Feruary 28, 1996

Jack XXXXX, M.D. Dept. of Pediatrics XXXXXXXX Annex

Re: Caleb Anderson GFC #: XXX XXX

Dear Jack:

Thank you for the referral of Caleb Anderson who is a delightful young man. Caleb was referred by yourself because he is a 13 year 10 month old eighth grader at XXXXX XXXXXX Middle School who is considered to be extremely bright/gifted, but struggling enormously with academic performance. At one point teachers had questioned whether he might not need to be retained in grade, although you had questioned that based on his presentation as a very gifted individual.You had wondered about possible giftedness with undermotivational syndrome, versus possible attention deficit-hyperactivity disorder, more inattentive type. Therefore you had requested full psychological evaluation on this young man. I would refer you back to your history and physical examinations as well as progress notes for background information on this young man.

Caleb and his parents, XXXX and XXXXXX did come into the Department of Neurosciences to see me for further assessment. He had come into the Department of Neurosciences on 2-01-96 to complete screening psychological evaluation.

Family history shows that Caleb is the oldest of three children born to XXXX (age 31) and XXXXXX (age 34) Anderson. They have been married fourteen and one-half years in this their first and only marital relationship. The only stress that the parents could remember or felt was contributory was the death of a paternal great grandmother to Caleb. The only other stressor would have been when the father was in the Persian Gulf War about five years ago for a six month tour. However, they were unceratin as to whether that was pivotal in any changes in Caleb.

Extended family history does not suggest anything relative to learning abilities, mental retardation, seizure disorders, movement disorders, etc. There is a maternal aunt who had difficulty in the course of her later adolescence with self-mutilatory behavior, but has not had any of that presentation in adulthood. The father, XXXXXX, questions whether he might not have had ADHD. There is thyroid disorders in the maternal aunt who is hypothyroid and does require replacement. In addition, a grandmother also had alcohol abuse syndrome, and also was an abuser of substances according to parental reports. No other family history of significance is reported.

School history shows that Caleb is currently in the eighth grade at XXXXX XXXXXX Middle School, where he has been doing extremely poorly academically. He has a 1.7 gpa, but his parents perceive him as extremely bright and capable "so they want to choke him for his under performance" (according to the parents). Caleb has always apparently struggled in school, struggled to complete school work, etc. He has extremely high Iowa Test of Basic Skills. The current teachers had questioned whether he might not be depressed, although it is mostly "suggestion of desperation based on how to motivate this young boy". The parents do not see him as depressed as referenced above. Prior to his current school situation at XXXXX XXXXXX Middle School, he did attend XXXXXXXXX Elementary School for three years, and also attended XXXXX XXXXX Christian School. Apparently, all teachers have had to "be hard on him or stay on him in order to keep him on track". He has never been evaluated by the school psychologist, nor has he had any retention in grade or extra or tutorial services. Other than academic nonperformance, he has not had behavioral problems.

Medical history shows that he is in good general health and on no prescried or over the counter medications. Prior to the current assessment, he was tried on Ritalin between the third grade and the sixth grade, but that was discontinued approximately 1 1/2 years ago. This was very low dose mdeciation according to parental report, and there was no significant difference seen. The parents did also not see him while on medication, as he did not take this medication in the afternoon, nor on weekends. Therefore, an adequate clinical trial of stimulant medication may not have been conducted with him. He did not report any side effects to the medication or complaints to the medicine. He has no unusual childhood illnesses, head injuries, high fevers or surgeries reported in his background. Appetite has been described as good. Sleep has been described as impacted by delaying tactics and difficulty with initial insomnia. In addition, he does have a history of nocturnal enuresis. He did have a positive response to imipramine and also DDAVP as it reduced his nocturnal enuresis, but did not eliminate it. However because of his side effects to the imipramine, namely according to parents that he became "beet red and had increased sweating", this was discontinued. The DDAVP again did have some positive benefits, but did not entirely eliminate his nocturnal enuresis.

More remote medicinal history show that he was the 5 lb. product of a pregnancy which was concluded three weeks early. He was a health baby. Developmental milestones were reached at an advanced age according to parental reports.

PSYCHODIAGNOSTIC RESULTS:

On Structured Clinical Interview and Mental Status Examination, Caleb Anderson is a 13 year 10 month od Caucasian male who sports long blonde hair, blue eyes and a fair complexion. He does wear glasses, and appears to be a handsome young man who is tall and slender in nature. He was dressed in a very casual style of clothing, but was always neat, clean and kept for the evaluation sessions. Behaviorally, he was verbal, fluent and articulate. He presented with excellent eye contact. He was cordial, cooperative and quite pleasant in the course of the assessment. Affectively, he did demonstarte a full range of spontaneously elicited affect. He was noted to utilize humor, smile readily and quickly, and did not appear to be dysphoric or depressed in any manner. His appetite is described as good. Sleep has always been somehwat troubled by initial insomnia and delaying tactics. There has been no change in that recently. Perceptually, there is no indication of any visual, auditory or olfactory misperceptions and he is fully oriented for his chronological age. Thought processes on mental status examination suggest above average intellectual ability with variable attention and concentration noted. Thought processes did appear to be logical, rational, accelerated, but intact. The current assessment is considered an accurate representation of his cognitive and metnal status abilities.

In order to have contrast or comparison for the TOVA test, we did utilize screening intellectual assessment. This was also to document his intellectual abilities since he is seen as a gifted student with above average Iowa Test of Basic Skills. Utilized for this cognitive purpose was the Peabody Picture Vocabulary Test - Revised (PPVT-R), as well as the Test of Nonverbal Intelligence - 2nd Edition (TONI-2). On the PPVT-R Which is a test of receptive language and cognitive ability, Caleb was able to obtain a standard score equivalent of 132, at the 98th percentile rank and in the superior range of intellectual ability. Consisten with that the TONI-2 which is a nonverbal test of intelligence that is language free and culture free was scored at a TONI-2 quotient of 135, at the 99th percentile rank, and in the superior range of intellectual ability. Clearly, this young man is a gifted and talented individual.

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