MM was referred for the psycho-educational evaluation by his adoptive mother due to the history of developmental delays. Furthermore, MM had been diagnosed with attention deficit hyperacticity disorder (ADHD). 

Measures Administered

Axis II diagnosis of intellectual disability 

CBCL 

TAT 

Clinical Interview 

Behavioural Observation

Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V)

Psychological Report for MM

Background Information 

MM is a 12 year, five-month-old youngster who was evaluated on two separate occasions. According to his clinical records, MM presents with a history of developmental delays and has been diagnosed with attention deficit hyperactivity disorder (ADHD), Oppositional Defiant Disorder (ODD), and a medical history of genetic duplication of 22q13.31, along with a history of seizures. MM’s clinical records also indicate that his biological mother used drugs during pregnancy. At the time of the first evaluation in MM was taking Tenex, prescribed to address symptoms of impulsivity. MM’s records also indicate exposure to cocaine in-utero. Based on a brief interview with Ms. M, MM’s adoptive mother, he has been living with her since he was five months old. She noted that his biological mother was known to have a history of mental illness. 

MM received visits from his biological mother up until the age of 5 years. It is unclear if MM and his family are still in contact with her. MM received early intervention services as a child, which included speech and language therapy, physical therapy and occupational therapy. Currently, MM attends an 8:1:1 classroom in a school in NYC, and is in the 7th grade. He was recently assigned a paraprofessional to work with him individually, due to disruptive behavior, which includes talking out in class, using inappropriate language, turning over tables and hitting other children. Ms. M indicated that MM does not like his class, he believes that the children in his class are very low functioning and that he should be in a different class in the school. MM does not want to go to school in the morning, and it is very difficult to encourage him to do so.

Other behaviors of concern include a lack of empathy for others and enjoyment in seeing others in pain (Ms. M noted for example that MM would laugh if a door slams on someone’s foot). Ms. M also noted that MM presented with some “problems with his ears” which clinical records indicate as a hole in his tympanic membrane that was repaired earlier this month. Ms. M also spoke at length regarding her concerns about MM’s self-help skills. She noted on several occasions that he does not “take care of himself” He needs help and continual prompting to bathe, dress and clean up after himself. He is not able to pick out appropriate clothing and needs help leaving the house. She believes that for his age, MM should have more developed skills in this area, even when taking into account his learning issues. 

Behavioural Observations 

From the compulsive behavior observed MM’s ADHD and ODD appear to be correlated where attributes of anxiety and bi-polar behavior also manifest. Consequently, a series of medical tests that can effectively separate information regarding the causes of the ODD whether ADHD, bi-polar personality, or anxiety. The childs apparent amusement in other’s pain and inability to stay put and follow instructions present classical signs of ODD. The child has chronic aggression, shows a tendency to argue with adults and peers, ignores requests and instructions from adults, tends to engage in annoying behavior intentionally, and is frequently spotted pulling tantrums that are baseless or meant to seek attention. 

Intellectual assessment 

WISC-V

On the WISC-V, an individually administered intelligence test, MM scored 52 (48-60) which falls in the 1st percentile. Additionally, on specific areas in the WISC-V score, MM scored 65 (60-75) on Verbal Comprehension, 61 (56-72) on Visual Spatial, 58 (54-68) on Fluid Reasoning, 67 (62-77) on Working Memory, and 45 (43-61) on Processing Speed. 

TAT

On the TAT responses, MM was able to describe the various situations highlighted on the cards. The responses imply that MM is able to interpret and analyse various situations according to the representation. 

CBCL/6-18

The CBCL/6-18, which tested on internalizing, externalizing, total problems, other problems for boys 12-18. MM scored 71-C on internalizing problems, which falls under the clinical line. Additionally, MM scored 75 on externalizing problems and 73 on the total problems. All scores were within the clinical range. 

Social/emotional assessment 

Social-emotional assessment should take place when MM is in the company of peers. In this test, the ability of MM to interact with others without causing trouble is essential to beating the implications of his ADHD-ODD condition. For instance, the test can take the form of a play activity where role-playing is used to enhance collaboration. For instance, the game of charades can enhance social skills through collaborative efforts shown by MM in participation in the game. In that esteem, ensuring that social skills of the child are tailored towards addressing his ADHD-ODD condition. 

Summary 

In essence, the psychological analysis of MM’s condition reveals that the child suffers from a case of ADHD that co-occurs with ODD. In that respect, intervention and treatment mechanisms should take the form of addressing both conditions at the same time. Whereas the effects of ODD may wear off as MM advances in age, ADHD treatment can go for longer periods and may be the cause of worsening MM’s ODD. To that extent, therapy and medication are both crucial aspects of treating MM’s condition as discussed. 

Recommendations

Based on the findings of the report, the recommendation necessary for application warrants that MM’s ADHD-ODD should be a matter of concern for both her parents and teachers. In that esteem, addressing the challenges of the child both at home and in school will play a central role in treating MM’s ADHD with co-occurring ODD. Therefore, the application of cognitive and social interventions both in school and at home can prove to be an effective means of enhancing the treatment of the child.