Reference no: EM133277309
Thomas McLearn
Read Me a Story
Thomas was referred to the clinic by his parents to evaluate his learning potential, and academic profile, and to investigate any possible areas of social/emotional concern. His parents were puzzled. Thomas, a bright, chatty, and active child, was falling behind in the second grade. What made this situation even more difficult to comprehend was that Thomas had already repeated the first grade to allow for the consolidation of foundation skills. Parents were convinced that if they held Thomas back a year, his increased maturity would guarantee his academic success. Although he seemed to enter second grade much better prepared than he would have a year ago, his first progress report indicated that he was well below his peers in the language arts areas.
Thomas presented as a typical 8-year-old and immediately was drawn to the picture of the solar system on the psychologist's office wall and engaged in a lively conversation about the planets and the fact that Mars has at least three moons that we know of. Thomas chatted at length about his love of the television science program Bill Nye the Science Guy, and how he loved the show on gravity, called "Attraction Action."
Thomas has an older sister, Elaine, who is currently at the top of her class, in the fifth grade.
Although Elaine is very protective of Thomas, he is finding it increasingly difficult to accept her successes, given his academic failures. His parents are now feeling uncomfortable praising her accomplishments in front of Thomas and are becoming increasingly concerned because their once confident son who can be a leader on the athletic field was becoming increasingly turned off by school and frustrated by homework assignments that he could not complete on his own.
Developmental History/Family Background
Nancy McLearn was very prompt in completing and returning the intake surveys and called the clinic to inquire whether there was any additional information that she might provide. The birth history was relatively uneventful, except for the fact that the delivery was very long and the labor was intense. Eventually, they had to use forceps to complete the delivery. Thomas achieved all developmental milestones as expected and walked just a few days after his first birthday. Once he began talking, he was very chatty and loved to talk to his sister who treated him as if he were a real live doll. Because they lived in a rural area, there were few other children around and Thomas and Elaine became very close "buddies" early on. Nancy did not send Thomas to preschool, since she was a stay-at-home mom and loved the time together, as she was home-schooling Elaine at the time. Eventually, the family moved closer to town, across from the community park, and at that point, Thomas and Elaine seemed to find their own set of friends.
The family took advantage of the community athletic complex, which had a very strong program for children in the summer and during the school year. Thomas loved sports and was a natural at T-ball. Soon he was playing soccer, softball, and joining his friends skateboarding at the park. He was a natural athlete and the young boys on his team looked up to him as their leader.
In the fall, Thomas and Elaine were enrolled at Garden City Elementary School, which was a short walk from their home. Thomas entered the first grade, while his sister began the third grade. Nancy also found a part-time job working for a real estate company, while her husband, Arnold continued to gain promotion after promotion in the sales department of a major corporation, 20 minutes from their new home. Everything seemed to be going according to plan, until Thomas got his first mid-term report. Even with his natural curiosity and love of science, his teacher was concerned because he was not progressing as she expected in the language arts program. Despite his love of science books, he was having problems learning the weekly word lists. His teacher also described him as having problems remaining focused on the task at hand and taking forever to get to work. Thomas clearly preferred socializing to working on academic tasks. Strengths were noted in his gross motor skills (well-coordinated), his ability to produce very detailed drawings for projects, and his facility with numbers. Nancy and Arnold met with Thomas's teacher to find out how they could support her efforts and enhance Thomas's success in the language arts program. The teacher recommended that Nancy continue to read to Thomas every night (Thomas loved this, especially science books) and help him review his word lists daily. Despite these efforts, Thomas was clearly not ready to progress to the second grade at the end of the school year, and the consensus was to repeat the first grade to allow for consolidation of key academic skills.
Although his parents were reluctant to have Thomas repeat the grade, they rationalized that since he had an early birthdate anyway, that this additional year would allow for Thomas to catch up and the increased maturity would benefit his skill acquisition and his ability to remain focused in class. Mid-way through the second year in the Grade 1 program, it looked as if the decision was a good one. Thomas was feeling more confident academically, although they did catch him telling his teammates that he was in the second grade, because he was embarrassed to let them know he had to repeat the first grade. The following year, it seemed that Thomas has started out on a better level; however, the mid-term report was very discouraging. Thomas was not progressing at the same rate as his peers, and despite his ability to tell beautiful stories orally, he was becoming increasingly embarrassed during oral reading and was not very successful on his spelling tests. In order to avoid his embarrassment, Thomas would have his mother read the passages to him at home every night and then memorize them so he could "appear" to be reading them during oral reading, the next day. This worked for a while, until the teacher introduced a new set of reading materials to the class. When it was Thomas's turn to read, it was as if the words were in a foreign language; he could not recognize any of the words he had previously "read."
His teacher expressed a number of additional concerns about Thomas's classroom performance, including ease of distractibility, poor ability to concentrate, daydreaming, losing or misplacing items necessary for tasks, making careless mistakes, being very disorganized, and forgetfulness. The teacher recommended smaller group instruction led by some of the older children (the reading buddies program) and suggested parents talk to the school psychologist about potential attention problems. Nancy and Arnold agreed to have the school psychologist observe Thomas in the classroom and then meet with them to discuss her impressions.
The school psychologist observed Thomas for one morning, during a class lesson, followed by a 15-minute period of independent seat work. During this time, Thomas was noted to be engaged in on-task behaviors for approximately 15% of the time and engaged in off-task behaviors for the vast majority of the observation period. The school psychologist asked the parents to complete the Conners Rating Scales and also obtained permission to have his teacher complete the scales as well. Thomas's parents and teacher both rated Thomas in the clinical range for inattentive problems (failing to finish tasks, problems in sustaining attention), the ADHD Index, and the DSM Inattentive and Total Scales. Based on the findings, the family agreed to seek further counsel regarding potential treatment for ADHD from the family pediatrician. Thomas was diagnosed with ADHD, primarily inattentive type, and was placed on a trial of Ritalin.
Although Thomas seemed to improve his on-task performance initially, and seemed to be better able to focus while on Ritalin, the quality of his work continued to reflect his continued struggle with reading and written expression. Despite considerable effort at home, Thomas was not able to bring these skills to new tasks with new reading or writing assignments.
Reason for Referral
Nancy and Arnold were becoming increasingly concerned about Thomas's psychological well-being. He could often be heard calling himself "stupid" when he was trying to complete his homework and was becoming more temperamental, breaking into tears or throwing his books on the floor in fits of frustration. He would be entering the third grade in the fall and was still struggling to learn even the most basic reading vocabulary. His strong analytical skills were often evident in class discussions, especially on science topics, yet written work would be far inferior to what he could express verbally. Often his poor spelling would result in Thomas using only words that he had memorized by sight, resulting in a very basic response to most writing assignments. Nancy and Arnold decided to take Thomas to the clinic for an assessment over the summer so that they could be better prepared to help Thomas tackle the Grade 3 program.
During the intake interview, the McLearns answered many questions about their family history, Thomas's developmental milestones, and his school history. There were a number of relatives on both sides of the family who did not go far in school, not because they were not intelligent (most were highly successful entrepreneurs), but because formal schooling was not a good fit for them. Nancy excelled academically, and if her financial resources had been better, she would have loved to go on to university and study architecture. Arnold was a different story. He admitted that he did not like school because he found it "boring." He would much rather "experience" life than read about it. In fact, he really disliked reading and throughout English classes, he would always seek out the "movie version" rather than have to labor through the written word. He stated that his high energy profile is an excellent fit with sales, and he could never be a "book worm." He also wondered if maybe Thomas was just more like him than Nancy.
Assessment Results
Guidelines to the interpretation of standard scores and T scores, as well as information regarding specific assessment instruments used in the case, can be found in Appendix C.
When Thomas entered the assessment room, he seemed innately curious about what was going to take place and asked some very good questions about the nature of the assessment process. He also asked if he had to do "school type work." When the response was "a bit," he immediately confessed that he was not good at reading or spelling, and he said that if the work was too hard he wouldn't be able to read it. He asked if we were going to any "fun stuff." The interviewer continued to try and establish rapport, since it was clear that Thomas was getting apprehensive about having to read or spell. When ask what he liked to do best.
Question 1:
At one point, Thomas' parents had a significant disagreement about whether or not Thomas should continue to be involved in extracurricular activities, given his poor academic performance. If you were the school psychologist, how would you advise his parents regarding this issue? What are the benefits and what are disadvantages of Thomas being involved in extracurricular activities?
What would you tell Thomas' parents about the short- and long-term prognosis for children with a specific learning disorder?
At first, Thomas' parents believed that he had problems with inattention and distractibility, and believed that he may have ADHD. How would you explain Thomas' behavior in relation to his SLD (in other words, how could his learning disorder be responsible for his distracting behavior)?
How would you suggest instruction changes for Thomas in the classroom in order to address his specific needs? What suggestions would you have for Thomas' parents in order to not only address his problems with reading but his self-deprecating behavior (calling himself "stupid," feeling upset about struggling)?