CONFIDENTIAL ADHD TESTING
Testing Date: September 8, 2021
Jane Doe; DOB April 15, 2013; Age 8
PRESENTING PROBLEM and REFERRAL QUESTION
Jane Doe started to struggle in class and get in trouble and struggle
with small behavioral things at school, he is angry a lot, and has
meltdowns, especially during math class.
NOTIFICATION
Prior to the initiation of the examination I notified Ms. Doe, as to the nature
of the confidentiality arrangement. I indicated to her that the visit would
result in the generation of a report that would be her sole possession. If she
wished the report released from the office to someone other than herself,
then she would need to sign a release form. I also indicated to her that she
required a straightforward presentation. I told her there were aspects of the
examination, which might reveal a lack of effort, symptom exaggeration or
dissimulation. She appeared to understand.
Background
Family and Social: Jane Doe lives in the home with her mother, father and
one younger sister, age 4. She was carried for 40 weeks, natural birth, and
induced labor. Mother reports that he met all developmental milestones.
Psychological and Substance Use:
Jane Doe did do counseling prior once or twice when school
started but there has been a barrier getting services due where they
live and did not want telehealth services. Family denies substance
abuse other than caffeine usage; he drinks 2 sodas per day.
Developmental, Medical, and Medications:
Jane Doe does not take any medications and has no known medical
conditions.
BEHAVIORAL OBSERVATIONS AND MENTAL STATUS
Jane Doe was alert and oriented during the telehealth session. He was
hyperactive during the session and had to be redirected by her mother and
therapist several times during the session and was defiant towards her mom
and therapist at times. Her mother reports that he often takes her anger out
on her and no one else in the household. He gets along well with her older
siblings per her mothers report.
PSYCHOMETRIC FINDINGS
The Conners 3rd Edition–Parent (Conners 3–P) is an assessment tool
used to obtain a parent’s observations about her or her child's behavior. The
instrument is designed to assess Attention Deficit/Hyperactivity Disorder
(ADHD) and its most common comorbid problems in children and
adolescents aged 6 to 18 years old. When used in combination with other
information, results from the Conners 3–P can provide valuable information
to guide assessment decisions. Ther report provides information about the
parent's assessment of the youth, how he compares to other youth, and which
scales and subscales are elevated
Response Style Analysis
The following section provides the parent’s scores for the Positive and Negative
Impression scales and the Inconsistency Index.
Positive Impression
The Positive Impression score (raw score = 0) does not indicate an overly positive
response style.
Negative Impression
The Negative Impression score (raw score = 4) does not indicate an overly
negative response style.
Inconsistency Index
The Inconsistency Index score (raw score = 6, number of differentials ≥ 2 = 1)
does not indicate an inconsistent response style.
Conners 3-P Content Scales
The T-scores for the following Conners 3-P Content scales were very elevated (i.e.,
T-score ≥ 70 ), indicating many more concerns than are typically reported:
Inattention (T = 90), Hyperactivity/Impulsivity (T = 72), Executive Functioning (T
= 78), Defiance/Aggression (T = 90) and Peer Relations (T = 90).
Scale Raw T-Score Guideline Common
Score (Percentile) Characteristics of
High Scorers
Inattention 26 90 (99) Very elevated May have poor
Score (Many concentration/attention or
more difficulty keeping her/her
concerns than mind on work. May make
are typically careless mistakes. May be
reported) easily distracted. May give up
easily or be easily bored. May
avoid schoolwork.
Hyperactivity/Impulsivity 23 72 (97) Very elevated High activity levels, may be
Score (Many restless and/or impulsive. May
more have difficulty being quiet. May
concerns than interrupt others. May be easily
are typically excited.
reported)
Learning Problems 8 59 (77) Average Academic struggles (reading,
Score writing, and/or math) May have
(Typical difficulty learning and/or
Levels of remembering concepts. May
concern need extra explanations.
Executive Functioning 20 78 (99)` Very elevated May have difficulty starting or
Score (Many finishing projects, may complete
more projects at the last minute. May
concerns than have poor planning or
are typically organizational skills.
reported)
Defiance/Aggression 12 90 (98) Very elevated May be argumentative; may defy
Score (Many requests from adults; may have
more poor control of anger and/or
concerns than aggression; may be physically
are typically and/or verbally aggressive; may
reported) show violent and/or destructive
tendencies: May bully others;
may be manipulative or cruel.
Jane’s scores are elevated (i.e., DSM-5 Symptom Count probably met,
DSM-5 T-score 3 65): There diagnosis should be given strong
consideration, meaning that her symptom count and her T-scores are
relative and absolute supporting the finding of ADHD-Combined Type
on the Conner’s Parent Report.
Other Areas of Concern:
The Symptom Count is probably met for Oppositional Defiant Disorder.
Follow-up is recommended to ensure symptoms are exhibited during
interaction with at least one individual who is not a sibling. Her raw score
was 21, and with her in the T-score of 90, and the 99th percentile for her age
compared to peers.
The Symptom Count was high for anxiety, indicating that Jane Doe has
trouble worrying, controlling her worrying and is irritable when
worrying and depressed, feels worthless, sad and gloomy, lost of interest
or pleasure in activities, tired and low energy and warrants further
investigation.
Specific Parental Concerns Reported: none
Impairment
The parent’s report of Jane Doe level of impairment in academic, social, and
home settings is presented below.
Jane Doe’s parent indicated that her problems seriously affect her
schoolwork or grades often (score of 2).
Jane Doe’s parent indicated that her problems seriously affect her friendships
and relationships very often or very frequently (score of 3).
Jane Doe parent indicated that her problems seriously affect her home life
very often or very frequently (score of 3).
Conners 3-P Results and IDEA
Scores on the Conners 3-P suggest possible consideration for IDEA 2004
eligibility in the following area(s): Autism, Emotional Disturbance, Other
Health Impairment and Specific Learning Disability.
The Conners 3–P provides information that may be useful to consider when
determining whether a student is eligible for special education and related
services under current U.S. federal statutes, such as the Individuals with
Disabilities Education Improvement Act of 2004 (IDEA 2004).
Elevated scores on the Conners 3–P may indicate the need for special
education and related services. The following table summarizes areas of
IDEA 2004 eligibility that are typically listed for children and adolescents
who have elevated scores on various portions of the Conners 3–P.
Checkmarks indicate which areas of the Conners 3–P were indicated or
endorsed, suggesting possible consideration of IDEA 2004 eligibility in
related areas. The information in the table is based on the IDEA 2004 and
general interpretation/application of the federal law.
Content Area Follow Up Possible IDEA Eligibility Category
Inattention Yes ED, LD, OHI
Hyperactivity Impulsivity Yes DD-Emotional, ED, OHI
Executive Functioning Yes LD, OHI
Peer Relations Yes Autism, DD-Communication,
DD-Emotional; DD-Social
ADHD Predominantly Yes ED, OHI
Hyperactive-Impulsive
Presentation
ADHD Predominantly Inattentive Yes ED, LD, OHI
Presentation
ADHD Combined Presentation Yes ED, LD, OHI
Conduct Disorder Yes ED
Oppositional Defiant Disorder Yes ED
Anxiety Yes ED
Depression Yes ED
ED = Emotional Disturbance; LD = Specific Learning Disability; OHI =
Other Health Impairment.
Conners 3–T Results and IDEA
The Conners 3–T provides information that may be useful to consider when
determining whether a student is eligible for special education and related
services under current U.S. federal statutes, such as the Individuals with
Disabilities Education Improvement Act of 2004 (IDEA 2004).
Elevated scores on the Conners 3–T may indicate the need for special
education and related services. The following table summarizes areas of
IDEA 2004 eligibility that are typically listed for children and adolescents
who have elevated scores on various portions of the Conners 3–T.
Checkmarks indicate which areas of the Conners 3–T were indicated or
endorsed, suggesting possible consideration of IDEA 2004 eligibility in
related areas. The information in the table is based on the IDEA 2004 and
general interpretation/application of the federal law. Specific state and local
education agencies may have specific requirements that supersede these
recommendations. The assessor is encouraged to consult local policies that
may impact decision-making.
Content Areas Follow Up Possible IDEA Eligibility
Category
Inattention Yes ED, LD, OHI
Peer Relations Yes Autism, DD-Communication,
DD-Emotional, DD-Social, ED
Depression Yes ED
ED = Emotional Disturbance; LD = Specific Learning Disability; OHI =
Other Health Impairment.
The Conners 3rd Edition-Teacher (Conners 3–T) is an assessment tool used
to obtain the teacher’s observations about her/her student's behavior in a
school setting. The instrument is designed to assess Attention
Deficit/Hyperactivity Disorder (ADHD) and its most common comorbid
problems in children and adolescents aged 6 to 18 years old. When used in
combination with other information, results from the Conners 3–T can
provide valuable information to guide assessment decisions. The report
provides information about the teacher's assessment of the youth, how he
compares to other youth, and which scales and subscales are elevated.
Response Style Analysis
Inconsistency Index.
Positive Impression
The Positive Impression score (raw score = 1) does not indicate an overly
positive response style.
Negative Impression
The Negative Impression score (raw score = 3) does not indicate an overly
negative response style.
Inconsistency Index
The Inconsistency Index score (raw score = 10, number of differentials ≥
2 = 3) indicates that responses to similar items showed high levels of
inconsistency. Scores may not accurately reflect the individual due to a
careless or unusual response to some items. Interpretation should focus on
understanding the reasons for differences in responses to similar items.
Scale Raw Score T-Score Guideline Common
Percentile Characteristics of
High Scorers
Inattention 19 67 (90) Elevated Score May have poor
(More concentration/attention or
concerns than difficulty keeping her/her
typically mind on work. May make
reported careless mistakes. May be
easily distracted. May give up
easily or be easily bored. May
avoid schoolwork.
Hyperactivity/Impulsivity 3 44 (52) Average Score High activity levels, may be
(Typical restless and/or impulsive. May
Levels of have difficulty being quiet. May
concern) interrupt others or talk too
much. May be easily excited.
Learning Problems/Executive 14 53 (66) Average Score Academic struggles (reading,
Functioning (Typical spelling, and/or math) May
Levels of have difficulty learning and/or
concern) remembering concepts. May
need extra instructions. May
have executive deficits.
Defiance/Aggression 5 55 (23) Average Score May be argumentative; may
(Typical levels defy requests from adults; may
of concern) have poor control of anger
and/or aggression; may be
physically and/or verbally
aggressive; may show violent
and/or destructive tendencies;
may bully others; may be
manipulative or cruel.
Executive Functioning (LE 11 62 High Average May have difficulty starting or
subscale) Score finishing projects, may
complete projects at the last
minute. May have poor
planning, prioritizing, or
organizational skills.
Peer Relations 11 89 Very Elevated May have difficulty with
Score (many more friendships, poor social skills, and
concerns than are limited social skills. May appear to
typically reported) be unaccepted by the group.
Learning Problems (LE 11 49 Average Score Struggles with reading, spelling,
Problems) (Typical Levels of and/or math. May have difficulty
concern) remembering concepts.
Additional concerns about student: (Jane Doe) is a highly intelligent child
who is loving and kind.
Student strengths or skills: understands difficult concepts. He's great in all
subject areas except for math and she avoids this and is often disruptive
during class.
INTERPRETATION SUMMARY
Jane Doe meets the diagnostic criteria for 314.01 (F90.2) ADHD-Combined
Presentation-Hyperactivity-impulsivity, Moderate; displaying a persistent
pattern of inattention and hyperactivity, impulsivity that interferes with
functioning and or development, as characterized by inattention,
hyperactivity, impulsivity of the following symptoms which have persisted
for at least 6 months to a degree that is inconsistent with developmental level
and that negatively impacts directly on academic activities. These symptoms
do not appear to solely be a manifestation of oppositional behavior, defiance,
hostility, or failure to understand tasks or instructions, even though he does
struggle with some executive functioning tasks. These symptoms were valid
on the Conners parent report, and some symptoms present on the Conners
teachers report;
They were as follows:
Inattention:
1. Often fails to give close attention to details or makes careless mistakes
in schoolwork, or during other activities.
2. Often has difficulty sustaining attention in tasks and/or activities.
3. Often has difficulty does not follow through on instructions and fails
to finish schoolwork, chores (or starts tasks but quickly loses focus
and is easily sidetracked)
4. Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort.
5. Is often easily distracted by extraneous stimuli (for older adolescents,
may include unrelated thoughts)
6. Often loses things necessary for tasks or activities
Hyperactivity and impulsivity:
Six or more of the following symptoms have persisted for 6 months to
a degree that is inconsistent with developmental level and that
negatively impacts directly on social and academic/occupational
activities.
1. Often talks excessively
2. Often has difficulty waiting her turn
3. Often interrupts or intrudes on others
4. Is often “on the go” acting as if driven by a motor
5. Often fidgets with or taps hands or squirms
6. Often unable to play or engage in leisure activities quietly
Several inattentive symptoms were present before age 12 years.
Several inattentive symptoms are presents in two or more settings (school
and home)
There is clear evidence that the symptoms interfere with, reduce the
quality of, social, academic functioning.
The symptoms do not occur exclusively during the course of
schizophrenia or another psychotic disorder and are not better explained
by another mental disorder (e.g. mood disorder, anxiety disorder,
dissociative disorder, personality disorder, substance intoxication or
withdrawal)
Jane Doe also scored significantly high for Anxiety from the parent’s
observations of Jane Doe behavior with regard to specific items that are
related to generalized anxiety, however he did not meet the full criteria for
the diagnosis. However there is being placed as a rule out, please see
recommendations.
Jane Doe also scored significantly high on depression screening items for the
parent and teacher observations behavior with regard to specific items that
are related to depression. However, he did not meet the full criteria for their
diagnosis and it is being placed as a rule out, please see recommendations.
CONCLUSIONS
1. Intellectually, Jane appears to be operating within the Average-range
of intellectual functioning, however full IQ testing was not conducted.
2. Psychologically, Jane Doe suffers from ADHD Combined Type; rule
out of Unspecified Anxiety disorder and Unspecified Depressive
Disorder is being placed.
3. Testing for learning disorders and executive functioning is warranted.
4. Jane Doe seems to also suffer significantly in the area of social
functioning, specifically, peer to peer relations and often isolates and
seems to be happy isolating and this is abnormal for 9-year-old
behavior.
RECOMMENDATIONS
1. Jane Doe does meet the DSM-5 criteria for ADHD-Combined Type
moderate; and evaluation is needed to assess for anxiety and
depression diagnosis.
2. Jane Doe would benefit from individual and parent-behavior
management training to address ADHD.
3. Jane Doe scores from both parent and teacher indicate problems in the
area of social functioning with peers, he would likely benefit from
social skills group, group therapy to address these concerns.
5. The scores indicated that Dylan may have learning problems in which
he may struggle academically (reading, writing, and/or math) and he
may have difficulty learning and/or remembering concepts and may
need extra explanations. An evaluation for IEP or 504 is
recommended. Parent should/can request IQ and educational testing
from Mississippi School District in writing and keep a copy of the
letter. The school has 21 days from the date of the letter to respond.
Based on the majority of test scores indicating problems in executive
functioning and learning disorders.
