Blocked Psychological Report On GM - (WAIS, WMS) [PDF]

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Psychological Report DISCLAIMER: This report and its contents are confidential. Its purpose is for the benefit of the client and its disclosure should be restricted to individuals directly connected to the case who have a current authorization and have knowledge about Psychological Evaluation. Its re-disclosure is strictly prohibited.

Examinee and Testing Information Examinee Name

GM G. Minor

Date of Report

10/1/2011

Date of Birth

12/1/1990

Handedness

Right

Sex

Female

First Language

English

Race/Ethnicity

Asian

Marital Status

Single

Grade

Junior

Examiner

Lauren Shapiro

Test Administered WAIS-IV WMS-IV

9/24/2011 9/24/2011

Age at Testing: 20 years 9 months Age at Testing; 20 years 9 months

Retest? No Retest? No

Reason for Referral This evaluation was requested to provide GM with information regarding her intelligence, cognitive and memory functioning.

Background Information GM is a 20 year old Korean American female who is single and living with her parents in Indio, California1. She is currently enrolled in College of the Desert to obtain her Bachelor's degree in Business and works part-time at Unknown Seafood Restaurant as a hostess. She described recently moved back home after attending California State University Fullerton for two years. She reports having a happy childhood despite her biological father abandoning her mother when she was 2 months old. Although she recounts having a

1

For the sake of brevity and without any disrespect intended, GM is referred to by her first name for the remainder of the report. Page 1 of 13

strong and healthy relationship with her mother and stepfather, GM admits that for many years she resented her mother for being absent as she was a single-mom working two jobs. Moreover, GM reported that as a child, she felt overly-protected by and clashed with her mother who is a devout Christian with very traditional Korean values. GM is a very friendly, outgoing person who appears to be a people-pleaser. She attributes her personality and wide social circle to being frequently uprooted as a child, which required her to start afresh at many schools. Despite being an only child, GM doesn't recall feeling lonely as a child and instead believes that it helped her learn to be independent and self-sufficient at an early age. GM recounts having many friends in her early childhood and adolescence but to her recollection the quality of these relationships were very shallow. This pattern in her relationships has apparently carried over to her dating experiences as she conceded to a history of promiscuity and superficial relationships. GM disclosed an extensive history of drug, tobacco and alcohol use. To her recollection, GM began smoking marijuana as a sophomore in high school. Until moving back to her parents' home in Indio, she smoked a bowl or joint daily. In addition, GM admitted to trying cocaine as a sophomore at CSUF. Over the last two years, she has snorted anywhere between 1 to 3 lines on six or seven occasions. Although GM denies dependency on any of these drugs or alcohol, she said that her drinking was a concern at several points throughout her last years of college where she had an extensive history of blacking out after a night of heavy drinking. GM denies having a history of mental illness or depression and suicidal or homicidal ideations; however, she reports recent feelings of loss of self control, bouts of crying and having difficulty concentrating but has attributed these changes to her step-father's recent diagnosis of Leukemia which prompted her to transfer schools and move back in with her parents. Despite these struggles, GM says that she is happy and healthy and looking forward to a possible transfer to biology. Page 2 of 13

Test Behavior and Mental Status GM arrived on time for the test unaccompanied. GM appeared to be of stated age, casually and neatly dressed and in no state of distress. The client engaged with the examiner in a cooperative and friendly manner. The client demonstrated good eye contact. Her speech was spontaneous with normal rate, rhythm and tone. Her responses to questions were appropriate and well-reasoned. Her affect and mood were situation-appropriate; however, she did appear to be somewhat anxious about her test results. Emotionally, she appears to view the world as a happy, optimistic place. GM indicated that she was not depressed and had no suicidal or homicidal ideations. Her thoughts were logical, relevant and coherent with no signs of abnormality. Her thought content did not reveal any delusional ideations, hallucinations, ideas of reference, obsessions or compulsions. She was alert and oriented to person, place, time and situation. Her memory was intact but her attention and concentration were poor. GM demonstrated boredom during testing and indicated she was anxious to finish quickly. Furthermore, she kept requesting to draw on blank papers and testing materials. This observed boredom seemingly translated into distraction and may have moderately interfered with her ability to perform at her full potential. GM's test behavior was somewhat argumentative. Furthermore, she accused the examiner of treating her like a baby whilst giving instructions as required by the manual, "I get it, move on". GM demonstrated difficulty with serial 7s, a numeric sequencing task, having made 2 errors which suggests a difficulty in concentration. Throughout testing, GM was preoccupied with scoring and her results, periodically asking "how am I doing" and "I got that wrong didn’t I". During the Design I and II subtests GM named the design cards objects (ex: a design that entailed wavy lines was called "beach"). Therefore, her intelligence was estimated to be above average; consistent with her level of education.

Tests Administered Page 3 of 13

WAIS-IV Scale

Score

WMS-IV Scale

Score

Verbal Comprehension

122

Auditory Memory

124

Perceptual Reasoning

123

Visual Memory

130

Working Memory

136

Visual Working Memory

126

Processing Speed

135

Immediate Memory

123

Full Scale

128

Delayed Memory

137

Interpretation of WAIS-IV Results General Intellectual Ability The Wechsler Adult Intelligence Scale-IV (WAIS-IV) is a comprehensive assessment of verbal and non-verbal cognitive ability assessing vocabulary, abstract reasoning , perceptualmotor reasoning, problem solving and several aspects of memory. GM achieved superiorly on the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV). GM's level of intelligence exceeds approximately 97% of her peers (FSIQ = 128; confidence interval = 123132). GM's results demonstrate a strength on the verbal comprehension, perceptual reasoning and processing speed tasks but a relative weakness on the working memory tasks. Verbal Comprehension GM's verbal reasoning abilities as measured by the Verbal Comprehension Index (VCI) were in the superior range and above those of approximately 93% of her peers (VCI = 122; 95% confidence interval = 115-127). The VCI was designed to assess verbal reasoning, abstract reasoning and concept formation. GM achieved her best performance of the VCI on the Similarities subtest but performed consistently and averagely on the Vocabulary, Information and Comprehension subtests.

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The Similarities subtest required GM to reason abstractly by identifying the similarities between two items. The Information subtest required GM to answer questions based on general knowledge acquired over the course of her life. The Vocabulary subtest required GM to define certain items based on previous learning. The Comprehension subtest required GM to explain abstract concepts reflecting social conventions, rules and expressions. Perceptual Reasoning GM's nonverbal reasoning abilities as measured by the Perceptual Reasoning Index (PRI) were in the superior range and above those of approximately 94% of her peers (PRI = 123; 95% confidence interval = 116-128). The PRI was designed to assess fluid reasoning in the perceptual realm with tasks that measured nonverbal concept formation, visual perception organization, spatial reasoning and visual-motor coordination. GM's performance on the perceptual reasoning subtests that contributed to the PRI are fairly variable but within normal limits. An examination of her individual subtest results suggest that GM has above average spatial reasoning abilities as demonstrated on the Block Design, Matrix Reasoning, Visual Puzzles and Picture Completion tasks but a relative weakness for Figure Weight tasks which measure mathematical and deductive reasoning.

The Block Design subtest required GM to arrange colored blocks according to a visual prompt. The Matrix Reasoning subtest required GM to identify the missing design that completes a pattern from multiple designs. The Picture Completion subtest required GM to examine a picture and identify the missing element or detail that was absent from the picture. The Visual Puzzles subtest required GM to identify which grouping of objects creates the visual prompts. The Figure Weights subtest required GM to identify which grouping of objects balances out the visual equation. Working Memory Page 5 of 13

GM's ability to sustain attention, concentration and exert mental control as measured by the Working Memory Index (WMI) was in the average range and above those of approximately 63% of her peers (WMI = 105; 95% confidence interval = 98-111). The WMI was designed to assess working memory through tasks of concentration and attention. GM's abilities to sustain attention, concentration and exert mental control are a weakness relative to her vocabulary comprehension, perceptual reasoning and processing speed abilities. GM's subtest results were consistently average and indicated a slight strength at completing mental arithmetic tasks, as found in the Arithmetic subtest, over tasks that involved holding and sequencing numbers and letters in her mind, as found in the Digit Span and Letter-Number Sequencing subtests.

The Arithmetic subtest required GM to solve oral arithmetic problems. The Letter-Number Sequencing subtest required GM to sequence letters and numbers that were recited orally. The Digit Span subtest required GM to repeat a set of numbers in a specific order after an oral recitation. Processing Speed GM's ability to complete problems and reason quickly without making errors as measured by the Processing Speed Index (PSI) was in the very superior range and above those of approximately 99% of her peers (WMI = 135; 95% confidence interval = 123-140). The PSI was designed to assess visual discrimination, attention to detail, fine-motor skill coordination, short-term memory and learning ability. GM demonstrated considerable and consistent strengths in these domains as indicated by her superior Symbol Search, Coding and Cancellation subtest scores.

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The Symbol Search subtest required GM to identify a symbol within a set of symbols. The Coding subtest required GM to recode a series of numbers with a predetermined series of symbols. The Cancellation subtest required GM to ignore distracting stimuli while marking a specific combination of colors and shapes.

Interpretation of WMS-IV Results GM was administered 10 subtests of the Wechsler Memory Scale-IV (WMS-IV). When interpreting GM's performance on the WMS-IV, it is important to note any factors that may affect her test performance. GM experienced difficulties staying focused and paying attention during testing, which may have contributed to a diminished concentration and incapability to follow instructions and demonstrate her true abilities. Auditory Memory GM's ability to process oral information, repeat it immediately and then recall the information after a 20-30 minute delay as measured by the Auditory Memory Index (AMI) was in the superior range and above those of approximately 95% of her peers (AMI = 124; 95% confidence interval = 117-129).

Within auditory memory, GM exhibited very superior strength on the Logical Memory II subtest relative to her weaker Logical Memory I, Verbal Paired Associates I and Verbal Paired Associates II scores. On Logical Memory I, GM was told a story and was asked to recall specific details immediately after its conclusion. Meanwhile, on Logical Memory II, GM was asked to recall specific details from the story that were relayed 22 minutes prior. This subtest measures GM's ability to recall verbal information that follows a central theme. Meanwhile, the Verbal Paired Associates I (VPAI) subtest required GM to recall novel word pairs as well as meaningful word pairs. The Verbal Paired Associates II (VPAII) subtest Page 7 of 13

required GM to recall these word pairs, both novel and meaningful, after a 26 minute delay. The VPAI subtest measures immediate learning of verbal associations over multiple exposures while the VPAII subtest measures delayed cued recall for word pairs. Visual Memory GM's ability to process visual details and reason abstractly as measured by the Visual Memory Index (VMI) were in the very superior range and above those of approximately 98% of her peers (VMI = 130; 95% confidence interval = 123-134).

Within visual memory, GM exhibited a strength on the Visual Reproduction II subtest; however, her scores on the Visual Reproduction I, Design I and Design II subtests were consistent and above average. The Visual Reproduction II subtest required GM to recall designs she had previously seen and drawn and after 28 minutes, to freely recall and reproduce them without any visual cues. Meanwhile, the Visual Reproduction I subtest requires GM to recall and draw designs immediately after viewing them. The Designs I subtest required GM to view a grid with 4-8 designs cards and recall the correct location and card details in spite of distractors cards. The Designs II subtest required GM to recall the correct design details and spatial location of the cards on the grid after a 24 minute delay without any visual cues. Visual Working Memory GM's ability to temporarily hold and manipulate spatial positioning and visual aspects as measured by the Visual Working Memory Index (VWMI) was in the superior range and above approximately 96% of her peers (VWMI = 126; 95% confidence interval = 117-131).

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It is important to note that GM's attentional difficulties observed throughout the assessment period are believed to have affected her ability to express her true capacity on these tasks. Despite her lack of focus and concentration, GM performed superiorly on the Symbol Span task but averagely on the Spatial Addition task and her scores on this subtest might have been higher had these difficulties not been present.

GM's performance on the Symbol Span was significantly better than her performance on the Spatial Addition subtest which suggests that her visual working memory functioning is subject to marked variability. The Spatial Addition subtest assesses spatial working memory and requires storing and manipulating information while ignoring distracting stimuli. Meanwhile, the Symbol Span required GM to retain a mental image of each symbol and its relative spatial location on a grid. The discrepancy between Symbol Span and Spatial Addition points to GM's inability to ignore distracting stimuli and may be attributed to her attentional difficulties. Immediate Memory GM's immediate verbal and visual recall abilities as measured by the Immediate Memory Index (IMI) were in the superior range and above those of approximately 94% of her peers (IMI = 123; 95% confidence interval = 116-128).

Within immediate memory, GM exhibited a relative weakness on the Verbal Paired Associates I subtest in comparison to her consistent and above average scores on the Logical Memory I, Design I and Visual Reproduction I subtests. As previously mentioned, the Verbal Paired Associates I subtest measures immediate learning of verbal associations over multiple exposures while the Logical Memory I subtest measures immediate recall of specific details from a narrative after one single exposure. The Designs I subtest required Page 9 of 13

GM to recall design cards and their spatial location on a grid immediately after exposure while the Visual Reproduction I subtest required GM to reproduce drawings immediately after viewing them. Delayed Memory GM's delayed verbal and visual recall abilities as measured by the Delayed Memory Index (DMI) were in the very superior range and above those of approximately 99% of her peers (DMI = 137; 95% confidence interval = 128-142).

Within delayed memory, GM exhibited a relative strength on Logical Memory II subtest in comparison to her consistent and above average scores on the Verbal Paired Associates II, Design II and Visual Reproduction II subtests. As previously mentioned the Logical Memory II subtest required GM to recall specific details from a story after a delay while the Verbal Paired Associates II subtest required GM to recall both unique and meaningful word pairs after a delay. The Visual Reproduction II subtest required GM to recall previously viewed designs and, after a delay, to redraw them without visual prompts while the Designs II subtest required GM to recall designs cards and their spatial location on a grid after a delay.

Summary of Intellectual and Memory Abilities A comparison of GM's auditory memory ability (AMI) to her results on the WAIS-IV revealed that tasks involving auditory information do not pose a challenge to GM. Information presented orally, such as a story, word pairs, letters or numbers, were easily repeated or recalled without prompts or cues.

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A comparison of GM's visual memory ability (VMI) to her results on the WAIS-IV revealed that tasks involving visual perception were performed superiorly. Tasks involving recalling specific details from visual prompts, reproducing diagrams from visual prompts, spatial reasoning and visual problem solving, appear to come naturally to GM.

A comparison of GM's visual working memory ability (VWMI) to her results on the WAIS-IV revealed that she has very superior ability to manipulate visual information while holding it in immediate memory. Subtests on both the WMS-IV and WAIS-IV that required manipulation of visual information required GM to recall specific details, designs and symbols and identify their spatial location and patterns.

DSM Diagnosis AXIS I AXIS II AXIS III AXIS IV AXIS V

304.80 Polysubstance Abuse (remission) ADD/ADHD (provisional) No diagnosis No medical conditions reported Indicates stress and emotional instability due to father's recent Leukemia diagnosis 75 (Sept, 2011) 85 (April, 2011)

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Discussion and Summary Given her superior scoring, GM's test results revealed a marked discrepancy between her working memory and her vocabulary comprehension, processing speed and perceptual reasoning abilities. GM reported an extensive mental health and substance abuse history. As a result, the incongruity between the indices suggests that her inability to hold and maintain thoughts might be attributed to her past substance abuse.

In conjunction with her lack of focus, inability to concentrate and high distractibility, her low working memory index scores suggests that GM may have attention and concentration difficulties. Inability to do serial 7s, a simple sequencing task, suggests that GM has difficulty with concentration. Furthermore, throughout testing, GM appeared to be bored, was easily distracted and frequently requested to draw. As such, GM should be referred to her general practitioner for further testing and to rule out the possibility of an ADD/ADHD diagnosis.

Despite her distractibility, GM demonstrates strong delay recall as indicated by the Logical Memory II and Visual Reproduction II subtests. This suggests that her history of drug abuse and potential attention difficulties might be interfering with her ability to immediately process information but do not affect her ability to recognize or recall details and facts that have been stored in long term memory.

It is also important to note that during the background interview, GM reported feeling as though her mother was overly-protective during her childhood; however, during testing, GM was argumentative and accused the examiner of babying her whilst giving the test instructions. This suggests that GM disregards authority and has trouble accepting instruction and directions. Page 12 of 13

Recommendations Psychological testing is probabilistic and inferential by its nature and provides hypotheses that should be explored with data from clinical interviews and other sources. Conclusions about an individual are not reached on the basis of psychological testing alone. Application of these instruments to the understanding of the individual must take into consideration the person's history, clinical presentation, present life circumstances, and other pertinent information. These tests results are only an estimate of GM's true cognitive and memory functioning. In all likelihood, if these tests were administered on alternative day under different circumstances, the obtained scores may be somewhat discrepant from the ones detailed in this report.

1) Rule out ADD/ADHD - GM should be referred to her general practitioner for possible attention and concentration difficulties. 2) Rule out anxiety and depression 3) Rule out substance abuse or relapse 4) Additional testing to clarify the nature of the discrepancy between her average working memory scores and her obvious higher potential in other areas. 5) Based on her superior cognitive functioning and memory abilities, GM appears to be a good candidate for higher education and should she desire to pursue such studies, would be expected to succeed. 6) GM should attempt to improve her working memory through memory card games, the creation and memorization of lists, and by removing all distractions from immediate area.

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