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

Interestingly, his manual dexterity is within normal limits, while otherwise fine motor skills and upper body coordination are below average.

And yes, the TOWL-4 vocabulary results are interesting. He can define words and comprehend them well, but doesn't use them as effectively, at least in writing. This is also the only truly open-response contrived writing task. Spelling and Punctuation are dictated, Logical Sentences is editing, and Sentence Combining starts with two or more stimulus sentences. Spelling and punctuation are as expected based on prior testing.

I'm more interested in the difference between his contrived conventions (Spelling and Punctuation) and his Contextual Conventions, which are in the aggregate above average/high average, which is the kind of distinction I often see in learners who have some awareness of their spelling relative deficits, and select only words they can spell for their spontaneous writing, which tends to artificially restrict their writing vocabulary. Actually, his overall spontaneous writing (self-selected extended narrative) is quite good, and generally commensurate with estimates of his cognition. Contrived writing not scored principally for conventions is also above average, especially Logical Sentences, which is the most conceptual of the writing tasks, and also requires the least original writing. He can generate complex/compound sentence structures.

Taken together, these results suggest to me that his written expression includes many intact elements, commensurate with cognition--with the exception of relative weaknesses in mechanics, and possibly some subtle expressive vocabulary vulnerabilities. And, of course, we already knew that his writing fluency was low.

This is looking more like the primary deficit is fine motor in nature, with secondary effects on mechanical/automatic writing skills (spelling, punctuation, handwriting speed, etc.). The only higher-level written expression task that wasn't up to his personal level was Vocabulary, which happens to be the task most like the homework assignment he had involving making multiple sentences from a collection of words (though this subtest allows him to add his own words, and only requires one stimulus word at a time).

Thank you so much for this detailed analysis. All I got from the SLP that did the testing was that "His writing is fine. He should probably learn more spelling and punctuation."

These results really surprised me. But I know he was pulled out three days for this test, so I'm guessing he just did it very slowly and carefully. Do you know how long it usually takes to do this test?

The idea of the restricted writing vocabulary makes *so* much sense. And now that you've said that, I think that's probably some of the reason he hates writing so much--because he wants to say so much more than he feels comfortable spelling. And his spelling is still relatively low because the letter formation is so difficult.

Do you have any reccomendations for working on the automaticity of skills like spacing and correct capitalization? His spontaneous/recreational writing still has lots of words with mixed cases and he still missed spaced between words even when he's working on class assignments. He knows the rules for those things, but it gets lost somewhere before he actually gets the letters on paper unless he's thinking about it with every word.



Another question that came up at our meeting is whether his fine motor skills are falling even further behind his age peers. He had the Berry VMI test in April 2017 with scores of VMI: 93%-ile, VP: 99%-ile, MC:30%-ile.

On his recent BOT-2, his fine motor composite was 8%-ile, and that OT (a different one than before) noted visual perception as a weakness. The OT wasn't at our meeting to consult with.

Do you think those two tests are comparable enough to be concerned about the drop?

To my eye, his handwriting hasn't changed much at all since he started forming letters at 3 and 4--it may have even been slightly better in kindergarten than it is now. I happened across one of his notebooks from when he was 4 the other day and his name looked almost identical to how he writes it now.

We decided to have him take the Beery VMI test again so we could make a direct comparison of the 2017 scores and now, and meet again in two weeks to discuss those results.

If it does seem his motor skills are falling farther behind his age peers, despite the interventions we've already got in place, what do we do next?

We saw a neurologist last summer who didn't believe there was a neurological cause for his fine motor weakness. If his fine motor skills are indeed falling further behind, it's clear we need to investigate that further, but I don't know where else to look for answers.

The TOWL-4 usually takes about 60-90 minutes to complete all sections, so 3 sessions could have been within range, if they were each about 30 minutes.

He may find spacing and sizing easier to maintain if he writes on square (graph) paper. Pick a grid size that approximates a legible version of his normal letter size. Or you can try placing a sheet of dark-lined square paper behind his worksheets, to use as a visual guide. Or writing on the backside of one-sized square paper, so the grids are present, but not in the way of his actual writing. (You can make your own; there are many free printables available. Search "free printable square or graph paper". Here's one: https://mathbits.com/MathBits/StudentResources/GraphPaper/full%20page.pdf)

His fine motor may very well be lagging further behind, if he is not progressing, while his peers are advancing. Although the two tests are not directly comparable, I would agree that it is worth examining the drop in performance further, such as with the re-test you already have planned.

I would speak to the OT regarding interventions. Often they can teach him exercises for hand strength or upper body stabilization, which may help. If the school OT isn't helpful, you may be able to get a referral through your PCP. Just because the neurologist believes it is structural/anatomical, rather than neurological in origin, doesn't mean it can't be improved at all with correct practice. Long-term, of course, it will be more valuable for him to become a fluent typist. (One of my sibs, who also has some level of ligament laxity, still has handwriting that looks like that of a 3rd grader. My parents started that sib on the typewriter (!) at age eight, which, in retrospect, clearly makes more sense than Palmer in the STEM field in which said sib is employed. It took a certain level of relentlessly-polite-yet-stubbornly-assertive advocacy, especially in that pre-ADA era. Also radical acceleration shortly thereafter to university, which made the argument moot.)

We got the results of the Beery VMI retest today.

The old (March 2017) results were (Raw Score/Standard Score):
VMI: 23/127
Visual-Peceptual: 25/142
Motor Coordination: 15/90

The new scores are:
VMI: 21/94
Visual-Perceptual: 25/106
Motor Coordination: 26/108

Everyone on the 504 team (except me) says it looks good because everything is in the average range on the new testing, and when asked about the drop, the psychologist said he probably just scored it more harshly than the OT that did it before.

I left the meeting way more puzzled than I was when I went in.

Curious what you think.

Hm. It is possible that the scorer could affect results, but mainly on the VMI portion of it. Visual-perceptual is either right or not (minimal output demands by the child), so it's hard to see that enormous drop coming from scoring differences. Motor coordination has more possibility of scoring effects, but that's the one that went up a standard deviation (still in the average range). This does line up with your previous report that his manual dexterity is within normal limits. The drop in the VMI and VP scores, which actually are more accurately described as failure to maintain progress over the past 1.5 years, are more interesting. To be fair, the ages at which he was tested are such that a one raw score difference can swing the standard score by quite a bit (note that the identical raw score resulted in 36 points of standard score difference when separated by 20 months of age difference).

I'm still thinking about whether that drop in visual-perceptual is meaningful. The recent OT, who did the BOT-2, reported visual perceptual as a weakness. So that's three data points on visual perceptual (by three different examiners, two OTs and a school psych): one is extremely high (2017 Beery:VP), one is average (2018 Beery:VP), and one is "weak" (2018 BOT-2), with the last two occurring only a few weeks apart. That suggests that some factor besides his intrinsic visual-perceptual skills affects his performance. Perhaps fatigue? Size or contrast of visual materials? Lighting? This may be leading back to Portia's suggestion of developmental vision evaluation.

What kind of doctor do we need to see for a developmental vision evaluation?

He's been wearing glasses since he was two, and has some strabismus. We've been to five different pediatric opthmalogists in three states since then, and several other optometrists. We've gotten many different diagnoses (it seems he never fits in any of their boxes), but the overall impression is that his glasses are correcting his problems well enough that it shouldn't be affecting him functionally. I think he's just *really* good at compensating over short periods, and making the doctors think it's less of a problem than it is. So I'm not sure where else we would take him to get evaluated for that.