Assignment 6

Six DIAGNOSTIC IMPRESSIONS AND SUMMARY

Some reports include a Diagnostic Impressions section as well as a Summary section, and others

do not. Diagnostic impressions or clinical implications may be included within the summary

section of the report at the end of the Test Results and Interpretation section or in a separate

section with its own heading. Although these sections may be combined for clarity, we will

discuss them separately. This chapter focuses on how to (1) report your diagnostic impressions

and (2) write clear, effective summaries that will lead to the recommendations.

DIAGNOSTIC IMPRESSIONS

After all the data have been analyzed, you will usually form a diagnostic impression about the

individual that is based on multiple pieces of data. In addition to the recommendations, clinical

impressions— whether formal diagnostic classifications or more descriptive impressions— can

be some of the most important information provided by the report (Wolber & Carne, 2002),

because they may help explain why an individual has trouble performing tasks or exhibits certain

behaviors. When writing a diagnostic impression, you will want to (1) describe data that support

the diagnosis, (2) provide enough data to support the conclusion, (3) use a diagnostic code when

appropriate, (4) consider the setting of the individual, and (5) consider whether you are qualified

to make a diagnosis.

Describe the Data That Support the Diagnosis

When a diagnosis is based partly on data from test scores (such as in the case of mental

retardation, a specific reading disability, or giftedness), then explicitly describe the test scores that

contributed to making the diagnosis. For example, in discussing a child who appears to have a

specific reading disability, you could write “Kara’s performances on tests of reading were significantly

poorer than would be predicted from her overall intellectual ability.

This discrepancy between and her WIAT- II reading scores (Reading Comprehension SS = 80 and

Word Reading SS = 85) are supportive of superior intellectual abilities, in contrast to specific difficulti

es in reading.” You would also include any additional data that further support this diagnosis, such a

s “Kara’s language arts teacher also reported that she reads very slowly in class and often has diffic

ulty pronouncing words. Furthermore, her parents indicated that Kara becomes easily frustrated with

her reading homework and often attempts to hide her assignments. Both the test scores and teacher

and parent observations indicate persistent difficulties in reading.”

Patterns of elevations or depressions in subtests may also provide support for a diagnostic hypothes

is. You may write “Michael’s depressed mood, lack of energy, insomnia, feelings of hopelessness, a

nd weight gain over the past month are in accordance with his elevated scores on the Beck Depressi

on Inventory and Major Depression Scale of the MCMI- III. This combination of elevations on tests of

depression and the constellation of specific depressive symptoms indicates a diagnosis of Major De

pression, Single Episode, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text r

evision ( DSM-IV-TR) Code 296.2x.”

Provide Enough Data to Support the Conclusions

Faulty diagnostic statements occur when not enough data exist to support the conclusion. For exam

ple, one report contained the following statement: “Eduardo’s inattention was evident in his low score

s on subtests that comprise the Working Memory Index of the WISC- IV. He performed equally poorl

y on tests of oral arithmetic, sequencing letters and numbers, and recalling lists of digits. His low perf

ormance on these subtests indicates a pattern of behavior that is consistent with a diagnosis of ADH

D.” Although poor performance on these subtests may provide some support for a diagnosis of ADH

D, without further data it does not provide sufficient evidence for the diagnosis. Additional supportive

information from outside the evaluation would be needed to draw this conclusion.

Although some data are more important than others, most of your findings will support your main con

clusions. If contradictions exist in the data, provide explanations that explain these inconsistencies.

DIAGNOSTIC IMPRESSIONS AND SUMMARY 107

If you cannot resolve the con traditions, do not make a diagnosis, but instead describe the contradict

CAUTION tory data and explain why definitive conclusions cannot be reached at this time. In some i

nstances, the data are not Do not make a diagnosis when the data are contradictory, but more infor

mation is needed before an accurate diagnosis can be made. For example, if the referral question as

ks whether Samantha has a learning disability but the data are insufficient or inconclusive, then expli

citly state that fact. As an example, the evaluator may write,

Findings consistently reveal Samantha’s motor difficulties and poor social skills. Additionally,

school anecdotal records and current teacher reports indicate that she is easily overstimulated and h

as trouble switching from one activity to another. Although her overall profile suggests that she has n

onverbal learning disabilities, this type of profile and the accompanying behavioral characteristics ca

n also be present in a host of other low- incidence neurological disorders. Therefore the Assessment

and Planning Team should view her current profile as a preliminary finding that requires further neur

ological and neuropsychological evaluation before an accurate differential diagnosis can be made.

Use a Diagnostic Code When Appropriate

Some referral questions request that a specific diagnosis be supported or refuted. In these i

nstances, evaluators record a code from the Diagnostic and Statistical Manual of Mental Disorders, f

ourth edition, text revision ( DSM-IV-TR; American Psychiatric Association, 2000) or the International

Statistical Classification of Diseases and Related Health Problems, tenth revision ICD-10; World Hea

lth Organization, 1992). Reports from medical or forensic settings often require Axis I: that the formal

DSM-IV or ICD- 10 codes be used. These codes and Axis II: classification systems are regularly upd

ated, so it is important to make sure that you use the most recent edition. Whether the code is writ A

xis ten in sentence or tabular format is V: a matter of style (see Rapid Reference 6.1 for an example

of each). In some cases, all five diagnostic Psychiatric glories of the DSM-IV system may be DON ’ T

FORGET DSM-IV Multiaxial Classification ( System Clinical disorders, Other conditions that may be

a focus of clinical attention Personality disorders, Mental retardation Axis III: General medical conditi

ons Axis IV: Psychosocial and environ mental problems Global assessment of functioning American

Psychiatric Association, 2000. Copyright © 2000 by the American Association.