Using the case of Jenni from the end of Chapter 12 of Psychopathology of Childhood and Adolescence, appraise the treatment plan offered for Jenni. What role do physical, behavioral, academic, and cognitive interventions play in the treatment process? What value does this bring to the treatment of Jenni? Is there anything missing from the assessment and intervention given all that you have learned though the assigned materials this week? Paper must be 2-4 pages of text and must include title page and references, APA format! Use appropriate resources as well as the one attached. REASON FOR REFERRAL AND DEMOGRAPHIC INFORMATION Jenni (fictional name) is an 8-year-old female whose parents presented with major concerns regarding her recent academic difficulties as well as social struggles. Jenni has started to fall behind in her schoolwork based on standardized testing reports and teacher comments. Jenni’s teacher recently reported that Jenni was forgetting about homework assignments, failing to turn in her homework, and rushing through her work too quickly, making careless mistakes. PSYCHOSOCIAL HISTORY Jenni struggles with paying attention to and remembering instructions. She requires frequent reminders from the teacher to stay on task. Parents report that although Jenni enjoys extracur- ricular activities, she often has difficulty with them. For example, it is hard for her to remem- ber or follow the rules during soccer practice. Jenni also has problems keeping friends. She has difficulty adhering to social boundaries, often acting impulsively, grabbing items from peers, or saying inappropriate things. Although Jenni is perceived as exciting and fun by her peers at first, they tend to eventually become annoyed and frustrated with her impulsive behavior. In addition to having trouble waiting for her turn to speak in social situations, Jenni also struggles with this issue in classroom situations. Teachers report that Jenni has difficulty staying in her seat, often getting up to sharpen her pencil or wander around the room when she is supposed to be seated. At home, Jenni’s parents experience some frustration with Jenni’s behavior. For example, helping Jenni with her homework can be extremely trying because of her impaired attentional and organizational abilities. Jenni has recently become more aware of the social problems she experiences and has mentioned feelings of sadness over these difficulties. MEDICAL HISTORY A review of developmental history revealed that Jenni’s mother’s pregnancy was uncompli- cated and she had regular obstetric care. Jenni’s sensory, motor, and language development were typical. She has not experienced any notable medical problems. EDUCATIONAL HISTORY Jenni is in second grade and has not received any special education services. Although her academic performance in kindergarten and first grade was Low Average to Average, her parents have noticed recent academic difficulties as the material has become more complex. Curren.

1. Using the case of Jenni from the end of Chapter 12 of
Psychopathology of Childhood and Adolescence, appraise the
treatment plan offered for Jenni. What role do physical,
behavioral, academic, and cognitive interventions play in the
treatment process? What value does this bring to the treatment
of Jenni? Is there anything missing from the assessment and
intervention given all that you have learned though the assigned
materials this week?
Paper must be 2-4 pages of text and must include title page and
references, APA format! Use appropriate resources as well as
the one attached.
REASON FOR REFERRAL AND DEMOGRAPHIC
INFORMATION
Jenni (fictional name) is an 8-year-old female whose parents
presented with major concerns regarding her recent academic
difficulties as well as social struggles. Jenni has started to fall
behind in her schoolwork based on standardized testing reports
and teacher comments. Jenni’s teacher recently reported that
Jenni was forgetting about homework assignments, failing to
turn in her homework, and rushing through her work too
quickly, making careless mistakes.
PSYCHOSOCIAL HISTORY
Jenni struggles with paying attention to and remembering
instructions. She requires frequent reminders from the teacher
to stay on task. Parents report that although Jenni enjoys
extracur- ricular activities, she often has difficulty with them.
For example, it is hard for her to remem- ber or follow the rules
during soccer practice. Jenni also has problems keeping friends.
She has difficulty adhering to social boundaries, often acting
impulsively, grabbing items from peers, or saying inappropriate
things. Although Jenni is perceived as exciting and fun by her
peers at first, they tend to eventually become annoyed and
frustrated with her impulsive behavior. In addition to having
trouble waiting for her turn to speak in social situations, Jenni

2. also struggles with this issue in classroom situations. Teachers
report that Jenni has difficulty staying in her seat, often getting
up to sharpen her pencil or wander around the room when she is
supposed to be seated. At home, Jenni’s parents experience
some frustration with Jenni’s behavior. For example, helping
Jenni with her homework can be extremely trying because of her
impaired attentional and organizational abilities. Jenni has
recently become more aware of the social problems she
experiences and has mentioned feelings of sadness over these
difficulties.
MEDICAL HISTORY
A review of developmental history revealed that Jenni’s
mother’s pregnancy was uncompli- cated and she had regular
obstetric care. Jenni’s sensory, motor, and language
development were typical. She has not experienced any notable
medical problems.
EDUCATIONAL HISTORY
Jenni is in second grade and has not received any special
education services. Although her academic performance in
kindergarten and first grade was Low Average to Average, her
parents have noticed recent academic difficulties as the material
has become more complex. Current and previous teachers report
that Jenni misses much of the material presented in the
classroom because of her attentional lapses. A previous
intelligence test placed her Full Scale IQ (FSIQ) in the Average
range (Standard Score of 92).
FAMILY HISTORY
Jenni is the oldest of three children. She has a 6-year-old
brother who struggles academically and who has some speech-
language difficulties. She also has a 3-year-old sister who is in
preschool and doing well. Although never formally diagnosed,
Jenni’s father suspects that he has Attention-
Deficit/Hyperactivity Disorder (ADHD) and recalls
experiencing learning difficulties as a child.
NEUROPSYCHOLOGICAL ASSESSMENT RESULTS
Wechsler Intelligence Scale for Children—Fourth Edition

3. (WISC-IV) Working Memory Index (WMI; Wechsler, 2003)
The WISC-IV WMI measures the recall of strings of letters and
numbers, and computing oral arithmetic word problems. On the
WMI, Jenni obtained a standard score of 91 (Average range),
with a percentile rank of 27. A table of Jenni’s performance on
the WISC-IV WMI is included below in Table 12.1.
Conners’ Continuous Performance Test (CPT; Conners, 1995)
The CPT is a measure of attention and response inhibition that
requires the participant to press a key when a target letter
appears on a computer screen and not press the key when the
letter does not appear. Jenni made an exceptionally large
number of errors of commission (T-Score of 70; 50 is average)
and a slightly more-than-average number of errors of omission
(T-score = 60). She was atypically fast but also often inaccurate
at responding and exhibited an atypical percentage of
perseverations.
Delis-Kaplan Executive Function System (D-KEFS; Delis,
Kaplan, & Kramer, 2001)
Jenni was administered three of the eight D-KEFS subtests. The
D-KEFS Tower Test assesses motor planning, problem solving,
reasoning, and speed. Jenni’s scores on this test all fell within
the Low Average range, and she had a relatively low Move
Accuracy Ratio score, indicating that she made many more
moves than needed to create the accurate tower. This pattern
suggests that she may have had difficulty planning ahead and
instead haphazardly attempted to solve problems without a
concrete plan. On the D-KEFS Sorting subtest, which assesses
abstract reasoning, Jenni also performed within the Low
Average range. She had dif- ficulty sorting the cards into
appropriate groups and recognizing the sorting strategy. Finally,
TABLE 12.1 WISC-IV Working Memory Subtest Scores
WISC-IV WORKING MEMORY SUBTESTS
Digit Span Letter-Number Sequencing Arithmetic WMI
Standard Score (mean = 100)
SCALED SCORE (MEAN = 10)
PERCENTILE

4. 9 34 8 21 8 21
91 27
Jenni was administered the D-KEFS Color-Word Interference
Test, which measures inhibi- tory control and cognitive
flexibility. Jenni’s ability to name colors and read words was in
the Average range. However, her ability to inhibit the automatic
tendency to read words when asked to name the colors in which
the words were printed (Inhibition condition) was in the Low
Average range. She also struggled in the domain of cognitive
flexibility, demonstrated by her Low Average performance
when asked to switch between naming colors and reading words
(Inhibition/Switching condition). Scaled Scores are included
below in Table 12.2.
Trail Making Test for Children (Reitan & Wolfson, 1992)
The Trail Making Test (parts A and B) is a measure of visual
processing, attention, and cog- nitive flexibility that requires
the participant to draw lines to connect numbered circles in
numerical order (Part A) and draw lines to connect alternating
numbered and lettered circles in numerical and alphabetical
order (Part B). Jenni completed Part A of the Trail Making Test
in 24 seconds and made no errors. She completed Part B in 43
seconds and made one error. These scores put Jenni’s speed of
performance within the Low Average range.
Rey-Osterrieth Complex Figure Test (RCFT; Meyers & Meyers,
1995)
The RCFT is a test of design copying, visual memory, planning,
and sustained attention. Jenni’s time needed to copy the design
was in the Average range. However, her copy score was less
than or equal to first percentile, indicating significant
impairment in the ability to accurately copy this complex
design. When asked to draw the design from memory after a
three-minute delay, she achieved a percentile ranking of 14,
indicating that she was relatively
TABLE 12.2 D-KEFS Subtest Scores
D-KEFS SUBTESTS
Tower Test

5. Total Achievement Score Mean First Move Time Time-Per-
Move-Ratio Move Accuracy Ratio Rule-Violations-Per-Item
Ratio
Sorting Test
Free Sorting Correct Sorts Free Sorting Description Sort
Recognition Description
Color-Word Interference Test
Color Naming Word Reading Inhibition Completion Time
Inhibition/Switching Completion Time
TABLE 12.3 Rey-Osterrieth Complex Figure Test Scores
SCALED SCORES (MEAN = 10)
8 10 11 7 8
7 8 8
9 8 7 6
PERCENTILE
≤1% >16% 14% 14% <1%
REY COMPLEX FIGURE TEST
Copy of Design Time Needed to Copy Design Immediate Recall
Delayed Recall Recognition
T-SCORE (MEAN = 50)
Below Normal Limits Within Normal Limits 39
30 22
weak in the Immediate Recall and reproduction of a complex
abstract design. Jenni’s Delayed Recall also resulted in a
percentile ranking of 14. On the Recognition subtest, Jenni’s T-
Score was 22 with a percentile rank of less than 1, indicating
that her visual recognition scores were far below normal limits
(Table 12.3).
Behavior Rating Inventory of Executive Function (BRIEF;
Gioia, Isquith, Guy, & Kenworthy, 2000)
The BRIEF is a questionnaire for parents of school-age children
that allows for the assess- ment of executive function in the
home environment. Results are presented in Table 12.4 as T-
scores; scores above 65 are potentially clinically significant.
Ratings were obtained from Jenni’s mother.
The results indicate that Jenni demonstrates significant levels of

6. difficulty in the areas of inhibiting inappropriate behavior,
controlling emotions, initiating tasks, holding and manip-
ulating information in her memory, and planning and organizing
tasks and materials. She was at risk for developing significant
impairment in the ability to fluidly shift from one activ- ity to
another and monitoring her performance and the impact of her
behaviors on others. Such difficulties are bound to make it hard
for Jenni to succeed in self-directed tasks, in the classroom, and
with peers.
Wisconsin Card Sorting Test (WCST; Heaton, Chelune, Talley,
Kay, & Curtiss, 1993)
This test required Jenni to sort cards according to different
rules. It measures higher level problem solving, hypothesis
testing, and cognitive flexibility. Jenni’s percentile scores for
the components of the test ranged from 2 to 55, suggesting that
she had difficulty in certain areas of this test, particularly in
maintaining set (Table 12.5). She had some trouble changing
sort- ing principles as well as maintaining set.
TABLE 12.4 BRIEF Scores
BRIEF INDEX/SCALE
Behavioral Regulation Index (BRI)
Inhibit Shift Emotional Control Metacognition Index (MI)
Initiate Working Memory Plan/Organize Organization of
Materials Monitor Global Executive Composite (GEC; BRI +
MI)
TABLE 12.5 Wisconsin Card Sorting Test Scores
T-SCORE (MEAN = 50)
70 68 65 76 75 70 81 77 75 65 75
RATING
Significant Significant At Risk Significant Significant
Significant Significant Significant Significant At Risk
Significant
WCST
Failures to Maintain Set Perseverative Errors % Perseverative
Errors Nonperseverative Errors % Nonperseverative Errors
RAW SCORE

7. 3 20
11% 18 25%
T-SCORE (MEAN = 50)
PERCENTILE
— 2–5% 49 47% 53 55% 35 7% 36 8%
RATIONALE FOR DIAGNOSIS
A primary diagnosis of Attention-Deficit/Hyperactivity
Disorder (ADHD) Combined Type is warranted, based on DSM-
IV criteria, parent and teacher Conners’ attention checklists (not
discussed fully in the limited space available herein), family
history of attention difficulties, observations and interviews of
Jenni, and patterns of test results strongly suggestive of inatten-
tion and impulsivity (see scores on the Conners’ CPT and the
other neuropsychological tests).
POTENTIAL INTERVENTIONS
1. Medication. Medication treatment, involving the use of
psychostimulants, may be benefi- cial. Such medications may
improve Jenni’s ADHD-related symptoms, thereby having a
positive impact on functional impairments across settings.
Medications should be mon- itored carefully to establish an
optimal dosage. Because the effects of medications only persist
as long as they are ingested and because they obviously cannot
teach skills, other interventions may also be warranted.
2. Behavior Therapy: Child-Focused. Given Jenni’s social
difficulties, social skills interventions would likely be relevant.
Additionally, treatment programs utilizing combinations of pos-
itive and aversive contingencies could yield important benefits.
Supplementation of these behavioral reinforcement programs
with cognitive strategies skills could be considered, including a
focus on self-evaluation procedures, particularly when Jenni is
entering the teen years.
3. Behavior Therapy: Parent-Focused. Parents could benefit
from consultation from a behavior- ist to learn how to target
problems for intervention, develop a reinforcement menu and
token reward program, measure behavior, and utilize consistent
(nonphysical) punish- ment procedures. Parents should also

8. focus on coordinating programs between home and school in
order to maintain consistent use of behavioral strategies.
4. Academic Interventions. Jenni’s teachers should be trained in
the implementation of behav- ior modification including
developing a clear reward system in the classroom. A daily
report card program would enhance consistency across home
and school settings. Certain accommodations based on Jenni’s
difficulties may also be crucial, such as extra time on tests and
assignments, to support Jenni’s academic progress.
5. Cognitive Training. Cognitive training paradigms have
yielded some promising prelimi- nary results in the research
literature in terms of improving aspects of executive func- tion
such as working memory. However, the long-term clinical
utility of such programs is not yet established and they should
be considered supplementary to primary, established treatments
like medication and behavioral therapy.
ACKNOWLEDGMENT
Work on this chapter was supported, in part, by National
Institute of Mental Health Grant R01 45064, awarded to Stephen
P. Hinshaw.
REFERENCES
Conners, C.K. (1995). Conners’ continuous performance test
computer program: User’s manual. Toronto, Canada: Multi-
Health Systems.
Delis, D., Kaplan, E., & Kramer, J. (2001). Delis-Kaplan
executive function scale. San Antonio, TX: The Psychological
Corporation.