152: Hit Me, Baby, One More Time
3;8;99 4\51Nite
Helo, all. Welcome back to my house. I DUnno. So,whats going on. Many of you might remember a few weeks ago, i printed an evaluation that was done of me when i was 16 years old. Some people, including myself, found it amusing. Well, snooping around my parents home, i came accross the same evaluation, done several years earlier, when I was just 7 years old. I printed it at a little ways down.

In the news of my CD, it could be several months before its actualy ready to be distributed, as I am looking into getting an apartment for the next year, which would take up all the money i could possably own, including that which would be used to make my CD. How ever, all the tracks will be available on line, in the mean time. The same 9 tracks are available as were last week, as well as 9 newly posted tracks that I made in Mario Paint when I was 12, which werent there last time you checked. However, the sight they are available from has been down as of recent days, it should be up again soon. So keep trying to get inbto ftp://ha:ha@128.122.54.249 until you get in. Thank you.

Now on with the letters, then right into the evaluation.

The fist letter this week is from Kristen S. of Sandy, Koufax:

Ben,

I listened to your songs and I must say they are rather interesting...my

favorite was "Sexy Bowler." Anyway, I would be interested in a copy of your

forthcoming cd. My mailing address is 208 Power St. Prov., RI 02906. I hope

you got some more mail this week...you sounded depressed about it.


Kristen S.

Dear Kristen,
Power st, eh???? Thats not that far.
Love,
Lance

The 2nd letter is from list member Matt R. of Dustin, Diamond:

Hey Ben. Listen up. Tuesday night I'm going to the Middle East to see my bro's band play. Wanna go? He can put us on "the list" so we can get in for free, and that day's my 18th birthday so i can get in! I plan on staying at his house so don't worry about me wanting to crash at your place or anything like that. Yeah, so get back in touch with me before tom. night so I know what you want to do.

~Matt

Dear Matt,
no.
Love,
Lance

And here you are, my evaluation:

CONDUCTED BY: Allan Berman, PH.D. ABPN; Jaffa Kessler Davies, M.S.; Donna DiSegna Merritt, Ph.D., C.C.C.
DATES OF EVALUATION: 8/7, 9/15, 9/17 & 9/18/87


REASON FOR REFERRAL
Concerns about learning skills in an otherwise bright child.


BACKGROUND INFORMATION
At the time of this evaluation, Benjamin was beginning the second grade at the Montessori Children's House, where he has been enrolled since he was 2 1/2 years old, in a highly individualized program. At the completion of the first grade, his teachers reported to the family some concern over his fine motor skills as well as his ability to attend. While teachers feel he is a bright boy, they were concerned that his achievement was not what might be expected for someone of his ability.

Apparently, teachers first began to mention difficulties during the last academic year, especially with Benjamin's difficulties attending when things are busy around him. Teachers moved his desk to a more quiet location and his work improved, but there are still concerns. Benjamin, himself, apparently has become more and more reluctant to go to school and seems to be experiencing more distress about his school work.

Parents report that Benjamin has always been an active child who has had difficulty sleeping, frequently walks in his sleep, and stays up late. He has apparently normal social relationships, is a lively and friendly boy, and participates in many things with other children. He's interested in swimming, wrestling, and other children's activities.

Benjamin lives at home with both parents. The father is a photographer and mother is an exercise physiologist. Both parents have extensive work schedules outside the home. There also have been several changes in child care over the past year. In addition, the family moved to a new house in October of last year. Although Ben seemed to handle this move adequately, in January, he developed a number of fears. specifically a fear of fires, a fear of taking off his outer clothes when in the house, and would frequently develop nervous tremors.

Ben's medical history includes hip dyasplasia at birth, and frequent history of ear infections. Parents report that he is frequently congested and has had occasional problems with hearing, but previous audiological examinations have reported normal hearing. However, the parents do indicate that he frequently "would go from February 'till June with constant ear infections". They report that he has difficulty following directions and remembering what he is supposed to do, although the parents feel that in all likelihood, his difficulty here is in not attending to what is being said. In addition, parents report their feeling that it takes Ben "a long time to get his ideas out".


BEHAVIORAL OBSERVATIONS
During the initial meeting together with his parents, Ben was friendl


y, not in any apparent distress, nor highly anxious. He was not particularly spontaneous, but seemed to relax quickly. He sat quietly throughout most of the interview, seeming somewhat subdued.

When he came for the actual psychological evaluation, without his parents, he tended to be much more outgoing and cooperative. He worked hard at all tasks that were offered to him, with out apparent impulsivity or difficulty attending, with the possible exception of some impulsivity on non-verbal tasks. In general, he seems to be the type of child who has a good idea of the kinds of things he's good at and the kinds of things that give him trouble, and he's not particularly motivated to spend a lot of time at the difficult things, although he will work hard at things where he's receiving some reinforcement.

He was able to talks somewhat about what he describes as a rather lonely lifestyle, where he feels isolated from other children, and frequently unable to discuss these issues with anybody around him. Although he stopped short of indicating that these are real problems for him, it should be kept in mind that Ben tends to deny that there is any problem at all that he is having, and wants to appear very much in control of things.

Ben was able to maintain his attention level for the first hour of the language part of this evaluation, but then he became more distractible and this interfered specifically with his ability to perceive what was being said. Ben's voice quality was hyponasal. He appeared congested, but claimed not to have a cold or other upper respiratory symptoms.

It was during the educational portion of this evaluation that Ben's anxiety as well as difficulty maintaining attention to task were more apparent. Initially, he was reserved, yet friendly and cooperative. After a while, especially as tasks became more difficult, Ben became increasingly silly and needed a great deal of external structuring. He began moving constantly in his chair, - at one point sitting on the floor. He made attempts to divert the examiner from the tasks at hand, and when these failed he engaged in some resistant behaviors. This type of interaction was particularly obvious when Ben was asked to do any type of writing task. Although his frustration tolerance was low, Ben denied having any difficulty. In fact, on a spelling subtest, he carefully marked each item with a check and announced that he had gotten every one correct before returning it.


COGNITIVE COMPONENTS
On the Wechler Intelligence Scale For Children-Revised, Benjamin showed a very superior level of intellectual ability, but nevertheless, there were significant differences between his verbal and non-verbal skills:

[I have omitted a chart of test scores here]

These results show a child whose verbal skills are in the 99th %ile for his age, but whose performance (or non-verbal) scores are in the average range. The 30 point discrepancy between his Verbal and Performance scores is highly significant. It should be pointed out, however, that the large discrepancy is due almost exclusively to his poor performance on two tests, impulsivity in noticing visual details worked to his serious disadvantage. It also seemed that he was having difficulty sequencing visual information. He has a tendency to want to verbalize his way through non-verbal tasks, and if he can, do this, it tends to improve his functioning quite a bit. Overall, upon examining his performance non-verbally, it appears that his difficulty is due mostly to his poor motor skills, with his good Block Design and Object Assembly scores suggesting a relatively strong, non-verbal reasoning and perceptual abilities.


HEARING ACUITY/AUDITORY PROCESSING
Ben's hearing was normal bilaterally as measured by pure tone audiometric testing. His auditory processing profile was variable and indicative of strengths and weaknesses with specific test scores as follows:

[I have omitted a chart of test scores here]

Ben's auditory discrimination is poor, both in a quiet setting and when noise is added. This difficulty perceiving small auditory units was apparent both during tests administered and in conversation. On several occasions, Ben clearly misperceived a key word and ask clarification by repeating what he had heard.

Ben had some average auditory skills if he is allowed a short latency period and if he repeats what he has heard (which he often does spontaneously). A number of small details or lengthy auditory input clearly overwhelms him, and one sign of this is increased silliness and/or loss of concentration.


LANGUAGE PROCESSING AND PRODUCTION
Ben's language skills are in the average range with indications of above average potential if he is able to perceive the input clearly and if his level of distractibility doesn't interfere. He scored as follows:

[I have omitted a chart of test scores here]

No significant receptive or expressive language problems were noted during this evaluation, even though Ben's history notes some difficulty :getting the words out." It was apparent at times he was losing his task concentration, but when gently brought back to task, her performed quite well.


VISUAL/PERCEPTUAL/MOTOR SKILLS
Ben is right-handed and holds his pencil very tightly at the writing tip. His control of both the pencil and writing surface is shaky. Near point was far from the paper. Ben writes in a very slow and deliberate manner exerting a great deal of pressure. As he worked, he often erased and seemed increasingly frustrated with the product of his labor. He uses a printing/writing style in which he interspaces upper and lower case forms fairly arbitrarily. Although alignment was fairly accurate, problems were noted with spatial organization and size constancy. Ben's fine motor coordination problems are also apparent in his letter formations.

Ben's performance on the Bender-Gestalt confirms impressions gained from the Wechler, that he has good perceptual accuracy about visual/spatial matters, but he has significant difficulty in executing the motor skills necessary to reproduce the designs. He made a total of four errors on the Bender, but most of these were in terms of alignment of lines or in execution of angles, while basic integrity of the designs was intact. In addition, he showed several signs that he's extremely anxious about his visual/motor skills and his high anxiety level serves to aggravate the motor difficulties he is already experiencing.


ACADEMIC COMPONENTS
Although Ben's performance on achievement testing indicates that his acquisition of academic skills is quite adequate for his grade placement, analysis of his approach to tasks, indicates constant difficulty with attention to visual detail as well as with those tasks requiring written expression. It is these factors as well as Ben's accompanying anxiety which seems to be impeding his ability to perform at a level commensurate with his potential. On the Woodcock-Johnson Tests of Achievement, Ben attained the following scores:

[I have omitted a chart of test scores here]

In the area of reading, although Ben's ability to identify single words appears at mid-second, beginning third grade level, his oral paragraph reading is far lower, at a clearly defined as he often got distracted by words above and below the line while he was reading. His reading is characterized by many false starts and omission of words as well as whole phrases. At times, he substituted similar appearing words for the words that were there. Despite these mechanical difficulties, Ben's comprehension of material read orally appeared stronger than that read silently. He seemed to be able to structure himself better verbally than when asked to work independently. On silent reading tasks he was observed moving both his lips and his head. Tracking difficulties were quite apparent. Ben exhibited a great deal of difficulty on a word attack subtest which required him to apply phonic analysis skills for decoding nonsense words. Since he was not able to use his strong vocabulary to meditate, his problems with visual attention and discrimination caused him to do quite poorly on this task. Some examples of his errors are as follows: He read the word "man" as "ran"; "mibgus" as "mimbles"; "saist" as "sats"; "knoink" as "koin", etc.

Spelling is quite problematic for Ben. He has difficulty recalling the sequence letters particularly in those words containing more than a basic cvc formation. Also, even with those words that he is able to spell correctly orally, difficulties ensue with the actual mechanics of writing. Ben tended to leave out letters in words or invert their order. For example, he wrote the word "next" as "nxte"; "house" as "hose"; "seen" as "sen". When asked to write on Math tasks, Ben demonstrated a very strong grasp of quantitative fact and concepts at an ending second grade level, while his written computational ability appeared at an ending second grade level. He tended to skip many items on the Calculations Subtest, and at times made errors involving sign confusion.

Ben's fund of information in the various areas of Science, Social Studies and Humanities is exceptionally strong. He seemed quite happy when responding to these items, and, in fact, said "These are the types of things that I like."


PERSONALITY COMMENTS
Ben is a child who is feeling lonely and vulnerable because he sense that he is not able to cope adequately. As is the case with many extremely bright children, Ben senses the fact that he has some areas of functioning where he does not perform up to his expectations or to the expectations of others. This causes him a good of anxiety since he doesn't really understand what the problem is and worries that something may may be wrong with him.

In addition to this, Ben has some uncertainty about whether he can feel comfortable letting others know about his distress. He tends to keep his distance emotionally, and gives indications that he feels that it is not desirable for him to indicate he might need special help or that he's not happy with the situations around him at home or school. He seems to be frightened of letting others know when he is in distress, preferring to endure his tension by himself rather than to seek the support of others. This type of distancing only increases his anxiety and sense of detachment from others, and it would be important for him to be able to more readily seek out emotional support from persons around him.


SUMMARY AND RECOMMENDATIONS
Ben is likely a child of gifted intellectual capacity but his ability to function at this level is being hampered by a combination of developmental-motor difficulties, as well as significant anxiety related problems. While academically, he appears to be functioning adequately for his second grade placement, the general configuration of his profile suggests that this very bright young child may be at risk for school difficulties if some of the basic problems he's having to cope with are not addressed.


1) Ben has a significant need for psychotherapy, to help deal with his sense of loneliness and vulnerability, and to assist him in becoming less detached from sources of support around him.

2) It will be important for his parents to be involved in the therapy process so that they might understand ways in which they might contribute to increasing Ben's sense of security and stability about his life. In addition, it needs to be understood by parents and teachers that Ben has a strong need for consistency and predictability in his environment, and despite his good ability, will need a fairly structured program around him at home and at school in order to function well.

3) There are a number of concerns that were raised by this evaluation which suggest that it might be beneficial to have a consulting examination by a neurologist to rule out possibility of any underlying disorders which may require medical involvement.

4) In view of the difficulties Ben has with motor control, referral for evaluation and recommendations by an occupational therapist would be in order.

5) Ben seems to be reasonably comfortable in his present environment at school, but likely could benefit from increased structure and reduced distractions. He needs a calm, fairly routinized environment where it is clear what he is expected to do and there are reminders about what task he is supposed to be performing.

6) Ben has a weak auditory processing profile, probably due to extensive periods of middle ear infections. His level of distractibility also exacerbates these already weak skills. Preferential seating, thus, is strongly advised for Ben. Thus two compensatory techniques he already uses (taking a latency and repeating the input) should be encouraged and reinforced frequently.

7) It will be important to routinely repeat information to Benjamin, almost making the assumption that he has not "heard" the input the first time around. This will be particularly important when giving classroom directions and it may be a good idea to ask Ben (and other students) to repeat the entire direction in order to increase his monitoring skills.

8) Ben will need help learning to recognize the essential detail in visually presented material. Figure/ground activities, completing jigsaw puzzles, identifying what's missing in pictures, or missing letters in known words, are activities that will be helpful to this end. In addition, games that require recognition of clues such as Twenty Questions or Password or Concentration, would also be helpful. Completing crossword puzzles and "word hunt" games appropriate for Ben's age level should also be considered.

8) Ben will need time allowances to be extended for all copied and written assignments, particularly those from the blackboard. Rote exercises and drills to focus visual attention and increase motor speed would be beneficial. Ben most likely will require markers or pointers to maintain the place and position of his writing or math problems.

9) The following are some activities which may be used to improve visual-motor dexterity: completing simple paint by number pictures; using sewing cards and laces to reproduce designs in a given length of time; reproducing designs drawn on paper by using an Etch-a-sketch or the new Ideal "Doodling Board"; playing games following specific rules, e.g., jacks, pack-up-sticks, marbles, etc.; writing simple Rebus stories or completing visual tracking exercises (Michigan Visual Tracking Program; DLM Tracking Association Cards).

10)Follow-up for Ben's hyponasality by his pediatrician is recommended. It may be that environmental allergies contribute in part to Ben's auditory processing difficulties and possibly his behavior.


BACK TO LANCE

well thats it for now, thank you.!! Keep the letters a poouring!


Love,
The Bubonic Plague Himself,
Lance Romañce



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