Ds(7.9) was recently tested. His coding score came back 6 SD below the GAI. We have seen difficulty with handwriting (not the writing process itself). The tester also hinted at a possible vision issue that presented with how he looked at the blocks on block design. The tester mentioned that this is a VERY VERY significant gap between processing speed and reasoning speed that will always be a hinderance to his abilities to takes notes, handwritten, etc. We have seen signs of hand pain, and not up to par automaticity in writing--but nothing that I thought was too far off average 2nd grade boy handwriting. How will this affect him long term? Can it be brought up through OT? What should I be looking out for? Symbol search was closer to avg at a nine.

Average for symbol search is still substantially below his GAI. It also represents a notable, nearly 3 SD difference between the motor-involved (coding) and motor-reduced (ss) subtests of the PSI. (I assume his coding score, based on 6 SD being the entire range of the test.) Has he been evaluated by an OT?

I second investigating both vision and fine motor.

Whether OT can sufficiently remediate any fine motor issues depends a lot on the reasons for the deficits, and the presence or absence of other interfering factors. It's likely worth a try, though.

I gather that actual visual spatial ability appears to be unaffected, though, as his block design must still have been quite strong to result in a GAI at the 99th %ile.

Thank you aeh. Yes he was seen by an OT for Sensory processing --mainly vestibular issues as well as some motor mirroring issues and fine motor skills issues. The motor mirroring issues have cleared up with age. At the time she also looked at his writing and didn't notice anything major but an odd grip. Said he was on par for his age. He was also seen by a dev opt who noted nothing, except near sightedness. I imagine that he can compensate fairly well with his intelligence on vision things--because I have too noticed a few quirky ways that he looks at things. But he scored fairly high in block design. But not as high as he "should" have -based on the testers comments afterward. He scored much higher in matrix reasoning. Do I really bother with vision if it is functioning well enough but just not at his PG level of reasoning? Will it catch up as he matures?

DS has developmental coordination disorder (and probably motor dysgraphia). We had him tested after a brain injury and one eye was not tracking normally at the time. I don't think he had much in the way of depth perception and he probably had some double vision. What he really bombed was a test called the "Grooved Pegboard" where he was timed and had to put pegs into little holes. His Z-scores were lower than -4 for one hand and -3 for the other. I don't know what the percentile ranking is for Z-scores that low but I think under the 1st percentile. He was at 50th percentile for coding, symbol search was around a 12, and block design was a 13, while matrix reasoning and picture concepts were 18/19. Block design is timed like coding and involves manipulating little blocks (according to the explanation in the report) but he didn't bomb it the way he did for the pegboard test. The neuropsych stated that because of the fine motor aspect, the score is likely an under-estimation of his visual spatial ability. I know that some OT tests involve tasks like the pegboard but you will want to make sure you get one that is timed. Since DS has such good visual spatial ability his score would be really high for the visual motor integration parts of the test (like the BOT-2), raising his composite test score, but in terms of raw motor ability scored alone, he has always been very low. His scores seemed especially terrible after the brain injury, though.

He has been in and out of OT (including school OT) and honestly, I don't know how much it actually helps in terms of increasing motor ability. It seems more helpful in terms of adapting, for instance learning how to hold a pencil correctly, practice with writing letters, etc. Our insurance has always paid part of the cost. I don't think it would be worth it to pay full price out of pocket. It isn't difficult to work on these types of things at home, with a child who will cooperate.

I'm going to speculate that he lost points on speed on block design, hence the "should". If this was the WISC-V, there should have been a motor-free spatial reasoning task, too (visual puzzles), which, presumably, would be better.

I don't know that you can really say his vision is functioning well enough. Something (vision, or fine motor, or something else) is not functioning well enough, or he would have scored a lot better than a 1 in coding. If it were "just" average scores, that would be one thing, but, unless there is reason to believe the coding score is not accurate, this is far below average.

Sometimes skills catch up with maturity, but sometimes they do need remediation to do so. Not clear from the available information which of these situations this is, but the severity of the deficit/delay is concerning.

I'll second everything aeh mentioned here. I have a ds with severe fine motor dysgraphia, and his coding score is significantly *higher* than this. I also have a dd who, when first tested on the WISC, had a coding score that *was* this low. In dd's case, it absolutely was a vision problem that we (parents and teachers) had *no* clue about. DD was functioning very well (at 8 years old, in 2nd grade) in spite of it, and she also had no idea that she was having to compensate for anything because she was too young to realize the rest of the world wasn't seeing things the way she was.

I don't know what the issue is for your ds (fine motor vs vision vs something else), but that's a very low score. As aeh mentioned, if it's accurate, *something* is a challenge, and chances are he would benefit from help with that challenge now, even if you don't directly see an issue.


Yes, yes, yes and a *resounding* yes!!! My dd who scored so low on coding had a vision issue. It's been remediated (several times), she has a wealth of methods to use as work-arounds, ways to deal with it etc.. and she has always compensated extremely well. In spite of all of that, it *still* takes a toll that is noticeable, particularly more so as she gets older and academic work demands increase. Her eyes fatigue more easily than her siblings. She often needs to re-read instructions etc on the board. She clearly takes in more when she learns through audio than through reading, yet it is *not* easy to get past having to read to get all the information you need to keep up in school.

Another note re dd - there are still many times when I don't realize the impact her visual challenges have, because she simply just deals with it and moves on. It can be really *really* tough to notice how much a challenge such as this is impacting another person. It's not only tough to see looking on from the outside, but also tough for the person experiencing it to understand the degree to which they compensate as they haven't necessarily ever experienced "normal" vision.



I've never heard of vision "catching up". Usually the opposite.

One thing that I wonder about - you mentioned that nearsightedness was noted. Does he have corrective lenses? I'm near-sighted. I can read/etc without issues, but even so, reading etc for a long period of time causes my eyes to fatigue.

The other thing about children who are near-sighted - I've been told that then children are young, there eye-sight can change *very* quickly - my ds' kindergarten teacher told me she'd had students who had to have their lens prescriptions updated as often as every month - so depending upon how long ago he visited the optometrist, it's possible his eyesight has changed significantly.

And... fwiw, my dysgraphic ds (fine motor issues) has a higher symbol search score than coding. The handwriting skills required for each are different - symbol search only requires a circle, which doesn't have to be precise. Coding requires a very specific direction-oriented mark which is more difficult than the circle task for a child who is having to focus intensely to compensate for fine motor challenges.

Just curious - why was your ds tested? Were you testing for giftedness, or testing because you'd seen issues with handwriting or other things?

Best wishes,

polarbear

One more note re: vision. We found that a pediatric ophthalmologist was able to truly determine the degree of our son's farsightedness and treat it for optimal correction, given its severity. A previous optometrist had correctly found he was farsighted, but had not come close to figuring out the exact degree. DS' eyes have improved over time, fwiw.

Thank you for all your great advice so far. I do need to clarify scores as an assumption was made that was not correct. DS was tested on the Wisc 4 because it was expected he'd need extended norms --so that his coding score was not a 1. I believe his coding score was a 5. His overall processing speed score was and 87. I don't have it available at the moment--At any rate it was at the 13th% I think. DS was primarily tested for giftedness for a decision to be made whether or not his sometimes Attention issues were related to ADD or just SPD and over excitabilities. They didn't 100% rule out ADD, but said it is most likely overexcitablities. What I don't understand is how if he was already seen by a dev opt, why they wouldn't have picked anything up if there was an issue?

If he was already assessed by a dev. opt. I think you can rule out vision issues as a cause of the low coding score. It could be a combination of things, like perfectionism with the test and wanting to be very accurate in copying the designs, possible anxiety during testing, slow processing speed, somewhat poor fine motor ability, etc. If you get fine motor testing and that turns out Ok, then I don't think you need to worry about it.

DD's coding score rose dramatically in a period of a year. Normally you can't repeat the WISC within two years so the second administration wasn't really a valid test, and the psychologist who gave it to her was overall incompetent, but I suspect that coding is a score that is not all that reliable.

Sorry, that was my assumption, that it was the WISC-V, and thus had no extended norms. Also, the term "off the charts" suggested the lower extreme of scaled scores to me. (13th %ile is 83.)

In any case, the essential arguments remain. Coding is still significantly lower than symbol search, and than all other aspects of the testing.

While they aren't as low as 1, those scores can still be significantly low for a 2e child. My ds had a coding score of 8, and processing speed around 100, but still has significant fine motor issues. The key is - you can't know what's causing the discrepancy from the WISC on it's own. Having achievement testing at the same time such as WJ-III etc can help give clues re what's up, but again, it is not going to point to the cause of lower subtest scores without additional information. Neuropsych exams will typically include follow-up testing to help pinpoint the root cause when this type of discrepancy is observed - tests that can tease out fine motor vs visual challenges, tests of executive function etc.


What look like attention issues are sometimes children who are dealing with LDs or other issues that are preventing them from accomplishing the task they are being asked to perform. There were adults in both my dysgraphic ds' life and my vision-challenged dd's life who were convinced they had ADHD prior to their real daignosis, totally based on their behavior. DS looked like he was never paying attention in class, dd couldn't sit still. Neither one of them has ADHD, and the symptoms that looked like it disappeared when we found out what their real challenges were and accommodated/remediated the challenges. I believe the same logic applies to what is often thought to be overexcitabilities.


My guess is there's a chance that his vision is changing as he grows. That's why I mentioned how quickly eyesight can change in young children previously. Might not be that, but if you're seeing suggestions of a potential vision issue, I'd just keep in mind that vision changes can occur quite quickly in young children.

Best wishes,

polarbear

ps - in your original post you mentioned that symbol search was "closer to average with a 9". A score of 8 for coding and 9 for ss are actually quite similar - a difference of 1 in a subtest score isn't considered to be statistically significant. It also makes me wonder if vision isn't at least a piece of the puzzle.

Sorry for the confusion. I didn't want to broadcast too much info. By off the charts low, I meant in terms of SD spread.

Now that I am home and can see it-
He had a scaled score of 5 for coding and 9 for symbol search.
Hope that helps. Sorry for the confusion.