Sample psychological report based on a videotape analysis

Dear Mrs. NN.

You requested to review the videotape of your prospective child.
The intent of my report is to interpret and explain developmental data as they appear in the video and written files that you provided.

Let me briefly comment on the accuracy of translation of the medical documentation, available for my review, and recorded interview depicted in the last section of the videotape. Basically, this is a complete and accurate translation with one, but significant, exception. Medical diagnosis under the rubric “current diagnoses” and under “specialists: neurologist, psychiatrist”: was translated as “mild developmental delays”. In fact, the correct translation should be: “mental retardation, moderate degree”. I suggest that you downloaded my article “Oligophrenia” from the BGCenter website www.bgcenter.com to read more on this diagnosis.

Most of the comments on the backdrop of the tape were unremarkable in terms of any additional information, not contained in the medical records. It is always a problem to determine to which extent the taped behavior is typical for a child in question. Please remember that videotaping by itself was rather emotionally charged, uneasy, and at times intimidating situation for Olga.

Name: Olga
Date of Birth: 00/00/00
Chronological age at the time of being videotaped: 12 years and 9 months

Physical appearance: Olga is a proportionally developed, normally nourished, and well-groomed child. Her body coordination, balance, and gross-motor proficiency appeared normally developed in those physical activities displayed on the tape (walking, dancing, running, etc.). Her fine motor skills cannot be comprehensively evaluated from the tape, but appeared within normal limits in what was indeed displayed on the tape. Her overall physical development was described in Russian medical record as “average”. She received all immunizations on time, which is a sign of a generally good health.

Speech and language: Language delays or disorders are the most common deficits in children from Eastern European orphanages. The common picture for many orphanage-raised children at the age of 3 is incomprehensible speech with only a few phrases used, very limited vocabulary, poor understanding of what is said, and slowness in learning new words. According to some research data, at the age of 4 only 14% orphanage raised children use two-words sentences. By age 7, about half of all orphanage raised children have clinically significant speech (articulation) and language delays and disorders. Please refer to my website www.bgcenter.com to find more information about language development in internationally adopted children.

Articulation: Olga showed significantly distorted articulation. Just based on this tape alone I would not hesitate to diagnose her with what is known in this country as “dyslalia” which means impairment of the ability to speak (e.g. articulate sounds of the speech). Dyslalia results in an inability of the child to pronounce vowels and sounds correctly. Therefore, speech is characterized by omissions, replacements, inversions, and additions, which make speech difficult to understand. The time limit to detect dyslalia is the child's 6th birthday. From that point onwards, all pronunciation mistakes must be eliminated and the child must pronounce words correctly. Olga is 12 and at her age this is a serious speech disorder, not just a developmental delay, as stated by a speech pathologist in Russia,. I cannot say if Olga’s condition is due to organic impairment/weakness of speech producing organs, or it has a developmental etiology or environmentally-induced nature, but I see an urgent need for thorough assessment and immediate remediation.

Another issue is the fluency of speech production, which is not mentioned at all in her Russian evaluation. Olga hesitated on many occasions, especially with several specific sounds. Based on this tape alone, I cannot determine the degree of her fluency issues, but suspect some problems here as well.

Receptive language: On the tape, Olga demonstrated an ability to follow the flow of the conversational speech provided by adults in the background, but she got completely lost during the rapid exchange of remarks. Her responses showed that she was capable of following up to three-step instructions. Her reaction speed to the verbal stimuli was somewhat delayed for her age expectations, but still within the normal limits (that is, her movements were synchronized with the verbal instructions, given to her). There were two episodes when she obviously misunderstood the question, but she corrected herself after receiving clarification in the form of a second question. In general, her receptive language appears functional for easy (undemanding) social interactions and communication.

Expressive language: Olga’s oral expressive communication skills are barely functional – this is her major weakness. All her verbalization was in response to stimulation from the adults on the tape: I observed practically no spontaneous speech to make a judgment. The length of sentences used (only a few), syntax, and vocabulary were very immature. She kept using a diminutive form of words and immature verbal mannerisms that are normally observed in much younger children. Her distortion of words structure (described in the speech therapy report and observed on a number of occasions on the tape) constitutes serious language impairment. Olga demonstrated word retrieval difficulties, as well as difficulties in modifying nouns and verbs, in conjugating numerals, nouns, and verbs. I observed that the more open-ended the question was, the harder it was for her.

Pragmatics of speech (ability to use language for social purposes, e.g. to participate in conversation and joint/shared activity) was limited, but functional. In one-to-one interview (the last taped segment) Olga demonstrated an application of pragmatic conversational features such as turn taking and sticking to the topic; she was able to sustain conversation and to respond properly to questions. On the other hand, her pragmatics skills were less effective in a more advanced stage of spontaneous shared/joint activities during her trip to the amusement park. Thus, it was more difficult for Olga to engage in goal-directed dialogue in more than three to four exchanges in “object-related” activity that required her to initiate, maintain, and terminate joint interactions through proper language application.

Behavior and adaptive/social skills: Olga appeared somewhat tense and nervous on the tape, probably due to the stressed situation of this tape recording. However, no unusual or bizarre behaviors or mannerisms were observed (e.g. rocking, breaks in receptivity, etc.). She was fully oriented in place, time, and activity. She was alert and attentive all the time. She demonstrated understanding of and responsiveness to social cues. She did not appear as a despondent, sad, and withdrawn child, just an extremely timid and hesitant. No hyperkinetic and/or repetitive movements were observed, although she was obviously high-strung at the moment. It seemed as if she anxiously tried to conform to what was expected from her and this may have caused some rigidity in her movements and body posture. She accepted praise and encouragement well. There was no avoidance or negativism in her interaction.

Cognitive functioning: I understand that this is your major concern. Unfortunately, I do not have enough data to answer the question if the diagnosis of mental retardation is correct. In a child who has severe speech and language impairments, many behavior patterns may look similar to what is usually observed in children with mental retardation. Olga’s current level of cognitive functioning, described in her Russian documents and in part observed on the tape, suggests significant delays, but these all may well be due to a combination of organically-based speech defect and educational neglect/deprivation. At the age of 5, Olga was placed in a “special” orphanage for children who could not cope in a regular Children Homes. This placement by itself may inhibit her potential for development. Based on the documents I reviewed, I can estimate her academic readiness close to 2nd grade in regular Russian school. Her current academic-related skills must be carefully evaluated to determine the degree of a remedial help she needs to benefit from the English language academic curriculum. I have to tell you that on the tape Olga appeared, cognitive-wise, in a better state that one can suggest based on her medical record. Nevertheless, I do not rule out her major diagnosis: I would be able to do this only based on my own “hands-on” comprehensive examination.

Conclusion: Based on the limited information given to me, I came to the conclusion that Olga demonstrates identifiable psychological/developmental handicapping condition: speech and language impairment. I can conclude that her current level of cognitive skills and academic readiness are well below age expectations, but I cannot rule in or rule out mental retardation as educational handicapping condition just based on the information given to me.

You have to realize that Olga is a child with special needs and prepare yourself for a difficult task of remediation. You have to consult your school district prior to your trip to Russia to create a plan that should include assessment, special education placement, and remediate/supportive services.

Sincerely,
Boris Gindis, Ph.D.