Gifted Issues Discussion homepage Forums Identification, Testing & Assessment Conflicting test results, 3 year gap

Hi folks,

A few years back DD (then 5) was tested by her school using the WPPSI III, in order to see if she qualified for their enrichment program. At the time I was worried about the gap between her manipulation/fluid reasoning (125) and her processing speed (87).

Skip forward a few years and DD (now nearly 8) has just done testing for ADHD that included WISC V. This time her processing speed is higher (126) and working memory and fluid reasoning are lower (91 and 100).

Anyone have any idea what's going on? Can these things flip around like that?

I'm really surprised that her results came back neither gifted nor ADHD because I've been pretty sure since she was a toddler that she was both. But mostly I'm confused about where to go next because I'm very sure that DD has some kind of divergence going on, whether it's ADHD or something else, that her teachers don't see because they don't work with her on a micro-level and see how her thought process works (which is very strange, very often).

Fwiw, both tests were given in the school language, which is much weaker than her home language, but the teacher said she made sure that DD understood the instructions.

Anyhow. If anyone has any thoughts on the big gaps and the strange reversal in strengths and weaknesses please let me know!

If you recall from our discussion a few years back, there were a lot of question marks then about what within-child attributes actually contributed to her performance. So the rise in processing speed is not necessarily that mysterious, especially given her age and testing behavior at the time.

On the decline in index scores, while not something I would dismiss out of hand, it may have some reasonable explanations. Firstly, this isn't the same test, and it has a different structure (despite the intentional similarity in labels). You point out two index scores that appear lower than expected.

1. We'll take the easier one first. Working memory was not assessed at all on the WPPSI-III, so this is a new domain altogether, with no possible indication of change.

2. Fluid reasoning's closest analog on the WPPSI is indeed the PIQ. However, the actual overlap in tasks between the PIQ and the FRI consists of a single untimed task. One of the other tasks now resides in the VSI (which you did not report on). The third task is now a supplemental subtest, and contributes only to ancillary index scores, which aren't typically obtained. not in the version of the test current in your country.

We didn't discuss her subtest scores back a few years, so I don't know if the change in scores in question is actually as great a change at the level of the individual tasks (rather, the one individual task). I'll also note that one of the subtests that was on the PIQ and is now in the VSI is timed, with bonus points for speed, so if your DD turned on the jets for that task (especially at the level she currently demonstrates), the high score on the PIQ could have been partly or mostly explained by that subtest.

If you have access to the subtests from past and present testing, we might be able to tease out some other possible hypotheses.

As far as the suspicion of ADHD goes, it might be worth thinking about what happens if you are a young person who acts quickly, at a pace, or after intervals, that in other people might constitute impulsivity, but in your case, are just because that's your natural speed. And if, perhaps, you also have some perceptual-motor strengths, which naturally incline you to engage in more motor activity, and possibly to have a more nonlinear problem-solving style.

BTW, did you see any change on the VCI vs VIQ? After nearly three years of instruction, you might expect a slightly more accurate representation of verbal cognition in the second language.

Hi aeh, thanks as always for your detailed reply!

I don't have a copy of the first test so I can't compare subtests, but her verbal scores haven't changed much. She got 104 on the WPPSI and 111 on the WISC V. I don't know much about how the verbal tests work but I know that over the last 3 years her grammar has improved more than her vocab. There are still lots of common nouns and verbs in Spanish that other kids would hear around the house, from their family, etc that DD doesn't know. She knows 'school Spanish'. She can use what she knows well, but if she hasn't heard it at school then she hasn't heard it.

I'm happy to share the subtest results of this most recent test, if you think it would be helpful.

They also did 7 other tests, many of which tested overlapping executive function skills, but the results look very strange/inconsistent to me, eg her ENFEN (executive functioning) subtest results ranged from 4/10 to 10/10, and she scored poorly on impulsivity. But her MFF20 (reflexivity and impulsivity) results were great for impulsivity (bottom 2%) but poor for inefficiency. Then her CARAS-R test results said she had great sustained attention (top 1%) but her CSAT-R results said she had terrible sustained attention. Happy to share the subtests from those test too, if you think it will help.

I really don't know what's going on. It's all over the shop.

Thank you for the welcome back!

I'm not super confident in the school psych. Her specialty is emotional health, family counselling, etc. She does a lot of stuff in school with the kids around meditation, recognising and naming feelings, emotional regulation, etc., etc. I don't think she has much experience in 2e.

Here are the WISC V subscores (I'm translating poorly from Spanish - sorry!). It's really a mess

COMPREHENSION VERBAL
Test Points Scaled Percentile
Similarities 23 11 63
Vocabulary 25 13 84
Information 14 11 63
Comprehension 23 15 95

VISUAL-SPACIAL
Test Points Scaled Percentile
Cubes 22 11 63
Visual Puzzles 14 12 75

FLUID REASONING
Test Points Scaled Percentile
Matrices 14 10 50
Balances 15 10 50
Arithmetic 11 8 25

WORKING MEMORY
Test Points Scaled Percentile
Digits 21 11 63
Drawing Span 13 6 9
Letters and 14 10 50
Numbers

PROCESSING SPEED
Test Points Scaled Percentile
Codes 61 16 98
Symbol Search 34 13 84
Cancellation 69 14 91

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.

Oh my goodness, aeh you are worth your weight in gold!! Thank you so much!!

They did a REY test with DD too. I don't think we can add images here, but her results were (translated from google):

"Copy: PD = 26.5 / PC = 99. Execution time = 8 '14 ”/ PD = 25. The quality of the line is good and the overall figure is well recognized, however, we can find some represented form of imprecise and unstructured form. Initially, in the execution of the test, she begins by focusing more on the overall shape of the figure and then on the details that form it.

Memory: PD = 25.5 / PC = 99. Execution time = 3 ’38” / PD = 99. The memory reproduction is quite organized, initially focusing on the global part of the figure to later perform the details. However, some forms are absent and others that are present are performed imprecisely.

In both cases, she obtains a score that places her within the normal range of her age, so there is no difficulty in perceiving and organizing the data to be fixed both in the copy and in the memory.

However, the runtime of the copy is somewhat longer than usual for her age group."

A few things pop into my head about her visual working memory problems:

* I have aphantasia (zero mental imagery). I've asked DD before how how the pictures in her head look, trying to establish if she is an aphant too, but her answers sounded like she had no problem forming mental images. Still, it's odd that we both have issues with the visual side of things.

* How does she always beat us at visual memory games? I mean the type where you have to flip a card/disc, remember the picture and location. Could it be that she processes the card locations quickly to her mid/long term memory, so she doesn't need to use her visual working memory much?

* Would her low visual working memory explain why she hates reading (and hated being read to, as a baby)? Also, DD does a bit of acting and she's actually really good at memorising lines (we read them out loud together, following the script). Would this be a similar thing, ie she's just processing them quickly into her long term memory and skipping over her working memory?

* Could ADHD medication help her access that part of the brain? Or am I better finding games/activities to try to strengthen her visual working memory? Or just find compensation techniques and then focus on playing to her strengths?

* What sort of specialist should I look for to follow up, seeing as the school wants to just 'wait and watch', which doesn't sounds like a great plan to me if DD has a LD.

Can I just say again how incredibly grateful I am, aeh? Really, you are so generous with your time and knowledge. You're amazing

I'm going to have to go back now and find all your threads, and read up on how visual development effects all this stuff! What are some of the things you did for your child that you would recommend I look into?

Sorry, I missed this before. No, outside of the EF tests her teacher didn't mention anything about DD's response times.

Sorry, I keep thinking of more things. If she has such low visual working memory then I wonder how much it impacted subtests like the cubes and puzzles. I mean, if she can't hold an image in her head for even a fraction of a second, she's not going to be able to mentally manipulate an image to solve a question. Likewise the matrixe and balances would have been tricky.

I think her fluid reasoning and problem solving is actually pretty good, eg when she was 4 she was able to navigate us between 2 places a few km apart (a shop and a park), that she'd never directly walked between before, based on where those places were in relation to 'Granny's house'. To make sure she didn't miss anyone in her class when making Valentines cards she drew a seating chart and ticked off names/seats, and when her friends were fighting over who should sit next to who at lunch time she drew up a grid for days of the week, filled in who had which extra-curricular activities on what days at lunch time, who was left over, and how they should rotate seats so that everyone had equal time next to the friend they were fighting over.

Also it's funny she did poorly on the balances because at home she does algebra without much trouble. But maybe it's because she can use a pencil to write down her working, which means she doesn't have to hold it in her head?

Just thinking out loud...

Her artwork is great, her handwriting is average for sizing and neatness but I've noticed she makes odd mistakes on layout when copying text. Eg, doesn't leave a line between paragraphs, will write the headline and then directly next to it start writing the first line of text, etc. Once I pointed it out to her, she didn't make the same mistake again (she was writing out a previously typed assignment), but it's weird that she made it in the first place.

There's always been lots of little things like that where a normal kid would just infer/use common sense. Not just on handwriting, but on everything. When they first started doing comprehension at school I had to explain to her that she had to read the text first, before attempting to answer the questions. Then I had to explain to her that she couldn't make the answers up, she had to get the information from the text. Stuff you wouldn't usually have to explain. I had to explain to her that she should read the introduciton paragraph in her maths book before trying to do the questions, etc. The other day she had a test in class, matching landform names to their definitions/pictures. There were no explicit instructions. The first question had the word 'plateau' and then 4 multiple choice definitions, of which she had to tick one. She completed the question. The next quesiton the format changed. There was the word 'island' and the four pictures. She didn't know what to do. She couldn't use common sense/inference to understand that she was still supposed to be matching things. She knew all the content for this unit inside out, in Spanish and English, including spelling, etc. But without very explicit instructions she didn't know what to do. Once things are explained in painstaking detail to her, she usually outperforms her peers. Anyways, I've gone off on a tangent.

I'm not sure what match games are - you mean like card-flipping-matching memory games? She regularly beats us.

Hm. What you are describing sounds more and more like executive function weaknesses, which also fits the questioning about ADHD, in addition to the existing EF results on the ENFEN and CAS. Aspects of EF that these behaviors would align with:

1. planning & organization: odd mistakes on layout when copying text, as well as difficulty inferring directions.

2. cognitive shift: adjusting slowly to changes in format or task demands.

3. sequencing: not knowing where to start from or what she should do first. This could also be from weaknesses in another EF skill (initiation).

4. inhibition (which is the positive skill that is impaired when we talk about impulsivity): inconsistencies in performance, especially on multiple choice tasks.

5. probably a combination of EF skills, but likely resulting in impediments in cause and effect thinking, which often shows up in inferential reading comprehension.

Some of these would have impacts on visual working memory, which (of the kind we've been discussing) is sequential, but not on simultaneous visual spatial memory.

Along those last lines, I also wonder whether she is a simultaneous or gestalt thinker, rather than a sequential thinker. That might explain why she did so much better on visual spatial tasks when young (when the designs are much smaller, and don't require as much part analysis), and was only average a few years later (when you need some part-to-whole thinking to efficiently reproduce the designs). Note the Rey-O results describe her as starting from the big picture and trying to work her way down, but missing some detailed elements.

And yes, the behavior with card-flipping memory games and with scripts (as well as the Rey results) suggests that she is extremely efficient at transferring to long- or mid-term memory, which isn't necessarily reflective of any working memory issues that might exist. Retrieval, on the other hand, may not be as efficient for every method of accessing from long-term storage, which may result in inconsistencies in her ability to demonstrate learned knowledge and skills, such as those you report.

I wish we could do some more fine-grained item analysis, and see if her Matrix Reasoning performance was slanted toward errors in the sequential items or the gridded items. Or see how she does on some of the other cognitive tests, like the KABC-II or CAS, which explicitly assess simultaneous vs sequential thinking. I'd also be interested in more thorough assessment of her memory structure, such as through an instrument like the WRAML or CMS.

As far as skill-building: well, EF happens to be one of the cognitive skills that can be taught explicitly (perhaps because it's actually a relatively late-developing skill, so the window for brain plasticity is longer). Not so much through an overpriced "braintraining" computer program, but through everyday parenting and classroom strategies, modeled, explained, scaffolded, repeated, and reinforced over time. For example, she might do well with mind maps or graphic organizers to scaffold the organizational process for longer writing assignments. Or scripts and flow charts for specific problem solving algorithms or procedures. Or visual models for the first few times she does a new task-type (or format for written assignments, etc.). Or explicit instruction for strategies for getting unstuck, such as "backing up", asking oneself framing questions (e.g., "what am I trying to find out?" "what do I already know?"), turning the problem around (various ways of looking at a question from a different angle, sometimes literally, such as with math problems that have diagrams).

If you haven't seen it before, I'd highly recommend Peg Dawson's "Smart but Scattered." (US Amazon page: https://www.amazon.com/Smart-but-Scattered-Revolutionary-Executive/dp/1593854455/)

FWIW, my lowest-EF kiddo is now (after years of parental scaffolding) a very organized young adult, with sufficient self-regulation skills. Still not exceptionally strong sustained attention or working memory, but compensated by long-term memory and high conceptual thinking. DC has also learned that having to organize and understand information enough to teach it to someone else is what transforms new learning into permanence. Which also makes them a popular classmate!

Wow, aeh, this was a bit of a revelation for me. I had never heard of gestalt/simultaneous thinkers. I had to google it. But it makes a lot of sense. Some thoughts:

* I used to comment when she was little that she seemed to learn by osmosis. I never saw evidence of direct learning, and most times I tried to directly teach her something it failed. Somehow she just absorbed information and skills. Oh, and she literally never stopped moving (another reason I thought she had ADHD). She never seemed out of control though, it was just constant motion. If gestalt learners need to move when incorporating new information, then this would explain a lot.

* She's nearly 8 and still has trouble knowing what time of day it is, eg will ask me if it's the afternoon yet when it's clearly dark outside. Took her a very long time to learn to read a clock. Follows a learned process to solve time/clock questions in maths, but doesn't really 'get' it.

* Good with graphs, fractions (the visual kind not the 'a over b' kind), but still doesn't know addition and subtraction maths facts by heart and will use her fingers.

* Weak in lots of sequential-thinking skills but, thankfully, is good at learning processes. Follows processes to do long addition, subtraction, algebra, etc. Follows processes to get dressed in the morning, get ready for bed etc. Also really great at following a process to construct and arrange entire songs using loops and samples, (makes chorus first, then makes verse, then makes intro, middle 8, etc., then copies/arranges the sections and adds in 'ear candy', sound effects, etc.).

* Reads a book or watches a show/movie but cannot tell me what happened. Struggles a lot with explaining order of events, or even distinguishing between important information/events in a storyline vs random facts.

* Good at learning choreography. Sees a dance move that might have arms, legs, torso all doing different things at the same time, and can just DO it, without having to break it down constituent movements. Likewise, good at most sports without having to breakdown movements.

* Always moving and often doesn't look at me when I'm trying to explain something (and I'm guilty of always telling her to sit still and look at me - but I'll stop now!)

I think I have a lot more to google on this topic.

Very glad that if DD's oddities turn out to be the result of EF weaknesses and gestalt learning style, that she can be taught skills to deal with both.

Can I ask you for one more huge favour? If you had to make a list of things to investigate further based on what we've covered in this thread so far, what sort of order would you put things in?

Oh, I just thought of another thing. In high school, my husband was diasgnosed with what he calls 'lateralidad', which I haven't been able to find much about but sounds like something to do with brain function and lateralization. I don't know how much of this is genetic, but if gestalt thinking is about right brain dominance, maybe there's something like my husband's diagnosis going on with DD. Hubby, however, still tested PG despite his 'laterality'.

Mm. I think your DH's lateral-thinking profile does have relevance to your DC. And remember he was identified as an adolescent, by which point he had probably developed better strategies for maximizing his own profile.

As to next steps--well, there are multiple ways to prioritize these. I'd probably start with the possibilities that are the simplest to eliminate, such as some of the vision and convergence/tracking considerations that Portia raised, and then tackle more angles on executive function. Although it sounds like she already had one of the more available EF measures in your region. Maybe a little more thorough clinical explanation from the evaluator? I would also strongly consider having your DH sit down with DD (or maybe not sit still!--whatever way of spending time together is most conducive to open communication with or without words), and see if he can elicit or identify any insights into her thinking and learning process, and how she experiences the world. If they are actually more similar in this domain, some things may resonate or feel familiar for him that others might not perceive as readily.

Thanks a million aeh! I've learnt so much in this thread. Even though my head is swimming with all the new info I've smooshed into it in the last few days, I feel like I have a much better idea of the possible ways that DD's head works, and what directions to explore further. I'll be sure to let you know how we go!

Happy holidays and the best wishes for the new year!!