Evaluation

Score: 72

PSYCHOLOGICAL ASSESSMENT

PATIENT NAME: Leslie DeVito

HOSPITAL NO.: 1728456

DATE OF BIRTH: October 25, 1985

DATE OF TRANSFER: November 24, _____

DATE OF ADMISSION: November 25, _____

AGE: 12

ASSESSMENT PROCEDURES
Wechsler Intelligence Scale for Children, III
Woodcock-Johnson Individual Achievement Test
(administered by hospital personnel)
Bender-Gestalt Test of Visual Motor Integration
House-Tree-Person Drawing
Thematic Apperception Test
Rorschach Inkblot Technique
REASON FOR REFERRAL
The patient was referred for assessment by Dr. Rosemary Lowenthal, child psychiatrist, Johnston Recovery Center. Specific information was requested regarding intellectual potential, achievement, and current personality features.

REASON FOR ADMISSION
The patient is a 12-year-old black female who was admitted to the Children's Treatment Unit at Johnston Recovery Center on November 25 because of severe behavioral problems, school problems, low self-esteem, physical aggression toward others, and problems related to past sexual abuse. The patient was brought to Johnston Recovery Center by her grandmother who has physical custody of her at this time. The patient denied suicidal/homicidal ideations as well as visual and auditory hallucinations. She was reportedly severely sexually molested and abused by her older brothers when she was 6 years of age. It is reported that her brothers shoved sticks and bottles up her vagina and that one of her brothers sodomized her. This individual is currently incarcerated at Barchfield Training School. The patient comes from a family of 6 siblings, and all siblings are separated from the home of their parents other than 1. The patient was removed from the home subsequent to the discovery of the abuse and remained in a shelter until age 9 when she was moved and placed in the custody of her grandmother. The patient currently lives within 2 miles of her natural parents' home. She is said to be involved with both her parents and to get along with them adequately. A conflictual relationship is said to exist between the patient and her grandfather who reportedly resents her presence. The patient reportedly failed the first grade and attends "LD classes." The patient began walking at about 13 months of age and had difficulty with speaking until the age of three. She had difficulty with toilet training and continued to wet her pants until she was 4 years of age.
The patient is said to have difficulties at school including inattention and poor listening skills. She has attacked another student at school physically. She has also displayed herself inappropriately in front of men and boys. The patient is said to have dental problems and is currently receiving treatment for her problems. She is said to have chest pain frequently when she exercises. Frequent headaches are reported. The patient is said to eat too frequently and gains weight easily. She is said to binge on food if the food is available. She complains of stomachaches frequently. The patient has few sleep difficulties at this time but is reported to have had nightmares frequently in the past. The patient is said to have one friend at school who is 9 years of age. Others have reported that she has low self-esteem. She has reportedly received treatment at a mental health center at Atkins.

OBSERVATION OF BEHAVIOR
The patient presented as an obese 12-year-old black female with black hair and brown eyes. She was dressed appropriately on the day of the evaluation, and she did not wear glasses or hearing aids. The patient reported to the examiner that "I did this 2 years ago at
Miss Amanda's office," in reference to the assessment tasks given her. The patient's fingernails were bitten and chewed to the quick. The patient seemed to have problems listening on occasions during the assessment, and she frequently asked to have items repeated to her. During several difficult assessment tasks, the patient looked at the examiner with a shy smile as she was completing the items as if to express pride that she had completed difficult items. She engaged in self-deprecatory comments from time to time, and she had to be encouraged to work on difficult items. She was very flat initially but began to smile occasionally toward the latter part of the assessment. She turned her chair away from the examiner and refused to maintain eye contact while elements of her past history were discussed. She clearly felt uncomfortable and was unresponsive. The test results obtained during this assessment appear to be valid estimates of her functioning.

TEST RESULTS
WECHSLER INTELLIGENCE SCALE FOR CHILDREN III
VERBAL TESTS PERFORMANCE TESTS
Information 4 Picture Completion 7
Similarities 5 Coding 5
Arithmetic 7 Picture Arrangement 5
Vocabulary 6 Block Design 8
Comprehension 1 Object Assembly 9
VERBAL IQ 70 Factor Scores:
PERFORMANCE IQ 80 Verbal Comprehension 68
FULL SCALE IQ 73 Perceptual Organization 85
Freedom from Distractibility 78
Based on the scores obtained by the patient on this instrument, she is apparently functioning overall within the borderline range of potential. A nonsignificant 10-point difference between verbal and performance scores was noted. The difference between the patient's perceptual organization factor score and her verbal comprehension factor score, however, was statistically significant. This suggests that the patient may be more efficient in completing tasks which require her to use visual or performance abilities. The patient scored highest on the subtest measuring her ability to put together puzzles of familiar objects. She scored lowest on the subtest measuring common sense reasoning about everyday problems and concerns.
WOODCOCK-JOHNSON ACHIEVEMENT TEST—REVISED
GRADE
RAW SCALE EQUIV. SS %ILE
Letter Word Identification: 18 1.2 58 3
Passage Comprehension: 10 1.6 71 3
Math Calculation: 10 2.2 64 1
Applied Calculation: 27 2.6 85 16
Dictation: 17 1.6 72 3
Writing: 15 2.4 84 15
Based on the scores obtained by the patient on this instrument, she is apparently functioning within the low-average range in math reasoning and writing, within the borderline range in reading comprehension and spelling, and within the deficient range in math calculation. Very deficient functioning was noted in letter word identification.

BENDER GESTALT TEST OF VISUAL MOTOR INTEGRATION
The patient completed the Bender task in 2 minutes 50 seconds, which is somewhat quicker than typical for task completion. She earned 2 errors using the Koppitz scoring system. This score is roughly age-appropriate and suggests adequate visual motor integration skills for her age.

HOUSE-TREE-PERSON DRAWING
The patient completed a drawing with the required picture elements. Her picture elements were very large and dominated the page. They were drawn in a quick manner with broad sweeping strokes. Several picture elements were heavily shaded while others were drawn with no apparent regard for boundaries. There were multiple windows in the house. Her drawing suggests poor behavioral controls as well as poor boundaries and limits. Aggressive behavior appears to be likely. The story told by the patient accompanies her picture suggests that she prefers to relate to her mother at times and that she is likely to display regressive needs. It appears that the patient is attempting to meet needs for support and care which she does not feel were satisfied at appropriate developmental levels.
THEMATIC APPERCEPTION TEST
Stories told by the patient to accompany the TAT material suggests the 5 following clinical hypotheses: The patient seems to see relationships as conflictual and untrustworthy. She seems to see the world as a threatening and dangerous place for her. She told stories which suggest that there is strong conflict among members of her family. She seems to be quite concerned regarding issues which were raised when she was removed from the care of her mother. There seem to be several unresolved matters which may date from the incidents or series of incidents. There were some indications of possible suicidal thought as well as likelihood that she demonstrates oppositional behavior toward her mother and her influence over her. She seems to understand the relationship problems in her family are solved by violence and has been solved by violence or aggression between individuals. Consequently, she seems to be maintaining only a superficial control over considerable anger and aggression.

RORSCHACH INKBLOT TECHNIQUE
The responses provided by the patient to the Rorschach suggest the following clinical hypotheses. The patient appears to look at the world in somewhat unusual ways. She does tend to focus on concrete and practical matters and is considered to be psychologically conservative. She probably exhibits poorly controlled emotions and is somewhat activated by emotionally charged events in her surroundings. She probably is defensive and has relatively poor intellectual and psychological resources to cope with complex surrounding events. Her reality testing and perceptual accuracy were poor.

SUGGESTED DIAGNOSIS
AXIS I: Oppositional defiant disorder, dysthymia, grandparent/child problem, and sexual abuse.
AXIS II: Reading disorder and rule out mathematics disorder.

SUMMARY & RECOMMENDATIONS
The patient is a 12-year-old black female who was admitted to the Children's Treatment Unit at Johnston Recovery Center on November 25 because of increasing behavioral problems, school problems, low self-esteem, increasing physical aggression, and past sexual abuse. The patient is currently being cared for by her grandmother who has physical custody of her. The patient was removed from her home when she was 6 years of age after molestation and sexual abuse was discovered. It is reported that several of the patient's brothers were engaging in sexual activities including inserting objects in her vagina and sodomizing her. One of her older brothers is currently incarcerated in Barchfield Training School. Other male siblings are not living in the home of their natural parents at this time. The patient reportedly lived in a shelter for several years after being removed from her home and was only recently placed in her grandmother's custody. The patient has had difficulty at school including poor attention focus and aggression toward other children. She has had academic problems from the first grade and is reportedly attending learning disability classes at this time. The patient walked at 13 months of age and had problems speaking until the age of 3. She also had delayed toilet training. The patient is obese, complains of chest pains during exercise, and has dental problems. She has frequent headaches, binges on food if it is available, and has no sleep difficulty. She has been treated at the mental health center at Atkins.
Based on the information gathered during this assessment, the patient apparently functions intellectually overall within the borderline range. Her score patterns suggest that deficient skills are present in verbal language areas and that low-average skills are present in visual perceptual areas. The patient scored within the low- average range in math reasoning and writing, within the borderline range in treading comprehension and spelling, and within the deficient range in math calculation. Reading recognition was measured within the very deficient range. Visual motor integration skills were measured as being commensurate with current intellectual potential. Personality features identified during the assessment include a concrete and practical or psychological conservative approach to surrounding events with little psychological sophistication. Defensiveness and an atypical way of looking at her surroundings was also noted. Poorly controlled emotions and significant underlying aggression was identified. Significant issues related to family issues and relationships appear to be present.

Based on the information gathered during this assessment, the following recommendations appear to be appropriate:

1. The patient appears to need continued hospitalization in the Children's Treatment Unit at the Johnston Recovery Center in order to take full advantage of the treatment milieu provided there.

2. The patient appears to have learning disabilities in reading and possible math calculations. The current test results may be submitted to the special education program developer in the school district where she currently attends school so that a proper educational program may be planned for her after discharge.

3. The patient will probably be a superficially cooperative participant in therapeutic activities. If she is pressed to discuss issues regarding her past which she considers to be personal, then she may become noncompliant and even combative. She should
respond well to behavioral management approaches which emphasize rewards and secondary reinforcers such as praises and verbal accolades. Further investigation of family functioning should be undertaken with an attempt to provide the patient with a
nonconflictual environment. The patient will likely continue to have difficulties with adjustment if the apparently dysfunctional relationships displayed for her by significant family members are not addressed directly.