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Ryan underwent a neuropsychological evaluation with Mimi Castelo, Ph.D. at MGH on October 21, 2008.  Ryan’s scores on the Wechsler Intelligence Scale for Children (WISC-IV) placed him in the average range for intellectual abilities.  Specifically, his nonverbal intellectual abilities were average and he showed weaknesses in verbal problem solving and his vocabulary base.  Ryan’s scores on the Wechsler Individual Achievement Test (WIAT-II), the Gray Oral Reading Test (GORT) and the Oral and Written Language Scores (OWLS) revealed deficits in language based academic skills, including phonological processing, phonemic awareness, reading accuracy and written expression.  Ryan scored significantly lower than expected based on his intellectual potential.  His scores fell in the 2nd to 5th grade levels.  Ryan also scored at the 5th grade level in his ability to derive meaning from passages he read. (Exhibit P-6)

Ryan’s reading rate and reading accuracy on the GORT-4 was low average.  This score placed Ryan at least one grade below grade level (4.7-5th grade).  On a test of written expression, Ryan scored in the average range.  Dr. Castelo reported, however, that Ryan’s responses revealed significant vulnerabilities in formulating meaningful and grammatically correct sentences. (Exhibit P-6)

Ryan’s teachers and parents completed behavior rating scales.  On the Child Symptom Inventory (“CSI”), Ryan exhibited symptoms of severe anxiety about his abilities in academic, athletic and school activities.  The results on the Behavior Assessment System for Children (“BASC”) revealed that Ryan worries about what his peers will think and often gets nervous on tests.  Ryan’s hyperactivity and impulsivity were consistently rated as concerns by his teachers.  The teachers reported that Ryan has trouble staying seated, often interrupts when others are speaking and calls out in class. (Exhibit P-6)

Dr. Castelo opined that Ryan’s weaknesses in receptive and expressive language and academic achievement are suggestive of a language based learning disability.  Ryan also demonstrated executive function weaknesses and difficulties with attention, inhibition and impulse control indicative of individuals with Tourette’s Syndrome.  Dr. Castelo characterized Ryan’s difficulties in this area as a cognitive disorder due to a medical condition. (Exhibit P-6)

Dr. Castelo recommended that Ryan receive support in reading, speech and language development, written expression and emotional functioning.  Specifically, Dr. Castelo recommended specific reading instruction in a small group or individualized at least twice per week on a year round basis. She recommended speech and language services to work on Ryan’s syntactic and higher level language deficits.  Finally, Dr. Castelo recommended that Ryan receive special education support services within the general education classroom. (Exhibit P-6)

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