blocked psychological report on gm - (wais, wms)

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 9/24/2011 Age at Testing: 20 years 9 months Retest? NoWMS-IV 9/24/2011 Age at Testing; 20 years 9 months 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

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. of 13

recounts having a 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

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parents. Despite these struggles, GM says that she is happy and healthy and looking

forward to a possible transfer to biology.

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

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entailed wavy lines was called "beach"). Therefore, her intelligence was estimated to be

above average; consistent with her level of education.

Tests Administered

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 ,

perceptual-motor 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 = 123-132). 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

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performance of the VCI on the Similarities subtest but performed consistently and

averagely on the Vocabulary, Information and Comprehension subtests.

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

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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

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

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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.

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,

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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 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

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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).

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).

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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 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 of 13

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.

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 304.80 Polysubstance Abuse (remission)ADD/ADHD (provisional)

AXIS II No diagnosisAXIS III No medical conditions reported

AXIS IV Indicates stress and emotional instability due to father's recent Leukemia diagnosis

AXIS V75 (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.

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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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blocked psychological report on gm - (wais, wms)

Documents

ignore distracting stimuli

verbal paired associates

exert mental control

logical memory ii

recall specific details

subtest required gm

meaningful word pairs

visual recall abilities