his cars in a repetitive manner and his mother reports Steven is most happy playing with his hot wheels on their deck. The DSM-IV-TR Scale on the ASRS questionnaires completed by Stevens mother and teacher were both in the clinically significant range. This indicates that Steven demonstrates behaviors that match many of the criteria of an Autism Spectrum Disorder. Overall, Steven presents as a child with no cognitive or academic problems but many concerns with his attention, socio-emotional, and behavioral functioning. Stevens mother and teacher report that his functioning in the socio-emotional, and behavioral domains has decreased in the last 6-8 months including problems with attention, impulsivity, aggression, and socialization. Steven also complains of frequent headaches and has irregular eating and sleeping patterns. However, Steven experienced physical abuse and neglect from his father until he was two years old. Sattler & Hoge (2006) report that children who are maltreated tend to be more impulsive, less flexible, and more impatient than children who have not experienced maltreatment. At this time it is important to determine if Stevens internalizing and externalizing problems are related to trauma to facilitate appropriate intervention. Personal Strengths Processing Speed Perceptual Reasoning Skills Computer Literacy Skills Personal Needs Coping Skills Independence Skills Interpersonal Relationship Skills

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Recommendations: Standardized questionnaires and comments from Stevens mother and teacher indicate that Steven is experiencing serious behavioral and socio-emotional difficulties. Given Stevens early life experiences with his biological father, the current socio-emotional difficulties need to be separated from the possibility of trauma. Further assessment and intervention through Vanier Childrens Services (519-433-0334) is recommended. Interview, observation, and questionnaire data indicated that Steven has many symptoms consistent with an Autism Spectrum Disorder. If there are still questions regarding Stevens social functioning following treatment at Vanier, Ms. ZZZZ should call the Child and Parent Resource Institute (CPRI) at 519-858-2774 to request an assessment through their Autism Spectrum Disorders Program. All questionnaires, observations, and interviews indicated that Steven demonstrates symptoms consistent with a diagnosis of ADHD. Ms. ZZZZ may want to further explore this possibility through an appointment with Stevens family physician. Steven appears to sleep and eat more than his classmates yet remains tired and hungry. He also complains of headaches. Ms. ZZZZ should consult with Stevens family physician to investigate a medical basis for these issues. While consulting with the family physician she may want to request referrals for a sleep study and hearing test. Given Stevens Low Average intellectual functioning and relative weakness in verbal reasoning he may show signs of academic difficulty as verbal demands increase. Steven may struggle with tasks such as writing where verbal, organizational, and attention demands are high. Stevens teacher may want to provide greater support on these tasks such as frequent check-ins, chunking, access to organizational software, or an adult helper. Steven currently struggles with organization, transitions, starting work, and staying on task. He may benefit at home and school from visual schedules and checklists for completing everyday tasks (such as getting ready for school in the morning or packing his bag for home). Stevens teacher is already using frequent prompts and cues and his future teachers may want to establish an on-task behavior program; wherein, Steven is taught to monitor his own behavior and later rewarded for staying on task. At school rewards may take the form of computer time. Finally, instructions should be broken down and given after the preceding task is completed (i.e. Steven put on your shirt rather than Steven get dressed and make your lunch). Stevens performance during the cognitive assessment indicated that he fatigues quickly. The quality of his work may improve when he is given frequent short breaks. Since Steven is prone to negative self statements and thought distortions it is important that his mother and teachers challenge incorrect beliefs (i.e. everyone hates me) and clarify that it is his behaviour that is the problem. Opportunities for positive reinforcement should be sought. Steven demonstrates less knowledge of social skills than his peers and is described by his mother as someone who prefers to be alone. Steven may improve his social skills while engaged in structured social activities such as sports, clubs, or camps. Direct instruction around entering play, remaining in

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play, and problem solving as opportunities occur would be beneficial. Adults should also recognize that Steven may become drained from these activities and forcing him to engage in them for too long may lead to undesirable behaviours. To prevent temper tantrums Stevens mother and teachers may want to carefully monitor his mood and functioning and adjust expectations accordingly. For example, when Steven is having a difficult day they may want to provide more structure and decrease expectations. On several occasions Steven demonstrated sensitivity to noise. Noise-cancelling headphones may help reduce off-task and irritable behaviours. Due to Stevens difficulties with emotional regulation a home/ school communication book will provide information to his mother and teacher regarding what to expect for the day. Ideally, Stevens mother should inform the teacher of the type of morning Steven had and the teacher should inform his mother of how Stevens day went. This book can also be important for communicating homework assignments. Steven may benefit from working with the School Support Counsellor or STEPS personnel practicing self talk strategies, relaxation techniques, and role playing to more effectively problem solve when he is feeling frustrated.

ZZZZZ, Steven 10 Indices ASRS Total Score ASRS Scales Social/ Communication Unusual Behaviours Self Regulation DSM-IV-TR Scale Treatment Scales Peer Socialization Adult Socialization Social/ Emotional Reciprocity Atypical Language Stereotypy Behavioral Rigidity Sensory Sensitivity Attention CBCL DSM-Oriented Scales Affective Problems Anxiety Problems Somatic Problems ADHD Problems Oppositional Defiant Problems Conduct Problems Syndrome Scales Anxious/ Depressed Withdrawn/ Depressed Somatic Complaints Social Problems Thought Problems Attention Problems Rule-Breaking Behaviour Aggressive Behaviour Stevens Syndrome Scales: Oppositional Cognitive Problems/ Inattention Hyperactivity Anxious-Shy Perfectionism Social Problems Psychosomatic Stevens Global Indexes: ADHD Restless-Impulsive Emotional Lability Total DSM-IV Scales: Inattentive Hyperactivity-Impulsive Total PIC-2 Short Adjustment Scales Impulsivity and Distractibility Delinquency Family Dysfunction Reality Distortion Somatic Concern Psychological Discomfort Social Withdrawal Social Skills Deficits Mother (ZZZZZZ) Clinically Significant Clinically Significant At Risk At Risk Clinically Significant Clinically Significant Clinically Significant Clinically Significant At Risk Clinically Significant At Risk Within Normal Limits At Risk Clinically Significant Within Normal Limits Clinically Significant Clinically Significant Clinically Significant Within Normal Limits At Risk At Risk At Risk Within Normal Limits Clinically Significant Clinically Significant Within Normal Limits Clinically Significant Teacher (ZZZZZZZ) Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant At Risk Clinically Significant At Risk Clinically Significant At Risk Clinically Significant Clinically Significant Clinically Significant Within Normal Limits Within Normal Limits At Risk At Risk Within Normal Limits Within Normal Limits At Risk Within Normal Limits At Risk At Risk At Risk Within Normal Limits Clinically Significant

Clinically Significant At Risk Clinically Significant At Risk Clinically Significant Clinically Significant Clinically Significant Clinically Significant At Risk Clinically Significant Clinically Significant Clinically Significant Clinically Significant Clinically Significant

Within Normal Limits Within Normal Limits Clinically Significant Clinically Significant Within Normal Limits Within Normal Limits N/A Clinically Significant At Risk Clinically Significant Clinically Significant Within Normal Limits Clinically Significant At Risk

Clinically Significant Clinically Significant Within Normal Limits Clinically Significant At Risk Clinically Significant Within Normal Limits Clinically Significant

ZZZZZ, Steven 11 Student Behavior Survey Academic Resources Academic Performance Academic Habits Social Skills Parent Participation Adjustment Problems Health Concerns Emotional Distress Unusual Behavior Social Problems Verbal Aggression Physical Aggression Behavior Problems Disruptive Behavior ADHD Oppositional Defiant Conduct Problems

Within Normal Limits Clinically Significant Clinically Significant Within Normal Limits Within Normal Limits Clinically Significant At Risk Within Normal Limits Within Normal Limits Within Normal Limits At Risk Clinically Significant At Risk Within Normal Limits