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Observations and Impressions Robert is an attractive 36-year-old Caucasian male of average height. He was neatly dressed in casual clothing and seemed adequately groomed, although some body odor was noticeable. His speech was clear and easily intelligible. He seemed somewhat clumsy (e.g., he had some difficulty seating himself). Robert avoided eye contact by gazing downward, and he seemed distant during much of the session. He would speak only when spoken to and then tended to answer in single words, although he was capable of formulating complete sentences. Although he was generally cooperative, he displayed occasional flashes of hostility when his responses were questioned by the examiner. Robert was wearing glasses but complained of having difficulty seeing some of the more detailed stimuli. Test Results and Interpretation Robert s performance on a standard measure of cognitive functioning (WAIS-III) places him within the mildly retarded range of intelligence (scores from all tests are listed in Table 9.4). His Full Scale IQ of 61 (59 66 with 90% confidence) indicates that he surpassed the mental functioning of only about 1% of the adults his age. Moreover, there was a significant difference between his Verbal IQ of 71 (3rd percentile) and Performance IQ of 55 (0.1st percentile). The 16point discrepancy is not only significant but unusual; differences of that magnitude or greater occur less than 7% of the time in adults with IQs below 80. Robert s IQs indicate that he displays far better mental skills in the domain of verbal comprehension and expression than in nonverbal reasoning and visual motor coordination. In the latter areas, he performed better than only 1 out of 1000 adults his age. His Verbal Performance split is consistent with the results of previous testing. Given that Performance tasks generally require a greater expenditure of physical energy than do verbal tasks, his poor performance on such tasks may also reflect his depressed emotional state. Consistent with this hypothesis was his Processing Speed Index of 66 (1st percentile) and his Perceptual Organization Index of 58 (0.3rd percentile), which require visual motor coordination and/or processing speed for success. His scores on these two nonverbal indexes were significantly lower than his performance on the Verbal Comprehension Index (74, 4th percentile), which measures verbal knowledge and expression. Robert s Working Memory Index of 73 did not provide a meaningful representation of his abilities as an abnormal amount of scatter was present among the subtests that comprise this index. Robert s relative strengths and weaknesses in his profile indicate a relative strength in shortterm auditory memory of stimuli that do not require processing of school-learned knowledge. His relative strength was evident in two tasks, one that required him to recall a series of orally presented numbers (25th percentile) and another that required him to track and orally repeat a sequence of letters and numbers (25th percentile). Particular deficits were noted on a verbal test of mental arithmetic (0.1st percentile). Compared to his overall performance at the 4th percentile on tasks of verbal expression and verbal conceptualization, he had significantly more difficulty on nonverbal measures involving the visual analysis and integration of social stimuli. Robert s approach to tasks calling for integration seemed to be to work piece-by-piece. He was unable to conceptualize a whole, and consistent with this difficulty in visual analysis and integration, Robert scored significantly below mental age expectancy on a separate measure of visual motor integration (Bender-Gestalt). His drawings were characterized by distortions of shape, rotations, and an inability to integrate the designs, all of which are signs of possible organic involvement. Robert s academic skills are also fairly consistent with what would be expected of someone with his global cognitive abilities. His academic skills were assessed with the Wide Range Achievement Test-Third Edition. His Reading (recognition only) standard score of 60 (0.4th percentile), Spelling standard score of 66 (1st percentile), and Arithmetic standard score of 68 (2nd percentile) were in the Extremely Low range of academic functioning. He can, for example,
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