HomeMy WebLinkAbout03-29-12- -~`~
: IN THE COURT OF COMMON PLEAS OF r a 'f ~~~`
IN RE: A -~,
~~~ ~~
:CUMBERLAND COUNTY, PENNSYLVANIA~~~-t: n} ~ _
-,~
JEFFREY DAVID SWEET, Jr., ~ -~~ '~
An alleged incapacitated person :ORPHANS' COURT DIVISION `,~ t~;<::~-~ ~' , ~.r}
;_- .,
PETITION FOR THE APPOINTMENT OF
EMERGENCY PLENARY GUARDIAN OF THE PERSON AND ESTATE
IN ACCORDANCE WITH 20 P.S. 5513 AND FOR PERMANENT PLENARY
GUARDIAN OF THE PERSON AND ESTATE
PURSUANT TO 20 P.S. §5511
AND NOW COMES THE PETITIONER, Cindy L. Villanella, Esquire, who represents and
avers as follows:
1. The Petitioner is Cindy L. Villanella, Esq., Guardian ad Litem for Jeffrey David Sweet, with
its office located at 44 South Hanover Street, Carlisle, Cumberland County, Pennsylvania.
2. The alleged incapacitated person is Jeffrey David Sweet, Jr., age 19, a dependent
individual (CP-21-DP-138-2008) who is currently residing with Donna Fahnestock and her
husband in Newville, Cumberland County, Pennsylvania.
3. The known relatives of the alleged incapacitated person are:
a. Kelli Sweet, adoptive mother
b. David Sweet, adoptive father
c. Robin Burge, biological mother
4, The Petitioner is not related to Jeffrey Sweet.
5. The Petitioner's interest is that of a Guardian ad Litem concerned with Jeffrey Sweet's
welfare and is familiar with his case.
~, __~_,
IN RE: IN THE COURT OF COMMON PLEAS OF `~/0 `- '.~' ~_
CUMBERLAND COUNTY, PENNSYLVANIA' ~~~? ~~~~
JEFFREY DAVID SWEET, Jr., ~ ,. -~
An alleged incapacitated person :ORPHANS' COURT DIVISION `;} ~,-; --:~
. NO. 21-12-~ ~~~ ~~, ~ ;, =~;
Y
G
PETITION FOR THE APPOINTMENT OF
EMERGENCY PLENARY GUARDIAN OF THE PERSON AND ESTATE
IN ACCORDANCE WITH 20 P.S. §5513 AND FOR PERMANENT PLENARY
GUARDIAN OF THE PERSON AND ESTATE
PURSUANT TO 20 P.S. §5511
AND NOW COMES THE PETITIONER, Cindy L. Villanella, Esquire, who represents and
avers as follows:
1. The Petitioner is Cindy L. Villanella, Esq., Guardian ad Litem for Jeffrey David Sweet, with
its office located at 44 South Hanover Street, Carlisle, Cumberland County, Pennsylvania.
2. The alleged incapacitated person is Jeffrey David Sweet, Jr., age 19, a dependent
individual (CP-21-DP-138-2008) who is currently residing with Donna Fahnestock and her
husband in Newville, Cumberland County, Pennsylvania.
3
4.
5.
The known relatives of the alleged incapacitated person are:
a. Kelli Sweet, adoptive mother
b. David Sweet, adoptive father
c. Robin Burge, biological mother
The Petitioner is not related to Jeffrey Sweet.
The Petitioner's interest is that of a Guardian ad Litem concerned with Jeffrey Sweet's
welfare and is familiar with his case.
6. Jeffrey Sweet was adjudicated dependent at age 15 on June 26, 2008, after coming into
CCC&YS's care and custody on June 19, 2008. Jeffrey Sweet was due to be discharged shortly
from a partial hospitalization (following a Meadows inpatient stay for suicide threats) with a
recommendation for placement in a residential treatment facility. His adoptive parents stated
they were fearful of Jeffrey Sweet and unable to have him in their home due to his behaviors.
Jeffrey Sweet also stated that he did not want to return home.
7. The following timeline of placements since June 2008 is provided:
a. August 18, 2008 Foundations Behavioral Health Residential Treatment Facility,
b. August 6, 2009 United Methodist Group Home for Children,
c. April 1, 2010 Abraxas Youth Shelter,
d. July 30, 2010 KidsPeace Residential Treatment Facility,
e. June 7, 2011 Community Residential Rehabilitation Host Home,
f. July 15, 2011 Ran to Huntingdon County to biological mother's home,
g. July 15, 2011 Abraxas Youth Shelter
h. July 18, 2011 Care and custody to biological mother to remain dependent for 60
days,
i. August 24, 2011 Return to CCC&YS custody, Children's Aid Society Shelter,
j. October 13 -November 3, 2011 Neuropsychological Evaluation,
k. November 2, 2011 Youth wants to leave CCC&YS custody, maintained at CAS until
discharge plan approved,
I. November 25, 2011 Ran from Children's Aid Society Shelter,
m. November 28, 2011 Abraxas Youth Shelter; and
n. February 15, 2012 Discharged from care and custody of Cumberland County Children
and Youth Services. Began living at Carlisle Cares Shelter on or around this date.
8. On November 9, 2011, CCC&YS received the Report of Neuropsychological Evaluation
from Thomas G. Bowers, Ph.D. of Family Development Services, P.C. It concludes, inter alia,
"He does not demonstrate an adequate capacity to manage funds in his own best interest at
this time; nor does Jeffrey demonstrate the capacity to independently manage contracts and
make other important decisions. This examiner would certainly encourage the appointment of
a payee or guardian to assist him in managing these difficulties." Report of Neuropsychological
Evaluation is attached hereto and incorporated herein is "Exhibit A."
9. David Sweet and Kelli Sweet, his adoptive parents are not in a position to assist Jeffrey
Sweet in any way.
10. Robin Burge, his biological mother is not in a position to act as Guardian due to her own
mental health issues.
11. Thomas Bowers, Ph.D., has determined that Jeffrey Sweet is incapacitated but he is
refusing the services of MH/IDD and Maranatha.
12. Jeffrey Sweet's mental incapacity prevents him from managing and caring for the affairs
of his person and estate.
13. The Petitioner believes and, therefore, avers that Jeffrey Sweet's SSI income is
approximately $609.00 a month.
14. Petitioner requests that Cumberland County IDD agency be appointed Emergency
Plenary Guardian of the Person and Estate of Jeffrey Sweet and subsequently be appointed
Permanent Plenary Guardian of his Person and Estate.
15. The proposed Guardian has no interest which is adverse to the interest of Jeffrey Sweet.
16. Petitioner believes, and, therefore avers that Jeffrey Sweet does not already have a
Guardian.
17. Petitioner asserts that Jeffrey Sweet is incapacitated as defined in Chapter 55 of the
Probate Estates and Fiduciaries Code.
18. Because of his impaired mental and physical condition, Jeffrey Sweet lacks the capacity
to provide for his own personal care and maintenance.
19. Because of his impaired mental and physical condition, Jeffrey Sweet is unable to
manage his financial affairs, property and business and is unable to make and communicate
responsible decisions relating thereto.
20. To Petitioner's knowledge, no previous application has been made for the order herein
requested or for a similar order.
21. No other Court has ever assumed jurisdiction in any proceeding to determine the
capacity of Jeffrey Sweet.
22. Petitioner avers that Jeffrey Sweet may have insufficient assets which would enable him
to pay for professional services rendered by a Guardian of his Person and Estate.
23. Since Jeffrey Sweet has insufficient assets to pay for Guardianship services, then the
guardian could seek payment under the Medical Assistance Regulations.
24. Medical Assistance regulations as set forth in Nursing Care Handbook instructions allow
for the payment of Guardian fees as a deduction when determining contribution toward cost of
care.
25. The amount of the Guardian's fee that is allowable as a deduction is the actual fee paid
subject to a maximum of 10% of the person's gross monthly income or $100.00 per month,
whichever is less.
26. Petitioner believes and, therefore, avers that it would be entitled to receive payment of
a Guardianship fee as allowed by Medical Assistance regulations and that said fee be a
deduction toward the cost of the care of Jeffrey Sweet.
WHEREFORE, the Petitioner respectfully requests that:
1. The Court appoint the Cumberland County Office of MH/IDD, as Emergency
Plenary Guardian of the Person and Estate of Jeffrey Sweet pending a final hearing on this
Petition with such Emergency Guardian having full power to place Jeffrey Sweet into a suitable
group home or residence deemed appropriate and such other powers and restrictions the
Court deems proper;
2. Pursuant to 20 Pa.C.S.A. §5513, the Court find that the emergency necessitating
the filing of this Petition will continue beyond seventy-two (72) hours from the date of any
Emergency Order;
3. Pursuant to 20 Pa.C.S.A. §5513, the Court schedule a final hearing on or within 23
days from the date of any Emergency Order;
4. The Court appoint the Cumberland County Office of MH/IDD as Permanent
Plenary Guardian of the Person and Estate of Jeffrey Sweet; and
5. Guardian shall be entitled to a maximum of 10% of Jeffrey Sweet's gross monthly
income or $100.00 per month, whichever is less.
Respectfully Subm
Cin Vill e a, Esquire
Gu rdia Litem
44 South Hanover Street
Carlisle, Pennsylvania 17013
(717) 243-9190
ID# 202325
'Jove ^ 1 05:37p Family Deve~~nment Servic
~7-909-1288 p.~
Family Development Services, P.C.
56 Erford Road, Camp Hill, Pennsylvania 17011-2395 • Telephone (717) 901-9280 • Fax (717) 909-]288
famdevservQcomcast.net
CONFIDENTIAL REPORT
OF NEUROPSYCHOLOGiCAL EVALUATION
Name: ~ Jeffrey D. Swf:et, Jr.
Dates of Evaluation_ 10/13/2011 and l l /03!201 ]
Date of Birth: 09/11/1492
Age at evaluation: ~ 9 years
Examiner: Thotnas G. Bowers, Ph.D. and Matthew Taylor, Graduate Intem
Place of Evaluation:: Family Development Services, P.C.
Referred by: Children and Youth Services'
. Cumberland and Perry County MH/MR and Early Intervention Programs
Reason for referral:: Assist for cognitive capabilities and assist in planning for future services.
In addition, assess far capacity and ability to manage independent living
- CONFIDENTIAL -
I. HISTORY AND BACKGROUND
Young'VIr. Sweet has long been involved with Franklin County Children -and Youth Services.
There was an extensive history of problems with his biological mother due to reported
alcoholism. There .also may have been a previous diagnosis for young Jeffrey's mother for
psychiatric disorders. ]effrey was initially adopted around age five or six. However, this
adoption did not work out well given multiple threats Jeffery was alleged to have made coupled.
with tlae fact that knives were found under Jeffrey's mattress. There were several other
placement attempts that apparently did not work out weU either.
As extensive historical information is available from previous placements. This history will only
be briefly summarised here. In general, several placements were attempted for Jeffrey--none
which seemed to work very well, .There was an initial contact cut-off from his adoptive fanvly.
Jeffxey is said to have had two youngez siblings in his family. His biological father has
Nov 09 11 05:38p Family Devement Servic X17-909-1288 p.4
s
SWEET, JEFFREY ~. 2
apparently not been tin the picture throughout Jeffrey's history. His biological mother is said to
have required in-patient hospitalization stays.
There has been at least two previous placements in residential treatment. 3effrey currently is
involved with Childen's Aid Society. He had attempted to stay with his mother in August of this
year, but that effort §ounded as if it did not work very well. There have been reports of self-harm
behavior, as well as considerable expressions of. anger and aggression. There have been prior
foster home efforts as well. Despite these many difficulties however, Jeffrey appazentiy has not
had any significant legal history to tins date.
The caseworkers foF Jeffrey have indicated that they feel they need to better understand how
young Mr. Sweet processes information. There was also some question if Jeffrey may require
group home placement, and hence, it was hoped that they might be able to find the best possible
placement with staff who could best meet his needs. Concerns were expressed about the
possibility of Jeffrey demonstrating signs of fetal alcohol spectrum syndrome given the reports
that his mother was an alcoholic and there was even reason to believe she may have been
drinking during her pregnancy.
Jeffrey was described as having many behavioral difficulties, as might be expected. There was
said to be problemstrusting adults, blaming others, and notes of self-harm behavior. He was
described as argumentative, having difficulty w7th problem-solving skills, and difficulty with
social interactions. ~I1S relationships are said to be difficult and he is described as impulsive and
easily frustrated. Previous intellectual testing uadicated a relatively low IQ, at 66. He was
receiving Risperidone 30 mg, Trazodone 50 mg, Abilify 30 mg, and Lithium Carbonate 300 mg,
two times daily.
II. TESTS ADA~IINISTERED
SA~echsler Adult Intelligence Scale - N (WAIS - N} (Previous Administration)
Wechsler Memory Scale -- N _{WMS -- IV)
Woodcock T.ohnson Tests of Achievement -- III (WJAT -- III}
Halstead-Reitan Neuropsychological Batten
Aphasia Screening Test
Sensjory Perceptual Examination
Trams A and B
.Category Test (computer version)
Speech Sounds Perception Test
Seashore Rhythm Test
Finer Tapping Test
Grooved Pegboard
Grid Strength
Tactual Performance Test {TPT)
Behavior Assessment Rating Scale for Children-II (BASC-II)
Nov 09 11 05:38p Family Deve~ment Servic
i
• ~
~7-909-1288 p.5
SWEET, JEFFREY~D.
E
III. EVALUAT)~ON BENEFITS
Intellectual Functioning
There were previou~ and relatively recent intellectual evaluations performed, which were said to
be a valid indication; of his level of functioning. The initial indications were that these
evaluations were pe}formed in April of this year. However, review of these records indicated the
results were actuall}i obtained April 7, 2010. Nevertheless, again, these appeared to be an
accurate indication ~f Jeffrey's overall level of functioning.
Jeffrey's intellectual abilities were in the extremely low range with aFull-Scale 1Q of 66, at the
l~' percentile rank. However, he did demonstrate notably better verbal and perceptual reasoning
scores, although stir in a relatively low range, at about the 4~' percentile. His Verbal
Comprehension Index was 74 at the 4~'' percentile rank. His Perceptual Reasoning Index was 73,
also at the 4`~ percentile rank. Both of these scores are in the borderline range. His working
memory abilities were quite weak at 69, uThich is at the 2nd percentile rank and in the extremely
low range. His proclessing speed abilities were also quite weak at 68, again at the 2nd percentile
rank and in the extremely low range.
In general, Jeffrey's~pattern of intellectual skills and abilities did not demonstrate much in the
way of significant ~~nation. He did not differ on any of his demonstrated index scores. He did
demonstrate a significant strength on the, Visual Puzzles subtest, suggesting his best abilities may
be in visual and perceptual reasoning processing with relatively little motor requirements.
Overall, however, ifi was most noteworthy that his intellectual capacity was at a very low level.
E
The results of previous evaluations also indicated very significant decrements, in terms o
adaptive skills and behaviors. Mr. Sweet's overall capacity to demonstrate adaptive and
independent living Skills were quite limited.
Memory
Jeffre}r was also ass6essed on his memory abilities by administration of the Wechsler Memory
Scale-IV (WMS-IV). His memory abilities vt~ere notably better than his demonstrated levels of
intellect, and his abilities were globally low-average and possibly even average in some domains.
This was actually notably better than his demonstrated level of intellect. His Auditory• Memory
Index was 93, whic~- was at the 32'a percentile rank and in the average range. This was relatively
adequate overall memory capacity. However, his Visual Memory Index was ?3, which was at the
4"' percentile rank and in the borderline range_ This latter memory score was almost exactly
what would be predicted on the basis of his demonstrated level of intellect. His immediate
memory score was 80 which was at the 9'b percentile, in the low-average range. Jeffrey's
Delayed Memory Index was $1 at the 10~ percentile rank, and in the low-average range. In
general, Jeffrey appeared to demonstrate much better auditory memory abilities, rather than
Nov 09 11 05:38p Family Dsve~ment Servic
7-909-1288 p.6
SWEET, JEFFREY D. 4
visual memory abilities. His delayed memory abilities, while not strong, were also not
appreciably weak relative towards his apparent overall level of memory abilities.
Academic Achieverinent
Jeffrey was screened on the basis of his academic abilities by administration of the Woodcock-
Johnson-III Tests ofAchievement. His abilities here were very low, in terms of mathematics
operations, but roughly low-average in terms of his basic reading skills. His mathematics skills
were quite weak, only between the 19' and the 3'd percentiles. His reading skills were roughly
consistent with.his dverall intellect, but again, it needs to be noted that his cognitive capabilities
have been compromised as well. His abilities here were below levels required for minimal
functional literacy.
Jeffre~r's pattern of abilities here were:
Woodcock-Johnson, !1! Normative Update Tests ofAchievement (Form A)
WJ Ill NU Compuscore and Profiles Program, Version 3.0
Norms based on age 19-1
CLUSTERlTest AE Proficiency RPI SS (90% Bandl PR
MATH CALL SKILLS 9-8 limited 2 ~,,/9C~ 61 {59-67) 0.5
Letter-Word Identification II-5 viimitedlE/90 81 {77-86) 11
Reading Fluency 12-2 limited 42/~o s2 {77-87) 11
Calculation 10-2 vlimited22/90 72 163-&G) 3
Math Fluency ~ 8-7 limited 37/90 50 (52-6G) 0.2
Symptom Validity effort Testing
As might be expected, young Jeffrey was relatively highly motivated for this evaluation and
hence, there was really little in the way of any indications or hints of any significant problems or
compromise for him along these dimensions. His performance on the Victoria Symptom Validity
Test was quite unremarkable. He managed 47 of 48 possible correct responses. 'Phis of course
was quite an exemplary pattern and not at alt indicative of any pariern of difficulties. It was
noted his response ]aiencies were very long; in fact quite longer than any of the comparison
condition. This may reflect notable problems in terms of the processing speed that he
demonstrated, as well as a fairly lengthy approach overall toward this type of tasi~ Embedded
measures of overallE symptom validity were unremarkable and again there was no reason to be
concerned about young Mr. Sweet emphasizing or exaggerating his difficulties.
Nov 09 11 05:39p Family Development Senric ~7-909-1288 p.7
• ~~
i
SWEET. JEFFREY D. 5
Neuropsychological Assessment
His overall pattern of neuropsychological test performance indicated globally distributed
cognitive compromise, with considerable indications of compromise to frontal region mediated
brain behavioral relationships.
Aphasia screening. Jeffrey had quite a bit of difficulty even on simple and relativel}~
undemanding aspects of basic screening. There were notable frequent signs of agraphia. There
appeared to be constructional dyspraxia and he had difficulty managing reproduction of even
fairly simple figure. His ability to demonstrate even fairly rudimentary visuallmotor
coordination seemed to be quite Limited. There also appeared to be acalculia, as well as left-right
confusion and bodyagnosia as well.
Sensory perceptual examination. Jeffrey's overall sensory perceptual abilities were not grossly
impaired, yet he demonstrated more errors along these dimensions than might otherwise be
expected. He actually managed simple unilateral and bilateral tactile stimulation without any
difficulties. He hadno difficulty with unilateral and bilateral auditory' stimulation. His visual
fields appeared to b~ intact, at least on this evaluation. He did have quite a bit of difficulty with
tactile forger recogryition, making five right-handed and five left-handed errors. Somewfiat
remarkably, he did Better on the usually more demanding fingertip number-writing perception,
making only a singly right-handed and two left-handed errors. Overall, however, this pattern of
results does suggest~impaired sensory perceptual functioning relative towards expectations.
Executive fimclioning. Jeffrey was evaluated on several domains that are sensitive towards
executive functioning processing. He demonstrated quite a bit of difficulty in virtually all
domains, although somewhat remarkably managed relatively good performance when visual-
motor requirernents~were posed for him. However, he.had at least mild but still significant
difficulty on the Ca~egory Test, making 61 total errors {SS=7*). This task requires problem-
solving, hypothesis besting, the ability to demonstrate flexibility, ability to learn from errors, and
so on. Jeffrey had at least mild difficulfies on this task. He v<<as also administered the Wisconsin
Card Sorting Test, which requires a person to learn how to respond to a categorical sorting task.
Jeffrey had quite a bit of difficulty with this task. He only completed three total categories, while
completing six categories would be more typical. He also made 33 perceptive errors, somewhat
higher than would generally be expected. His performance on both of these tasks appeared to be
impaired. Somer~vhat remarkably, he managed quite rapid performance on Trails B, completing
the task in 46 seconiis which was actually quite a bit above-average (SS=13). On this partiGUlar
task, he appeared to manage average or even above-average performance.
l~sual motor functioning. Jeffrey's overall capacity, in terms of visual and motor functioning
analysis did not appear to demonstrate severe difficulty, somewhat remarkably. He certainly did
demonstrate quite x bit of constructional dyspraxia and quite a bit of difficulty with reproduction
of even simple geometric figures. However, he managed simple, non-demanding, visual-motor
tasks and requirements'without much difficulty. It was later noted that his motor abilities were
I
,Nov 09 1 i 05:39p Family Devel~ ent Servic ~7-909-1288 p.8
SWEET, JEFFREY p.
6
quite good and this shay account for his strengths in this dimension. His performance on Trails A
was easily average and his performance on Trails B, as noted earlier, was also quite good.
Sirriple motor speed rrnd strength. Jeffrey's overall motor skills and abilities were quite adequate.
His finger-tapping speed with his right-dominant hand was adequate at 45 taps per period,
although this was slightly below average. His finger-tapping speed with his non-dominant hand
was solidly average at 46 taps per period, which again was almost exactly average. His
performance on the grip strength task was quite good. He had a very strong grip strength r~nth
his right-dominant hand at 71.5 kg, well above average. His left, non-dominant hand was also
quite strong at 69 kg.
Jeffrey had quite a bit of difficulty demonstrating fine motor speed and coordination, however_
On the grooved pegboard task his performance was excessively slow, with both his dominant and
non-dominant hand.; He was observed to speak to the examiner on that task, and his distraction
there may urell have; slowed his already-compromised performance. He managed the task in 120
seconds with his right hand and 124 seconds with his left hand.
Receptive and Expressive Auditosy Analysis. Jeffrey's receptive auditory abilities appeared to be
only mildly weak. I~is performance on the Speech-Sounds Perception Test was average.
However, he had more difficulty vt~th the Seashore Rhythm Test. managing only 23 out of 30
correct responses at only (SS=6'~}. This latter task requires considerable efforts with attention
and. concentration; a~ well as receptive auditory analysis. His expressive speech production ~-as
marked by only a fairly modest dysarthric error, and hence, was not felt to be excessively
problematic.
Sensory perceptual~unctioning. Jeffrey's overall performance on tests that depend on his
demonstration of tactile and kinesthetic abilities demonstrated adequate performance with his
right-dominant hand, but mildly slower abilities w7th his left non-dominant hand. In contrast; he
managed a solidly average performance when allowed to use both hands. Overall, his pattern of
performance along these lines on the Tactile Performance Task (TPT) was adequate at .64
minutes per block, (SS=8). His memory score was mildly weak at 6, although his localization
score of 3 scored asaverage in Heaton norms. Other normative analysis, however, would
consider this to be a problematic demonstration of abilities. Yet overall, it appeared most likely
that Jeffrey's abilities were reflective of some mild non-dominant hemisphere compromise, in
terms of speed and productivity here, but in the face of adequate overall .sensory perceptual
analysis.
Personality and te,riperament. It was apparent that young Jeffrey would be unable to read and
process material at a level to allow administration of a comprehensive personality inventory,
such as the MMPI-II or a similar instrument. As a result, his guardian and caseworker, Pamela
Gross, was requested to ftll out the Behavior Assessment System for Children II behavior rating
scale for young Jeffrey, in the hopes it might give some identification of his ~abiiities and
temperament., The overall pattern of ratings on the BASC-II suggested caution because there
was an F-Scale elevation. However, this examiner feels this may well reflect her role as a
Nov f1Q 11 05:40p Family Deve~ment Servic ~7-909-1288 p.9
SWEET, JEFFREY D. 7
caseworker and guardian rather than as a parent, and hence, there was probably still same utilit~•
to cautiously interpreting and analyzing this overall pattern of results.
Jeffrey's pattern of ratings. indicated a high elevation on externalizing problems-above the 99"'
percentile, an at-risle range elevation for internalizing problems. Behavior symptoms were also
quite elevated abova the 98`~ percentile level. The externalizing difficulties appeared to reflect
ratings indicating h}~peracti~~ity, aggression, and conduct problems. Of course, there was a long
history of reports and records suggesting difficulties along these dimensions. Somewhat
remarkably, there were limited indications of internalizing difficulties with no indications of
anxiety at all, and only a modest at-risk range of elevation for depression. Somatization ratings
were elevated, however. Elevations on atypicality and withdrawal were only in the at-risk range,
and v~lthdrawal scores, barely so. There were indications of elevations on attention problems,
however. Jeffrey's gverall adaptive skills were noted to be in the at-risk range, in terms of
adaptability, social skills, and leadership. Functional communication abilities were also rated
and quite lov+r-in fact, at about the 1S` percentile. Activities of daily living were rated at
approximately the 25`~ percentile; however, it also needs to be cautioned that more direct
behavioral analysis along these lines from the previous psychological assessment actually
indicated quite a few difficulties along these dimensions. His overall adaptive skills were rated
at the at-risk range, but in this case it corresponds to the 3rd percentile and hence, reflects quite a
bit of limitations. ,
IV. SUMMARY, DIAGNOSIS, RECONLI~IENDATIONS AND OUTLOOK
Jeffrey Sweet, a 19-.year-old male, was evaluated on his neuropsychological functioning in order
to assist v~Rth the planning of future services as he begins to develop as an adult. There was some
concern that Jeffreymay require group home placement and that he may demonstrate signs of
fetal alcohol spectrum difficulties. Young Jeffrey demonstrates many difficult behaviors and
there have been reports of occasional self-harming behavior, as well as aggressive and
argumentative.difficulties. He is said to have problems with poor problem-soh~ing skills and
difficulty 7th social interactions.. He is followed by psychiatry and being treated with
Risperidone, Trazodone, Abilify, and Lithium Carbonate.
In terms of his current functioning, Jeffrey's previous psychological evaluation indicated aFull-
Scale IQ of b6. His Verbal and Perceptual Reasoxung Index scores were somewhat better, in the
lo~n~ 70s, but Jeffreys also demonstrated very severe difficulties, in terms of demonstrating
adaptive skills and behaviors. On this evaluation he demonstrated low-average overall memory
capacity with an occasional hint of average levels of performance. His academic skills and
abilities were quite ~~eak-especialljr in mathematics, although his reading abilities were ranged
between limited. and very limited levels. His overall neuropsychological pattern of .results
indicated a sharp cgmpromise in executive processing abilities, problem solving, and other high
level types ofproce'ssing skills. Most of these skills are managed by integrated frontal-mediated
abilities. His overall motor abilities appeared to be only modestly weak in the non-dominant
hemisphere and sensory perceptual functioning appeared to be globally weak, bilaterally. His
Nov 09 11 05:40p Family Deve~ment Servic
SWEET, JEFFREY D.
~7-909-1288 p.10
performance on subtests that require his demonstrated adequate attention and concentration were
also compromised. Behavioral rating score results did suggest some caution in terms of
interpretation, yet much of the behavioral ratings were highly consistent with what has been
reported in Jeffrey's history and hence were felt to be globally adequate. The behavioral rating
patterns were remar$able, in that while they indicated problems with hyperactivity, aggression,
and conduct difficul><ies, they indicated atypicality and withdrawal only, to a lesser degree. In
addition, there was riot much in the way of indications of significant depxession and anxiety.
In general, this type of pattern results does suggest compromise, relatively globally distributing
and relatively prominently impacting on frontal-mediated executive processing skills and
abilities, as well as same compromise to sensory perceptual processing pattern and analysis.
Moreover, there app~azs to be a pattern suggestive of quite a bit of emotional behavioral
dysregulation, with difficulty managing attention, impulsiveness, and similar difficulties. This
type of pattern may ~e seen with exposure to tezatogens, but there also is not a definite history
noting the growth, cognitive and facial dysmorphia needed for a definite diagnosis of such an
effect. in contrast, there appears to be little sign of affective difficulties, at least at this juncture
on this particular evaluation.
In summary, in drag~osiic terms, Jeffrey demonstrates the following:
Axis l: Cognitive Disorder, NOS
Conduct Disorder
Impulse Control Disorder NOS
Axis II: Mild mental retazdation
Axis III: ~ Deferred to medical evaluation
Axis IV: Limited adaptive skills. housing problems, difficulty managing
independent living
,Axis V: GAF 3 S
young Mr. Sweet certainly brings a complicated and very severe pattern of difficulties to bear.
He has apparently lied problems with physical aggression in the past, and he has received quite a
bit of treatment for Elepression, suicidal thoughts, as well as some behavioral problems.
It is felt this pattern; and description of difficulties is relatively conservative, as young
Mr. Sweet has had psychiatric treatment and followed in the past for a range of behavioral and
psychiatric difficulties. This examiner would certainly recommend this type of treatment to
continue. Mr. Sweet has had a course of treatment in two residential treatment facilities in the
past. At this time, lie does demonstrate a pattern of difficulty that is severe enough to sharply
compromise his abilitti• to demonstrate independent adaptive skills and behavior, significant
,Nov 09 11 05:40 Family Devel~ ent Servic
.,
7-909-1288 p.11
SWEET, JEFFREYb. 9
functional living skids, and even impo~~erished abilities in terms ofproblem-solving and decision
making,
This examiner would certainly encourage the consideration of a group home placement,
particularly with some significant therapeutic support services. This type of setting would be
able to provide fundamental basic needs. such as shelter, housing, food and soon, while at least
providing the opportunity for the development of adaptive skills and increased self-regulation of
behavior. At times, it does appear that Mr. Sweet may well require placement in residential or in-
patient treatment facilifies. It is possible, though, over a period of time, he may manage to se[f-
regulate in a better fashion.
The outlook for young Mr. Sweet is very uncertain. He may well experience considerable
involvement and conflict with authority figures from time to time. I-3e does not demonstrate an
adequate capacity to manage funds in his own best interest at this time; nor does Jeffrey
demonstrate the capacit)~ to independently manage contracts and make other important decisions.
This examiner would certainly encourage the appointment of a payee or guardian to assist him tun
managing these difficulties.
Thomas G. Bowers, Ph.D.
Clinical Psychologist
TGBimalv7mbl 10811