Fortunately, I know what the original English subtest names are. Though I did have to do a little digging to figure out the other neuropsych tests. =)

So the seemingly conflicting results on the ENFEN, MFF20, CARAS, and CSAT can be partially explained by the nature of the tests in question. The MFF20 appears to be used (more in Europe than in N America) as an EF test, although the original intent was not to identify pathology, but to distinguish the cognitive styles they labled impulsivity vs reflexivity, meaning quick-with-lower-accuracy vs slow-but-accurate. The CARAS-R is essentially a variant of the same type of task represented by Symbol Search or Cancellation, both of which she did quite nicely on. CSAT is the local translated adaptation of the CPT, which is one of the gold-standard computerized direct measures of sustained attention and impulsivity. Before even looking at results, I would tend to favor the CPT/CSAT if looking for data regarding ADHD. The ENFEN is local to your region, but appears to be a respectable EF measure similar to the DKEFS.

So a priori, I would tend to weight the ENFEN and CSAT results more than the others, as those two instruments were being used for the purpose for which they were designed. The other two are either being used differently than the original authors intended, or are very narrow measures whose interpretation can be based on a quality other than impulsivity/attention.

I think the CARAS-R results regarding sustained attention need to take into account the short period of sustained attention required (three minutes), and the examinee's documented strengths in processing speed. IOW, I think they were measuring her PSI rather than attention.

The MMF20 is believed to measure a different type of impulsivity than most other measures, which involves behaviors like looking over all of the possible responses prior to making a selection from multiple choices. The CPT looks at what's called Go-No Go impulsivity, where you either respond only when you see the target stimulus, or only when you see a certain short target sequence. Or some variation of this. Your description of her performance sounds like it took her a relatively long time to search through the field to find the response, but I'm not entirely clear what you mean by "high" on inefficiency. In any case, it's still two different kinds of impulsivity.

On the WISC-V, what I'm seeing is that her VCI is probably still being affected by language acquisition. Notice that her "common sense" verbal reasoning is in the Very High range (Comprehension), which doesn't rely quite as much on academic language or specific vocabulary. The index overall has risen a bit in the past few years, in this case from the Average to the High Average range, which is expected for a language learner. It will probably continue to rise for another couple of years.

Both VSI and FRI are pretty consistently Average, suggesting that this is a real result.

Likewise, auditory working memory (Digit Span and Letter/Number Sequencing) is consistently Average, and processing speed is pretty consistently Very High.

Visual working memory (Picture Span), on the other hand, is lower than any other task on the test, in the Very Low range. This shouldn't be affected by language, as the images are ordinary ones that, if she encoded them using language, are open to either or both language. No verbal response is required, actually. However, it does require looking across a field of possible matching response items, which includes distractors--which makes it the task on the WISC that is most like the MFF20 (except performed from memory).

If I were to put my speculations out there, I would look for confirmatory data on the presence of challenges in both sustained attention (CSAT) and impulsivity (ENFEN), as well as some possible visual working memory concerns, perhaps on an instrument like the Rey Complex Figure Test (RCFT) (preferably with the recognition trials) or the related variant Rey-Osterreith Complex Figure (Rey-O), which looks at both visual memory and visual organization. The combination of these three types of weaknesses could well explain the ADHD-like presentation.

And secondly, I would speculate that her area of strength may be closer to verbal than at first appeared (although we've known all along that it was likely underestimated).

Finally, a question about clinical commentary: did the evaluator say anything about impulsive or overly-quick responding on anything outside of the EF tests? Because that's another factor for a lower score on FRI: both of the core tasks are multiple choice, which, I think we're starting to see, doesn't always bring out her most accurate performance. (Arithmetic is not, but it's also aessentially an auditory working memory task, which may have capped her performance on that basis alone.) This would bring us back to the question of impulsivity and accurate visual scanning or memory.


...pronounced like the long vowel and first letter of the alphabet...