Gifted Issues Discussion homepage Forums Identification, Testing & Assessment WISC Results- Help Please

So, I finally got DS9's WISC 5 results this morning. The evaluation was requested because we wanted to evaluate for a specific learning disability in writing, which they told us only the psychologist could diagnose. However the psychologist's report only mentions evaluation for GT, which we already knew he qualified for. Our IEP evaluation meeting is supposed to be tomorrow morning.

Here are the results:

Block Design: 18
Matrix Reasoning: 11
Coding: 12
Figure Weights: 12
Picture Span: 19
Arithmetic: 19
Similarities: 17
Digit Span: 19
Vocabulary: 16
Visual Puzzles: 13
Symbol Search: 11

Verbal Composite: 136
Fluid Reasoning: 109
Processing Speed: 103
Visual-Spatial: 132
Working Memory: 155
Full Scale: 133

His recent KTEA results are:
ASB: 138
Reading Composite: 126
Math Composite: 158
Written Language Composite: 106

And the KTEA subscores are:
Letter and Word Recognition: 115
Reading Comprehension: 131
Math Concepts and Applications: 150
Math Computation: 160
Written Expression: 114
Spelling: 99
Phonological Processing: 108
Nonsense Word Decoding: 116
Silent Reading Fluency: 110
Word Recognition Fluency: 120
Reading Vocabulary: 133
Associational Fluency: 120
Object Naming Fluency: 91
Listening Comprehension: 143
Oral Expression: 140
Letter Naming Facility: 97
Writing Fluency: 74
Math Fluency: 103

Besides the fact that he has an incredible working memory, what can we learn from these WISC results? Which subtests would be affected by a fine motor weakness? Which would be affected by some sort of visual processing issue that could also be affecting his writing?

What specific questions do I need to ask at our meeting to actually get the answers we need?

On the cognitive side:

He has exceptional working memory, both visual and auditory, meaningful and rote, topping out the scale. Processing speed (which is the area most affected by fine motor) is his weakest area, in the Average range. He actually shows better language reasoning than non-language reasoning. His visual spatial skills are actually solid to exceptionally strong, which isn't consistent with a visual processing deficit.

What is more suggestive of writing concerns is what we see in his KTEA, which is extremely strong in all reasoning and application skills (with the exception of written expression, which is in the upper end of the Average range). The areas of personal or general weakness are all centered on fluency skills, with a consistent pattern of relative weakness (in the lower half of the Average range) in rapid naming skills, which contribute to automaticity skills. (Rapid naming is also one of the three pillars of effective phonetic reading development, but since his other two are solid (phonological processing) to exceptionally strong (auditory working memory), this relative weakness doesn't appear to have affected his reading decoding skills in any way. That doesn't stop it from affecting writing/encoding skills.) Since written expression requires a host of automatic skills (letter formation, spelling, capitalization, punctuation, grammar) before you can even get to generating organized and meaningful language, it is not surprising that he should have some challenges with writing.

The very high Block Design score suggests that it is not visual processing that is the obstacle, but more likely automaticity, probably for skills like spelling and letter formation, at a guess. His untimed spelling is Average, which is functional, but far below his verbal cognition. Then you see writing fluency, which is Below Average (and this isn't even scored for accuracy--purely for the number of words generated), and also far below his written expression. His other pencil-and-paper fluency score (math) is much lower than his untimed basic skill score. See also the sizable gap between written and oral expression, which tells you that it's not language that's the issue (not that we thought it was, with those verbal cognitive scores), but the process of putting it to paper.

Has he been looked at by an OT? That's who you need to actually rule in/out fine motor issues.

I'd also be interested in some error analysis. Was his Writing Fluency score slow because of his actual rate of physically writing words, or because he kept stopping to correct spelling, or because he was slow to generate sentences, or because he got distracted, or something else? What kinds of errors did he make on Written Expression? Were they predominantly mechanical errors, or evenly distributed across grammatical, structural, and mechanical errors, or some other distribution? (Because if they were mostly mechanical (spelling, punctuation, capitalization, etc.), that would tend to support the idea that it's automatic skills that are his area of struggle in writing.) How is his writing if you have him try typing/keyboarding or speech-to-text?

We started this whole journey with an SLP and OT evaluation at the end of second grade (when he was 7 1/2) due to speech and handwriting concerns. At that point, they gave him the Goldman-Fristoe Test of Articulation, which he scored <.1 %-ile on, and the Beery VMI Test, with results of VMI: 93 %-ile, VP: 99.9 %-ile, MC: 30 %-ile. The OT noted bilateral small motor weakness, causing decreased fine motor skills. They also gave him a KTEA, with similar results to the more recent ones above.

We put him on an IEP for speech/articulation, which included OT for hand strengthening and handwriting and access to a Chromebook for typing as desired. In the same meeting as the IEP, we decided to do a full grade acceleration at the recommendation of his 2nd grade teacher. So he skipped third grade.

He received speech and OT somewhat sporadically through his fourth grade year. Every time we brought up concerns about it, they starting doing it again for a couple of months and then it kind of faded out again. His speech improved some; however, his handwriting showed no notable improvement.

At the end of that year, they gave him the GFTA test again and said his articulation was now within normal limits, so he no longer qualified for the IEP. (I honestly do not believe his articulation was ever as poor as their test implied, nor do I believe it improved as much as their test implies. He still has a lot of trouble using voice-to-text, for example.)

He had also started complaining about words disappearing when he reads, particularly on a computer screen, which is where the concerns about visual processing came in. His basic letter formation is still so poor that it seemed like a possibility they were related.

We've seen 4 pediatric ophthalmologists in 3 states since he started wearing glasses when he was 2, and they all swear that his vision shouldn't be affecting reading or writing.

I asked the IEP team to consider his eligibility for a specific learning disability in writing, because his writing hadn't improved. The OT then came to the next meeting and requested that we see a neurologist to evaluate for a possible neurological cause of the fine motor/small muscle weakness--particularly because he also has vision issues, along with the articulation. We set up a 504 with accommodations for writing. When I pushed the issue of IEP eligibility for a SLD in writing or for orthopedic impairment in writing, they indicated that only the psychologist could give either of those diagnoses. At that point, I requested a new IEP evaluation to look for those issues. Those papers were signed 4 days before the end of the school year last May.

Over the summer, we saw a pediatric neurologist, who also noted bilateral hand weakness, hypermobility, and limited web space. She didn't think it was necessary to do imaging to look for a possible brain lesion because his strength is symmetric and there's no focal area of weakness. Essentially, she thinks it's just a structural issue with his hands, with possible genetic causes.

They administered the KTEA again this fall as well as this WISC.
The report from the psychologist that I just got this morning says nothing about any of his fine motor issues or the visual processing concerns. Just that he qualifies as gifted and talented, which was never in question.

In the meantime, he remains at the top of his class (as a just-turned-9-years-old 5th grader) in every area except writing. He's learning algebra 1, got a score of 248 on the 6+ Math MAP, and reads at a high school level. I hope this doesn't come across as me just being arrogant, but I don't think a FSIQ of 133 accurately reflects his cognitive abilities.

However, the writing is still a huge issue. His homework a couple weeks ago involved writing declarative and interrogative sentences from a set of words, like: newspaper astronaut was the an in. He was supposed to write "An astronaut was in the newspaper." and "Was an astronaut in the newspaper?" That sentence alone took him almost an hour to write both ways. We suggested he type it instead (which isn't really better for him, but it's a different option), but he didn't want to. Voice-to-text is usually more frustration than it's worth as well. He seems to spend so much of his cognition to even be able to form semi-legible letters that spelling, punctuation, spacing between words, etc. is too much for him to focus on. Even after 1 1/2 years of focused handwriting practice and OT, there's been very little improvement. His letters in print are large, misformed, and very difficult to read. He does somewhat better in cursive, but it takes him even longer. They had a cursive worksheet in class a few days ago. He said everyone else in his class finished it in 10 minutes or less. He worked on it for nearly an hour at school (his estimate), and then brought it home and worked on it for another hour, to get the 50% done that he's required to do per his 504. And that was just rote copywork. If he had had to create and punctutate sentences by himself, it would have been even more of an impossibility for him to complete.

So I'm at a loss at what we can do besides continue with the accommodations on the 504. I may push for scribing and oral assessment to be added. But mainly I'm frustrated that because he performs at such a high level, it's a fight to get them to acknowledge this as an issue at all.

Does it mean anything that his processing speed and working memory are so different? It seems like they're grouped together in a lot of places, like when discussing GAI vs. FSIQ.

Do both of the processing speed subtests require writing?

Excluding block design and matrix reasoning (which are oddly switched), he has a score less than 14 on every timed subtest and a score higher than 15 on every nontimed subtest.

In fact I'm really puzzled by that block design score knowing that it's both timed and fine-motor dependent. Hmm..

It's all coming back now...I do remember you describing this history!

With the marginal articulation, he would have to use human scribing, and, preferably, oral assessment. I would affirm that recommendation. The key really is the huge difference between his written and oral output. The exercise you described ("astronaut", etc.) is exactly like one of the tasks on the CELF-5, which is one of the core language assessments given by SLPs. If he did well on that task (which he should have, and which the absence of language therapy Rx suggests), but struggled with the written version of it for multiple hours, that is a really stark difference between oral and written language skills. If it is not the case that his ability to complete this task orally is substantially better than his ability to complete it in writing (which would be evident on a CELF-5), then that may suggest an actual language expression disorder, which would indicate speech/language therapy, not just for articulation.

And of course, I'm not a neurologist nor an occupational therapist, but given his history of both severe speech articulation and handwriting weaknesses, I'm a little surprised there was no further investigation regarding motor planning skills, as that is one of the deficits that would be involved in both of those presentations.

Processing speed and working memory really aren't all that related to each other per se. They're grouped together because they both primarily affect efficiency (hence output), rather than abstract reasoning. Also, they are both sensitive to a number of other common concerns, such as challenges with attention, emotional interference, low motivation, fatigue, etc.

Both processing speed subtests do involve pencil work, but one of them is just slashes, while the other is letter-like forms. Notice he did equally Average on both. But the letter-like forms are unfamiliar to all students (hypothetically), so no one really gets to use automaticity skills on them, with the exception of the minority who memorize them in the brief timespan of the subtest. His original VMI scores were extremely high in visual perception, still quite high in integration, and on the lower end of Average in coordination. These were, of course, untimed scores.

His BD score probably reflects his visual perceptual/spatial reasoning more than his speed or fine-motor performance, mainly due to his age. His chronological peers aren't getting enough items correct to separate by speed (three years from now, this score may begin to reflect effects of speed more than accuracy, as the number of items correct obtained by the median student rises), so the fact that he correctly completed many designs, albeit slowly, is more important than the lack of bonus points for speed.

Though I too am a little puzzled by the lower Visual Puzzle score. It does have time limits, though. Also, not true that every timed subtest is below 14. Arithmetic is timed, as are Word Recognition Fluency and Associational Fluency, which are the equivalent of 14s.

Not as puzzled by Matrix Reasoning, as it is very close to Figure Weights. I'm more interested in how he is this strong in math, when his most math-associated cognitive tasks are just average/high average (other than the actual math task, Arithmetic).

Thank you, aeh. Besides scribing and oral assessment is there anything specific you'd ask for in the meeting tomorrow? I'm pretty sure they're not going to count him as eligible for an IEP, so we'll just be adding things to his 504.

I wasn't looking at the KTEA scores when I was talking about the timed tests, just the WISC.

And he's probably so good at math because we have a very math-centric house. DH teaches college math full time, I teach college math part-time and the gifted math at their elementary school part-time, including his algebra 1 class this year. He has also always been extremely interested in math, from toddlerhood.

The one remaining unknown (unless you have CELF results from the previous eval; I can't quite tell, as you only listed artic assessment, but that might not have been the whole of it) is whether there are genuine expressive language challenges too. I wouldn't think so, given his KTEA-3 OE score, but the CELF is a bit more in-depth, so it's possible there are subtle deficits or relative weaknesses that would show up there, but not on achievement testing. I would say that that is the one remaining area that one might consider looking at, if one were going to do any more testing. I'm not advocating strongly for this one, but fwiw.

Graphic organizers: also called mindmaps, idea maps, etc. Some are even more specific, and can be converted directly into a paragraph or multiparagraph product, either by hand copying or clicking. It's unclear how much of a factor organization and planning is in his writing (not much paragraph-level writing is in the KTEA), but certainly, if one has to devote a lot of mental energy to the physical and technical mechanics of writing, not much working memory is left for holding one's ideas and writing structure. Externalizing that into a graphic organizer might help. I'd consider both paper and electronic graphic organizers (he can try them and see which ones work better for him).

Clean copy of notes: he's a bit young, so notes probably don't come up much now, but as he goes into middle school, this will likely become a problem. With his slow, illegible handwriting, and rudimentary typing, having complete notes provided by the teacher after class, and skeleton notes during class, will be important. He has a really good memory, but everyone has limits.

I'm assuming he already has extended time, and you've already mentioned reduced work load. I might clarify that to:

Starred items only, sufficient to demonstrate mastery, no more than 50% of workload. Meaning that (like the existing 504) he doesn't have to do more than 50%, but he can stop when he's demonstrated mastery of the skill/concept. I prefer that the teacher star the specific items that will allow her/him to assess mastery of the learning standard. On a page of 25 items, one can usually narrow it down to five that will demonstrate mastery. The remaining are for practice and reinforcement. I typically tell students that they'll get a handful of starred items, which they should do first, and then if they have time, they should go back and do as many of the other ones as is reasonable, but not if it interferes with other important life functions (like eating, sleeping, having a life outside of homework). The extra items will give them more practice, and act as backup, in case they got one of the the starred items wrong.

Word prediction: I know he doesn't type well, or like typing, but adding word prediction might help, as he reads well, so he'll know if the word prediction is on target or not.

Spellcheck/thesaurus: So I know he has a deep vocabulary, and he spells adequately, but his spelling isn't keeping up with his vocabulary, which is why using the two in conjunction might help make his writing reflect his oral language a teeny bit better. I usually have students use the words they can spell (or get close enough that the spellcheck recognizes them!), and then use the thesaurus function to locate the more nuanced word in their existing vocabulary that they would have preferred to use, if they could have spelled it. Even though his spelling is not atrocious in isolation, it sounds like it kind of falls apart when he has to do anything else at the same time (which is typical for certain types of dysgraphics).

Well, the cognitive skill he has that is both strong and strongly associated with math is his working memory, so that part of the equation adds up. And BD, which is visual spatial, has some connection to geometric and logical thinking too, depending on how people solve the puzzles.

Also, on both the WISC and KTEA, the timed tasks that scored well are all oral only. So it's probably not processing speed per se that's the issue, but only certain types of speed (fine motor, rapid naming).

The rapid naming is visual identification, right? So these results indicate that basically anything that he has to process visually or with writing is notably slower than the tasks he can complete using only his aural-oral connection?

Which feels like it puts us back in the visual processing realm.

How would a dyspraxia/motor planning diagnosis affect his visual processing? Would this be an expected consequence of that type of diagnosis?

And yes, his spelling utterly falls apart when he has to use it in context. Even if he spells the word correctly orally before he writes it or has it written in front of him, he still frequently writes it wrong and erases multiple times. He even forgets spaces between words still.