EAST VALLEY

District of Residence:Any USDDistrict of Attendance:Any USD

Home School:

School of Attendance:

Any DistrictAddress

City, St, ZipPhonePSYCHO-EDUCATIONAL ASSESSMENT REPORT

LEGAL NAME

BIRTHDATE

CHRONOLOGICAL AGE

GRADE

PARENT/GUARDIAN

ADDRESS

PHONE

GENDER

ETHNICITY

ENGLISH LANGUAGE LEARNER

SCHOOL OF ATTENDANCE

DATES OF ASSESSMENT

DATE AP SENT

DATE AP RECEIVED

REASON FOR REFERRAL:

@ was referred for an initial psycho-educational evaluation in compliance with the requirements of IDEA and the California Education Code, to ascertain eligibility as an individual with exceptional needs. The request for evaluation came via a written parent request. Parent noted concerns in the areas of ____________When a student is eligible for and receiving special education services, a comprehensive re-assessment of the pupil is conducted by the Local Educational Agency at least once every three years, unless the parent and LEA agree in writing such a reassessment is unnecessary (EC 56381 (a) (2).

Testing was conducted as part of a triennial evaluation to determine eligibility for continuation of Specialized Academic Instruction (SAI) within the most appropriate, least restrictive placement.

RELEVANT HISTORY:Educational:Socio/Cultural:The primary language spoken in the home is LANGUAGE. Parent reports @s preferred language is LANGUAGE. A translator was/was not needed for this assessment. Medical:Hearing Screening:Date: Results:

Vision Screening: Date: Results:Developmental History:

Social Communication Questionnaire: (SCQ)*Score > 15 = Developmental history typical of ASD

Total Scored Behaviors:

Significant/Not SignificantAutistic Spectrum Disorder (ASD) is developmental in nature. Because the cause of Autism Spectrum Disorders is not yet known, ASD diagnoses are based purely on observations or reports of behaviors. ASDs are defined by difficulty in three areas of behaviors:

1) Reciprocal social interaction,

2) Communication

3) Repetition and insistence on sameness.

Exactly how an individual is impacted across these three areas varies greatly.

The Social Communication Questionnaire is a screening tool used to identify symptoms associated with Autism with consideration of early development. Parent completed the Lifetime Social Communication Questionnaire (SCQ). Total score on this rating scale was a __, where a score of 15 or higher can be an indication of a possible autism spectrum disorder. NAME OF CURRENT ASSESSMENTS:The testing and assessment materials and procedures used for this assessment were selected and administered so as not to be racially, culturally, or sexually discriminatory. The tests and other evaluation materials were administered by trained personnel in conformance with the instructions provided by their producers. The tests and other assessment materials have been validated for the specific purpose for which they were used, and were administered in conformance with the instructions for the test or other assessment materials. The tests and other assessment materials include those tailored to assess specific areas of educational need. A child will not be determined a child with a disability if the determinant factor is lack of instruction in reading or math or limited English proficiency. No single procedure was used to determine @s eligibility for special education and/or determine appropriate educational programming. Test scores are estimates of the attributes measured by the test. Results are felt to be a valid estimate of @s current functioning except where specifically stated otherwise. WISC-IVWechsler Intelligence Scale for Children Fourth EditionWASI

Wechsler Abbreviated Scale of IntelligenceCAS

Cognitive Assessment System KABC-2Kaufman Assessment Battery for Children Second Edition WJ-III CogWoodcock-Johnson Tests of Cognitive Abilities Third EditionKBIT-2Kaufman Brief Intelligence Test Second EditionWIAT-IIWechsler Individual Achievement Test Second EditionWRAT

Wide Range Achievement Test

VMI-5

The Beery-Buktenica Developmental Test of Visual-Motor Integration 5TONI-IIITest of Nonverbal Intelligence IIITAPS-3Test of Auditory Perceptual Skills Third EditionTVPS-3Test of Visual Perceptual Skills Third EditionBRIEF

Behavior Rating Inventory of Executive FunctioningADOS-2Autism Diagnostic Observation Schedule - 2KTEA-IIKaufman Test of Educational Achievement Second EditionTOWL-3Test of Written Language Third Edition PPVT-IIIPeabody Picture Vocabulary Test Third EditionBASC-2Behavior Assessment System for Children, Second EditionSAED-2Scale for Assessing Emotional Disturbance Second EditionWJ-IIIAchWoodcock-Johnson Tests of AchievementLET-II

Learning Efficiency Test Second EditionCTOPPComprehensive Test of Phonological ProcessingABAS-IIAdaptive Behavior Assessment System Second EditionSCQ

Social Communication QuestionnaireSRS

Social Responsiveness ScaleVADPRSVanderbilt ADHD Diagnostic Parent Rating ScaleVADTRSVanderbilt ADHD Diagnostic Teacher Rating ScaleDP-3

Developmental Profile 3

Bender-Gestalt Test of Visual Motor Integration Second Edition

Conners Rating Scale Revised: Short Version

Sentence Completion

Records Review

Teacher Observation

Classroom Observation

Pre-Assessment Interview

Educational Evaluation

DEFINITION OF ASSESSMENT TERMS: Standard Scores and Scaled Scores are referenced to a childs age.

Standard Scores have a mean of 100 and a standard deviation of 15. Average range would include scores from 85 to 115, using these end points as extremes. A score of 2 or more standard deviations, or roughly 30 points or more below 100 would indicate a significant delay. (Note: certain tests, for example the Gillian Autism Rating Scale, report Standard Scores that have a different statistical basis.)

Scaled scores have a mean of 10 and a standard deviation of about 3. Average would be indicated by scores of about 8 to 12. Scores 6 or more points below 10 represent significant delay.

The Grade Equivalent score is the grade of a child who would attain the same number of items correct as this child on a specific measure.

A Percentile represents the percentage of children of the same age in the norm sample who scored below this student on this test.

A Confidence Interval (e.g.90-110) represents the range of scores between which this students true score falls, with a 90 or 95 percentage of certainty.

T Scores- A T-Score is a standard score with a mean of 50 and a standard deviation of 10.Unless otherwise specified, the following descriptors will be used:Ability ClassificationStandard ScoresScaled ScoresPercentiles

Very Superior/Gifted130+17+98+

Superior120-12914-1691-97

High Average110-1191375-90

Average90-1098-1225-74

Low Average80-8979-24

Borderline/Below Average70-794-62-8

Extremely Low/Deficit129Very High

120-129High

110-119Above Average

90-109Average

80-89Below Average

70-79Low