jeffrey m. merin, ph.d., p.a.
professional association
clinical psychology neuro psychology
3703 swann ave tampa fl 33609
813-871-5220 fax 813-877-1795
adult-child family
received apr 23 2015
psychological report
alan chandler
sex male
age 46
date of birth 11 16 1968
referred by ms. patricia drayer - division of vocational rehab
date of eval 3 30 15
reason for referral
this forty-six-year-old man was referred for a learning disability evaluation,
abbreviated neuropsychological evaluation, and general personality assessment.
mr. chandler was evaluated in order to help determine the absence or presence
of a specific developmental disorder and to what degree neuropsychological as
well as psychological factors are relevant to vocational rehabilitation
history and observations
historical information was obtained from ms. drayer, records provided to this
examiner via voc rehab, and mr. chandler. ms. drayer revealed
her client presents with multible infirmities that have significantly compromised
daily activities and gainful employment. of particular concern is the subject's
psychiatric history including a general anxiety disorder and depression. medical
history is remarkable for obesity and hernia. his work history reflects the the degree
to which the above infirmities have significantly compromised his capacity to
maintain pace and persistence. ms. drayer noted, "many of his jobs lasted
between one week to a couple of months" including primarily physically
demanding jobs and driving a taxi. mr. chandler, though, noted blaming others
including his employers for his lack of employment. of particular concern to mr.
chandler was the degree to which employers mistreated him. in addition,
pg2
neuropsychological factors are of concern, with particular emphasis given to long
and short-term memory.
a review of records included a rather lengthy list of jobs ranging from computer
tech to cashier to driving cab. a review of records made by this examiner
revealed mr. chandler has had myriad jobs. count was approximately 20 to 30
different jobs.
consultation with mr. chandler was consistant with the above information related
to his history of anxiety and depression for which he is now prescribed and taking
lexapro. his medical history is remarkable for back pain, limited strength, and
stamina. he complained of "swelling under my ribs" and a "bad spot in my back."
he has difficulty lifting heavy objects, squatting, and bending. inquiry, however,
did not reveal any specific injury, accident, or illness related to his presenting
status. he did, though, have his gallbladder taken out six to seven years ago.
recovery was unremarkable.
drug and alcohol histroies are unremarkable. he denied any evidences of drug
abuse, alcohol abuse, or tobacco use. medications are limited to lexapro.
developmental history revealed mr. chandler is originally from new jersey and
reared by both parents till age of three. at that time, he recalled his mother
"ran away with us" to avoid the father who was reportedly opposed to the
mother's religious preference of being a jehovahs witness. he does not have
contact with his father, who worked as a electrican and for an air filter factory.
mr. chandler is currently living with his mother, who was described as "getting
old" and "very egocentric." despite their differences, mr. chandler gets along
adequately with his mother.
educational history reveals mr. chandler was held back in 9th grade. he did,
though, graduate with standard diploma. he denied any evidences of
premorbid learning disabilities, add, and/or other learning impairment.
marital history reveals mr. chandler has never been married, nor has any
children. he attributed his single status to a lack of financial resource.
occupational history, as noted above, is remarkable for myriad positions that
included labor-intensive jobs as well as driving a taxicab for several companies.
he is currently applying for social security benefits in relation to the above
infirmities. he stated that availble jobs are "physically too difficult." "i can't do
the kind of work that's out there."
legal history is unremarkable. as noted above, though, mr. chandler is currently
applying for ssdi.
pg3
mental status evaluation:
mr. chandler was brought to this evaluation by his mother. she was not,
however, present during the clinical interview or examination.
results of the mental status evaluation revealed mr. chandler to be oriented in
all spheres with no evidences of a formal thought disorder or manic condition. his
responses, though, were often disinhibited and impulsive. mr. chandler
presented as a poorly dressed, marginally groomed, white male. he was
unshaven, appeared younger than his stated age, and chewed gum throughout
this evaluation. he remained cooperative and compliant throughout the
evaluation, while putting forth good levels of effort and motivation on
examination. as noted above, however, many of mr. chandler's responses were
often impulsive and disinhibited. communication skills were simplistic and
concrete, while information was candid and non-defensive. affect was within
normal limits with no evidences of emotional distress. he noted his mood was
"flat" and dependent on his mother's mood. he denied any evidences of suicidal
ideations, behaviors, or homicidal thoughts.
procedures administered:
clinical interview
history and observations
mental status evaluation
reviewof preliminary assessment
review of resume
consent form, release form, notice form
wechsler adult adult intelligence scale-fourth edition
wechsler memory scale-third edition [selected subtests]
wide range achievement test-4th edition
controlled oral word fluency exam
rey osterrieth complex figure drawing
bender gestalt visual motor test
trail-making exam
boston clock drawing test
beck depression inventory-ii
minnesota multiphasic personality inventory-2
intellectual factors:
on the wechsler adult intelligence scale-fourth edition, mr. chandler obtained
the following scores.
subtest scaled score
block design 16
pg4
subtest scaled score
similaries 6
digit span 9
matrix reasoning 7
vocabulary 11
arithmetic 5
symbol search 12
visual puzzles 11
information 10
coding 6
scale composite score percentile rank
verbal comprehension 95 37
perceptual reasoning 107 68
working memory 83 13
processing speed 94 34
full scale 95 37
the above scores placed mr. chandler within the average range for verbal
comprehension, perceptual reasoning, and full scale iq. composite
scores revealed relative weaknesses with regard to verbal processing, scaled
scores noted above revealed significant weaknesses across all domains
including verbal conceptualization, nonverbal reasoning, processing speed, and
complex attention/concentration. in contrast, the subject's long-term verbal
development with regard to vocabulary and information was within the average
range. similarly, attention to visual information was within normal limits.
strengths were above average with regard to eye-hand coordination.
constructional skills were above average. this appears consistent with the
subject's work-related history in which he preferred jobs that required physically
engaging tasks.
academic factors:
on the wide range achievement test-4th edition, mr. chandler obtained the
following scores.
subtest standard score %ile grade equivalent
word reading 112 79 >12.9
sentence comprehension 126 96 >12.9
spelling 95 37 12.2
math computation 81 10 5.7
reading composite 120 91
pg5
on the basis of the above scores, there were evidences of an arithmetic
disorder. when taking into consideration the error of measurement, i.e., plus or
minus 3 points, it is evident mr. chandler's math computation score noted above
fell significantly below what one would expect given his ability level, i.e., full
scale iq of 95. otherwise, his reading, comprehension, and writing skills were
well within normal to above average limits. in fact, mr. chandler's reading and
comprehension skills are well above what one would expect given his limited
academic history. he reading well above average.
although the subject presents with an arithmetic disorder, his overall
achievement with regard to language-based skills, e.g., writing and reading, is
within normal limits. there are no evidences mr. chandler basic academics
would significantly comprimise vocational rehabilitation per se.
abbreviated neuropsychological factors:
on the wechsler memory scale-third edition, mr. chandler obtained the
following scores.
test index score percentile
auditory immediate 80 9
auditory delayed 77 6
the above scores placed mr. chandler within the low average to mildly impaired
range with regard to short-term and long-term memory. further analysis of
scaled scores, noted below, clearly clearly revealed the degree to which mr. chandler
had difficulty acquiring relevent information and retaining it over time. irrespective
of presentation, mr. chandler had difficulty encoding, consolidating, and
retrieving verbal information. weaknesses were clearly demostrated via the
following scaled scores.
test t-score percentile
immediate recall 79 >99
delayed recall 70 98
pg6
the above scores placed mr. chandler well within the average range to
superior range with regard to short-term and long-term visual memory. in
general, mr. chandler's ability to acquire and retain visual information was well
above average. item analysis also revealed excellent retrieval of internal detail
and external configuration. note was made, though, his drawings were
somewhat haphazard and careless. this was also evidenced on the bender
gestalt visual motor test in which he was able to reproduce specific items in a
rather haphazard and disinhibited manner. there appeared to be some level of
disinterest.
on the controlled oral word fluency exam, mr. chandler produced a raw score
of 23, placing him at the 10th percentile. verbal fluency was mildly impaired.
on the trail-making exams, mr.chandler produced a scaled score of 8 on part
a, placing him at the 21st percentile. processing speed was mildly impaired.
however, his performance improved trail-making, part b, in which he
obtained a scaled score of 9, placed him at the 31st percentile. in general,
cognitive control strategies with regard to sequencing and shifting were within
normal limits.
despite the subject's adequate performance on trail-making, part b, he revelaed
marked difficulties on the boston clock drawing test, again revealing the
quickness with which he was disinhibited, careless, and prone to errors. he had
difficulty accurately translating verbal instruction to spatial context. this appeared
related to impulsivity rather than impaired executive processing per se.
personality factors:
results of the personality examinations appeared to be valid and reliable
measures of mr. chandler's current psychological status. while there were no
evidences mr. chandler attempted to exaggerate or minimize psychological
issues, his validity profile revealed significant elevations indicating the presence
of long-term infirmities with which he has poorly resolved. this appears
consistent with the subject's history of childhood traumas and adult adversities.
mr. chandler clinincal profile on the mmpi-2 revealed significant elevations
indicating the presence of acute emotional distress within the context of long-
term characterological traits and dynamics that leave him vulnerable to everyday
stressors. he described himself as a rather depressed individual who harbors
underlying feelings of inadequacy and insecurity. defense mechanisms will
include denial, minimization, and suppression within the context of somatization.
despite diagnosable conditions, mr. chandler reported myriad physical
symptoms that are beyond what one would expect given any medical conditions
with which he presents. there are evidences of a somatoform pain disorder in
addition to long-term depression. there is a high degree of probability mr.
chandler will experience multiple physical symptoms in lieu of psychological
pg7
distress. this does not minimize or discount the subject's physical conditions, but
rather reflects the extent to which his medical conditions may intensify and
magnify inresponse to emotionally difficult tasks and/or challenges with which he
perceives as unreasonable and/or unrealistic. at this point, mr. chandler's profile
on the mmpi-2 revealed the degree to which he perceives himself as a physically
and emotionally disabled individual.
on the beck depression inventory-ii, mr. chandler produced a raw score of 17,
placing him within the mild range. mr. chandler described himself as a
somewhat sad and pessimistic individual who harborsfeelings of inadequacy and
worthlessness. he confided being agitated and irritable, while frequently
fatigued/tired. he also revealed harboring occasional suicidal ideations although
denied any imminent threat to self.
conclusions and vocational implications:
mr. chandler, age 46, was reffered for a learning disability evaluation,
abbrreviated neuropsychological assessment, and general personality evaluation.
mr. chandler presents with a history of vague, yet significantly disabling, medical
conditions that affect his back, ribs, and capacity to walk. he is currently
unemployed and attributed his status to physically disabling conditions as well as
a history of depression and marked anxiety. at the time if his evaluation, mr.
chandler was prescribed and taking lexapro. he has been hospitalized on at
least one occasion for the above diagnoses. he continues to experience periods
of anxiety and depression, particularly in relation to his current unemployment
status.
the results of this evaluation revealed several areas of concern related to mr.
chandler's intellectual functioning, achievement, neuropsychological capacities,
and psychological status. in particular, mr. chandler's performance on the
wechsler adult intelligence scale-fourth edition revealed relative weaknesses
with regard to verbal processing, with particular emphasis given to concept
formation. he also revealed the extent to which he had difficulty grasping
abstractions, solved novel problems, and attending to auditory stimuli.
conversely, mr. chandler performed well within the average to above average
range with regard to visual attention and construction. results from the wais-iv
clearly revealed the degree to which mr. chandler's strengths are related to
visual perception and spatial processing. this appears consistent with the
subject's vocational careers/occupations. he is given toward those jobs that
allow hands-on work rather than academic/cognitive processing. however,
despite the subject's limited education, i.e., high school, results from the wide
range achievement test-4th edition placed him well within the above average to
superior range with regard to reading and comprehension. writing was also
well wthin the average range. conversely, arithmetical skills were at the 5th to
6th -grade level, representing a learning disability. weaknesses, though, will be
circumscribed to those jobs and tasks that require some degree of arithmetical
pg8
skills. this may include counting, cashiering, and/or measuring. otherwise, the
subject's performance on the wrat-4 was absent any signicant concern.
the abbreviated neuropsychological portion of this evaluation revealed
significant impairments with regard to verbal learning. this was especially
evident on the wechsler memory scale-third edition in which mr. chandler was
unable to effectively encode, consolidate, and retrive verbal information within
context as well as repeated over a series of trials. in general, the subject
performed within the impaired range, particularly when considering his ability
level, i.e., full scale iq of 95. he consistently when difficulty maintaining and
reatining attention and memory to verbal tasks. this was evident via behavior in
which mr. chandler was often disinhibited, distracted, and careless. he gives
little time to incorporate and integrate relevant information and instead responds
in the absence of comprehensive instructions. as a result, error rate increases.
this may result in redirection and/or correction by others, e.g., his boss. mr.
chandler, though, appears to have limited insight into his psychology and
cognitive infirmities and degree to which they interfere with work-related skills. in
addition, mr. chandler's response to the boston clock drawing clearly revealed
the degree to which he is a rather impulsive individual who responds to specifc
words rather than context and comprehensive instruction. this may interfere to
varying degrees with cognitive tasks as well as psychologicaldevelopment. he is
quick to respond without adequate information. this appears related to
underlying feelings of inadequacy and insecurity with which mr. chandler is
unable to change/resolve. his inability to effectively identify cause and effect
relantionships contributes to his constant state of emotional turmoil with which he
may occationally turn outward. there appears to be a consistent and close
relantionship between the subject's neurocognitive infirmities and psychological
status. he may often feel frustrated and discouraged.
the above findings revealed a complex of factors including the presence of
impaired verbal memory, an arithmetic disorder, and attention deficit
hyperactivity disorder characterized by impulsivity, carelessness, and
distractibility. he has difficulty acquiring and retaining verbal information and
applying it in a coherant and accurate manner. mr. chandler frequently feels
frustrated and discouraged, while lacking insight into the [sychology of his
personality and instead manifesting a host of physical symptoms in response to
stress-related conditions. this is not to minimize and/or dismis any bonafide
medical condition, but rather reflects the degree to which mr. chandler's physical
symptomsemerge in response to challenging tasks and/or adverse
circumstances. there appears to be a close and integral relationship between
the subject's cognitive infirmites, psychological distress, i.e., depression and
anxiety, and pain response. behavioral observations as well as examinations
revealed the extent to which mr. chandler responded in an impulsive manner,
while committing several errors. his responses were noted to be concrete, rigid,
and inflexible irrespective of task demand. he has difficulty shifting cognitive set
in order to accommodate new demands. error rate increases. there is a high
pg9
degree of probability this personality and cognitive style may either aggravate
others and/or initiate concern and comment. mr. chandler does not respond well
to criticisms and/or correction. as a result, his work history reflects a number of
jobs. nevertheless, his intellectual development and reading abilities are clearly
within the average to above average range. academics may facilitate
alternative job/work considerations. therefore, the following recommendations
are made in an effort to help mr. chandler assess his vocational strengths and
weaknesses beyond previous employment.
recommendations:
1. given mr. chandler's level of emotional turmoil and distress, he should
maintain close contact with his prescribing physician in order to monitor
his current medications.
2. a work evaluation is warranted in order to assess mr. chandler's
vocational strengths and weaknesses.
3. given the subject's poor verbal memory, impulsivity, distractibility, and
carelessness, those with whom he works should ensure that all goals,
responsibilities, and communications are clearly articulated, in written
form, and reviewed on a frequent basis.
4. in the absence of resolving physical and psychological stressors and
manifestations, prognosis for full-time gainful employment is poor.
diagnostic impressions:
315.1 mathematics disorder
300.4 persistent depressive disorder
300.00 anxiety disorder
316 psychological factors affecting other medical conditions
314.01 attention deficit hyperactivity disorder, combined presentation,
with impaired verbal memory
jeffrey m. merin, ph.d.
licensed psychologist
jmm:mb
chandler, alan
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