Example Cognitive Evaluation – Psychology Research Paper

Example Cognitive Evaluation – Psychology Research Paper
Miss Alias volunteered to be evaluated in order to assist the examiner in obtaining experience and basic understanding in administering and interpreting cognitive instruments. This was a requirement for Forensic Assessment I 6705.

BACKGROUND HISTORY:
Miss Alias is a single 33-year-old female. She was born in the City, California and raised in an intact, upper class family of British, German, and Norwegian descent. She has one sibling, who is two years, her elder. All members of her family are highly educated with “respectable” jobs. Her father is a mechanical engineer who has a Bachelor of and Science degree in engineering. Her mother is a teacher and has a degree in home economics. Her sister is an attorney who also has a master’s degree in Library Arts and Science. Miss Alias is a high level executive in advertising who has a BS degree in Finance and Business Administration. She owns a “moderately” large house located in prestigious part of the city in which she lives. She explained that in the future she would like to be married and have a child while maintaining her career. Miss Alias stated that she was very pleased with her job.

Miss Alias reported that she had a “reasonably happy childhood.” Her extracurricular activities included: Pixies, Brownies, Girl Scouts, Tap dancing, Cheerleading, Swimming, National Charity league, and Tennis. She described herself as being outgoing at an early age, always playing with the neighborhood children, and having a “large” number of friends. As a group activity her family worked on remodeling their house. She remembered she and her sister having to clean the used bricks, which left their hands raw and bloody. Miss Alias stated that at times her sister and she would feel their parents loved their house more than their children. Although she never witnessed her parents fighting, she said they were non-demonstrative towards each other. She said her parents do not believe in God, which is difficult, because she aliass. She stated that her parents view individuals who have a religious affiliation as being weak; therefore she hides her belief in God from them.

Miss Alias stated that “conflicts between herself and her sister started when she arrived home from the hospital at birth.” She explained that her sister always wanted to “kill” her. Her sister hid her favorite stuffed animal, hit her, and threw heavy objects at her. Miss Alias stated that her parents’ thoughts were that “her sister could do no wrong” and would say “poor Karen what are we going to do about Karen.” Her family considered Miss Alias to be the beauty of the family and because of this, they told her she was “blessed”. Her sister was not considered beautiful and because of this Miss Alias felt
guilty. Her current relationship with her sister is “better”, although Miss. Alias said she is waiting for the “other shoe to drop.” She stated that she could never trust her sister.

Educational History:
Miss Alias stated that in kindergarten, she had a hard time reading and spelling. Because of this her parents made her read extra books as well as memorize all the state capitals which helped her overcome this difficulty. She stated that she was forced by her mother to become right handed. Her weakest area was spelling and her strongest area was mathematics. She reported her intellectual and academic abilities as being above average. She was enrolled in advanced placement classes, graduating high school with a 4.5 GPA. She graduated from college in less than three years with a 3.0 GPA. She stated that she was an exemplary student, never receiving detention, nor ever being reprimanded in school.

Work History:
Miss Alias performed various odd jobs before her college years. During college, she concentrated on her studies and was fortunate to have parents who would support her without her having to work while she attended school. Upon graduation from college she obtained employment at a bank as a new accounts customer service representative. While at the bank she became acquainted with people in the modeling industry, and although she occasionally modeled she mainly became interested in becoming a scout for new talent. She thereupon withdrew from the bank and worked for a modeling agency two years as a scout. Following this, she obtained a position in an advertising agency as an account executive. The reason for this career change, according to her, is that she was not using her finance and business training, which was “going to waste.” Miss Alias rapidly rose up in the ranks in the advertising agency, to the point that she is presently holding some major accounts essentially on her own.
In her present position as an account executive, Miss Alias is required to use various cognitive and intellectual capabilities, including verbal communication (holding meetings with clients and colleagues, giving presentations, talking on the phone, working on reports and developing ad campaigns). In addition, she uses her creative abilities to a great extent, as she either individually or in cooperation with coworkers develops such verbal and visual structures as advertising copy, layouts, logos, slogans, music, art and photos as well as other aspects of ad campaigns.

Health History:
Miss Alias was the product of a 9 1/2 month pregnancy. Birth weight was 6 pounds 4 ounces. Her birth was complicated due to the umbilical cord being wrapped around her neck two times. Aside from this complication she was healthy. Her developmental milestones were reported to be normal. Miss Alias stated that her mother might have drunk wine while carrying her.
Miss Alias reported that at the age of four her sister pushed her, resulting in her “cracking her head.” She stated she was injured and required stitches. In 1988, at the age of 15, Miss Alias states she was raped by a classmate while attending a debate competition. Miss Alias reported that in 1989, at the age of 16, while intoxicated at a party, six men “violently” raped her, after the rape, she blacked out. She did not know what caused her to black out. She sought no medical treatment following this event. At the age of 18 Miss Alias reports she contacted a rape crisis counseling center. In 1992, at the age of 20, while getting out of the shower, her sister, hit her with her fists and knocked her onto the floor, she said she slightly hitting her head. She denies being injured or unconscious.

In 2000, at the age of 28, she had a concussion, due to a car accident. After the accident she could not make proper sentences for approximately three days and then she reported feeling normal. She reported that she was in the backseat of her friend’s car, when the car was hit by another car, sending the car spinning. The first thing she remembered before the collision was the other car turning towards her. The first thing she remembered seeing, after the accident, was the airbag dust and crackers that were spread throughout the car. She went home, believing she was fine. Two days after the accident she was dismissed from work for the day, in order for her to see a doctor. The doctor took x-rays and told her she had a concussion and would be fine.

Drug and Alcohol History:
Although Miss Alias experimented with “street drugs,” during her adolescent years, at the present time, she restricts herself to moderate social drinking. She aliass not smoke cigarettes or marijuana.

Physical Appearance:
Miss Alias is a 33 year-old Caucasian female. She presents herself with a well groomed and fashionable appearance. She is approximately 5’ 3” with blonde hair and blue eyes. She arrived for the evaluation in casual chic attire; wearing a grey v neck tee shirt with black slacks and black high heels and carrying a black cardigan sweater. She appears clean and well groomed.

BEHAVIOR OBSERVATIONS AND RESPONSE TO EVALUATION:
Miss Alias was courteous and cooperative during the evaluation, but appeared at times overly nervous about the correctness of her responses. During the assessment tasks that required more creative thinking, such as Picture Completion, she was anxious to find the correct answers and looked to the examiner as to whether her responses were correct. The examiner responded that it was not a part of the assessment process to give her the answers. At times during the assessment process, Miss Alias manifested anxious behavior, especially during the timed tests. At other times she appeared indifferent. She was mostly enthusiastic and eager to perform the tasks correctly and in a timely matter. However, during the later subtests, she almost seemed numb and emotionally insensitive, perhaps from fatigue.

During the assessment process, Miss Alias maintained eye contact with the examiner and seemed especially attuned to the time limits allotted during the timed tasks. During these times she looked anxiously at the examiner for some clue when the allotted time would elapse. Before each task she asked if it were timed and occasionally stated that she liked the “challenge” of being timed.

Miss Alias maintained an upright posture during the session, which was neither rigid nor slack. She did not apparently tire during the assessment process until the very end.

At various times during the assessment process, Miss Alias asked the examiner for particulars as to why the tests were being administered and how the results would be interpreted or applied to her case. She was extremely curious and eager to learn all that she could before, during, and after the assessment. At the end of assessment, she appeared neither anxious to leave, nor desiring to stay. She appeared tired when she stood up and left. Miss Alias commented that although she felt “stupid” at times she found the experience to be “unique, perplexing and extremely interesting.”

THE EVALUATION PROCEDURES:
• Interview
• Wechsler Adult Intelligence Scale, Third Edition (WAIS – III)
• Wide Range Achievement Test, Version IV (WRAT – 4)
• Peabody Picture Vocabulary Test – Third Edition (PPVT – III)
• Observation

RESULTS OF EVALUATION:
Intellectual Factors.
Miss Alias was administered the WAIS – III, which is a measure of an individual’s intellectual ability and overall cognitive capabilities. This assessment instrument is made up of 14 separate subtests that are divided into two major areas: Verbal subtests and Performance subtests. The Verbal subtests consist of tasks that involve language and logical verbal sequencing, while the Performance subtests consist of tasks that involve
visual and spatial reasoning. Miss Alias completed the WAIS – III in 3 hours and 37 minutes.

Objective results of the WAIS – III were as follows:

Scale IQ 95% Confidence Interval Percentile Rank
Verbal Scale 115 110-119 84th

Performance Scale 87 81-95 19th

Full Scale 103 91-99 58th

Factor Index 95% Confidence Interval Percentile Rank

Verbal Comprehension 120 114-124 91st

Perceptual Organization 93 86-101 32nd

Working Memory 109 102-115 73rd

Processing Speed 81 74-92 10th

Scaled Percentile Corresponding Scaled Percentile Corresponding
Subtest Score Rank IQ Subtest Score Rank IQ
Picture
Vocabulary 12 75th 110 Completion 5 5th 75

Digit
Symbol-
Similarities 16 (S) 98th 130 Coding 6 9th 95

Block
Arithmetic 14 (S) 91st 120 Design 12 (S) 75th 110

Matrix
Digit Span 9 (W) 37th 95 Reasoning 10 50th 100

Picture
Information 13 84th 115 Arrangement 8 25th 90

Symbol
Comprehension 11 63rd 105 Search 7 16th 85

Letter-Number Object
Sequencing 12 75th 110 Assembly 8 25th 90
*(S) indicates a significant relative strength, p < .05; (W) indicates a significant relative weakness, p < .05. Miss Alias’s Full-Scale IQ is 103, which is in the Average range of intellectual ability. This score is at the 58th percentile of the general American population. Individuals in this range can be expected to perform moderate mental tasks and often may be found in non-managerial, professional career tracks. Persons having a Full-Scale IQ in this range sometimes obtain a higher education. In addition to the Full-Scale IQ, the WAIS - III also measures separate Verbal and Performance abilities. It is interesting to note there is a significant discrepancy between Miss Alias’s Verbal IQ (115) and her Performance IQ (87). Her Verbal IQ is significantly higher than her Performance IQ, which indicates a disparity between her language-related capabilities and her visual spatial capabilities. While her Verbal IQ lies at the 84th percentile, her Performance IQ is at the 19th percentile. These scores indicate that Miss Alias scores within the top 16% of the general American population (in the High Average range) in her verbal ability, and within the Low Average range, 19th percentile, on her non-verbal ability. The WAIS - III also provides four Indexes that measure ability clusters. These include the Verbal Comprehension Index, Perceptual Organization Index, Working Memory Index and Processing Speed Index. The Verbal Comprehension Index is a good measure of language ability and language-related intellectual capacity. On this Index, Miss Alias’s score is 120, which indicates that she is in the top 9% of the general American population. This score is in the Superior range. Miss Alias’s second highest Index score is in the Working Memory Index 109, which is at the 73rd percentile. This score is in the Average range. This score indicates that Miss Alias has an Average short-term memory capacity for learning either verbal or numeric information. On the Perceptual Organizational Index, Miss Alias had a score of 93, which is considered in the Average range and lies at the 32nd percentile. This result indicates that Miss Alias’s perceptual abilities, in such areas such as spatial reasoning, is substantially below her verbal abilities. Furthermore, Miss Alias scored 81 on the Processing Speed Index in the Low Average range (at the 10th percentile). This result indicates that Miss Alias’s cognitive abilities appeared to be slowed in a way that aliass not match her high verbal capacities. Miss Alias’s strengths and weaknesses can be most effectively evaluated by examining three sets of data: her IQ scores, her Index scores and her Subtests scores. First, in evaluating her IQ scores there is a discrepancy between her Verbal IQ and her Performance IQ of 28 points. Miss Alias’s verbal intellectual capacities are much higher than her performance intellectual capacities with a difference that is significant at the .05 alpha level. This difference might indicate certain weaknesses related to abilities measured by the Performance Scale or might indicate an organic or functional disorder. In terms of Miss Alias’s Indices, her Verbal Comprehension Index is far higher than the other Indices, which include Working Memory Index, Perceptual Organization Index and Processing Speed Index. The most striking difference is a Superior score on Verbal Comprehension Index as compared with Low Average performance on Processing Speed Index. This discrepancy indicates that Miss Alias’s verbal comprehension and expression are in the Superior range as well as her nonverbal reasoning ability involving visual stimuli and concrete materials. Conversely, on tasks that emphasize non-verbal reasoning ability as well as tests that require visceral motor processing speed Miss Alias falls within the average general population. These results are perplexing when taken into account that she has a college degree and works in a high level managerial position. To further clarify the discrepancies in her results the subtest scores will be examined. On such subscales as Vocabulary, Similarities, Information, Arithmetic and Letter Number Sequencing Miss Alias scored in the Very Superior, Superior or High Average range. These results indicate that Miss Alias’s concentration on computational skill sequencing, verbal information and language related abilities are on a level that is equivalent to her professional capacities. She especially aliass well on verbal tasks that require information. However, on verbal tasks that require short term memory such as Digit Span and Comprehension she falls within the Average range. The results from the verbal subscales seem to indicate that Miss Alias’s capacities are most pronounced when processing speed or short-term memory are not involved in the task. While looking at the Performance subtests, Miss Alias scores in the Low Average range and Borderline range on such subtests as Picture Completion and Symbol Search. The tasks involved in these subtests require short-term visual memory, concentration, attention and a person’s ability to pick out essential from nonessential details, as well as visio-spatial reasoning abilities. The subtests that are most markedly low involve processing speed assignments, on such tasks Miss Alias performs poorly. She scored in the Average range in Matrix Reasoning, Picture Arrangement, and Digit Symbol Coding. The only Performance scale subtest that Miss Alias performed in the High Average range was Block Design. Objective results of the PVVT – III were as follows: Chr. Age Raw Score Standard Score Percentile Rank N.C. Equiv. Stanine Age Equiv. 33-1 166 88 21st 33 3 17-01 Miss Alias was administered the Peabody Picture Vocabulary Test - Third Edition which is a test that measures receptive verbal ability. Her scores on this measure are well below her age mates. Miss Alias scored at the 75th percentile on the WAIS – III Verbal Comprehension Index in contrast to her score in the 21st percentile on the PVVT – III. This suggests that Miss Alias’s expressive appears to be more advanced then her receptive vocabulary. Achievement Factors. Objective results of the WRAT IV were as follows: Subtest Standard Score Percentile Word Reading 103 58th Sentence Comprehension 107 68th Spelling 107 68th Math Computation 116 86th Reading Composite 103 58th The Wide Range Achievement Test IV is incorporated in the test battery administered to Miss Alias to provide a more diverse base of assessment, that is helpful in evaluating for possible educational and or vocational strengths and weaknesses that might impact personal, educational, and or vocational goals. The WRAT IV is a norm referenced test that measures academic skills. The assessment included subsets such as Word Reading, Sentence Comprehension, Spelling, and Math Computation for individuals between 5 and 94 years old. The Word Reading component is an estimate of letter and word decoding skills that are measured through letter identification and word recognition. The Sentence Comprehension subtest is an assessment of an individual's ability to comprehend meaning, ideas, and information contained in sentences using a cloze technique. The Spelling subtest is an estimate of an individual's ability to encode verbal information into written format. The Math Computation subtest is an overall assessment of mathematics ability regarding oral and written materials. The results of Miss Alias’s WRAT IV assessment indicate an average intellectual ability in verbal and a high average in number related skills. Her subtests scores on Word Reading, Sentence Comprehension, Spelling and Reading Composite are within the average range of ability that indicates the verbal intellectual abilities of the average college student. Her highest subtest score was in Math Computation which indicated a better ability to handle numerical information and calculations. The score comparisons between the subtests do not indicate a marked discrepancy between the various achievement abilities measured by the WRAT IV. Moreover, the results of the WRAT IV for Miss Alias do not indicate any significant cognitive weaknesses and or learning disorders, they fit the profile of an average college educated adult. SUMMARY AND CONCLUSIONS: The overall results from this assessment indicate an inconsistent profile of an average learner who may suffer cognitive and or organic deficits that may impair the consistency of her performance. This inconsistent profile can be exemplified by Miss Alias’s Low Average performance on the Peabody compared with her Very Superior performance on the Similarities subtest of the WAIS -III. In addition a marked inconsistency can be seen by comparing the profiles obtained of the examinee on the WAIS - III and the WRAT - IV. On the WAIS - III Miss Alias performed in the High Average range on tasks that emphasized verbal reasoning, arithmetic and informational tasks. However, in tests that involved nonverbal visio spatial manipulations, creative thinking, working memory and processing speed, Miss Alias’s scores were below the majority of individuals in her age group. Her scores on the WRAT – IV, however, indicate a consistent profile of an average learner and a well-balanced ability to deal with information, both verbal and numerical. The keys to this inconsistency may be within both Miss Alias’s results on the PVVT–III and in her low scores on the WAIS - III for both Performance IQ and Processing Speed Index. Miss Alias’s Low Average performance on the PVVT–III (21st percentile), when compared with her results for the Verbal subtests on the WAIS - III and in her Verbal subtests scores for the WRAT IV might indicate either memory or processing problems. Miss Alias’s apparent deficits in slowness of processing speed and short-term memory performance may be due to possible brain damage, as her history indicates that she suffered a concussion six years ago and lost her ability to form sentences for a short time. There may have been a residual amount of damage that resulted from the accident, as well as other reported head “impacts.” Furthermore, these deficits may be caused by either attention deficits, anxiety or the psychological residue experienced in past years, an attention deficit disorder might account for the inconsistency between Miss Alias’s test scores on these assessments as it would explain the discrepancy between her ability and her performance. Perhaps during certain assessments administered by this examiner Miss Alias faltered because of distractions or lack of attention. In addition, the fact that Miss Alias experienced being raped by six men could lead to post-traumatic stress disorder that might manifest in an inability to focus on a given task. RECOMMENDATIONS: Considering the results of this evaluation, the following recommendations are suggested: 1. It is recommended that Miss Alias undergo a full neurological examination that can determine whether her deficits may be due to organic brain damage or some other neurological deficit. 2. Because the Picture Completion subtest from the WAIS – III is so substantially than all other abilities, it is recommended that Miss Alias undergoes a complete physical examination by a physician to determine if she suffers from any vision impairments, nutritional deficits, physical illness or disease. Low scores on this subtest may reflect vision difficulties, alertness to the environment, field dependence/independence and visual acuity. 3. It is also recommended that she is further assessed for attention deficit disorder and or post-traumatic stress disorder due to her lower score in the Symbol Search subtest from the WAIS – III. Low scores on this subtest may reflect attention span, concentration, distract ability, visual acuity, verbal elaboration, visual elaboration, planning, reflectivity/impulsivity or ability to perform under time pressure. 4. To address Miss Alias’s processing difficulties, it may be helpful for Miss Alias to use mnemonic aids and verbal mediation strategies.

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