Intellectual Disability Report
Intellectual Disability Report
Strictly Confidential
CONTENTS
(1) Biographical Details
(2) Referral Information
(3) Informed Consent
(4) Background and Clinical Presentation Information
(5) Cognitive Assessment
(6) Adaptive Behaviour Assessment
(7) Summary
(8) Conclusion and Summary of Intellectual Disability DSM-5 Criteria
(9) Recommendations
(10) Appendix
(11) Brief Biography of Author
BIOGRAPHICAL DETAILS
Name: John Smith
Date of Birth: 25/02/2003
Gender: Male
Age: 17 years
Grade: 11
School: Subiaco High School
Address: 123 Example Street SUBIACO WA 6008
Parent’s Phone Number: 0411 111 111
Parent’s Email Address: janesmith@[Link]
REFERRAL INFORMATION
John was referred to Psychological and Educational Consultancy Services (PECS) by Dr James Brown
(Consultant Paediatrician) for a Cognitive and Adaptive Behaviour Assessment to assess for an Intellectual
Disability.
INFORMED CONSENT
John’s parent(s) were informed of the reason for the assessment, the assessment components, and that the
results would be used to compile a report which would be provided to them and the referrer (if applicable).
John’s parent(s) indicated that they understood all that was conveyed to them and signed a Consent Form
acknowledging that they consented to the administration of the assessment; and for the report to be
generated and disseminated accordingly.
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BRIEF BACKGROUND INFORMATION AND CLINICAL PRESENTATION
Relevant information reported during the initial interview session with John’s mother:
Was born with no apparent complications
Reached all of the major developmental milestones (e.g., walking, speaking, toileting) later than the
expected age ranges
John wears a nappy because he is not toilet trained
John uses orthotic inserts to address his balance and tone issues
John had surgery to fix a squint at Princess Margaret Hospital
Normal visual and auditory acuity reported (last tested in 2015)
No prescription medication use
Is solely right-handed/right-footed
Has fine and gross motor coordination problems
Because of John’s fine motor difficulties, he needs help to eat smaller foods
Things such as buttons and zips are too difficult for John to manipulate
John finds writing and holding scissors very difficult
John’s awareness of danger with scissors is non-existent
At present, John is unable to walk alone, so he uses a walking frame
John appears to be unaware of others in his path, and often hits people with his walker
John was diagnosed with a Global Developmental Delay at age 1
John’s cousin has a Global Developmental Delay
John is part of the NDIS
John has had several interventions to address his difficulties; such as, OT, speech therapy,
physiotherapy, eye tests, hip X-ray’s, genetic blood tests, and an MRI
John has been with Senses Australia since he was 18 months old, doing physio, speech, and OT
John has participated in play group and hydrotherapy
John needs full time assistance
John is unable to dress himself or blow his nose
John is severely behind his peers in all areas
John has had an Educational Assistant (EA) in the classroom
John is a very happy and social boy who loves school, but is often distracted by others
John’s sister has been diagnosed with ADHD
John appears to be more entertained by watching others than joining in; however, he likes to join in
when he is capable of doing the activities
John tries really hard to fit in and be part of everything, so he can get very frustrated when he can’t
physically do what others are doing
John has a very limited vocabulary (50-70 words), and consequently uses short sentences (3-4
words)
John says T or D for the ‘G’, ‘C’, and ‘K’ sounds
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Information reported in Dr Jill White’s Paediatric Neurologist Report (May 2007 - at age 4 years):
John presented at the age of 6 months with a serious form of epilepsy known as West Syndrome,
which refers to a combination of “infantile spasms” (a type of brief tonic seizure), “hypsarrhythmia”
(a very irregular electro-encephalogram with very frequent multifocal epileptic activity) and arrest
of neurodevelopmental progress.
Current working diagnosis is cryptogenic West syndrome.
John’s epilepsy has responded well to treatment. However, West syndrome is commonly associated
with significant learning difficulties and impairment of frontal lobe executive functions and
unfortunately John has shown significant delays in both linguistic and fine motor skill development,
as well as impaired concentration and reading ability.
He has been assessed by and received therapy from educational psychologists, speech pathologists
and occupational therapists.
Previous trials of stimulant medication have been unhelpful for his short attention span and have
not improved his academic performance.
Please note that only a brief overview was obtained due to John and his parents already having provided more detailed
background information to Dr Brown.
See checklists for more behavioural information.
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COGNITIVE ASSESSMENT
Cognitive Tests Administered:
Test Date of Administration
Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV, 2008) 03/09/2020
WAIS-IV Overview:
The Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) is a test designed to measure intelligence
in older adolescents and adults (aged 16 years and above). It is composed of 10 core subtests and five
supplemental subtests, with the 10 core subtests comprising the Full-Scale IQ. The WAIS-IV has been
language adapted for Australia and New Zealand.
WAIS-IV Subtests:
Please see Appendix for full subtest descriptions.
WAIS-IV Indexes:
The Verbal Comprehension Index (VCI) is a measure of verbal acquired knowledge and verbal reasoning
incorporating the 3 core Verbal subtests of Information, Similarities, and Vocabulary and one supplemental
subtest Comprehension.
The Perceptual Reasoning Index (PRI) is a measure of fluid reasoning, spatial processing, attentiveness
to detail, and visual-motor integration comprising the 3 core Performance subtests of Visual Puzzles, Block
Design, and Matrix Reasoning and two supplemental subtests; Figure Weights and Picture Completion.
The Working Memory Index (WMI) comprises the two core subtests of Arithmetic, Digit Span, and one
supplemental subtest; Letter-Number Sequencing. The subtests provide a range of verbally presented tasks
that require the individual to attend to information, to hold briefly and process that information in memory,
and then to formulate a response.
The Processing Speed Index (PSI) is an indication of an individual's ability to process simple or routine
visual information quickly and efficiently and to quickly perform tasks based on that information. Good
speed of simple information processing may free cognitive resources for the processing of more complex
information and ease new learning. The PSI comprises two core subtests; Coding and Symbol Search and
one supplemental subtest; Cancellation.
The General Ability Index (GAI) is an optional summary score that is less sensitive to the influence of
working memory and processing speed. As working memory and processing speed are vital to a
comprehensive evaluation of cognitive ability, it should be noted that the GAI does not have the breadth of
coverage as the FSIQ. GAI is not considered to be valid if there is an 18+ difference between the VCI and
PRI.
The Full-Scale IQ (FSIQ) score is the overall summary score that estimates an individual’s general level
of intellectual functioning. It is usually considered to be the score that is most representative of global
intellectual functioning. FSIQ is not considered to be valid if there is an 18+ difference between the VCI,
PRI, WMI or PSI.
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WAIS-IV Qualitative Descriptions:
Examiner’s Details:
TEST ADMINISTRATOR: Dr Shane Langsford
QUALIFICATIONS: Bachelor of Psychology
Bachelor of Education with First Class Honours
Doctor of Philosophy
REGISTRATION: Psychology Board of Australia and AHPRA Registered Psychologist
Test Behaviour:
John was observed as having a lively affect and he seemed to genuinely enjoy completing the various tasks.
The examiner was unable to understand several of the answers given by John during the Information and
Similarities subtest.
The manner and sophistication of John’s interaction with the examiner was judged as being reflective of a
person with cognitive deficiencies.
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Table 2: WAIS-IV Index Level Discrepancy Comparisons
Critical Significant
Value Difference Base
WAIS-IV Index Difference 0.05 (exceeds 0.05) Rate
Verbal Comprehension – Perceptual Reasoning -7 9.74 No 31.8
Verbal Comprehension – Working Memory -3 10.60 No 41.5
Verbal Comprehension – Processing Speed -10 12.47 No 26.4
Perceptual Reasoning — Working Memory 4 10.18 No 39.7
Perceptual Reasoning – Processing Speed -3 12.12 No 43.9
Working Memory — Processing Speed -7 12.82 No 32.5
Full Scale IQ – General Ability Index -2 3.96 No 37.6
Statistical Significance (Critical Values) at the .05 level
Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant
Table 4: Differences Between VCI Subtest Scores and Mean of VCI Subtest Scores
Scaled VCI Difference .05 Strength or
VCI Subtests Score Mean From Mean Critical Value Weakness
Similarities 4 4.00 0 1.91
Vocabulary 5 4.00 1 1.58
Information 3 4.00 -1 1.64
"High" or "Low" is indicated when the score falls within 20% of the critical value required for reaching statistical significance
Statistical Significance (Critical Values) at the .05 level
*Non-core subtest
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Table 5: Differences Between PRI Subtest Scores and Mean of PRI Subtest Scores
Scaled PRI Difference .05 Strength or
PRI Subtests Score Mean From Mean Critical Value Weakness
Block Design 5 5.33 -0.33 2.05
Matrix Reasoning 5 5.33 -0.33 1.92
Visual Puzzles 6 5.33 0.67 1.99
"High" or "Low" is indicated when the score falls within 20% of the critical value required for reaching statistical significance
Statistical Significance (Critical Values) at the .05 level
*Non-core subtest
Table 6: WMI and PSI Subtest Discrepancies from FSIQ Index Subtest Mean
Please note, the statistics provided in this table are not standard WAIS-IV analyses and are provided as a guide only
Subtest FSIQ Difference Nominal Strength
Scaled Mean From FSIQ Critical or
Subtest Score Score Mean Cut-off Weakness
Working Memory
Digit Span 4 4.8 -0.8 2.50
Arithmetic 5 4.8 0.2 2.50
Processing Speed
Symbol Search 5 4.8 0.2 2.50
Coding 6 4.8 1.2 2.50
Scores referred to as ‘High’ or ‘Low’ fall within 20% of the critical value for statistical significance *Non-core subtest.
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ADAPTIVE BEHAVIOUR ASSESSMENT
Adaptive Behaviour Tests Administered:
Test Date of Administration
Adaptive Behaviour Assessment System–Second Edition (ABAS-II, 2008) 17/09/2020
ABAS-3 Overview:
The Adaptive Behaviour Assessment System – Third Edition provides a comprehensive, norm-referenced
assessment of adaptive skills for individuals ages birth to 89 years. The ABAS-3 may be used to assess an
individual’s adaptive skills for diagnosis and classification of disabilities and disorders, identification of
strengths and limitations, and to document and monitor an individual’s progress over time.
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(2) Teacher Provider Form (Ages 5-21) – Completed by John’s Teacher
Table 1: Sum of Scaled Scores to Composite Score Conversions
95%
Standard Percentile Confidence Qualitative
Composite Score Rank Interval Range
General Adaptive Composite (GAC) 43 <0.1 40-46 Extremely Low
Conceptual 53 0.1 49-57 Extremely Low
Social 58 0.3 54-62 Extremely Low
Practical 45 <0.1 41-49 Extremely Low
Adaptive Domain scores have a mean of 100 (50th percentile) and a standard deviation of 15.
Percentile Rank refers to John’s standing among 100 individuals of a similar age.
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SUMMARY
REASON FOR REFERRAL:
John was referred to Psychological and Educational Consultancy Services (PECS) by Dr James Brown
(Consultant Paediatrician) for a Cognitive and Adaptive Behaviour Assessment to assess for an Intellectual
Disability.
COGNITIVE ASSESSMENT:
95%
WAIS-IV Scale Composite Percentile Confidence Qualitative
Score Rank Interval Description
Verbal Comprehension Index (VCI) 66 1 62-73 Extremely Low
Perceptual Reasoning Index (PRI) 73 4 68-81 Borderline
Working Memory Index (WMI) 69 2 64-78 Extremely Low
Processing Speed Index (PSI) 76 5 70-87 Borderline
Full Scale IQ (FSIQ) 65 1 62-70 Extremely Low
General Ability Index (GAI) 67 1 63-73 Extremely Low
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CONCLUSION AND SUMMARY OF INTELLECTUAL DISABILITY DSM-5 CRITERIA
Intellectual Disability (Intellectual Developmental Disorder) is a disorder with onset during the developmental
period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains.
(DSM-5 Definition, p.33).
Criterion A.
Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking,
judgement, academic learning, and learning from experience, confirmed by both clinical assessment
and individualised, standardised intelligence testing.
A1: Criterion Met
Clinical Assessment. (see Background and Clinical Presentation Information and Test Behaviour
section)
A2. Criterion Met
Intellectual Assessment (as per FSIQ/Index/ Subtest scores in Cognitive Assessment section)
Criterion B.
Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural
standards for personal independence and social responsibility. Without ongoing support, the
adaptive deficits limit functioning in one or more activities of daily life, such as communication,
social participation, and independent living, across multiple environments, such as home, school,
work, and community.
B. Criterion Met
Adaptive Functioning (see Background and Clinical Presentation Information and Adaptive
Behaviour section)
Criterion C.
Onset of intellectual and adaptive deficits during the developmental period
C. Criterion Met
Onset prior to age 18 John is currently 17 years of age
Severity:
The various levels of severity are defined on the basis of adaptive functioning, and not IQ scores,
because it is adaptive functioning that determines the level of supports required. Levels of severity
are Mild, Moderate, Severe, and Profound.
Severity. Moderate
(see Background and Clinical Presentation Information, Adaptive Behaviour
section, and Adaptive Behaviour Table in Appendix)
As indicated in the summary table above, John meets the criteria for a diagnosis of an Intellectual Disability,
which can be described as being of a “Moderate” nature.
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RECOMMENDATIONS
Please note, PECS does not provide micro-strategies (e.g., sit student at front of classroom, etc) as part of their
recommendations. PECS’s provides recommendations on what further assessment is required, what intervention is necessary,
and who is the most appropriate to provide the assessment/intervention recommended.
SCHOOL INVOLVEMENT:
(1) A case-conference involving John's parents and the key Department of Education personnel should
be held to discuss John's individual learning requirements.
NDIS:
(1) John’s parents should provide a copy of this report to the NDIS.
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APPENDIX 1: ADAPTIVE BEHAVIOUR SEVERITY SUMMARY TABLE
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Severe Attainment of conceptual Spoken language is quite limited The individual requires support for all
skills is limited. The in terms of vocabulary and activities of daily living, including meals,
individual generally has little grammar. Speech may be single dressing, bathing, and elimination. The
understanding of written words or phrases and may be individual requires supervision at all
language or of concepts supplemented through times. The individual cannot make
involving numbers, quantity, augmentative means. Speech responsible decisions regarding well-
time, and money. Caretakers and communication are focused being of self or others. In adulthood,
provide extensive supports on the here and now within participation in tasks at home, recreation,
for problem solving everyday events. Language is ad work requires ongoing support and
throughout life. used for social communication assistance. Skills acquisition in all
more than for explication. domains involves long-term teaching and
Individuals understand simple ongoing support. Maladaptive behaviour,
speech and gestural including self-injury, is present in a
communication. Relationships significant minority.
with family members and
familiar others are a source of
pleasure and help
Profound Conceptual skills generally The individual has very limited The individual is dependent on others for
involve the physical world understanding of symbolic all aspects of daily physical care, health,
rather than symbolic communication in speech or and safety, although he or she may be able
processes. The individual gesture. He or she may to participate in some of these activities as
may use objects in goal- understand some simple well. Individuals without severe physical
directed fashion for self-care, instructions or gestures. The impairments may assist with some daily
work, and recreation. Certain individual expresses his or her work tasks at home, like carrying dishes
visuospatial skills, such as own desires and emotions to the table. Simple actions with objects
matching and sorting based largely through nonverbal, non- may be the basis of participation in some
on physical characteristics, symbolic communication. The vocational activities with high levels of
may be required. However, individual enjoys relationships ongoing support. Recreational activities
co-occurring motor and with well-known family may involve, for example, enjoyment in
sensory impairments may members, caretakers, and listening to music, watching movies,
prevent functional use of familiar others, and initiates and going out for walks, or participating in
objects. responds to social interaction water activities, all with the support of
through gestural and emotional others. Co-occurring physical and
cues. Co-occurring sensory and sensory impairments are frequent barriers
physical impairments may to participation (beyond watching) in
prevent many social activities. home, recreational, and vocational
activities. Maladaptive behaviour is
present in a significant minority.
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BRIEF BIOGRAPHY OF THE AUTHOR
Dr Shane Langsford is a highly qualified and very experienced psychologist who has conducted more
than 4000 child and adult assessments since establishing Psychological & Educational Consultancy
Services in 1999.
Dr Langsford is fully registered with the Psychology Board of Australia (PBA) and the Australian Health
Practitioners Regulation Agency (AHPRA).
Dr Langsford is a Full Member of the Australian Psychological Society (APS), Australian Association
of Psychologists (AAPi), Australian ADHD Professionals Association (AADPA), and ADHD Australia.
Dr Langsford is also an APS College of Educational & Developmental Psychologists Full Academic
Member. To be awarded Full Academic Member status, an individual must have completed a PhD in
psychology, have at least two years’ experience as a researcher or educator in psychology in the College
specific area of practice, and have published a notable body of relevant research in the College-specific
area of practice.
In 2015, Dr Langsford was personally selected from a shortlist by the then Federal Minister of Health
(the Hon Sussan Ley) to be part of the 13-member Mental Health Expert Reference Group (MHERG).
The group was formed to provide advice to the Commonwealth Department of Health in relation to the
government’s response to the National Review of Mental Health Programmes and Services. Dr
Langsford was the only practising psychologist in Australia appointed to the group, and the only member
in the group from Western Australia. (For more information, see [Link]
With regards to ADHD, Dr Langsford has conducted over 1500 ADHD assessments for various
Psychiatrists and Paediatricians, was asked in 2014 to be on the National Shire ADHD Expert Panel
for the “A Snapshot of ADHD: A Consumer and Community Discussion”, and in April 2018 was the
only Psychologist from Australia invited to the ADHD Institute’s “Meeting of the Minds” Forum in
Madrid (Spain). Dr Langsford was for the second year running once again the only Psychologist from
Australia invited to the Forum, which was held in Munich (Germany) in November 2019. (For more
information, see [Link]
Dr Langsford’s extensive knowledge of a wide range of disorders led to the creation of the PsychProfiler,
which is a reliable and valid instrument oriented to the DSM-5 and has been the most widely used
Australian global psychiatric/psychological/educational assessment tool since 2004.
(For more information, see [Link]
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