Ethan is 10 years old and in fifth grade. He was referred for neuropsychological assessment at the request of his parents, who are concerned about his difficulty completing tasks and academic underachievement. Language processing difficulties were identified early in Ethan's development, and he received speech and language therapy before entering elementary school. Ethan's parents note that although they have no current concerns about his language skills, Ethan is reluctant to initiate writing tasks, often getting upset and claiming, "It's impossible!" This is true even when the writing is not related to his schoolwork (for example, making cards or writing notes to family members). He loves to have books read to him but argues when his parents try to encourage him to read on his own. His parents are concerned that an underlying learning disorder might be contributing to his increasing resistance to school. Although respectful of their concerns, Ethan's teacher feels that his issues are more likely related to anxiety and his tendency to procrastinate. The neuropsychologist assessing Ethan noted that he struggled with writing tasks. He had difficulty forming letters, which were printed awkwardly. In addition, his spelling and written output appeared slow and laboured. Ethan made frequent erasures as he worked and, on an untimed test involving math problems, he appeared reluctant to use a paper and pencil to work on the problems, preferring to do them in his head. Test results showed Ethan's general cognitive abilities to be in the high average range, with processing speed (measured by timed tests with pencil and paper) to be the one area of relative weakness. Ethan's executive functioning skills are generally typical for his age, although his parents state that he has difficulty controlling his emotions at home, especially  with regard to completing his homework, when he can quickly become frustrated and angry. Achievement testing showed that Ethan has strong math reasoning ability and good reading comprehension scores. However, his writing skills are more problematic and discrepant from most of his other abilities. Ethan needs considerably more time than average on writing tasks. He appears to struggle as he thinks about how to form each letter as he writes it. He shows poor visual-motor control, but his fine motor speed and coordination are not delayed. On standardized tests, Ethan scored below age expectations in terms of his ability to write conventionally (e.g., use of paragraphs and punctuation) and had even more difficulty with his contextual language skills (e.g., with fragmentary sentences, run-on sentences, absence of compound sentences). However, with a topic of his choosing, Ethan was able to show good story construction, with sequence and plot, and scored in the average range. The neuropsychologist concluded that Ethan meets the criteria for Learning Disorder of Written Expression, as evidenced by his differentiated difficulties with handwriting, conventional writing skills, and clarity of written expression. With this understanding, Ethan's teachers worked with his parents to develop a plan that included decreasing the amount of written work required of Ethan, while at the same time providing him with greater support to improve his writing skills, increase his confidence in his writing, and decrease his feelings of frustration and inadequacy. Additional strategies, such as reducing unnecessary copying, providing additional time for tasks requiring written work, and increasing the use of keyboarding and dictating for longer written assignments, were also recommended.

 

1. What is the likely diagnosis of the patient?

2. What TR assessment tool will you use to assess the patient (after-referral)?

3. Simulate assessment data, assuming that you use the assessment tool in 2 above to gather assessment data from the patient.

4. Based on the assessment results in 3 above, develop 2 treatment goals for the patient.

5. Select an activity intervention using evidence-based practice for the patient, and the activity intervention should be aligned with the treatment goals in 4 above,

6. How will you evaluate the program for effectiveness of the activity intervention in achieving the desired outcome?