A new client is cоming tо yоur clinic for аn evаluаtion today (May 6, 2026). Their date of birth is June 30, 2009. What is the child’s chronological age? Write your answer with this format to receive credit for your answer: X years, Y months, Z days. Copy and paste the format into your response, just change the X, Y, and Z to the numbers you want. Here is the case for the exam, just in case it doesn't open in Honorlock: FINAL EXAM CASE: SERENA Serena is a 4th grade student who moved into this school district 2 weeks after the start of the 2nd quarter. Three weeks later, Ms. K referred Serena to the school’s RtI problem-solving team (PST) Ms. K completed the PST Referral Form (see below) and routed it to the school social worker who coordinated the problem-solving team. After the social worker received the referral, she invited the OT to come to Serena’s PST meeting. The social worker felt that the OT might have something to contribute to the case because she and the OT had collaborated before to support other students who struggled with making friends and turning assignments in on time. Initially, the PST suspected that Serena’s difficulties turning in homework assignments were a result of poor organizational skills and that her difficulties with making friends had to do with a limited ability to socialize with them in informal situations, but they determined that they needed more information before they could make recommendations to support Serena. Teacher Observations: Ms. K identified that Serena had strong oral reading skills compared to her peers and that when she was paying attention, she could orally answer comprehension questions. Serena was also able to do basic math computation in her head and was often the last student out in the math flash card game they played every Friday. Ms. K told the PST team that Serena had the most difficulty completing independent assignments in class and turning in her homework. The assignments that she did turn in were of poor quality (e.g., items missing, copying errors, difficult to read). Most often, however, Serena failed to turn in assignments at all; this included assignments that Ms. K had witnessed her working on and completing in class. She had repeatedly provided Serena with extra copies of worksheets and the number to the school’s homework hotline. Serena did not perform well on tests and had stated several times that she didn’t study because she was out late at her aunt’s house. Ms. K described Serena as a sweet, well-behaved, kind young lady who seemed to want to do well and was very willing to stay in during lunch recess to make up assignments she had lost. When asked about Serena’s difficulty making friends, Ms. K indicated that she thought there weren’t many opportunities for her to interact with other students. Serena often arrived a few minutes late to school, which meant that she missed playing with and talking to peers on the playground before the morning bell. Ms. K noted that often Serena would come to school with uncombed hair and seemed fidgety in the winter when she wore wool sweaters. It didn’t prevent her from participating in classes, but she just seemed uncomfortable. In the afternoon, Serena’s mother also often picked her up a few minutes before the dismissal bell. Ms. K moved Serena’s desk twice so that she would be able to sit with different groups of students in the effort to help her get to know her classmates better. Social Worker Observations: The social worker met with Serena’s mom Joy via phone, where she learned that Joy worked two jobs and that Serena spent many afternoons and evenings at her aunt’s house. While she was there, Serena was expected to complete her homework, help with cooking dinner, and clear the dishes. Serena also had the opportunity to play with her 2-year-old cousins, whom she adored. Joy was apologetic about the late drop-offs and early pickups. She reported that she often had to pick Serena up early so she could make the evening shift at the retail store where she worked. The evening shift ended at about 10:30 pm, when Serena was often asleep on the sofa. Once at home, Serena was expected to wash up, brush her teeth, put on her pajamas, and get her clothes ready for the next day. Serena sometimes had difficulty getting back to sleep and awoke sleepy most mornings. Joy described her morning routine as a quick dash out the door in an effort to get to school on time. To assess Serena’s social skills, the social worker arranged for Serena and 3 classmates to have lunch in her office. The other children all got along well but were anxious to finish quickly and get to the playground. Serena did not speak very much, but answered questions posed to her. She attentively listened to each of the other children talk, but did not know how to insert herself into the conversation. Afterward, the social worker asked Serena if she had a good time, and she looked at her feet instead of answering. The social worker’s impression was that Serena had some anxiety in social situations with her peers. OT Observations: The OT observed Serena for approximately 15 minutes on two separate occasions. The first observation included a math assignment where Serena had to copy even-numbered problems from her textbook onto notebook paper. She also had to complete the problems by showing how she arrived at her answers. The OT noted that, while her answers were usually correct, Serena completed the assignment at a very fast pace, which impacted the quality of her performance because she needed up skipping problems and forgetting to show her work several times. During the math assignment, Serena readily and consistently maintained focus and she used goal-directed task actions that were focused on completing the math assignment. Serena was not distracted by the chatter produced by other students and reluctantly answered one of her peer’s questions after being interrupted twice. Serena continued working on the assignment even after the teacher instructed the class to put it away and submit their math homework from the previous evening. When the teacher said it was time for the students to gather their lunch tickets from their desks and head to lunch. Serena quickly put her notebook paper and math book in her desk and began searching for her lunch ticket. Serena used a random pattern to search her desk – upper right quadrant, lower left quadrant, upper right quadrant, then lower right quadrant. While she was searching, other student began getting in line. Serena raised her hand and Ms. K came to help. Ms. K located the ticket under the math book in the upper left quadrant of the desk. Serena then lined up for lunch. During the 2nd observation, Serena was observed on the playground during lunch recess. The girls in her class were playing four square and group of students in 3rd grade were playing a jump rope game. Serena looked like she wanted to join but didn’t. When the recess monitor approached Serena about joining one of the groups, she shook her head and said, “What if I can’t do it?”. The OT spoke to the PE teacher about Serena’s participation in class. She reported that Serena was hesitant to participate, but ultimately did whatever she was asked. She felt that Serena was less coordinated than her peers, and sometimes did not know several of the games that the other children knew. Follow-Up Meeting Based on the above observations, the PST discussed that they needed a new working hypothesis to explain the reason behind Serena’s issues in the classroom to develop evidence-based recommendations to support her at school. The occupational therapist suggested that Serena’s performance may be affected by multiple factors including family routines, vision-related issues, anxiety, and some subtle sensory processing issues. She suggested completing an occupational therapy evaluation to determine the extent to which these areas might be interfering with her work at school.