Gifted Issues Discussion homepage Forums Identification, Testing & Assessment neuropsychological evaluation

I have been investigating having a full neuropsychological assessment of my DS11. We had a partial assessment done last year because of issues at school (unhappy, acting out, refusing to do required work, attention and EF issues), and the tester diagnosed a NVLD based on spread in the WISC-IV score (VCI-142; PRI=113;WM=109:PSI=100) and a writing sample.

After doing lots of research and reading (including all the posts here!) I began to doubt the diagnosis and realized that the tester had not really done a thorough evaluation.

I finally found a paediatric neuropsychologist in my area, who sounded really good from his CV and web site. He does assessments for giftedness, LDs, ADHD, depression and anxiety in children and adolescents.

I sent him some information, including the WISC results and the conclusions of the previous tester. I spoke to him on the �phone today and he described what his evaluation would include:

WISC-IV (he wants to repeat it to see how �stable� the results are)
Academic assessment in math, reading and writing (WIAT-II )
Tests for executive function, attention and memory
Conner�s and behavioural rating scales (parents and teachers)

The testing would last 6 hours and be done over 2 mornings during the same week

Does this sound about right?

I wondered about a couple of comments he made on the phone.

He said he was very surprised at the NVLD diagnosis, and that nothing in the WISC profile would suggest it since DSs PRI was high average. I tend to agree with him there.

He went on to say that he is �of the old school and thinks that if all areas are average or above, you don�t have a learning disability.� I don�t know about this. When I said that there was a lot of spread in the results, he answered that yes, it was �statistically unusual� (or something of that nature) but didn�t necessarily point to a problem and that DS has a "functional" WM and PSI. He also said that he wasn�t really a fan of gifted programs. I didn�t have the presence of mind to ask why, so this leaves me a bit puzzled. On the good side, he did seem concerned about my description of low mood and sleep issues, which other professionals I�ve seen pretty much ignored.

Does he sound like an OK choice, or should I keep looking?

I would keep looking... those 2 are red flags to me. The fact that he did not say "some gifted programs" but seemed to imply all of them (from what I can infer on the post).

The disability part is harder to gauge in my opinion. I can understand his opinion but I can also see how a huge spread COULD in fact also become a type of disability for a child.

Follow your instincts and keep looking. It is a lot of money and time, be sure this is the right person.

The timing, 6 hours over two days sounds standard. Sometimes with younger children they might spread over 3 days, some places cram it into one. I agree that just because there is a large spread between VCI and PRI this does not mean NLVD - It is hard for me to understand how a child can have a deficit if their PRI is actually in the high average range and better than 80% or more of the general public. With my son, I choose to think of his PRI as a relative weakness compared to his verbal abilities.

I disagree that scores in the average range rule out learning disabilities. The average range is very big - from the 75% to the 25% on most tests. Surely one would expect better academic skills from a person with and IQ above the average range than say the 25 percentile. While the discrepancy model shouldn't be the only way one can diagnose LD, if a discrepancy exists, it should be considered very carefully.

I like that he would look at EF and consider mood and sleep. I guess I would want to find out more about his concerns with a gifted program. Does he dislike them because they might exclude 2-E students (gifted with LD)? I guess I wouldn't take the comment at face value until I dug a bit deeper if I felt he otherwise would be a good match and comes recommended. If your goal is to enroll your child or keep your child in a gifted program and you find via your questions that he simply does not like them under any circumstance, I think you should move on as it is unlikely his recommendations will support your goals.

I am still reading through and digesting my DDs evaluation but as you know her scores were very similar to your DS's.

My understanding was that even though the PSI and WMI are in the average range, the fact that the spread is so large (>30 points) means that there is a big bottleneck causing major frustration.

I imagine it sort of like trying to use sophisticated new software on an old PC with insufficient RAM - it just doesn't work well. I could be wrong in my understanding but that's what I got from it.

My DD tested for 6 hours on one day and they administered the WAIS-IV, selected sub-tests of the WJ-III Cognitive, the WAIT-III, Nelson-Denny Reading, Learning Disabilities Evaluation Scale, Behaviour Rating Scale of Executive Functioning, Gilliam Asperger's Dissorder Scale, Auchenbach Child Behavior checklist and the Student Styles Questionnaire.

She was diagnosed with ADHD inattentive and recommended for the trial use of medication. She asked if re-taking the WAIS while medicated would change her scores and she was told it probably would, but that she could not re-take the test for 3 years since the results would be compromised due to familiarity if re-taken within 3 years.

Nik - your description of what lower PSI and WMI can do is exactly right when you say, <<I imagine it sort of like trying to use sophisticated new software on an old PC with insufficient RAM - it just doesn't work well. I could be wrong in my understanding but that's what I got from it.>>

For my son, the problem is mostly with PSI - I say, the web page is loading,,,,,,,,,,, and sometimes it just times out!

As far as re-testing - my son's scores didn't go up even when he was on medication, but I have seen many cases where they have. The WISC can actually be given every 12 months, but it is preferable to wait 3 years. If you feel a real need to get the information before the 3 year period, it is within the guidelines to do so. The evaluator could also use a different IQ test such as the Woodcock Johnson Cognitive or the Stanford Binet. But, you the constructs of the tests are all slightly different so you would not know for sure that a change in working memory or processing speed is due to the test or the medication.

Thanks for all these comments.

Nik -- was your DD given an ADHD-inattentive dx based mostly on the spread in her WIAS scores? Did they do specific tests for attention and executive function (besides the behaviour rating scales)? The neuropsych. I spoke to proposed specific tests (not IQ or achievement tests) related to attention, EF and memory.

I'm still mulling over my options here. The person I spoke to seems like the only neuropsychologist in my area who deals exclusively with children and adolescents and he did sound smart and well-informed.

He also does gifted assessments, so I think his comment about not being a fan of gifted schools was probably more to do with the philosophy of the programs in my location.

I asked whether if was a problem to re-do the WISC, since our potential app't would be a year or maybe a month or so less since the previous testing. He said that a 60 day gap was enough -- it sounds like this might not be correct? I didn't necessarily want to have it re-done, but he thought it would be better to do it again.

No, I listed all of the tests that were given to my DD, the report states that the listed concerns provided by both my DD and myself, and the rating scale results consistently supported a diagnosis of ADHD inattentive.

It sounds like maybe the guidelines are different for the Adult and child versions of the test. I know my DD, even at 10 she would have done significantly better (on portions not related to speed or working memory)if she repeated a test like that within 60 days just because she would have a better idea of what was expected.

Honestly, I was a little concerned about how quickly the ADHD conclusion was drawn and any other potential LDs ruled out.

From what I read, you are supposed to wait a year between tests for the WISC-IV. I think neuropsychologist I spoke to was not well-informed (another reason to make me hesitate). I don't know if the results are invalid if you don't wait that long or if it is just a recommendation.

I checked the dates, and my DS's potential testing would be 11 months and 1 week after the first test, so I guess that would be OK. I'm more interested in the results of the EF and attention testing, and the behaviour rating for depression/anxiety.

We have done the Conners' behaviour scale twice now (at 4 and 10, with a different tester and a different teacher each time) and were told both times that there was no indication of ADHD (but he rated high in "oppositional" behaviour both times).

It seems like there is no perfect tool to understand what is going on with kids like this.