Case II

Case II: A nine year old male referred by his teacher and family to explain his history of school failure (This is the summary and conclusions section of a report written for both the teacher and family)

The patient has a prenatal history remarkable for alcohol exposure, and a recent academic history remarkable for school failure. The present evaluation, due to this prenatal insult or some other cause, did uncover cognitive deficits. These deficits were present across most major areas of cognition. The patient’s verbal and non-verbal reasoning abilities are markedly limited. Truly in any format, the patient is not able to produce logical thought at an age appropriate level. He did, to be sure, express particular instances of insight and reasoning that were sound and consistent with his age. This attests to the fact that he is not pervasively impaired. Still, as a rule, he lacked rigorous ideas and the fluency to express himself. Most of all, he had trouble thinking abstractly. To these deficits in reasoning are added significant problems comprehending instructions; especially complex and multi-faceted instructions. Furthermore, the patient’s memory and learning are delayed. He absorbs little of what he is exposed to and recalls little of what he has absorbed. Even in a narrative format, he does not retain themes, events or details to the expected degree. On the other hand, the patient’s attention is relatively intact. This is an especially fortuitous strength given his history of prenatal alcohol exposure. He also shows relative strengths in information processing and visual-perceptual understanding. This simply means that he can take in information quickly and think spatially in three dimensions. Nevertheless, his weaknesses predominate; still further, these weaknesses will be routinely exposed in classroom learning: When the teacher asks questions, when he has to read a book, when he has to report to the class, when he is tested.

In light of this patient’s cognitive deficits, his academic skills are not greatly impaired. He does express some moderate reading problems, which suggest that his response to special education interventions should be measured. He might truly benefit from focused time-limited phonetic instruction. However, his performance on tests of spelling and reading suggest that he is not learning disabled. Aside from performing near grade level and within the Low Average range, his pronunciations were nearly phonetically true, even when they were incorrect. For example, he read phonograph as photograph and naïve as ‘nigh-ave;’ such mistakes more or less preserve the structure of the word and are more subtle than those typically committed by learning disabled children. Again, mistakes were only made when reading advanced words and were not egregious. They could always be read and the reader would always correctly guess what word was meant. However, classification and special services need to be taken as a serious option. Such interventions should be considered, less for his moderate phonetic weakness and limited reading fluency, and more for his cognitive deficits. When considering these academic and cognitive deficits along with his behavioral and self-regulation problems, classification becomes the best option. Moreover, the most basic argument for classification is that regular education has been tried and it has not worked. He has not succeeded with traditional learning methods and moderate supervision. Creating a classroom environment in which he can academically succeed is very important. It is also important to give him marketable skills. At his age and with his current deficits, a strong vocational component should be added to his curriculum. This will give him the opportunity to develop mastery in a particular area, develop a success identity and prepare him to be a self-sufficient adult and a contributing member of the community.