Gifted Issues Discussion homepage Forums Twice Exceptional WISC-IV today- just starting to understand

I know there are some WISC-IV experts out there. DS9 just had testing today- we wanted to get a better picture of his academic strengths and struggles. The feedback from teachers (and general observation) has been that he is slow to complete classwork but highly capable. In 4th grade, we started to notice more frustration with any writing assignment- and makes frequent writing mistakes (though he usually immediately recognizes them and gets frustrated/ but fixes them). He is also HIGH energy, "wiggles to learn" and we've often wondered about ADHD/ ADD but teachers say they don't see it as a big problem.

I don't have the full report but curious what others think given the info. I can recall.

VCI-140
PRI-133
WM- low 90s (can't remember actual score)
PS- low 90s
I think FSIQ was either 122 or 126 and it looked like GAI was calculated out to be 144? (how would that be possible if VCI and PRI are both lower than that?)

Coding subtest was his lowest scaled score- 7

Overall- very laid back kid, enthusiastic learner when it's topics he likes, can't do timed multiplication tables to save his life in 4th. His writing skills seem no match to his ability to explain things.

The diagnosis would probably be "dysgraphia" but he does generally well at grade level in all subjects and has a sweet disposition - no real behavior issues as long as his energy/movement in class doesn't bother others.

Is it worth taking up with the school (we did private testing) or just let it ride and accommodate only if it bothers him?

My DS's VCI and PRI are similar with a GAI at 146- it's statistical "regression to the mean." I can't explain it because I haven't been in a stats class for 20 years, but the GAI looks correct.

The working memory and PRI are significantly lower. Maybe enough to suggest a learning disability such as ADHD. At the least, there will be discrepancies between ability and performance. I would talk with an educational psychologist for more insight into how these scores translate into ability/ performance.

Your son is a gifted/ highly gifted verbal and perceptual reasoner. Those areas are scored in the 98th to 99th percentile. The other scores are low average and somewhat concerning considering the exceptional reasoning ability.

Excuse me- PSI (processing) is lower (not PRI). Can't keep my WISC acronyms straight!

Yes, if it were my child, I would consider an evaluation for learning disabilities (maybe ADHD since you mention movement?).

He's a gifted kid who may be performing (or will later perform) far below his ability due to lack of accommodation. *IF* there is an issue it will get harder as he gets older and can not longer compensate with raw intelligence. .

Hils, I am not an expert on test scores, but the reason (as I understand it) that the GAI or FSIQ might be higher than the individual sub-components of VCI, PRI etc is that the *combination* occurs less often than the individual scores.

The WISC scores you have could very well be dysgraphia - was this part of a neuropsych eval where you'll have the results of additional follow-up testing included in the report? If so, that will help you understand more about the root cause of the lower coding speed (visual vs fine motor etc).

Is it worth "taking up with the school?" *ABSOLUTELY*. You've asked if you should "accommodate only if it bothers him." I'll address that question in two ways. First, it sounds from what you've written above that it most likely *does* bother him: for instance, he wiggles a lot. That could be a sign of a visual issue - my dd who has a vision challenge is a very squiggly wiggly kid. When her eyes are working together a-ok, she wiggles much less while working on schoolwork. You also mentioned seeing frustration with writing assignments and frequent writing mistakes - that is classic dysgraphia. He needs to be able to show his full knowledge at school, and chances are he can't at the moment without accommodations. As the workload in school ramps up in the next few years, chances are it's going to become more and more difficult if he doesn't have accommodations.

Next point of view - let's suppose it's really not impacting him at this point in time and he's happy as a clam. That's good - for now. But if he's truly dysgraphic he's most likely at some point in time going to need accommodations. It's a good thing to start implementing them now both for him (so he'll learn how to use them and feel comfortable using them) as well as to be sure he is *able* to get them later on. It's typically easier to get accommodations when you have a professional report that is current than to try to use that report 2 or more years from now - if you wait, you'll probably have to re-eval.

The other thing you noted was that "he does generally well at grade level". I think most of us here would expect a child who has a VCI of 140 and a PRI of 133, and who *wasn't* dealing with an unaccommodated LD to be working "really well" and "above grade level".

polarbear

Good point polarbear, our DS7 (we tested last year because he was miserable in 1st grade) has a similar GAI but much higher PSI and WMI. He coasts through school, even with a grade skip.

It's just hard to get the school to acknowledge a gap- hopefully this independent testing will help us get somewhere. On the standardized tests (CA- CST) he scores advanced in language arts and high proficient in math, so if there aren't major behavior issues, they have said they have no reason to test unless there is a huge gap between performance and ability.

Sounds like we should move forward with further testing- great if the school will do it. Who can evaluate a vision issue? I know I had visual processing issues as a kid and went through a year of eye therapy. An ophthalmologist caught it - I was very farsighted and slipped through routine exams at school and with an optometrist. We took him for an exam through our Naval hospital- wondering if they missed something important?

Another BIG question- DS9 had a very rough delivery. They induced 3 weeks early because they thought that he was not growing well at the end of pregnancy. (I measured small and an ultrasound seemed to confirm the low weight). The induction caused heart deceleration even before they started pitocin. Long story short, it was a very fast delivery and his Apgar at 1 min was 2, at 5 min up to 9. Every so often, I stew over it because it turned out that they were completely off with his weight estimation. He was over 6 lbs, three weeks early so the induction was completely necessary. Anyone know if there are studies about what parts of the brain are most impacted by birth trauma? Could that have any relation to his slow procession and working memory?

My 7 (almost 8) yo DD has ADHD. She holds herself together pretty well in school (even though she can be very hyper at home), but her main issues are focus, slowness and processing speed. I am debating having her tested. She also has a big problem with math facts/fluency and her brother who is 16 months younger has surpassed her (even though the neuropsych said that he's concerned about the younger brother's processing speed!). DS scored a 141 on perceptual reasoning but a 109 for processing speed and the neuropsych said this is a large discrepancy and it is going to cause him problems and that his understanding of concepts (math in particular) will be very high but he will probably need more time to do things like calculations, or make careless mistakes. It is possible he has ADHD as well, but if so it's not nearly as obvious as DD. I am taking him back to the neuropsych in a few weeks to do testing specific to ADHD. DD might end up scoring similar to your 9 year old (she hasn't had an IQ test yet). If we play games like Memory with her she seems completely spaced out. But when she's on her medication she does fine.

Both my kids had kind of weird deliveries. The NICU had to come in for DD because she had extreme heartrate accelerations (like over 200 beats per minutes with huge rapid spikes on the monitor--very alarming). Whenever they tried to elevate me it got worse. Not sure what the deal was. The perinatologist mentioned "benign tacycardia" to me after she was born. DS had an extremely slow heartrate every time I had a contraction and he looked purple for a couple hours after he was born. But no one acted too concerned about either one of them. DS wasn't breathing very well so they sent him to the nursery for observation. I know that preemies have a higher rate of ADHD than full-term babies, but I don't know what parts of the brain are involved.

In terms of vision, OT's can do some of that. They just gave my DS a perceptual vision test a couple weeks ago. But it looked to me like it was measuring visual spatial ability, visual memory, similar to the perceptual reasoning part of the IQ test. So your DS would probably do well. The OT is trying to get us to go to a developmental optometrist, saying she can hook him up to a computer to see how his eyes are tracking. My DS had a brain injury and skull fractures on Dec. 31st that paralyzed a cranial nerve and caused one eye to be "stuck" for several months and we're not sure if it's completely normal now or not. Since he reads so fast and fluently and his eyes appear to be tracking together, the neuro-opthamologist thinks his eyes are fine. But the OT is completely unconvinced.

Having heard lots of simulate stories I've come to the conclusion that actually they can't tell the size of the baby with ultrasound any better than a midwife can with a tape measure. I also know from personal experience they can't tell gestation very well either.

Hils fwiw my DS7 has a huge spread in his scores with his processing speed down in the 9th percentile (we were never given raw scores) and his working memory is really low as well. His birth was a textbook 10 hours of labour, no interventions and no drugs for either of us. I don't know what his apgar scores were but we both walked out of the hospital 3 hours later without protest so it must have been decent enough.

Sorry it was such a dramatic start for him but try not to beat yourself up. It might not be a contributing factor.

I think GAI exists because processing speed and working memory are so disconnected from other measures of intelligence. As much due to the inadequacy of the tests as actual operational abilities being disconnected from other mental abilities. If a kid is scoring near average on those, I personally don't think it should be an area of concern. Below average then I'd think it has diagnostic value.

The developmental optometrist testing was very helpful for us. FWIW, our DS6 had 20/20 vision and was tested as >12.9 grade equivalent for reading on the WISC yet he has tons of eye issues with tracking, accommodation, and teaming. (He also scores in the 2nd% on the Beery VMI which reflects both his visual and motor challenges.) So really great reading skills CAN co-exist with vision challenges in children with high IQs.

Zen, a score near average on PSI or WM for a child who's PRI and/or VCI are high can be extremely significant in terms of how that child functions academically. For other kids, it's possible it doesn't mean a thing - the key is how the student is functioning overall, not just on the WISC tests, and also in understanding why the scores are relatively low, which is why neuropsych evals include additional testing beyond IQ and achievement.

So yes, a score near-average on PSI or WM isn't in and of itself something to be concerned about, but most of us who are posting here with kids who have high VCI/PRI and "average" PSI/WM also have other concerns - our kids are either struggling with schoolwork, behavior issues, etc - and there is something that's up that's behind those challenges. Whatever it is that's behind the issues will sometimes cause a PSI or WM score to be low relative to other scores, and although it's not the *cause* of the issue, it's often the first "data" showing there is an issue and the dip in scores can be very significant. The issue isn't an "average" PSI/WM, the issue is a challenge which is *reflected* in a dip in PSI/WM.

polarbear

It took us a *long* time to advocate successfully at school. Having the private eval was a critical first step, but we also had to do a lot of legwork of our own as parents: observing and keeping samples of the types of schoolwork where the challenges impacted the most was really key. It also helped us to simply graph some of the results from private testing in a way that illustrated the challenge. Depending upon what your evaluator feels is driving the lower PSI/WM scores, you may find there are other tests that illustrate more clearly the impact of the challenge. As our ds grew older, it was also helpful to have his input to include at school team meetings.


In our state, the state tests are *not* good measures of a gap between performance and ability for high-ability students because the ceilings are very low. There were two ways that were useful for us to show the gap between performance and ability. The first was looking in detail at the achievement tests that were done in conjunction with the IQ test. Since our ds' challenge is fine motor that impacts his ability to use handwriting efficiently, when we charted his individual WJ-III Achievement tests vs response type (oral, written and written+timed), there are very clear trends. Oral response subtests chart at around the same percentile as his VCI/PRI scores - which means that with an oral response, achievement matches ability. Handwritten responses showed a signifcant drop in scores, and handwriting+timed subtest scores were very low.

The other thing we did was to create examples at home showing the discrepancy - having ds tell us a story vs writing it out showed the difference in quality of response; having ds write out the alphabet upper+lower case and timing how long it took then comparing it to grade-norms (found online) showed his handwriting speed was significantly below grade level. While this doesn't carry the weight of a professional report, it is still an example illustrating an issue which the school then has to disprove (and most likely won't be able to), and it was a very helpful tool for us in advocating.

One other thing to consider since writing is potentially an issue for your ds, is to request the school give him the TOWL (Test of Written Language). This is a very common test used all over the US for assessing written language, and most schools will have it.


Vision can get tricky - if it's a tracking issue or convergence etc (how the eyes work together) it's something that a routine eye exam might miss entirely but a developmental optometrist exam would pick up. There will potentially be clues in your psych testing, though - possibly just within the WISC subtests, and also in additional testing if your psych included additional testing. You can also sometimes see clues in how your child holds their head while reading etc.


I would try to not put too much worry into the past and what might have caused the challenges your ds has now. The past is over, and it's what it was - you can't go back and change it, and even if you could, could you really have changed anything? My ds took a huge fall on his head in an accident when he was around 5 - and his neuropsych feels that his issues might be the result of TBI. Knowing that his fall might have caused even a tiny part of his challenges left me feeling sooooo so very sad and guilty - but the accident wasn't something I could have prevented; I wasn't anywhere near him when it happened. And in reality, we've learned in the years since his diagnosis that dyslexia and dysgraphia are present all over the place in dh's family - so at least part of his challenges are most likely due to genes, not that fall. Anyway, I totally understand the looking back and second guessing. Try not to spend any time there, chances are it's not related and even if it is, it will be ok.

Best wishes,

polarbear

Thank you for saying what I wanted to say, more eloquently than I probably would have said it.

I'm not even convinced that the low PSI is not the cause of the issue in many cases. Or, more specifically, the VCI-PRI/PSI mismatch. When your brain can do the work but you can't formulate it into words and spit them out fast enough, it can be enormously challenging to deal with.

Totally agree with everything polar ear and happily mom posted! My advice would be to Heed their advice! I also blamed my DS difficult birth (and twice he stopped breathing) for his challenges. Took 8 years to finally get enough info and realize DS's birth issues were a result also and not a cause.

DS's beery VMI was Ok (around 63rd percentile) and the peceptual vision test was over 90th (with some of the subtests like visual memory being 99+ percentile). DS has a lot of problems tracking his eyes on command and I'm not sure why, but they dramatically cross like what happened when he had the nerve palsy (and that's what the OT saw when she assessed him--she was asking DS to follow her pointer or finger with his eyes and he couldn't do it at all). But when he's just moving them naturally (for instance reading), they look Ok and aligned. I'm not sure if we will go to the developmental optometrist yet. I wouldn't mind getting another opinion if our insurance will cover it. I'm curious what this computer test is that the OT was talking about, because that would probably be the only way to get an objective result since DS can't track on command when someone is watching his eyes.

Grrrr.... when others advocated for their children, trusting their "gut" that something was off, were you met with the majority of teachers minimizing your concerns?

Yes, yes and yes!

Yup, I think they give education majors a class specifically in this at college

Yep. Teachers minimize everything.

ok- for all of you with 2E experience, here are subtest scores. Full report included notes on dysgraphia (but further testing needed for diagnosis... we only did WISC-IV) The take on inattentive/ ADHD-like behavior history was inconclusive. The Dr. didn't think his testing behavior really raised flags- but my DS said later.... "were all those interesting things in the office a test? I tried really hard to focus." Once again- he is easily distracted but has enough desire to please adults that he tries REALLY hard to control his distraction. He is always reading, very verbal, always "perched" on a chair or standing when he is doing things that require him to stay in one place. Really struggles with memorizing math facts- but yet could rattle off tons of abscure dinosaur names or fold you some beautiful origami from memory. We have always "thought" mild ADHD because of his high energy, impulsivness, and trouble staying on task with "non-prefered" activities. However, if medication is the last thing on our list of possible interventions (he is an amazing swimmer and we wouldn't want that to impact his future growth in any way), then will digging deeper to evaluate ADHD have a positive yield?

Here are the subtest-
Sim: 17
Voc:17
Com: 16
Block: 17
Picture: 13
Matrix: 16
Digit: 9
Letter: 9
Arith: 11
Coding: 7
Symbol: 11

I don't think there are any permanent effects to growth with ADHD stimulants, if that is your main concern. That being said, DD was around 75th percentile for height before she started meds and now 1.5 years later she is 50th. The difference in her when she is medicated vs. unmedicated is amazing. I can tell immediately if she has not had her meds. The other day the teacher called around lunch time and asked if DD had been medicated. Turns out she hadn't had her pill, although she had her patch (the patch takes a few hours to kick in). The teacher was able to tell that she was probably not medicated properly. I don't think her behavior was "bad", she was just incredibly slow (slower than usual) and made tons of mistakes with math calculations.
With meds, you can always give it a try (if you do actually get an ADHD diagnosis), and if you give it a chance, try the various doses (you always start on the lowest and go up) and they do not seem to help very much and it's not worth the risk to you, you can discontinue.

I am taking my DS in for a computerized ADHD test in a couple days. It looks at the kids' responses, how slow they are, how quickly they lose attention, how impulsive, etc. and compares them to other kids the same age. With DD we just filled out inventories with the pediatrician which I thought was grossly inadequate. But it's obvious she has ADHD whereas with DS it is more questionable.
BTW, DD's ADHD was missed in kindergarten when she was grade accelerated. Even the school psych who tested her didn't seem to think it was an issue. And she's pretty severe. Even after we moved her up a grade, it took the teacher about 4 months to finally admit that what she was seeing were ADHD red flags.