Miriam Cherkes-Julkowski, Ph.D. www.educational-advisor.com edconsult@eudoramail.com Mesa/Apache Junction, Arizona 480 209-1968 59 Philip Drive/Storrs, CT 06268 860 429-4894 30 Seaview Ave./Ocean Grove, NJ 07756 732 988-8432 xq Diagnostic Cognitive and Achievement Evaluation CA: 17 GR: 11 BACKGROUND: I evaluated X just prior to his entry into fourth grade. History until that time established him as a very bright, creative and energetic child with a “complex mind”. He seemed to have difficulty in new situations, highly stimulating environments (cities, large shopping areas) and when things did not turn out as expected. At the same time, X was reported to take many physical risks and to have had a number of accidents. Academic achievement was fairly consistently below what ability was thought to be. When tested prior to grade 4, there was heightened emotionality when X was confused. He commented, “the really depressing thing is thinking you’re right, you give it to the teacher and it’s wrong, wrong, wrong.” He described himself as having fairly extreme mood swings and felt some embarrassment about his lack of full understanding of math skills. Most of the earlier testing was taken without stimulant medication. Ritalin (5 mg) was taken for the administration of the Stroop Test and a partial re-administration of the Gray Oral Reading Test. Reading skill when reading words in isolation was above average (116, word attack). When reading in connected text, without medication, accuracy was reduced to low average, 9. Some of this seems due to impulsivity (skipping lines) and impatience (failing to decode methodically). Some of his impatience was seen to be to his credit in that it was a reflection of some urgency to get to meaning rather than spend time with ensuring accuracy with each individual word. When taking medication, accuracy increased to high average, 12. Comprehension is superior when reading short passages. There was a slight dip when reading the longer passages on the Gray but performance increased with medication (14). Writing was significantly problematic, characterized by runaway thinking and orthographically based spelling errors. In math, X seemed to have more than enough insight (applied problems 115) upon which to base computational skills. However, there seemed to be little connection between his insights and the skills he was memorizing without understanding (calculation 88). Testing at that time found impulsivity/impatience with problems controlling mental effort on his own (object sequences 5) but adequate mental effort/working memory when in interaction with someone. X is currently at the YYY Academy. His fall midterm academic report from this year, grade 11 (October 18, 2001), was reviewed. Teachers continue to find X very able but also erratic in his performance and inclined to perform at a level below his full potential. There appears to be concern in nearly all classes about late assignments, poor test preparation and general disorganization. Xattends Academic Support for help in these areas but X has difficulty concentrating for a long enough period of time to get his work done. X’s best grades were in English, B-, and Spanish, C. Math is currently a C-, Chemistry D, U.S. History D+. In math and chemistry, X is described as being able to do the work but failing to prepare, failing to hand in assignments and failing to complete those he does hand in. His math teacher describes X as doing better with some of the most complicated material. He reports that X claims to have a desire to master the material. History is more of the same, i.e., poor grades due to missed deadlines along with good insights. X is said to take notes in class but in a way that is poorly organized. TESTS ADMINISTERED: Woodcock-Johnson - R Gray Oral Reading Test - 4 Raven Test of Progressive Matrices Test of Written Language - 2,3 (TOWL) Rey Osterrieth Complex Figure (ROCF) California Verbal Learning Test (CVLT) Comprehensive Test of Phonological Processing (CTOPP) MEDICATION: dexedrine :2 spansules + 7.5 mg AM; 5 mg PM wellbutrin TEST OBSERVATIONS: There is a steady theme that ran through my discussions with X and through his test responses. Regardless of the context, X seems to be torn between a rich, fluid rush of ideas and the desire to constrain them into a more “organized” and “technically skilled” and time-manageable format. He explained a problem in completing a history paper which proposed an interesting, rich and complicated idea, the “successful failure” of the Articles of Confederation. This he felt was too complicated to manage at a level that was satisfying to him and in the end opted to ignore the complexity in favor of getting the work done in a simple, clean way. X described his art work as expressionistic but felt he should spend more time with representational material in order to develop his technical skill. Similarly, in discussing how he felt about his medication, X said he could produce 6 paintings or drawings in a row when he is not taking medication. “They just happen, they’re more fun.” When taking medication, he describes himself as being more focussed on what his art work means. There were many instances at this testing when X had a rush of ideas with which he had to struggle in order to come up with some clarity of expression. When supplying the missing word on the passage comprehension test (see Woodcock-Johnson results below), X went through a rich set of associations before settling on precisely the right word. In so doing, he revealed his appreciation for every nuance of what the passage called for but also the persistent problem of channeling all of them into a response worthy of them. Often he is not successful in his effort to constrain his thinking in a way that is expected of him. He can give fully developed, insightful summaries of what he’s read but then cannot force them into the constraints of those options given on a multiple choice test (Gray Oral Reading Test). Whether successful or not, it is exhausting forXto go through the process. Since he accepts the test and its choices as authority, X feels that it is his inadequacy when the richness of his thinking does not conform to the answers. In his words, he wonders, “What am I not seeing that someone else would see?” Despite his belief that getting better organized, more constrained, more technically correct is what is “good” (X’s word), he really has little tolerance for it. He says he likes reading primary source documents but does not like to read secondary sources because they seem to have the same story to tell and “you can’t find what you’re looking for”. His moods seem to have a good deal to do with where he is along this continuum. He describes his choices in music on the one hand as classic rock, Mozart and Windham Hill/George Winston and as rap (by his description aggressive, negative violent) on the other. He describes his art as fun on the one hand, focussed on the other. Although X is very interested in developing his art (thought he might like to apply to the Rhode Island School of Design for college), he was accepting of the fact that his academic schedule did not allow him to have an art class this term. TEST RESULTS: Woodcock-Johnson standard score* percentile word attack 118 88 letter-word recognition 110 74 passage comprehension unprompted 142 99.7 prompted 149 99.9 calculations unprompted 99 48 prompted 101 53 applied problems 126 99 *Standard Scores have a mean of 100, standard deviation of 15 Reading skill is more than adequate. X made a small number of errors (three) in reading the pseudowords on the word attack test, two of which he realized later. His few errors in reading the real words on the letter-word identification test showed some lack of familiarity with vocabulary. For example, since X didn’t seem to recognize the word stochastic, he sounded it out as ch in church. The passage comprehension test consists of short passages of one, two, or three sentences in length. X was to supply the missing word. X takes very little at face value. When reading a passage about some islands that are like “nature in the raw”, his search for the contrasting kind of island went through a number of associations: civilized, buildings, infrastructure. Having considered all of these characteristics, X decided correctly that the best single word would be developed. There was similar consternation about the right word to supply in description of particles in the air when an airplane is flying very fast. The test-preferred answer is that the particles become abrasive. X considered this and potentially dangerous but found them both inadequate at first. He explained, “the plane is moving fast. That’s where the danger lies, not in the particles.” Having said this and weighed a number of options, X finally gave in to the syntax dictated by the passage, i.e., provide a descriptor for the particles and settled on the test prescribed correct answer, abrasive. This tortured pondering of precise meaning finally gave way to a far looser, more expedient set of answers that were certainly justifiable but often slightly off the test-desired answer. The struggle, humiliation, self-doubt and fruitless effort put into calculations cannot be understated. X worked long and hard at many problems only to abort in the end. At its source, the problem is the same across computational skills, although there is some variation in how it gets expressed. X always has some valid intuition about the problem, at least at a level adequate for realizing that his answer is not right. At the same time, he engages in procedures that are confused and in their confusion reveal their lack of conceptual foundation, replaced instead by an effort to memorize formal algorithms. This is true at very basic levels. For example, X forgot the algorithm for dividing by a fraction and reasoned that 8 1/2 divided by 4 1/8 could be expressed as: 8 1/2 4 1/8. This would have brought him to a correct solution except that he attempted to simplify the problem by assuming that the 8 and 4 were multipliers that could be factored out. In a similar vein, when multiplying to find 12% of 6, X correctly set the problem up as 6.0 x .12 He multiplied correctly but then, using the subproducts, added the digits in the first two columns and multiplied in the third: 6.0 x .12 120 60__ . 620 At this point his intuition told him that .62 could not be the right answer. He checked his work but since he used the algorithm he believed to be right, X could not find his error. And, to find a common denominator, X found a correct denominator but then did not change the numerator in order to maintain equivalence (6/7 = 6/14; 1/2 = 1/14). Despite the fact that he is now in Algebra II, X was not able to manage many of the more basic algebraic problems. A consistent source of difficulty was manipulating positive and negative signs. In one example of this, he used algebraic procedure to solve 2x + 3 = 11 but subtracted 3 from one side of the equation and added it to the other, producing 2x = 14 and an answer of 7. X understood that this could not be right but could not find the breakdown in his procedure. He had no idea how to solve for 2 unknowns, how to find the factors in a quadratic equation. Nor did he successfully recognize the full extent to which he could simplify algebraic expressions. X was able to answer only one algebra problem correctly (8-x = 2x). As with the calculations, X worked very slowly through the word problems on the applied problems test. He was allowed to use a calculator so that eliminated at least one source of error. The same doubt and confusion seen on the calculation test was evident here as well. X continually stopped to recheck his thinking. In trying to find an average, X made an inaccurate computer entry that resulted in an answer he knew could not be correct. Rather than check for his procedural error, X immediately began to question his entire conceptualization of the problem. He often had a quick, initial insight into the way to manage a problem and then would undermine himself by questioning whether he had conceptualized the problem correctly. In one particularly lengthy problem, X had an insight into the structure of the problem out of which a number of permutations began to generate. In getting them all noted down and operating at a more detailed level, however, he lost sight of what the guiding principle was and began to question why he had taken any of the steps that he had. With a simple question (what’s the distance to school?), he could be reoriented and then continued to solve the problem correctly (prompted credit). The two math tests, calculation and applied problems, took an inordinate amount of time to complete. There was certainly no quitting and no attempt to find a quick and easy way out. The result, however was mounting anxiety and exhaustion with little satisfaction. It would not be possible for X to spend the disproportionate time needed at testing, to say nothing of struggle, for the daily completion of math homework and still manage the rest of his commitments. Comprehensive Test of Phonological Processing (CTOPP) standard score* digit memory 12 *standard scores have a mean of 10, standard deviation 3 Xcould manage 6-digit strings by grouping digits into units of 3. Beyond this, he was overwhelmed by the input and lost control of the end portions of the list. Gray Oral Reading Test standard score* percentile rate 11 63 accuracy 16 98 comprehension 12 75 *standard scores have a mean of 10, standard deviation of 3 The Gray uses paragraphs of 7 or 8 sentences in length. They were read aloud and then summarized. The comprehension score is based on answers to multiple choice questions. The passage score is a combined measure of rate and accuracy. It is possible that these scores are slight over estimates since baseline was assumed for rate/accuracy and for comprehension. X read the last 2 passages on the test, at the eleventh and twelfth grade levels. His reading rate for each of these two passages was below the sixth percentile. Rate was reduced due to time needed to figure out unfamiliar words (accoutrements, eclat, tangential, palatable) and to weed through some of the denser and more indirect language. But accuracy was always at the highest possible level, despite a small number of decoding errors (tangenteel, platable, casual for causal). X’s summaries of the passages read came with the usual rush of ideas and slow evolution into something more stream-lined in expression but still capable of implying the richness of his ideas. His summary of a passage concerning the swing in public reaction to violence in the media went as follows: However many years, the oscillating, moving up and down, the peak of a new genre, at the peak of a new genre of violence in the media, there’s an escalation of violent crimes, then a process in which society deals with this. Scientists do their studies. Activists make a big deal of it and then they tone it down (here X offers the censorship of Beevis and Butthead as an example). It dies down until the next peak. Despite his own reference to the cycle of rising and falling of attitudes toward portrayal of violence in the media, X did not answer the test question correctly, What is the main point of the passage, that required this point for its answer. Instead, X picked the answer, “The portrayal of violence in the media is a complex issue with many ramifications”, explaining that he considered and rejected the test-preferred answer because the one he selected was the “biggest idea of all” and therefore the “only thing that could qualify”. Despite an adequate summary, X answered only 1 of 5 multiple choice comprehension questions correctly according to test criteria. He could justify all of his answers, however, in a way that was more than convincing. Conversely, X missed the point in the other passage he read and then answered 4 of the 5 questions correctly. The suggestion is that he performs better at test when he limits his engagement with the complexities and intricacies of the material while understanding less. Raven prompted unprompted raw score 51 51 percentile (1986 norms) 65 65 standard score equivalent* 106 106 *standard score equivalents have a mean of 100, standard deviation 15 The Raven1 is a test of abstract reasoning that uses pictured patterns. It is important to note that X was given this test to do immediately after his very discouraging experience with the math tests. In addition to his general feeling of defeat, X was simply exhausted from the effort required to work through his math difficulties. As with most things, X was capable of an early, broad insight but then did not work through all of the permutations of the pattern. For example, he sometimes could see what the necessary elements would be but then failed to notice that orientation was a critical feature. Or, he would recognize that number was an issue and lose sight of the fact that shape had to be considered as well. X felt that he did not have command over the problems and wondered, “What am I not seeing that someone else would see?” Because he had spent considerable time and commitment on his own and because he was fairly discouraged, very little prompting was done. Prompting ordinarily consists of focusing attention on each aspect of the problem and pacing information intake. X’s performance on this test should be taken as a measure of his difficulty in transforming an original insight into a fully explicated analysis. It should not be taken as a measure of his cognitive ability which shows itself far more strongly in other contexts (passage comprehension). California Verbal Learning Test (CVLT) The California Verbal Learning Test measures a number of memorial, verbal, organizational and attentional functions. There are 5 consecutive exposures to a list of 16 words that fall into 4 categories. This is followed by the learning of a second list, also with 4 categories. One of the List B categories overlaps with one on List A although the items are different (i.e., cherries on list B, apricots on list A). This trial is followed by a series of short-delay and long-delay recall trials concerning the list A items. Most scores are reported as z scores, measures of standard deviation. As might be expected given the rest of X’s profile, initially he seemed overwhelmed by the very long and apparently chaotic list of words. This is seen in his below average performance at Trial 1, z=-1. X does manage to improve his performance with repeated trials such that his growth manifests as a fairly steep learning curve, with steady, sustained attention and with an above average performance at the end of Trial 5 (z=1). His approach, however, bespeaks something of the sheer strain and effort X goes through in order to reach this outcome. Rather than avail himself more fluidly of the underlying categorical structure of the list (fruits, clothing, spices and herbs, tools), Xntakes the hypervigilant, hyperfocused approach of conforming precisely to the format of instruction, i.e., the serial order in which the list is presented (serial cluster score, z=1). He does not distance himself from instruction in order to come to a more independent appreciation of the structure of the material itself, vs the format of instruction and therefore receives a below average semantic cluster score, z=-1. The shallowness of this approach can be seen in the fact that X was able to retain List A information for short recall trials (z=1) but experiences some fading at long delay free recall (z=0) and still further at long delay when asked to recall information by category (z=-1). In trying to learn List B, X is back squarely in the same place as before, overwhelmed by the amount and chaos of the list and below average in performance (z=-1). Despite his lack of use of the categories and his poorest performance when asked to recall the list by category at long delay, X is certainly aware of the categories since he consistently inserted category words that were not on the list (oranges, a nonlist fruit). His high level of intrusions (z=2) as well as his implicit awareness of the categories suggests that there is an underlying fluidity that gets repressed in the interest of following the format of instruction. This is an unfortunate sacrifice of a natural, unstrained and highly effective strategy for one that is forced, requires hypervigilance, increased mental effort and less effective in an immediate sense and becomes even less effective over the longer term. Rey Osterrieth Complex Figure Test (ROCF) (Taylor Scoring) standard deviation increase/decrease from average copy + .24 immediate recall +1.56 Not only did X have a perfect score for the copy drawing, his approach was ideally anchored in perception of the central, most informative structural features of the figure. This is in polar contrast to his approach to the CVLT lists. Because he was able to have an instant awareness, a direct perception of the integrated qualities of the figure, X worked easily, fluidly, without error, without strain, even, it seemed, with some pleasure. Because of his age, his fluidity and ease with the task are not seen in the scoring since most people his age manage an accurate rendering, although most do not manage it with quite so much elan. The advantage of his initial insight shows up in the recall score. The structure he so fully and effortlessly appreciated at intake served as an effective framework for the organization and consolidation of detail, thus making memory an immediate byproduct of deep understanding. Test of Written Language - 2 standard score* percentile thematic maturity 10 50 contextual vocabulary 13 84 syntactic maturity 11 63 contextual spelling 10 50 contextual style 10 50 standard scores have a mean of 10, standard deviation 3 Test of Written Language - 3 standard score* percentile contextual conventions 10 50 contextual language 14 91 story construction 13 84 standard scores have a mean of 10, standard deviation 3 The TOWL-2 scoring credits each instance of a correct response. Short passages are therefore penalized, longer passages may have inflated scores. The TOWL-3 is a more qualitative scoring system. The lower scores on the TOWL-2 reflect slightly decreased rate of production and therefore a shortened passage as well as the fact that X remained somewhat independent of the theme implied by the picture and thus lost opportunities to accrue topical points on the thematic maturity scale. X’s passage was a mild parody that seemed to be taking off from much of the current state of affairs, with reference to international collaboration. The language was sophisticated in vocabulary choice as well as complexity. It is certainly a more than adequate passage in technical skill as well as content. Nevertheless, it does not live up to the capacity for independence of thought and insight that is suggested in conversation. ANALYSIS Cognition A good deal of X’s learning profile is embedded in those dynamics that are common to both what is identified as ADHD and what is identified as intellectual giftedness: urgency to explore, invent, discover; novelty seeking, intolerance of/impatience with repetition and narrow focus. In the case of ADHD, these characteristics sit within a biochemistry of dopamine seeking that maintains the urge to seek, explore, and to learn in a broad, global, non-focal way. That biochemistry is distributed through brain structures in such a way that is biased toward right hemisphere functions, unchecked by frontal inhibitions. In particular, as the frontal areas continue to strive for dopamine (feelings of satisfaction and reward), they do not perform their dopamine enervated function of inhibiting primary thoughts and feelings. This leaves the right hemisphere unchecked in its role of supporting and expressing feelings/urgencies/personal valences and also unchecked in its cognitive function of perceiving global, integrated, broad, essential properties, those that can be appreciated through direct, immediate perception and without the need for highly focal, narrow, vigilant, detail collection and post hoc compilation (via formal rules, syntax, algorithms). The latter are the purview of the left hemisphere and become subdued in contrast to the unleashed dynamics of disinhibited right hemisphere functions. The introduction of X’s medication regimen is meant to reset the balance such that there is greater frontal inhibition and in the end a more dominant role for focal, vigilant, sustained information pick-up in the way the left hemisphere supports and in a way that is often the primary means of grading and assessment in schools. As can be seen in the findings at this testing, this “benefit” is not cost free. There remains a struggle for X in the form of suppressing his more natural tendency to think globally and expansively in compliance with medication as well as academically induced constraints. Much of the time he seems quite literally tied in knots by the tension, stuck in a middle zone where he can optimize neither right hemisphere facilitated fluidity nor left and frontally facilitated tight controls. The contrast emerges distinctly in X’s performance on the CVLT vs the ROCF. Because of the pictorial presentation of the ROCF, it affords X the opportunity to use his right hemisphere mediated direct visual perception of the essential and structural determining features of the figure. And, because he so clearly appreciates the essence of the material, he remembers it nearly totally, without effort. Although delayed recall was not tested, statistically it does not vary from immediate recall and should be assumed to be similar to the s immediate recall score. On the CVLT, on the other hand, the sequential list presentation obscures the underlying structure. In that case, X is drawn into a far more shallow, unrewarding and passive strategy consisting of trying to comply with the precise format of presentation/instruction, one fragment at a time. In terms of X’s own formulation, when he comes too soon to a way of organizing (in this case according to serial order) or to technical precision (serial order, steps in an algorithm) he limits the possibility of deeper and more enduring understanding. It is important to consider the role of medication in X’s current functioning. X’s view of the medication is that it makes it easier for him to stay focussed and to stay organized. This, of course, is what the medication is meant to and does do. At its best, it makes it possible for X to sustain attention when the material is not immediately accessible (CVLT list learning, math calculation). However, it does not make the material more accessible in any fundamentally meaningful way. On the CVLT, X dutifully practices the list and can repeat it in exactly the form given only to lose much of it 20 minutes later at long delay and never to have an explicit grasp of its essential structure, i.e., the categories. In math (see below), it makes it possible for X to work long and hard at learning and trying to apply algorithms but it has not made it possible for X to understand them well enough to actually retain them or apply them in slightly modified form (calculation results). An important outcome of his struggle is that X has come to an awareness that his instincts don’t align themselves with school requirements (summaries don’t fit easily into multiple choice options on the Gray). He seems to have concluded from this that his instincts are not to be trusted even though this is not at all the case. Nevertheless, he seems to believe that when he does not see what other people see (comment made during the Raven test), it is his failing rather than his gift and from there he suffers considerable lack of confidence. Time becomes an issue for him in a number of ways. If he is to unravel his unconstrained thinking,he needs time. If he is to learn formalisms as given, i.e., take in the organization given by others, he needs time for practice and memorization. If he is to rely on tight focus, he needs time to patch together the focal information he accumulates back into a more integrated impression. Reading/Writing The pattern described in the cognition section above repeats itself in the context of reading as well. X richly appreciates what he reads (passage comprehension well into the very superior range, Gray summaries). The difficult part for him is that he can’t always rein in on all of what occurs to him. So, finding a precise word takes time but in the end the word embodies much of the richness of his thinking (passage comprehension). At this testing, one implicate of his unconstrained thinking is that he is not always clear where his thinking has departed from what was actually written. This hurts him at test since he does not seem to have a firm record of what has been said vs what he understands about what has been said. This is a skill that can be learned and probably a problem that is less of an issue if he can have the source material available for referencing. In any case, “objective” or multiple choice testing is hard for him in situations that require text interpretation since he not only does not have an opportunity to get credit for the richness of his thinking but in fact runs the risk of being penalized for it. X’s writing falls more closely along the CVLT side of the “struggle” than the ROCF, i.e., it seems to conform to a fairly standard model, with a fairly familiar content. A large part of the explanation can be in the test situation which imposes limitations in terms of time and in terms of the material that must be addressed. Time limitations make brevity and use of a standard model not only expedient but in some way the only practical solution. It is important to note, however, that the test situation in the sense of prescribed limitations is a fairly close simulation of school requirements and likely would invite the same compromise. Math Nowhere is the pull between intuition and tightly constrained formalisms more apparent and more detrimental than in math. This same dynamic was apparent in the fourth grade at which time there was already a lag in skill acquisition. Now, even though X has more than ample capacity for understanding advanced math material, he does not. There seem to be at least two important reasons for this. In the first and most obvious place, he does not have the prerequisite knowledge to succeed in algebra II. Lacking are not only many skills often covered in algebra I but also some basic computational knowledge including decimals, percentages and fractions. Without constant access to a calculator, the lack of these fundamental skills could be a critical interference in balancing equations in both chemistry and math. In the second place, almost exactly as it was at the fourth grade testing, X fails to connect his intuitions about math operations with the algorithms prescribed for them. He does not seem to understand the conceptual underpinnings of the algorithms or he wouldn’t be able to confuse them in the way that he does. If he understood, for example, that finding a common denominator was a special case of an equivalent fraction, he would not be able to convert 6/7 into 6/14. If he understood what the algorithm for multiplying with decimals was about, he could not add in two columns of the subproduct and multiply in the third. These confusions indicate that he has opted for trying to conform to a precisely stated algorithm, to instruction as given (as he did with the CVLT) and it is precisely in that context that X does not find meaning, relies on practice without a conceptual framework and then cannot recall the material at long delay. There is every indication that X is capable of truly understanding what he is doing in math (applied problems, intuitions, realization that a number of his answers can’t be right). An effective program for him will need to build on his capacity for understanding rather than allow him to try to conform to and memorize formalisms. RECOMMENDATIONS 1. There will need to be some thoughtful discussion with X, his prescribing physician, the school and family concerning how best to manage his talents in the face of academic requirements. Right now he seems caught between two conceivably desirable places, i.e., adjustment to academic demands and making optimal use of his less constrained, more creative talents in art as well as in innovative thinking in the content areas. His medication does not serve to take him all the way in the direction of meeting school demands and this may be the good news, i.e., his intuitions and urgencies are not about to be constrained. Given that X’s history establishes this outcome, it seems that the only constructive option is to give rein to the other option. Following are some suggestions for how to do this: Make art courses a priority. This might mean forgoing academic support during the school day, taking summer courses or yet another alternative that would be apparent to the personnel at X’s school who know what graduation requirements are. Use art and other kinds of creative efforts as projects in the subject areas. This would allow X to anchor his practice and knowledge acquisition in a purpose that has meaning and value to him. Examples might be using animation (which X says is an interest of his) to develop satires or dramatizations for a history or literature course. X says he has an interest in developing technical skill in his art. If so, creating “portraits” of characters he reads about in literature or history might be another way to consolidate more fragmented, narrative information. Of course, figures and graphics would be a way of presenting information in nearly any class. A corollary of the above is to have X negotiate assignments with his teachers so that he is covering the content that is critical but might be allowed to do so in a way that optimizes his commitment, creativity and insight. It is possible that if the above kind of intervention is tried, there would be less need for academic support since X would be led more integrally by the structure of his project and would not necessarily need an externally imposed organization and discipline. However, some guidance and monitoring of long term assignments is likely to be needed and at best to be faded out gradually. This might be done, however, in a way that does not sacrifice an option for more art work. 2. Some portion of whatever academic support X gets ought to be devoted to helping him achieve a balance between his rich, unconstrained flow of ideas and a more contained, focal way of channeling them. Although he clearly needs some organization to his thinking, it ought to emerge out of the richness and fullness of his thought and the material itself and not out of the expedience of simplicity. This would mean encouraging his initially unchannelled ideas and then supporting him in exploring how they relate to each other. Support would take the form of asking him questions, helping him detect contradictions, irrelevancies, poorly argued positions... The above support could be offered in the context of paper writing or other kinds of long term projects. Since images can carry complexity more immediately than narrative, he can be encouraged to use this to support his expression. 3. X’s time issues need to be managed in a number of ways. He will need extended time for formal testing, especially the SAT. When it comes to getting his work done, time limits should be maintained. Where X might benefit most from help is selecting an idea or part of an idea of real interest to him that can be carved out of his broader thinking and shaped into a project that could be completed given the time constraints. 4. Since X currently lacks prerequisite skills for algebra II there will need to be some way to address this in both his math and chemistry programs. Possibilities run to a number of extremes and should be considered carefully by X and his teachers and family. Some options to be considered would be: Get through both algebra II and chemistry with whatever content area tutoring and support would be necessary to function well in the course. This kind of tutoring might have to be done after school hours. With the additional support of a calculator, X might be able to get by. Drop one or both of the chemistry and math courses. Learn the necessary math skills in a more meaningful way and then begin again in algebra II and/or chemistry next year. Forgo the algebra sequence altogether and take a more basic, functional math course if there is one. X mentioned during this testing that he believes he should have better command over basic skills such as percentage. If he continues to want this, instruction should be provided in those basic skills he is currently missing: fractions, multiplying with decimals, percentage calculation. This could be done fairly quickly as long as instruction supports X’s understanding of fundamental principles. Regardless of what program X ends up in, math instruction will need to ensure that algorithms are not simply memorized. It is important that X be able to explain mathematical procedures, derive one from another and even be able to re-invent them. 5. Whenever there is a multiple choice test in an area other than math, it is recommended that X be allowed to answer the question without reference to the choices. True/false testing should be modified in the same way. 6. It is not clear how X’s chemistry course is taught. There should be a review of math requirements in the light of those difficulties documented at this testing. It is more than likely that X cannot complete the math portion of the chemistry course without considerable support. 7. As suggested throughout this evaluation, it might make most sense at this point to invest everything in X’s natural talents and fluidity. This would mean: 1) a trial period without medication (to release as much right hemisphere supported urgency to explore and create as possible), 2) assignments that allow him to utilize his right hemisphere strengths as suggested in recommendation #1 and 3) support in all of this. This would need to be monitored carefully. 8. All of these recommendations needs to be discussed with X who needs to play the primary role in how his program gets developed. Miriam Cherkes-Julkowski, Ph.D.