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Tony was referred by his teacher Mrs. Teacher, due to irritability, depression, inattention, and mood swings in the classroom since returning to school about six months ago. The team would like to determine if Tony meets IDEIA and TEA guidelines to receive special education services.

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All background information was provided through a clinical interview with Ms. Toni Mother (mother) and records review. Tony is a 9th grade, 14 year old boy who lives with his mom and his two brothers ages 6 and 10. In the accident Tony's father was killed and Tony and his mother were badly injured. Prior to the accident Tony's father lived in the household and they were very close.

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Tony's hearing and vision were evaluated by Jane Doe, RN, school nurse at Hufflepuff Elementary School following the accident on June 9, 2017. The results indicated no hearing or vision problems.  Tony's motor skills were also evaluated by John Ritz, OT, at Hufflepuff Elementary School on June 15, 2017 and deficits concerning hand coordination were found. As a result, Tony presents issues with holding writing utensils, which impacts his ability to participate in hand-written class assignments. Tony is left-handed.

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Tony has attended Hogwarts School District since kindergarten. He attended Hufflepuff Elementary, Ravenclaw Middle, and currently Slytherin High School. Tony is currently in 9th grade. He has missed a significant amount of school days in the past 3 months due to health problems related to a motor vehicle accident. Records indicate that Tony's academic performance has been average prior to the incident. However, his grades have dropped significantly since returning back to school.
Tony's grades in social studies, math, science, and english are well below average, and is in danger of failing. Previously, he has passed the STAAR exams with satisfactory scores, and has never been held back in a grade level. Tony's ninth grade CBM scores in math and reading are average compared to his peers, but his current grades are dropping. His teacher reported Tony withdraws from participating in class and does not complete assignments. He is not receiving any present accommodations or 504 services in school.
Teacher reported Tony's engagement in problematic behaviors has increased for the past 3 months. These problematic behaviors include not following instructions, disrupting others during class, and refusing to complete assignments. As of the beginning of the 2017/2018 (9th grade) school year, Tony has been in in-school suspension 3 times for physical aggression.

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Mrs. Mother reports that Tony has avoided any social interactions with his peers and prefers to stay at home. Tony's lack of socialization has prevented him from engaging in extra curricular activities. Prior to the accident, Tony was involved in...At home he is often withdrawn and irritable. His withdrawn and irritable behaviors has made it difficult for him to follow instructions from his mother, refusal to complete homework assignments, and difficulty with getting to school on time. He frequently remains in his room. The family does not currently engage in activities together.

His mother is supportive of Tony and described him as a generally outgoing and successful student prior to the family's recent car accident. Since the accident he has become distanced from his friend group, who stated that when they tried to get Tony to go out and engage in activities, he has declined. His mother and teachers indicate a general withdrawal that is becoming more and more evident. His mother also indicated some additional family supports in the way of uncles and extended family that have facilitated their recovery. Tony and his siblings continue to get along well, and while Tony says they do not discuss the accident they are also supportive of him.

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Tony's mother reported a typical full term pregnancy with no complications. He was a healthy baby at birth. His mother indicated he walked at 9 months, spoke his first words at 13 months, and was potty trained at 3 years. His mother did report that recently he seems to be having trouble sleeping, but his eating habits appear normal.

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Prior to the accident Tony had no medical issues or any emergency hospital visits. There are no medical issues concerning paternal and maternal history. Tony's mother was also involved in the accident and sustained a broken arm, however, these injuries did not significantly impact Tony's behavioral or academic functioning according to Ms. Mother.

Tony was involved in a car accident six months ago that resulted in the death of his father. Tony sustained multiple fractures in various parts of his arms and legs. Tony was evaluated by Dr. Ian Smith, pediatrician, at University Hospital in College Station, Texas immediately after the accident. He currently takes Tylenol 200mg for the lingering pain he experiences. Since the accident, Tony has reported experiencing nightmares up to 5 times a week. He also reports experiencing high levels of anxiety, depression, and flashbacks.

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Based on Tony's mom's responses on the BASC, Tony's externalizing problems index was in the normal range. However, Tony has a T score of 80 (Clinically Significant) for Hyperactivity indicating that he often acts impulsively, has poor self-control, and is disruptive to others.

Within the content scales, Tony also had at-risk scores for emotional self-control, executive function, and negative emotionality. Based on his scores in these areas, it is important to note that he received a T score of 59 for Anger Control, and a score of 60 would place him as at-risk in this area as well. Mrs. Sample (mother) noted in the interviews that Tony had severe anger problems and this near elevated score is congruent to her reports.
Tony received a score within the at-risk range for the Emotional Self- Control scale. This indicates that Tony will become easily upset, frustrated, or angered, in response to environmental changes. Tony obtained a score on the lower limits of the at risk range on the Executive function content scale. This indicates that Tony will sometimes have difficulty controlling his behavior and mood.
Tony received a T score of 64 for Negative Emotionality, which places him in the 91st percentile. This indicates that Tony has a tendency to react negatively when faced with changes in everyday activities.

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According to the parent report completed by Tony's mother, the Depression scale fell in the Clinically Significant classification range and usually warrants follow-up. She reported that Tony is often sad, lonely, negative about things, and irritable.

Behavioral Symptoms Index
The Behavioral Symptoms Index (BSI) composite scale T score is 64, with a 90% confidence interval range of 60-68 and a percentile rank of 90. This score on this composite scale falls in the At-Risk classification range. Attention Problems T score is 65 and has percentile rank of 91. This score falls in the At-Risk classification. This means Tony has difficulty maintaining necessary levels of attention at school. The problems experienced by Tony might disrupt academic performance and functioning in other areas.

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Achievement Measures:
The Woodcock-Johnson Achievement, Fourth Edition (WJ-IV) includes tests that measure abilities in Reading, Math, and Written Language.  Average scores range from 85 to 115 on subtests and cluster scores, with a mean of 100 and standard deviation of 15 points.

Reading measures an individual's ability in Letter & Word Recognition and Reading Comprehension tasks. Tony earned an overall Reading score of 83 which is within the Below Average range. An overall Reading standard score of 90 corresponds to a percentile rank of 39. This means Tony is performing as well as or better than 39% of children his age who have been administered the test. There is limited variability among the subtests, indicating this is a good measure of Tony's ability in Reading tasks. His scores may indicate challenges in areas requiring him to read passages or comprehend read material.

Math measures an individual's ability in Math Concepts & Applications and Math Computation. Tony earned an overall Math score of 103 which is within the Average range. An overall Math standard score of 103 corresponds to a percentile rank of 58. This means Tony is performing as well as or better than 58% of children his age who have been administered the test. There is limited variability among the subtests, indicating this is a good measure of Tony's ability in Math tasks.

Written Language measure's an individuals ability in Written Expression and Spelling. Tony earned an overall Written Language score of 89 which is within the Average range. An overall Written Language standard score of 89 corresponds to a percentile rank 23. This means Tony is performing as well as or better than 23% of children his age who have been administered the test. There is limited variability among the subtests, indicating this is a good measure of Tony's ability in Written Language tasks.

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The primary language spoken at home is English.  Tony has not been exposed any additional languages.

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His mother's responses under the Leadership scale fell in the at-risk range indicating Tony has difficulty being placed in a leadership role as evidenced by endorsing items such as: "Is never usually chosen as a leader." "Is never good at getting people to work together." "Never prefers to be a leader." However, he is often able to make decisions easily and is sometimes highly motivated to succeed. This means that Tony might be uncomfortable with tasks that require him to make decisions for and lead others. He may need additional assistance in fostering leadership skills so he can become more comfortable. Otherwise, Tony demonstrates effective adaptability skills, is able to easily complete tasks of daily living, and communicates effectively with others.

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Learning/Executive Functioning
The t-scores on the Learning Problems scale were only elevated for Teacher 1. This could be interpreted as Tony is experiencing more difficulty in the subject with Teacher 1. The t-scores on the Executive Functioning scale were very elevated for Teacher 3 and 4, and were elevated for Teacher 1. However, t-score for Teacher 2 was only 5 points away from being elevated. This means Tony is experiencing difficulties with appropriately expressing and controlling his emotions, managing his time, and sustaining attention for long periods of time.

Hyperactivity/inattention
The t-scores on Inattention are all in the very elevated range, with the exception of Teacher 2 who’s evaluation place Tony in the Elevated range. All teachers agree that this is a problem for Tony. The types of problems that Tony has are

The t-scores on Hyperactivity indicate variation between the reporters. Two of the four teachers ratings placed Tony in the Very Elevated range and Two teachers ratings placed him in the average range. Some variability in the hyperactivity scores may be due to differences in teacher classroom management strategy or different behaviors in different subjects based on the student’s preference.

Defiance/Aggression

For defiance/aggression, 3 out of 4 teachers reported scores in the average range. However, 1 teacher reported an elevated score. This means this teacher perceived Tony's aggression in a concerning manner.

For peer relations, 3 out of 4 teachers reported scores in the average range. However, 1 teacher reported a very elevated score. This means this teacher has multiple concerns for Tony's peer relations in his classroom.

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The Behavior Assessment System for Children-Third Edition (BASC-3) was administered to Tony to gather more information regarding his behavioral functioning at home and in the classroom. The BASC-3 is a norm-referenced rating scale designed to help identify a variety of emotional and behavioral disorders of children. The BASC-3 gathers information from parents, teachers, and the child. The instrument includes several composite and scale scores, Toni's obtained results were compared to his peers. The Behavioral Symptoms Index (BSI), or overall score, measures the overall level of behavioral problems. On the Clinical Scales, scores from 41 to 59 are considered average, and about two out of three children have scores within this range. Scores from 60 to 69 are considered at-risk and areas to be aware of and monitor. Scores of 70 and above are considered clinically significant and likely deserve attention/further follow up. However, on the Adaptive Scales, higher scores denote more positive behaviors. Scores from 41-59 are considered average, while scores of 31-40 are considered at-risk, and scores of 30 and below are considered clinically significant.

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Overall, Tony's cognitive abilities ranged from below average to average. These scores suggest that Tony may need more time than the average student to decode readings in order to fully comprehend them.Tony's academic abilities are average with the exception of his abilities in verbal comprehension which is in the below average range. This is consistent with his scores on the VCI which measures verbal conceptualization, stored knowledge access, and oral expression.

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Tony was administered the Wechsler Intelligence Scale for Child -Fifth edition (WISC-V) on 08/16/18  to obtain a global measure of his cognitive ability. The WISC-V is one of the most common measures used for this purpose with children of Tony's age. Tony's performance is compared to other children his age across a range of verbal and nonverbal tasks. In order to obtain a more comprehensive snapshot of Tony's abilities, he was also administered specific subtests from the Woodcock Johnson Tests of Cognitive Abilities – Fourth Edition (WJ COG-IV) on 08/21/18. Results of these two measures are combined to generate composite scores for a number of Broad Abilities. Average scores range from 85 to 115 on subtests and cluster scores, with a mean of 100 and standard deviation of 15 points.

Tony obtained index scores ranging from an 82 to 108, therefore, his overall FSIQ was not interpretable. It is best to interpret his cognitive results based on the index scores.

Overall, Tony performed in the average range on the Visual Spatial and Fluid Reasoning Indexes. These results indicate the he would perform well working with visual content, 3 dimensional objects, understanding patterns, and attention to detail; understand abstract information and solving nonverbal problems.

Tony performed in the average to below average range on the Processing Speed Index. There was significant variance between scores so an additional measure from the WJ-IV Cog was given. Based on this performance, overall he obtained scores in the average range. It is expected that he performed below average on the subtest Block Design because....

Verbal Comprehension Index (VCI) assesses an individual's speaking ability, comprehend vocabulary terms, and understand general information topics. Tony obtained standard score on this index was in the below average range. His performance indicates that it has a significant impact on reading difficulties, vocabulary skills, and oral expression.