Claimant: John Doe Date of Birth: 6/24/2000
Age: 7 years Date of Evaluation: 7/907
Examiner: Alice Cullen Date of Report: 7/16/07
Reason for Referral: (note: Your reason for referral may indicate that this was apart of the class responsibility). John is a 7- years-old African American male who was brought in for a psychological evaluation by his mother as a result of concerns about his behavior. She reported that John has a history of behavioral problems, including difficulty focusing for long periods of time in school, difficulty staying in his seat at school, hyperactivity, and crying for no reason. His mother would like to know if his behavior is consistent with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD).
John lives with his mother and great-grandmother in a house. John’s mother and father were never married. His father discontinued his relationship with John and his mother when John was three years old. John’s mother, Ms. Doe, reported that John was hurt by the situation. He would often ask her mother when his father was coming back home. She also indicated that John had a close relationship with his great-grandfather. Unfortunately, his great-grandmother and great-grandfather divorced when he was three years old, and his great grand-father no longer spends time with John. John also had a difficult time dealing with the divorce of his great grandparents. According to his mother, John has a good relationship with her boyfriend, and has several uncles. John reported getting along well with his mother and grandmother. However, his mother reported that he does not follow directions given by her or his great-grandmother.
John currently attends the 2nd grade at Nancy Drew Elementary School. He generally earns grades of A’s and B’s.