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General report writing tips

Know your audience

The primary audience for your test report is your referral source: usually an attorney,

physician, social worker, case manager, parent, or the client. The referrer will use your report to

make certain decisions about the client. In the “Identification and Referral” section of your

report, you should make clear the goal of the assessment, reflecting the decisions that will be

based on the test results.

A secondary audience for the test report is always the client or a party responsible for the

client, such as a parent, guardian, or conservator. With rare exception, this person is legally

entitled to obtain a copy of your test report, so you should write it as though he or she were

looking over your shoulder. Specifically, you should write it to minimize the chance of

misinterpretation and to minimize the chance of emotional harm.

A third audience for the test report is the legal system, medical system, and other

unknown people in the future who are involved with the client. The report could be requested

and read at any point in the future (APA guidelines require you to maintain records for 15 years).

It may end up as evidence in a custody dispute, liability lawsuit, disability determination, or

competency hearing and it may be seen by other family members and other medical and mental

health professionals.

Report writing guidelines

With all of these potential audiences in mind, you should follow these guidelines:

 Write at a level that a typical college graduate would understand. Avoid legal,

psychological, and medical jargon. If such terms must be used, they should be explained.

In addition, when reporting test results, it is important to use tentative language and

report results in past tense.

 Avoid statistical information: There is no need to speak about significance levels and

confidence intervals. Translate statistical concepts into plain English.

 Avoid a pejorative tone. When psychology was a younger profession and psychoanalytic

theory was popular, there was a tendency to write reports which appeared to cleverly

reveal hidden pathology. These reports included sentences such as, “The patient is

deeply conflicted, harboring latent interpersonal distrust, aggression and hostility.” Such

declarations are generally based on weak evidence, are of little use in treatment planning,

and have the potential to harm the client. They also give the appearance that you

personally dislike the client, which may cause the reader to discount other information in

your report.

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 Write with the goal in mind. Your report should clearly communicate information that

the referral source can use to help the client and achieve the referral goal. Make sure the

referral question is addressed in your summary and recommendations.

 Be consistent: Your psychosocial, mental status exam, and testing should be consistent

with each other. You should also explain inconsistencies. For instance, if a college

graduate obtains an 80 IQ, you need to explain why (distracted during the testing, cultural

difference, brain injury, etc.).

 Justify your conclusions: Your diagnoses and recommendations should be clearly

supported by everything that comes before. You should include enough information in

your assessment so that a mental health professional could read your report and

independently verify that your diagnoses are correct. For instance, if you diagnose Major

Depressive Disorder, the “mood and affect” section of your mental status exam should

list sufficient symptoms to meet the DSM criteria. Your recommendations should answer

the questions posed by the referral source, mentioned in “Identification and Referral,”

and should follow logically from the assessment.

 Suggest the most likely reason for findings: Textbooks typically present multiple reasons

for particular test findings. For instance, verbal intelligence could be lower than

nonverbal intelligence because someone is a non-native speaker of English or because of

cultural difference. The discrepancy may also be seen in persons with antisocial

personality traits and may result from brain injury. Suggesting several reasons for a

finding is useful in a textbook or research paper; it is not useful in a test report, and may

mislead the reader. You should suggest the most likely reason for a test finding, based on

your knowledge of the client and your professional judgment.

 Avoid provisional diagnoses: At this early stage in your career, you may feel reluctant

about committing to a diagnosis and express this lack of confidence by indicating a “rule

out,” or “provisional” diagnosis. This is usually unnecessary. A psychological

assessment which includes testing is likely to be the most extensive mental health

evaluation that the client will ever receive. There is unlikely to be a more skilled

clinician down the line who can better make a more conclusive diagnosis. The only

exception might be if a general medical cause needs to be ruled out before a conclusive

mental health diagnosis can be made.

 Stay within your scope of practice: Keep in mind that your scope of practice is limited to

mental health matters. For instance, you should not recommend medical tests, such as

MRIs or CAT scans. These are expensive tests that are generally based on clear medical

symptoms. If appropriate, you would recommend a referral to a medical specialist who

would determine what medical tests and treatments were needed. Same with making

recommendations for psychotropic medications, make referral to a psychiatrist for

medication evaluation.

 Know more than when you started: If a client has a history of major depressive disorder

and appears depressed when she walks into your office, you know immediately that she

could benefit from treatment for depression. Your recommendations should suggest

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more than what is initially obvious and should incorporate all of the additional

information that you obtained from testing, interview, and record review. Same with

making recommendations for psychotropic medications, make a referral to a psychiatrist

for a medication evaluation.

The meaning of significant difference

The notes below mention certain parameters for determining a significant difference between test

scores. This is an important concept and is one reason why understanding statistics is so

important for test interpretation.

A statistically significant difference between test scores is based on the correlation between test

and retest over a certain time period and the standard deviation of the scores. This information

can be used to calculate a standard error of measurement which can, in turn, be used to calculate

a margin of error around a test score. This margin of error is important because it tells you the

stability of test scores over a certain time period. It tells you that with a certain degree of

confidence (usually 95% or 90%) and for a certain time span between test and retest, a retest will

be within x number of points of the original test score.

Knowing the margin of error of a test score is important because score differences that are

smaller than the margin of error are unstable and therefore meaningless. Suppose a client obtains

a WAIS-IV Verbal Comprehension Index of 111 and a Perceptual Reasoning Index of 109. It

would make no sense to say that his non-verbal abilities are slightly weaker than his verbal

abilities because the two point difference between the two indexes is nonsignificant. If he were

to take the test again, there is a good chance that the difference would disappear or even that he

would score slightly higher on PRI.

The score differences indicated below are “rules of thumb.” While more exact margins of errors

can be calculated based on test manual statistics, these figures will be sufficient for most

purposes.

WAIS-IV interpretation

Start with the most general and work down to the more specific.

1) Report the Full Scale IQ score, its percentile, and its classification (Low Average,

Average, Superior, etc.). Indicate whether or not it is consistent with what you would

expect, based on education and vocational history and daily activities. If there was a

history of brain injury or disease, you should estimate functioning prior to this event (pre-

morbid). If IQ is not consistent with expectation, indicate why not. If brain injury or

disease is suspected, you should comment about whether or not, and to what degree, this

injury has affected cognitive functioning.

2) Compare the VCI and the PRI. Indicate if they are consistent with, relatively weaker,

or relatively stronger than each other (+/- 12 points). Make a statement about this. If

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there is a significant discrepancy, indicate the most likely explanation (i.e., cultural

difference, language difference, brain injury, testing conditions, lack of motivation for the

testing, distractibility, emotional interference, etc.).

3) The Verbal Comprehension Index (VCI) measures the ability to perform tasks using

words, including verbal reasoning, general knowledge, and practical knowledge. Report

the VCI, its percentile, and its classification. Discuss any VCI subtests that are

significant strengths or weaknesses. To determine a strength or weakness, average all of

the VCI subtests. Consider a subtest to be a significant strength if it is at least 3 points

above the mean; consider a subtest to be a significant weakness if it is at least 3 points

below the mean. For instance, if the Comprehension subtest is a relative strength, you

would comment that the client’s common sense, judgment, and practical reasoning

abilities are a relative strength.

4) The Perceptual Reasoning Index (PRI) measures nonverbal reasoning and performance.

Report the PRI, its percentile, and its classification. Discuss any PRI subtests that are

significant strengths or weaknesses. To determine a strength or weakness, average all of

the PRI subtests. Consider a subtest to be a significant strength if it is at least 3 points

above the mean; consider a subtest to be a significant weakness if it is at least 3 points

below the mean.

5) The Working Memory Index (WMI) measures immediate auditory memory,

concentration, and attention. Report the WMI, its percentile, and its classification.

Indicate if it is consistent with, relatively weaker, or relatively stronger than the Full

Scale IQ (+/- 12 points). Interpret and discuss. Discuss any WMI subtests that are

significantly strengths or weaknesses. To determine a strength or weakness, average all

of the WMI subtests. Consider a subtest to be a significant strength if it is at least 3

points above the mean; consider a subtest to be a significant weakness if it is at least 3

points below the mean.

6) The Processing Speed Index (PSI) measures psychomotor speed and immediate visual

memory. Report the PSI, its percentile, and its classification. Indicate if it is consistent

with, relatively weaker, or relatively stronger than the Full Scale IQ (+/- 12 points).

Interpret and discuss. Discuss any PSI subtests that are significantly strengths or

weaknesses. To determine a strength or weakness, average all of the PSI subtests.

Consider a subtest to be a significant strength if it is at least 3 points above the mean;

consider a subtest to be a significant weakness if it is at least 3 points below the mean.

7) The WMI and PSI are often looked at together as a measure of concentration and

attention. They tend to be relatively weaker with diagnoses, such as ADHD, autistic

spectrum disorders, anxiety, and depression. If they are relatively lower, you might

suggest a likely reason. If a condition, such as ADHD, is suspected, but these indexes are

not relatively lower, you might suggest that “this suggests ADHD is not present”, if this

conclusion is supported by your other data.

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WRAT-IV interpretation

On the WRAT-IV, five subtests are reported:

Word Reading

Sentence Comprehension

Spelling

Math Computation

Reading Composite

For each subtest, report the standard score, its percentile, and classification (Low Average,

Average, etc.) and a brief description of what it measures. Indicate if it is significantly different

from IQ (at least 15 points) and if it is a significant strength or weakness relative to other

WRAT-IV scores (at least 10 points). An academic achievement score at least 20 points lower

than IQ is generally considered to reflect a learning disorder, unless the discrepancy can be

otherwise explained (i.e., cultural difference, truancy history, vision problems).

Reading Composite is a combination (but not an exact average) of Word Reading and Sentence

Comprehension, so you should report Reading Composite, and then go on to discuss Word

Reading (sight-reading ability) and Sentence Comprehension (reading comprehension ability).

If Reading and Sentence Comprehension differ significantly (at least 10 points) from each other,

you should briefly discuss this.

MMPI-II interpretation

Interpretations of the MMPI-II generally start out with a discussion about test validity, based on

the validity scales. This should be a fairly brief paragraph, primarily stating whether the test

results are valid and, if there is a notable response tendency, whether the client tended to

exaggerate or downplay psychopathology. It should not make general statements about

psychopathology, since response tendencies may vary based on situation, and since the validity

scales are intended as measures of test validity, not personality or psychopathology.

The scale names on the MMPI-II are archaic and misleading, and generally should be avoided.

For instance, elevation on scale 8, Schizophrenia, could mean many things other than a diagnosis

of schizophrenia. It is preferable to use scale numbers to avoid misleading the reader.

Since the MMPI-II is intended as a measure of psychopathology, it is best to just focus on

clinically elevated scores, T-score  65 on the MMPI. Low scores (T-score<40) are sometimes

mentioned on scales 5, 9, and 0, reflecting, respectively, exaggerated gender-role adherence, low

energy, and extroversion. The general approach is to interpret the meaning of elevated scales

individually, and then discuss what is suggested by scale configurations or “code types.” T-

scores can be converted to percentile but these percentiles are generally not included in test

reports.

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PAI interpretation

When reporting results from the PAI, begin by reporting test validity and whether the profile is

valid or should be interpreted with caution (based on results). Report significant clinical

elevations, that is, scales that are clinically significant in the profile summary (rather than all of

the scales of the PAI). Similarly, report results from clinically significant elevations in subscales.

When reporting results, it is important to clinically analyze these with the client’s history, rather

than simply reporting numbers. It is best to provide a narrative of the elevations and possible

symptoms and patterns- avoid reporting T scores and scale names and abbreviations.

Interpreting scores

On the WAIS-IV and WRAT-IV scores are shown as standard scores with a mean of 100 and a

standard deviation of 15. So 100 is average, 85 is one standard deviation below average, at the

16th percentile, and 115 is one standard deviation above average, at the 84th percentile. This is

the scale usually associated with IQ and is also used for the WAIS-IV index scores (VRI, PRI,

WMI, PSI) and the WRAT-IV subtests (Word Reading, Sentence Comprehension, Spelling,

Math Computation, Reading Composite).

The subtest scaled scores on the WAIS-IV (Comprehension, Vocabulary, Matrix Reasoning,

etc.) range from 1 to 19 and have a mean of 10 and a standard deviation of 3. You can convert

one of these numbers to an IQ-like number by subtracting 10, multiplying by 5, and adding 100.

So a scaled score of 12 is equivalent to an IQ of 110.

The MMPI-II and PAI use T-scores, with a mean of 50 and a standard deviation of 10. T-scores

of at least 65 are generally considered clinically elevated, at a level that might merit a diagnosis.

A z-score indicates how many standard deviations a score is from the mean, and can be positive

or negative. Standard scores are converted to z-scores with the following formula.

Z = (Score – Mean)/(SD). An IQ of 70 converts to a z-score of (70 – 100)/15 = -2.

Standard scores can be converted to percentiles by using the table below, or by entering

=NORMSDIST(z) into Excel, substituting the z-score for z in the formula.

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IQ/Std.

Scores z-score

Scaled

Scores

T-

Scores Percentile

50 -3.3 17 0.04%

55 -3.0 1 20 0.1%

60 -2.7 2 23 0.4%

65 -2.3 3 27 1.0%

70 -2.0 4 30 2.3%

71 -1.9 31 2.7%

72 -1.9 31 3.1%

73 -1.8 32 3.6%

74 -1.7 33 4.2%

75 -1.7 5 33 4.8%

76 -1.6 34 5%

77 -1.5 35 6%

78 -1.5 35 7%

79 -1.4 36 8%

80 -1.3 6 37 9%

81 -1.3 37 10%

82 -1.2 38 12%

83 -1.1 39 13%

84 -1.1 39 14%

85 -1.0 7 40 16%

86 -0.9 41 18%

87 -0.9 41 19%

88 -0.8 42 21%

89 -0.7 43 23%

90 -0.7 8 43 25%

91 -0.6 44 27%

92 -0.5 45 30%

93 -0.5 45 32%

94 -0.4 46 34%

95 -0.3 9 47 37%

96 -0.3 47 39%

97 -0.2 48 42%

98 -0.1 49 45%

99 -0.1 49 47%

100 0.0 10 50 50%

101 0.1 51 53%

102 0.1 51 55%

103 0.2 52 58%

104 0.3 53 61%

105 0.3 11 53 63%

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IQ/Std.

Scores z-score

Scaled

Scores

T-

Scores Percentile

106 0.4 54 66%

107 0.5 55 68%

108 0.5 55 70%

109 0.6 56 73%

110 0.7 12 57 75%

111 0.7 57 77%

112 0.8 58 79%

113 0.9 59 81%

114 0.9 59 82%

115 1.0 13 60 84%

116 1.1 61 86%

117 1.1 61 87%

118 1.2 62 88%

119 1.3 63 90%

120 1.3 14 63 91%

121 1.4 64 92%

122 1.5 65 93%

123 1.5 65 94%

124 1.6 66 95%

125 1.7 15 67 95.2%

126 1.7 67 95.8%

127 1.8 68 96.4%

128 1.9 69 96.9%

129 1.9 69 97.3%

130 2.0 16 70 97.7%

135 2.3 17 73 99.0%

140 2.7 18 77 99.6%

145 3.0 19 80 99.9%

150 3.3 83 99.96%

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Standard Score Range Classification

Under 70 Very Low

70-79 Borderline or Low

80-89 Low Average

90-109 Average

110-119 High Average

120-129 Superior

130 and higher Very Superior