DD#2 - now age 11.5 - was in a lockstep, low-level-stated-mandated-test-prep-oriented not-at-all-accelerated-or-differentiated public school through the first half of 3rd grade. Second half of 3rd grade, we transferred her to a school for "gifted and superior [top 10% on something]" kids, which is a start-up and kind of disorganized (no clear curriculum path, no vertical alignment of curriculum), but the kids are overall fairly bright, and they do read and write and stuff instead of just prepping for low-level standardized tests the way the public school did. DD#2 was not grade or subject-accelerated (never ever allowed in our system), though we did do lots of playful acceleration things at home, and read tons and tons.

DD#2 reads voraciously for pleasure at home, mostly fiction, but sometimes science too. She now loves to write fiction and plays as well, though she was turned off of writing for a while in 3rd grade, when a very bad gifted-pull-out teacher taught them writing and insisted on quantity over detail and depth.

Developmental milestones for both of our daughters are consistent with "exceptionally" gifted profile / possible Ruf 5. DD#2 started speaking meaningfully and with complexity early. Very interested in books and stories very young. But reading didn't take off very early with her the way it did with our older EG DD#1. DD#2 preferred to be read to, and before kindergarten (age 5.5) was really just reading Dr. Seuss books herself. During full-day kindergarten (plus long bus ride), she was tired after school, and would read to herself some - Dr. Seuss books or the easy Little House books (not the real ones). But she seemed to get tired out very quickly. Reading began to take off summer after kindergarten, with the sudden realization on everyone's part that she could easily read a full Magic Treehouse book, wait! several full Magic Treehouse books! in a row. Then another big jump the summer after 1st grade (age 7.5) when she read Harry Potter books 1-5. By the beginning of second grade, she was testing at 6th grade on Accelerated Reader computer-adaptive STAR test, and by the beginning of ninth grade, she was testing at 9th grade on the same test. On another school computer-adaptive test at the beginning of 3rd grade, she tested overall at almost the 8th grade reading level, with scores at 10th grade for short passages, and lower scores for long passages, higher scores for fiction, and lower scores for non-fiction.

When she was 10.5, we had her tested by psychologist specializing in gifted kids with WISC-IV and WJ-III.

Results for WISC-IV Age 10:

Verbal Comprehension (VCI)
COMPOSITE SCORE 155
PERCENTILE RANK >99.9

Perceptual Reasoning (PRI)
COMPOSITE SCORE 129
PERCENTILE RANK 97

Working Memory (WMI)
COMPOSITE SCORE 132
PERCENTILE RANK 98

Processing Speed (PSI)
COMPOSITE SCORE 94
PERCENTILE RANK 34

Full Scale (FSIQ)
138
PERCENTILE RANK 99

General Ability Index (GAI)
151
PERCENTILE RANK >99.9

WJ-III Age 10

Total Achievement
SS 140
PERCENTILE RANK 99.6
GE 12.6

Broad Reading
SS 128
PERCENTILE RANK 97
GE 10.2

Broad Math
SS 142
PERCENTILE RANK 99
GE 13.0

Broad Written Language
SS 134
PERCENTILE RANK 99
GE 13.0

Academic Skills
SS 142
PERCENTILE RANK 99.7
GE 13.0

Academic Fluency
SS 122
PERCENTILE RANK 92
GE 8.3

Academic Applications
SS 135
PERCENTILE RANK 99
GE 13.0

DD#2 ceilinged out on all 6 of the GAI subtests (did not meet discontinue criterion on any of them); actually, same for all of the GAI supplemental subtests, with exception of Information.

Psychologist noted big difference between other indices and the PSI. Said there were no mistakes on any of the PSI subtests, but speed was slow. She also gave DD#2 the supplemental Cancellation test (not included in the reported PSI), and that score was even LOWER - at 16th percentile for random Cancellation and at 5th percentile for structured Cancellation. The Cancellation tests were the last tests given in a couple hours of testing that first day (the psychologist did give breaks, but DD does tend to tire, and she is slightly anxious about performance, and had been nervous about doing the testing, so even though I think she eventually relaxed with the very nice psychologist, I am sure it was stressful for her, and she hadn't slept very well, had mild stomach ache at the beginning). Also, Block Design scaled score was 14 - no errors - she solved all the puzzles but got no bonus points for speed, and she solved the hardest one out of the time limit so got no credit for that one. So clearly lack of speed suppressed PRI.

Psychologist also noted possible effect of "low processing speed" on the writing and math WJ-III fluency tests - overall Academic Fluency was 122 while Total Achievement was 140.

Finally, psychologist noted relatively low WJ-III reading scores. Reading Comprehension score was 123, with several errors. Reading Fluency was around the same, with her making several errors and skipping one sentence.

So what does all this mean? ... Many possibilities....

DD#2 does not act in that dreamy way that classic ADD / primarily inattentive kids do. She speaks very quickly. She does have some performance anxiety, and her natural "set point" is to try not to make errors; although, if she has experience with the tradeoffs between speed and accuracy - e.g., playing a video game over and over - I think she is able to adjust by speeding up even at the cost of some errors, if that increases the overall score (i.e., she's not stubbornly obsessively perfectionistic, just cautious by default). She has sometimes gone too slowly on homework, particularly when she is anxious about teacher's response, when it is writing (she has "too many ideas" and has trouble getting them all down in a coherent way, she feels), and/or when she is tired after a long day. Example: Difficulty in 3rd grade "writing a story using vocabulary words" as homework after a long day, because she thinks the story should make sense and have a good story arc (and that would be hard to do for an adult to do quickly too!). I had to repeatedly reassure her that it's okay for the story to be silly at times to incorporate all of the vocabulary words, and still get the story done in 15 minutes. My older daughter (diagnosed with ADHD) acted the same way, except she didn't have anxiety - she also took forever to write stories because the stories in her head were LONG and COMPLICATED, yet she had a PSI in the 120s.

We have seen less of this problem - melt-downs with homework and having to be talked down - as she has adjusted to the new school over the last 2.5 years.

As a result of all of this, I am not necessarily convinced that the low PSI for DD#2 means anything other than that she is naturally cautious. It COULD mean something else, but I am not convinced that it does.

The reading comprehension and reading fluency scores are interesting. As I said, DD#2 reads voraciously for pleasure (6 or more hours during the summer), and she appears to read very, very fast. (Much faster than I or my husband read - I don't consider myself a super fast reader, but I read fast enough to get a perfect score on the LSAT, so watching my 9-10-year-old read 50% to 100% faster than me is an eerie experience.) One of the psychologist's suggestions was maybe that because she reads fiction for pleasure so much, and since her school emphasizes critical thinking, she may have developed a habit of not worrying too much about picky little details.

In general, the psychologist noted "processing speed's" effect on different scores. She suggested that DD#2 may have a visual processing problem (we had had an earlier 30-minute OT screen that suggested mild visual tracking problem and mild problem catching a ball - never followed up).

So I have a very general question. How surprising is it that a kid with a 155+ VCI would have a WJ-III Comprehension score of 123, or a WJ-III Broad Reading score of 128? She spent K-first half of 3rd grade in a school environment that didn't challenge her at all (in any way). Her new school is more engaging and I believe she is learning much more over all, but they don't do worksheets where the focus on making sure that they don't miss little details (and the curriculum is a little scattershot too - sometimes they read books and then end up never discussing them, due to lack of time - new school, new teachers, etc. - which means that if she is missing details in reading by reading too fast for "big picture" stuff, she might not ever find out). I know I've read that it's not unusual for achievement scores to be below IQ scores where the kid has not had much opportunity for acceleration or enrichment, and she has not had that IN SCHOOL. I do realize that that's a pretty big gap....

The reason I ask is that I'm trying to figure out whether there is some other "issue" - beyond her just being cautious the only time she had a chance to take the 3 subtests for PSI, and her having a habit of maybe NOT reading carefully on timed or untimed tests where details will turn out to matter much more than the "big picture". A year after the psychologist's testing, I have finally gotten her an appointment with a developmental optometrist. We had the first of two scheduled appointments earlier this week, and she apparently is far-sighted: +1.5 in one eye, and +1.25 in another. At first I thought "ah ha - we have missed that - maybe that's IT [cause of all problems and test discrepancies]!!!" (she'd only had vision screens with pediatrician each year, and these were normal). But when I started researching, it seemed like far-sightedness in kids isn't that unusual, this amount of far-sightedness is very mild, and kids can usually "accommodate" for it. I guess we'll know more at later appointments, either from more testing or from more explanation by optometrist. But I'm already wondering about this. I'm pretty sure the optometrist wants her to get glasses to correct that far-sightedness, and she's going to try to see if "prisms" will help or not. She also said that DD#2 has something like tight resting eye muscle state (NOT her exact wording, just my understanding), which comes from reading a lot as a young child (and maybe because of the far-sightedness?) and which could be very tiring, and that vision therapy might or might not turn out to be useful for that or necessary for that. At the next appointment, the optometrist will screen for more stuff, like the visual tracking and I don't know what else.

I do realize that some of this developmental optometry stuff is controversial. I really wish it had turned out that she was very far-sighted, and then we could give glasses a try and see if that helped significantly. But with such low amounts of far-sightedness, I do wonder if glasses will even make any difference, and I am not eager to engage in expensive, VERY troublesome (for us and for DD#2 who is already in school 7 hours a day plus bus rides in both directions), and controversial visual therapy, etc., all based on a processing speed score that could be explicable in other ways, reading and writing achievement scores that could be explicable in other ways, and other symptoms (like fatigue, dislike of writing in 3rd grade) that come and go and could be explicable in other ways.

So I'm wondering about thoughts on these WISC-IV and WJ-III results in relation to possibly related IRL things and in relation to vision issues in particular.

Oh, one more thing: When questioned specifically, she says that she reads something like paragraphs all at one time, and ALWAYS reads at least full lines at one time - she does not perceive herself as moving her eyes as she reads across a line. Obviously, she could be wrong, but I thought it's interesting that she thinks that.

Welcome!

These are excellent scores all around, with the exception of the timed tasks. It is true that there are many possible explanations for the lower speeded scores, including vision/tracking/convergence issues, perfectionistic tendencies, anxiety, and fatigue.

At face value, her reading comprehension appears a bit lower than might be expected by her VCI/GAI, but is actually not strikingly low, based on the available regression tables (there are better discrepancy tables released by the publisher of the WJ for the WISC-III and WJIII, but I had to use a more generic regression table for the WISC-IV). IOW, the difference, while noticeable, may not represent a meaningful finding. Any score between about the low 120s and mid 150s on the WJIII would be considered in the range for her VCI/GAI. (within 1.5 SD, taking SEE into account.)

I would also note that

1. she may be reading so swiftly that she is not always absorbing specific details.
2. if the computer-adaptive test is using Common Core reading criteria, it is likely asking for a very specific way of demonstrating non-fiction ("informational text", in CC parlance) comprehension, in which she may or may not have received instruction. So that the particular narrow slice of comprehension measured by that instrument was not able to capture her expressions of comprehension, nor was she familiar with their methods of expression.

One of my siblings reads like your DC does. I've observed this sibling reading, and notice that saccade activity appears quite different than that of other, more typical readers that I've observed, anecdotally. That particular sibling describes reading in whole lines, straight down the middle of the page. Incidentally, there is also a history of convergence issues. Watch your DC's eyes as she's reading, and then watch another skilled reader's eyes, and you may find that she is correct; her eyes may be moving far less, or in a different way, than others.

As to whether there is a hidden concern, in need of remediation or accommodation--you are already working on clarifying the convergence/tracking category. More importantly, what is -she- concerned about? Is she happy in school? Not unusually stressed by her educational experience? Would you have been worried about her if you didn't know her achievement scores? Are there IRL concerns? Her academic fluency scores are not actually discrepantly low, by your report. Does she frequently have difficulty completing assignments/assessments in a timely fashion?

The first rule of test interpretation that one learns is to use the child to interpret the test, not the other way around.

One aspect of your story that strikes me is your frequent mention of your DD being tired at the end of the day, suggesting you find her noticeably more so than typical? Gifted kids have amazing ability to compensate for learning issues: they create incredible workarounds and can look really effective. But doing so can be exhausting. We all get tired and less competent as the day goes on. However, I have learned to see that if my child seems to have skills in the morning that just aren't there after school, then they probably don't actually *have* that skill, but rather are using some intensive and difficult compensation strategies which are increasingly hard to sustain as the day goes on.

My psych actually says she always prefers to test for learning disabilities in gifted kids at the end of the day, because they're not as good at hiding them.

FWIW, my DD is far-sighted to a similar scale as yours, but got glasses when she was 6 (her eyes were starting to wander when focusing got too difficult). I thought they'd be impossible to keep on her; in fact she hasn't had them off since the day she acquired them. So I assume they make a notable difference for her. She can read without them - she tells me they don't change her focus or look of the text - but they make the text bigger and less tiring to read. She also has convergence insufficiency (and dyslexia). We did vision therapy overlapping with reading remediation. There were huge improvements in reading, and I believe - though can't prove!! - that the VT played a significant part in her increased reading comfort (not to mention rapidly evolving art skills). Certainly, before the VT, if you waved a pencil in figure 8s, or brought it towards her nose, or had her jump her sight from one object to another and back, in every case you could see her eyes jerking inconsistently all over the place and unable to stay focused on an object for more than a moment. This no longer happens, and we have to imagine that being able to move smoothly between words and lines has contributed to her major reading progress.

There's a great summary of the evidence base - such as it is - for visual processing treatments; look at the 3rd last clinical practice guideline listed here, as well as the overview of vision-related learning issues (last item):

http://www.aoa.org/patients-and-public/caring-for-your-vision/clinical-practice-guidelines?sso=y

The combination of reading tons, early, but seeming to tire out quickly is, as you note, the kind of thing you might expect to see when you combine a VCI so high that reading is super-easy, with something that also makes reading unusually laborious, like having to work extra hard to focus, or track smoothly. So, to echo aeh, whether you keep looking for something wrong depends on what you are seeing in real life. With a VCI like your DDs, the question may not be whether there are things she can't do, but rather, are there things you expect her to be able to do easily, but somehow seem harder than they ought to? And do they get increasingly harder as the day goes on and she gets more tired?

One quick CORRECTION, for clarity:

"and by the beginning of ninth grade, she was testing at 9th grade on the same test"

should read:

"and by the beginning of 3rd grade, she was testing at 9th grade on the same test [Accelerated Reader STAR reading test]"

Thanks, aeh! I have been lurking on this board for several years, and I had hoped you'd answer.

This is the gist:

"More importantly, what is -she- concerned about? Is she happy in school? Not unusually stressed by her educational experience? Would you have been worried about her if you didn't know her achievement scores? Are there IRL concerns? ... Does she frequently have difficulty completing assignments/assessments in a timely fashion?"

And that's what's not clear.

This last school year, things have been pretty good. In particular, one of her best friends from public school moved to her new school, and so she has that solid best-friendy relationship she really wants, and she has someone to work with on most of the big projects. I think she is very stimulated working together with another kid whom she likes and gets along with (in fact, the fact that she seems to work well with other kids and gets a lot out of it, is one of the main reasons I'm not homeschooling, even though there are some major problems at this school). I do not believe that the other girl is doing all of the work (though I don't know for sure) - my daughter is very engaged and knowledgeable, and fights, in a nice way, to do things her way. I think it's more that having some else to work with is fun and stimulating and that it lessens her perfectionism - if my BF thinks this is good enough, then I guess it's good enough (teachers won't be mad), and we can keep going.

In 5th grade, there has been much less daily homework than in 3rd and 4th grades. With regard to some big projects that had to be done mostly at home - on 2/3, she has worked with the BF, which keeps her much calmer and more enthusiastic. But, as I alluded to before, at times during both 3rd and 4th grades (and once in a while during 5th grade), she's had crying jags over homework - starting too late in the evening, feeling overwhelmed. This almost always has to do with writing, although I think once there were some calculations / worksheety thing in science that was hard to understand. Oh yeah, and in 4th grade, occasionally upset over Khan Academy exercises, when she would make a mistake, sometimes a miscalculation but sometimes just pushing the wrong button, and having to start the 5-problem sequence over again.

She is VERY affected by missing sleep, also by late meals. You could easily just say that a lot of this stress is a kind of perfectionism (rising to her own standards) combined with fear over teacher disapproval (teachers sometimes grumpy and unreasonable, in unpredictable ways).

And yeah, she has had trouble with finishing things, sometimes. Sometimes I know just what's going on, and it's NOT about vision or even a bad kind of perfectionism. In 4th grade, a teacher assigned writing poems, several of them, in one weeks, and she tried to take a lot of care with them - plays on words, alliteration, rhyme, rhythm, alluding to things without being blunt about them. The teacher said it should take only 30 minutes, at most, but she spent more than an hour and still wasn't finished. That was just wanting to write a good poem, and I thought that was fine, and it was more about a bad assignment and unreasonble teacher - why force a child to write 3 poems in 3 days, rather than 1 more satisfying and higher quality poem in 3 days? (No reason!) And during 3rd grade, when she was still in the public school gifted pull-out, the teacher was frustrated that she spent too much time "thinking" about her story before writing it down - she had a long plot with a lot of details that she hadn't thought out completely, but they were there in her head. And so other kids were starting their 3rd piece of writing when she was still on her 1st. I finally had to sit with her one weekend before the thing was due and have her dictate a "skeleton" to me, to show her that she either needed to cut details, or break to story into 2 or more parts, so she could finish one (it was to be "published" with the class'), and then I typed it for her for several hours while she dictated to me. That assignment was supposed to have been finished in class. That same year, she had been punished by her main teacher (not given candy when other kids were) for her bad handwriting, and that, in combination with the gifted teacher's responses to her, made her very resistant to writing, fiction or non-fiction, for about 9 months, until she got a better teacher in 4th grade at the new school, who coaxed her along and rehabilitated her really well. Now she's writing 14-page screenplays at home, so that's certainly better! Let's see what else - she wasn't able to write down the spelling list words in the time alotted in public school.

Whether she's slower than average, I don't know. Whether she had (and now ocassionally has) crying jags and feels overwhelmed about her work, more so than the average child her age, I don't know. She plays it close to the vest at school, so the teachers there wouldn't necessarily know, and they're pretty disorganized so I don't necessarily trust what they say in either direction. (For example, an email will come out saying that your child should be finished with 3 out of 5 steps in a project, and DD#2 will be half-way through the 1st step, but then I'll find out that lots of other kids are at the exact same stage. Or they might not tell me, or even notice, if she's not finishing things as quickly as others.) It's in the evenings or on weekends, when I have her, when she tended to fall apart. Even at the worst times, in 3rd and 4th grades, I don't have to sit with her to do homework and projects more than I did with DD#1 (in fact, it's less so), but DD#1 has an ADHD diagnosis, so not the best person to measure against!

I am actually kind of more concerned about the PSI tests than the achievement tests. The psychologist's report includes remarks that make it sound like she's going to have a tough life because of the disparity between PSI and 3 other indices. And do I see it IRL? I just don't know. Sometimes it does seem like I do. Now that they have very little homework (and since they have no standardized tests) and with a very flexible, warm language arts teacher, not so much.

I appreciate your looking up the tables to tell me how (not) rare the VCI/GAI and the reading achievement tests - that's just what I was wondering. Of course, the fact that she ceilinged out on all of the GAI tests, the fact that her working memory test also yielded a high number (and thus could be helping her as well), and the fact that developmental milestones related to speaking (though not as much to reading) also indicate that VCI / GAI may be an underestimate puts a little more strain on the difference between possible potential and achievement. Not to mention, believing that there's only a 19/20 of 9/10 chance that the difference is indicating a problem, isn't super reassuring to a parent, even if it's scientifically reasonable to draw a cutof at that point. Especially because people say that vision therapy done younger is better, I feel a bit nervous about trying to figure out if vision problems are having an effect, so I can decide whether to try to do something about it.

Some other issues that I didn't mention before: (1) She's used to have some trouble reading aloud - had to backtrack a lot - she has asked to read aloud to me a lot during the last couple of years (used to hate doing so before that time), so maybe she's been doing self therapy. Over time, she's gotten much better, but occasionally still has the trouble when tired, it seems. OTOH, is it more than most kids? I really have no idea. She was reading books aimed at adults to me often. (2) Her handwriting is sporadically fairly messy. She especially seems to have trouble with spacing words, and sometimes with consistent letter size. When she spends a lot of time on it, it's better (though not beautiful), but that takes time, concentration, effort. How will this affect SAT essay, AP exams later? How does it affect her ability and willingness to write now, while she's still on the cusp of learning to type well (22 WPM now - we keep working on it, because that saved me and DD#1)? (3) Difficulty with writing things sometimes, both her own fiction ideas for pleasure, and her non-fiction writing at school. She says she feels frustrated that she has stories and ideas and "worlds" in her head that she can't get down. Much better this last year, though. The way I think of it is this: maybe her executive function is just average for her age (and handwriting even weaker), but her ideas - she is extremely creative, as well as verbally gifted - are very big. And she has a whole childhood of reading long, complicated, often excellent books. When you're 8 or 11, comparing yourself with J.K. Rowling is really harsh! And even short stories that kids read are usually 5,000 or more words - that's a lot for an elementary school age kid, esp one with handwriting problems, to keep track of, quickly, and yet that's her idea of a short story. So it's like she has a really big toy close of 500 toys, and she's pulled them all out, and now she feels overwhelmed about cleaning them up. She might not have weak executive function - any kid would feel overwhelmed at organizing 500 toys. But most kids don't have 500 toys, so they don't feel overwhelmed as often.... (4) She has headaches occasionally. Also nausea. (I have pretty severe motion sensitivity, and we are now thinking it's possible that I've had mild vestibular migraines my whole life, though that's far from certain.)

I do think she may be reading too quickly to get the details. And so long as that's just a habit that can be corrected, as we start to have her take practice standardized tests where the picky details are the whole point - DD#1 did Duke TIP summer classes and DD#2 really wants to qualify and go to the summer classes, so I'll probably have her take a couple of practice SATs, or the equivalent broken down into pieces, in 7th grade, before the real thing, to make sure that she understands that the picky details DO matter and has practice focusing on them - that's not a problem. Assuming that that is really the only issue.

I took a look at her eyes the other day. They do move horizontally while reading, but I have no way to judge whether it's a normal amount, or a normal pattern, or not. Presumably the optometrist will be much more skilled. No one has specifically mentioned convergence issues yet. Just the tight eye muscles thing that the optometrist mentioned, and the "mild visual tracking" issue that the OT in 3rd grade screening mentioned.

Platypus - thank you for your response. Super interesting about your DD's farsightedness Rx and glasses use. I will probably write more tomorrow, or soon, when I've had a chance to think more about your post.

One other thing: the 33 percentile PSI didn't include the Cancellation tests, which were super low (16th percentile to 5th percentile). I realize that if you test for enough stuff, you'll find "a problem", and the psychologist had not designated Cancellation tests to be included in PSI, so it's appropriate that she didn't put them in that. But again, what does a 5 percentile on Cancellation structured mean? That's another reason I felt I couldn't just ignore the possible vision issue, kwim?

One more In Real Life thing - she feels like she's one of the worst at sports. Of course, she's had little experience - my husband is now blaming himself for this, as he was the more sporty one. Part of this is just that you can't do everything in life, and we're older parents, so doing sporty things with her hasn't been something that's easy for us. I was never naturally coordinated as a child, I think, but I did play tennis for a while (my parents were fanatics) and we had a ping pong table in our house, that at least helped some. I am not sure how much "catching / hitting" a ball is related to the vision problems with reading (if they exist) or far-sightedness. But that is one other IRL issue that may or may not have anything to do with vision.

Responding (mostly) to Platypus:

I don't know if it's more frequent. She's pretty sensitive and emotional, and strongly affected by lack of good sleep or delays between meals. When I took her to the optometrist last week, she was a little bit sleep-deprived, and I thought this was a good thing for purposes of good testing. She also had just gotten braces on, and was in some pain, so not in ideal form for that reason as well. But I only have one other kid of my own to compare with, and she had/has her own issues.

Let's just put it this way. With a lot of intellectual challenge, and some emotional stress, in school, as part of a 7-hour school day and almost an hour on the bus, I'm not exactly surprised that a kid wants to do other things in the evening, her own intellectual and artistic projects, hanging out with family and pets, reading fiction books, daydreaming, outdoor play, instead of homework, esp if it's stressful. I think a lot of people expect way too much out of kids in this respect. With homework, it did sometimes seem to take her too long, but that's maybe because it just feels like too much, and then she's the kind of kid to get very emotional about that, and worried she won't finish, and that just makes it all worse.

But it's really hard to judge. Just because *I* could write down some answers to open-ended questions quickly, doesn't mean a 3rd or 4th grade should be able to do so.

And, as I've said, it was much better this past year. Maybe her far-sightedness has been getting better, and that was part of the improvement - who knows?

The psychologist's report says that she will do worse when graphomotor + visual + speed requirements + fatigue are combined. I would add that she was in a new environment when being tested, relatively comfortable with the psychologist fairly quickly, but she does take a while to adjust to things and is very concerned about pleasing adults, so that kind of anxiety could also have affected things.

This has definitely been the case at a new school in 3rd grade, and with new teachers who are not warm and reassuring.

DD#2 is worried about the eyeglasses because she thinks she will be teased, and they won't look good, esp with the braces, while will make her doubly nerdy. I've told her not to worry, she doesn't HAVE to wear them at school, and if she finds that they are helping her a lot and wants to wear them more of the time, she could get contacts when she's older. (I have a -12 myopia Rx and started wearing glasses for myopia in 6th grade and contact lenses in 7th.)

I have recently heard that kids with stats like mine (very high VCI or GAI, and PSI four standard deviations below) can also read 6+ years above grade level, but still turn out later to have stealth dyslexia and/or vision problems. This is what made me go ahead and get the optometrist appointment. The PSI subtests aren't relevant for dyslexia - am I right? Dyslexia seems like less a fit to me than vision problems do. But DD#1 has a type of epilepsy that is highly correlated with lots of stuff, including dyslexia / reading problems, and the research, such as at is, often extends to siblings and suggests screening for siblings. So who knows on that either... For now, working the vision angle is enough trouble...

I'm kind of unclear on what parts of vision testing or vision therapy are controversial and what aren't. I think prisms are controversial, right? I know that everyone seems to agree that VT for convergence insufficient is a good thing (right?), based on apparently good research, but I'm not so clear on the other things. I picked this optometrist because an acquaintance MD with a daughter with convergence insufficiency was cured by VT, the MD acquaintance says.

In fact, I'm having trouble at this point understanding the differences between different vision issues. Far-sightedness is presumably an objectively measurable thing, right? Am I correct in understanding that if she is getting tired out from, or having problems from, minor far-sightedness, it must be because she is having problems with accommodation that are not typical in a child her age?

Does anyone have anything more to explain about this tight eye muscle thing? I imagine I will hear more later, but you know how medical professionals are almost always more rushed than you'd like, and if I go in understanding what she's talking about, I may be able to ask better questions sooner.

Again, thanks so much for the note about your DD. I was starting to be skeptical when I read how most optometrists use +3.0 or even +5.0 as a minimum for treatment for far-sightedness.

I'm not trying to create a problem where no problems exists, y'know? But all kids have problems, and at times, we have had fairly significant problems (just not as much recently, probably in part because I've devoted huge resources and our family makes large sacrifices, to make sure she gets the sleep she needs). There's never time during the school year to do as much as is possible in the summer, and I don't want to miss any "window". So that's why I'm pursuing this, even though the problems are less acute than a year ago, when we actually did the testing with the psychologist.

Short on time right now, so I'll have to come back tomorrow to follow up, but just a quick few comments (teasers, really!) and further questions:

1. Since she ceilinged on VCI, did they also use extended norms?

2. Low Cancellation does mean something. More on that later.

3. Low PSI can be relevant for dyslexia, including stealth/compensated dyslexia.

aeh-

1. The psychologist gave all regular tests and all substitute tests from the WISC-IV, but planned in advanced to use only the regular tests for the actual computations of scores; all subtest scores are recorded in the report, however. Here's what the report says about "ceilings." DD#2 "reached a ceiling on all but the Information subtest. If the discontinue rule has not been invoked, then it is likely that even more difficult questions could have been answered correctly if
they had been presented. Thus, it could be expected that [DD#2's] verbal comprehension composite score would be even higher had the test had more questions. As such, her current Verbal Comprehension Index of 155 should be considered an underestimate of [DD#2's] true verbal ability." Although she did not put a similar verbal description like this with regard to the PRI, all 4 of the PRI subscores are ALSO marked "ceiling effect", just like all but the Information subscore of the VCI tests are marked "ceiling effect". I think this means that she missed questions as she went along, but she still ran through the end of each of these tests, without ever meeting the discontinue criterion (?). So I suppose that the PRI could also be considered a possible underestimate of her ability in that area (?). As to your specific question, the psychologist did apply extended norms, but the only subtest in which it made a difference was Vocabulary, where she scored 20. DD#2 often feels nervous about being wrong, and will not volunteer in most classes at school unless there is an objectively right answer to something and she is certain that she is right. So I had told her before the WISC-IV and WJ-III testing that there was no penalty for wrong answers and she should feel free to answer when she wasn't sure she was right and even just "guess". However, even though she felt relatively comfortable with the psychologist (one of the reasons I decided to get this testing done preemptively, because I knew that rapport could matter hugely for DD#2), DD#2 still told me afterward that she refused to answer some questions when she wasn't sure she was right. In fact, she was able to immediately tell me of some particular vocabulary words that she thought she knew but hadn't been willing to "guess" on, and I asked her to tell me what they meant, and her answers seemed accurate and articulate to me. So I am sure that a 20 on Vocabulary was an underestimate in that sense. I think the same happened on the Information subtest. For example, there is a calendar item on that test (this was later mentioned in the psychologist's report) that most younger children have memorized, but DD#2 wasn't sure of the answer, so she said she didn't know, but she would have gotten it right if had been multiple choice. She said the same thing about the Vocabulary subtest: "I wish it were multiple choice". Not so much because she couldn't recall the answer, but because she wasn't sure of the answer and didn't want to volunteer if she was wrong. I believed using the extended norm for the 20 on the Vocabulary subtest changed her VCI by a couple of points, but I don't remember exactly. It wasn't a huge difference. Apparently by age 10, she could run out all of the GAI tests, regular and supplemental (except Information), but missed enough questions along the way that the extended norms didn't make too much of a difference for her. Of course, now I wish I had had her tested when she was younger. I didn't have DD#1 tested until she was 13, really just as part of an ADHD evaluation (and with people not experienced with gifted kids who didn't even seem to know about extended norms), and of course, she didn't meet discontinue criteria on anything either. At least I got this one in at age 10.5.

3. I misspoke. I can see that PSI can be relevant for dyslexia. But given that the Cancellation tests were dramatically lower (Symbol Search at 33 percentile, Coding at 33 Percentile, Cancellation Random at 16 percentile, Cancellation Structured at 5 percentile), I was thinking that this leans toward vision versus dyslexia (considering only those two things and not other possibilities like tendency to avoid all risk of error). Of course, the two Cancellation tests were the last tests of a couple of hour testing period.

We had the second day of visual testing today. They didn't tell us anything, but will prepare a report and then we'll have a conference about it.

LaurieBeth,

Did the psych who administered the testing include any additional tests to try to tease out why the processing subtest scores are relatively low? That's really a large discrepancy between PSI and her other scores - even if your dd's other scores had been significantly lower, the PSI scores are low.

FWIW, some of what you wrote about your dd sounds a lot like my dd who has vision challenges (and who benefitted tremendously from vision therapy). Fatigue at the end of the day was one thing in particular. She also doesn't read word-by-word, but reads in blocks, and reads *very* quickly. Her vision has been remediated for some time now, and she loves loves loves to read (fiction and medical books lol), but she still has to work extra hard (compared to most people) to keep her eyes tracking. She also scored extremely low on symbol search on the WISC-IV (prior to vision therapy), but I also recall she scored extremely low on one other sub-test in either PRI or VCI that included a visual component. Sorry I don't remember which subtest it was.

Let us know what you find out from the optometrist's report!

Best wishes,

polarbear

Thanks polarbear. The only test (other than WISC-IV and WJ-III) that she did was "The Beery-Buktenica Developmental Tests of Visual-Motor Integration, Sixth Edition". The report doesn't mention this test specifically at all, other than to list it at the beginning. The reports mentions "visual-motor integration" a few times, but it's not clear if that's just about WISC-IV PSI results. The psychologist didn't recommend any more testing either, other than maybe by a developmental optometrist.

Did you have other clues, in retrospect?

And what was your daughter's specific visual problem, if you remember? I am just beginning to learn some of the terminology.

1. It does sound like the VCI and PRI could be considered low estimates, between her perfectionism and the lack of natural ceilings.

2. In my experience, cancellation draws heavily on visual scanning skills. It's a large field of visual stimuli, with either some or negligible visual structuring (depending on the trial). Fine motor is a fairly small aspect of it (and probably not the major factor in this case, as the other PSI scores, one of which has more fine motor demands, were higher). Sustained attention and visual organization also affect performance. I wonder how much of the lower performance on Cancellation had to do with maintaining a smaller, more structured visual field for scanning and tracking.

3. We have insufficient information to nail down the differential diagnosis, obviously, but FYI, where low processing speed fits into dyslexia is in decoding automaticity. This is not, btw, incompatible with reading extremely quickly, for a child with very high cognition and memory, as one can reach high reading rates using predominantly whole-word/sight reading. In order to detect the lack of decoding automaticity (sometimes called orthographic mapping), one would have to administer timed tests of decoding nonsense words (such as the Decoding Fluency subtest on the KTEA-3), to reduce access to compensatory strategies that involve sight vocabulary. None of the achievement measures you listed included such a test.

I agree that pinning down the role of vision is key right now, but I would keep dyslexia in the discussion, as that might be another factor affecting comprehension (she may be reading purely by sight, which occasionally results in key miscalls in comprehension passages).

And yes, perfectionism is almost certainly in the mix. Whether it is primary or ancillary is another question.

Another correction:

Coding was at 37th percentile.
Symbol search was at 37th percentile.
These two were included in the PSI, which was at 34th percentile.

Cancellation tests, not included in the PSI, and which were the last two tests of the day were:
Cancellation overall was at 16th percentile.
Cancellation random was at 37th percentile.
Cancellation structured was at 5th percentile.

* The psychologist mentioned orally that DD#2's eyes "opened really wide" when she saw the cancellation test. An anecdote that may mean nothing at all.

* What you're saying about dyslexia, aeh, is exactly what I've been thinking. How much of her reading is really sight reading? She can sound words out, but with new words / names or less familiar words, she often skips a syllable the first time she says it. Of course, EVERYONE thinks I'm crazy for even thinking about it, with a child who can read so very well, loves reading, and can spell fairly well (does that matter? she is one of those people who spells better after she looks at what she's written or pretended to write - spelling by sight check, in other words, which I know is a different skill). If it really is something like dyslexia, I wouldn't even know where to begin with getting that tested. I would need someone who really knows "profoundly" (exceptionally, highly, whatever) gifted kids, right? That is what the psychologist we used was, but she didn't mention anything about dyslexia. I do have a friend whose son, a strong reader, was diagnosed with stealth dyslexia, but he had problems with spelling and I think more problems with handwriting than DD#2 has. What other things related to dyslexia would we likely have noticed?

The type of epilepsy DD#1 has been found to be correlated with a number of things, including "speech sound disorder". In fact, though the research is in its infancy, there have been a number of studies publishing showing a high - sometimes equally high - correlation between being a sibling of a kid with the epilepsy and particular problems. In other words, a sibling without overt seizures is just as likely to have problem X as the epileptic kid herself. (DD#2 doesn't have seizures that we know of, and she's never been tested for the characteristic EEG pattern that goes along with this epilepsy.) So there could be other problems that are more common with siblings that just haven't been researched or documented yet (and DD#1 could also have problems that were never diagnosed, of course).

Professional pamphlet: 2/3 of children with DD#1's form of epilepsy have trouble learning to read.

DD#1 knew almost all letters and sounds they made by around 18 months, reading early readers at age 3.5 years old.

Both kids could pull words apart into phonemes at the right age or earlier.

LaurieBeth, I have a HG+ dd who has a reading challenge that was far from obvious and took several years to figure out. The standard tests that pyschologists use (for standard evals) don't necessarily pick up on reading challenges, especially if it's not conventional dyslexia. We were able to get to the nuts-and-bolts of dd's reading challenge through an evaluation by a Speech Language Pathologist who specializes in working with dyslexic children and other types of reading/writing challenges. I can post the list of tests that dd was given here if you're interested - I'll have to look them up because I don't remember the names of all of them, but the key was each test looked at very specific skills relating to reading (and there are a *ton* of different skills). The one test I remember the name of is the Gray Oral Reading test... but there were at least 4 other tests dd was given too.

Best wishes,

polarbear

Your clarification on Cancellation makes it clear that, actually, 3 out of 4 PSI tasks received exactly the same score, in the Average range. The last trial of Cancellation is the only task that scored below average. That makes it less likely that it is something specifically about Cancellation that pulled the score down, and more likely that it was fatigue, as that was the actual last task completed. Most students score slightly better on the structured condition than on the random condition (factored into the norms, of course). This does not, of course, change the general finding of relatively low processing speed.

As to diagnosis of dyslexia: most evals involve identifying two areas of deficit--an aspect of reading performance, or achievement (e.g., phonetic decoding, fluency, comprehension), and a cognitive process that is associated with reading mastery (e.g., phonological processing, phonological/working memory, retrieval fluency/automaticity). In an exceptionally high cognitive individual, these relative deficits may still lie in the average range, as the individual may be able to use cognition to compensate. This does not mean they have no deficit in that area; it may be that they are able to generate normative performance at great cost to higher-level functions and energy drain.

Relevant measures of achievement may include the tests already mentioned, and others: GORT-5, KTEA-3, PAL-II, WIAT-III, WJ-IV, OWLS-II (tests vary in quality and range of reading measures).

Process measures may include

1. measures of phonological processing, such as are found on: CTOPP-2, PAL-II, WISC-V (ancillary), WJ-IV, some speech-language instruments (a standard starting point for speech/language evals is the CELF-5).

2. measures of phonological/working memory, such as are found on: CTOPP-2, WRAML-2, WISC-V, WJ-IV, TAPS-3, D-KEFS.

3. measures of retrieval fluency/automaticity, such as are found on: CTOPP-2, WJ-IV, WIAT-III, KTEA-3, D-KEFS.

Although it can be helpful to give the evaluator some guidance with regard to your concerns, it is also good to keep an open mind, and let the assessment lead the diagnosis, as the obstacle is not always what one thinks it is.

Oh, and on spelling, her approach to spelling (visual) is entirely consistent with being a whole-word/sight reader who has not achieved automaticity for phonetic decoding/encoding. I suspect that she's just powering through reading and spelling with her exceptional memory. This works for everyday tasks, and may be sufficient to get by on all her life (especially if she slants toward less text-heavy fields, such as STEM), but it is not efficient, and likely means she is always performing under her true verbal capacity when text is involved (interpreting or generating).

With your daughter's verbal skills + memory, and the amount of reading she does, dyslexia could be very hard to see. As aeh describes, you'd want very specific testing that dives deep into the underlying phonological processing skills, because she can fake the surface output extremely well. My daughter (for comparison, MG and average memory), was still 88th percentile in terms of phonological awareness, but her scores dropped dramatically as the phonemic manipulation tasks got more complex.

In terms of what you can see yourself, there are a few things I can think of you may see when she reads aloud, though none definitive when a child reads as much as yours. Does she tend to do things like miss suffixes, or skip small connecting words? Substitute plausible but wrong words that may the same first letter or shape? Resist reading out loud? Dyslexics tend to scan for the big meaningful words to extract the gist of the the text, while skipping over the bits in between. It means verbally-gifted dyslexics counter-intuitively tend to do better with longer, more complicated text than short snappy bits that provide less context.

With respect to hand-writing issues, note that dysgraphia and dyslexia frequently go hand in hand, but not always. A lot of the archetypical "dyslexia" signs, like reversed letters and handwriting issues, actually relate more to dysgraphia.

Thanks guys. I've been reading these and will follow up with more details/responses soon.

The one thing that strikes me is that it is true that a big part of my feelings about this - why I'm even considering dyslexia or something similar, and to some degree why I'm thinking about visual problems, is simply the psychologist's testing results. Yes, there are IRL things, but I have only 2 kids, so not a huge knowledge base on what's typical (for things like making some mistakes in reading orally), and as we've discussed, there are many reasons why the testing could have come out the way it did. To the extent that this is about the PSI, I kind of wish I could just go back, have her take the tests again (practice effects wouldn't be that big after more than a year, right), and just tell her to try to go faster - she didn't make any errors on the subtests, according to the psychologist. If that happened, and her PSI was more in the range of DD#1's (I think that was in the 120s), then I probably wouldn't even be concerned. It bothers me that so much work, second-guessing, stress can be based on just a couple of minutes of testing.

LaurieBeth - I sent you a private message. Sue

Sue, wanted to make sure that you saw that I PM'd you back.

Not in any particular order:

* The developmental optometrist did the evaluation. They told us at the end that she would write up a report and send it, and then we could meet in person to discuss (or on the phone if better for me). They did not tell us anything.

* My daughter said that a machine that they were planning to use was broken.

* She also said that she was given a test where she had to stuff from line to line - numbers - and the doctor told her she got them all right. I guess, though, that her speed would still have mattered. Also, the reason she told me that was because she was reading out loud to me and mentioned that she had started to go to the wrong line. I asked her how often that happens and she says pretty often. Of course, asking the question can influence the answer.

* At some point, she was looking at something on a screen, maybe through an instrument, and the doctor asked her to read something and she said she couldn't see the stuff on the edges, and the doctor said, "Is it fuzzy?" and she said, "No, it's just too dark," and she said the doctor seemed surprised, but who knows.

* DD#2 has unexplained mild headaches and mild nausea occasionally.

* DD#1 had some blurring of vision at age 8. This happened several times in school, then resolved after 30 minutes or something like that. I took her to my optometrist and he didn't find anything wrong. They went away, so we never consulted her neurologist (the one prescribing for her epilepsy).

* My sister had far-sightedness and amblyopia at age 4-5. She wore glasses with an eye patch for a very brief period of time, and it resolved completely.

* DD#2 NEVER complains of blurred vision, and when I ask her about blurred vision, she says she NEVER has that.

* If she has mild (+1.25 and +1.5) far-sightedness now, perhaps she had more when she was younger? Maybe she is happier in school this last year in part because she isn't have to strain her eyes as much to accommodate for the far-sightedness?


* Aeh, you said, with respect to the Cancellation subtest, "Sustained attention and visual organization also affect performance. I wonder how much of the lower performance on Cancellation had to do with maintaining a smaller, more structured visual field for scanning and tracking." Could you elaborate?

* Aeh, with respect to the tests you describe for dyslexia issues, would average scores on these tests rule out dyslexia diagnosis? Or would they also be affected by unusual strengths?

* Polarbear, thank you for these notes. If you could post the tests you mentioned, that would be great (if it's not too much trouble).

* One thing to remember: I am not mentioning "issues" randomly - rather, I am specifically mentioning things that I think might be relevant. So I am trying to be aware of the possibility of confirmation bias on my part - e.g., I know that spelling by visualization could mean something, so the fact that she MIGHT be spelling that way more than is typical (and how much do I really know about what is typical?) is something I mention. But I could be wrong about whether she does that an unusual amount. The other day, I just gave her a real word with many syllables (I think it was "initiation") and asked her to spell it. She spelled it correctly, but interestingly, she says when I say it, she visualizes the whole word in her head. I don't do this, not for such a long word. For "home", yes, probably. For "initiation", I may sort of be visualizing it, but if I am, it's really only syllable by syllable, or a general idea of how long the word is and what it starts with. I don't think I have a strong enough visual memory to visualize a word like that in my head at one time (I'm in my early 50s). I don't know if we're doing things differently or not (sounds like it), or if I'm the unusual one or she is. But I guess that's the kind of thing to be inquiring into, maybe at some point. Basically, she shows a few signs of a difficulty (and that's including the WISC-IV and WJ-III results) and seems to be missing many others.

* OTOH, I asked her to do the same - spell another long word that wasn't actually a word, but that would have a typical spelling in English, based on its pronunciation, and she did that okay too. (They did Saxon phonics through 2nd grade.) And I was already pretty sure she had the capacity to spell based on phonetics. But did she do it too slowly? I couldn't tell; it seemed okay to me. I guess that's what they test for, right - how difficult it is to spell nonsense words versus real words quickly.

* Field she is interested in: She says she wants to be a writer, an actor, a teacher, and a scientist (not in any particular order). She is clearly verbally gifted, but she likes science too. Certainly I would not want to rule out humanities/writing fields for her.

* As you can imagine, it's scary to hear all of this. There is a therapy for it, right? I have a friend - my child's kindergarten/first grade teacher (whom she loves)- who is Orton-Gillingham trained. Of course, she thinks my kid can't be dyslexic, because she had no trouble with spelling or with writing (at those ages, anyway), and read so many years above grade level and loved reading. But of course, my friend doesn't specialize in EG / PG kids, and probably hasn't had experience with dyslexic kids with such verbal strengths. (Unlike most do or would, she didn't ridicule me for even thinking it might be a possibility. Just said, I don't think so, but I'll be interested to know what you find out.

* Obviously we need to wait and see how to visual evaluation comes out, what effect wearing glasses has, etc. But again, I wouldn't want to miss a window for therapy for dyslexia-like issues if those were in the mix. My biggest concern would be who to get an evaluation from. Esp if test results would be skewed by DD#2's strengths, and if there aren't objective tests which would isolate the weaknesses, I wouldn't know who to try to find. I suppose I could get a DYS family counselor and ask. We used a regionally very well-known psychologist who specializes in gifted kids for what I guess was a "psychoeducational" evaluation, rather than a "neuropsychological" evaluation. And she didn't mention anything about dyslexia. A friend got a surprise stealth dyslexia diagnosis from someone who is physically much closer to us, even though her son was reading years above grade level (but had spelling and handwriting problems), but she also does ed psych evaluations, so I'm not sure what more I would be getting from her? Maybe she more specializes in dyslexia, I don't know.

* Platypus: Thanks for those details about your daughter. That's useful information, in terms of specifics. In answer to your question, she does do some of those things - when reading aloud, occasionally skipping words or parts of words, substituting plausible words that may not even look similar. I can't tell if it's an unusual amount, though. Don't we all tend to make guesses about what's coming next, e.g., finishing out a cliche before seeing that the next word is actually a different word. Interestingly, she used to resist reading aloud, but for the last couple of years, she has done the opposite - she asks to read aloud to me or her dad, and seems to take pride in it and enjoy it. I wonder if that could be a form of self-therapy. In addition, I have noticed over the last year that when I read to her (I still read to her 15-60 minutes each night, at least), she wants to be a position where she can see the words and she often follows along with me, and will catch me when I skip a word or misspeak or whatever! Again, could be a form of self-therapy.

* Example of the kind of mistake she might make when reading out loud: The other night, she was reading and read "Giordano" as "Giorando" (otherwise pronounced like you'd expect, accent on the right syllable). I stopped her and asked her to look at the word again, and she was able to sound it out. I asked her what she thought had happened, and she said that she "didn't see" the "a", and couldn't figure out how to sound it without ("Giordno") so she just added a vowel sound. I'm not sure what this means, with respect to visual versus language processing, and it doesn't happen SUPER frequently, but it does happen. This was in a room that isn't super bright; she doesn't yet have glasses, and it was around bedtime. She was reading a fiction book by Madeline L'Engle at a normal reading pace.

* One other thing that occurs to me. Her older sister has a diagnosis of ADHD (much more likely to skip words like "not" when taking tests, much more likely to skip problems or pages of problems on tests). However, she has a form of epilepsy that is correlated with various problems, and sometimes the attention problems that are related end up getting described as "attention deficits related to epilepsy". I'm not sure if any one really knows if "epilepsy" type attention problems are different from attention problems in those who don't have epilepsy or abnormal EEGs, but DD#1 does take stimulant medication now, with some good effect. As people often say, "inconsistency is one of the hallmarks of ADHD". As DD#2 is the full sibling of DD#1, I wonder if she could have problems that are variable. I.e., variable not just with typical things such as sleep deprivation, but just variable. DD#2 used to complain about having complicated thoughts she couldn't get down on paper - either things that were required for school, or things she just wanted to do on her own. But during the last 1-2 years, she has seemed to have less of a problem with this, which makes it seem like it's either related to maturing something-or-other (executive function? handwriting?) or related to lowered anxiety with nicer teachers and thus more confidence in her writing at home as well. At times, she writes quite "flowingly" - she wrote a 5-page play by hand in one afternoon and was happy with it, for example. Other times, not so much. But ... is that so unusual? Artistic temperament, muses, writer's block, and all that. When I start writing like this, I do feel like I’m "overthinking" the whole thing. It's really hard with unusual children (and I'm unusual myself) to know what's really a deficit of some kind, and what's just not being, y'know, perfect in every area.

*DD#2 is right-handed and had some mild difficulty with left/right when she was younger (not sure if it was unusual at her age). Just this week, I asked her about this, and she said, "I don't have trouble now, because left hand makes an 'L'." Well, yes, but is she actually still using that mnemonic to remember which side is her left? She says yes. I am not sure if this is true. I don't think she actually looks at her hand making an "L", but it's possible she is visualizing it in her head. I'm not sure if this abnormal, but I sure don't do this. Her dad (right-handed) also has a little bit of trouble here, or maybe did in the past (though it might just be mis-speaking?). DD#1 is left-handed, and also took a while to remember left and right, but again, not sure if it was abnormal.

aeh, polarbear, and Platypus:

I have PM'd all 3 of you. Thank you!

Sustained attention/visual organization and Cancellation:

The visual field for Cancellation has a big mass of visual images filling up a two-page spread, with no visual or verbal guidance about how one should search through the field in an organized manner to find the target items. Symbol Search and Coding, OTOH, are laid out in grids, with nice, neat visual boundaries for each row. An individual who relies on visual scaffolding to maintain tracking, or organization, benefits from the gridlines on SS and Cd, and lacks them in Ca. If the lower Cancellation score is a genuine finding, and not just a mark of testing fatigue at the end of the session, it might be that the absence of a visual frame impeded her speed and efficiency in the visual search task, or caused her, for example, to skip whole lines, thus omitting possible correct responses.

Average scores:

HG kids can definitely use cognition to power through dyslexia-related tests that non-disabled NT kids complete automatically, resulting in similar scores, but arriving by very different paths. So no, average scores do not necessarily rule out dyslexia in a high-cognitive individual.

Received optometrist's report and had in-person meeting.

Report is kind of unclear but main diagnoses seem to be (1) convergence excess and (2) oculomotor (tracking) dysfunction. However, I think the second may be without foundation in the testing - seems to be based on a typo or something in the entry of the data re the Developmental Eye Movement test (i.e., there's an extreme inconsistency between the optometrist's report and the DEM test report I was given - two important numbers are reversed which it appears should definitely change the diagnosis, per the DEM manufacturer's instructions).

(She also has mild far-sightedness, apparently accommodated and on range of +1.5 and +1.25.)

Has anyone ever had a kid treated for convergence excess, with vision therapy or glasses?

Apparently the optometrist thinks she will need glasses eventually, but said that they weren't working well right now, during a fairly short appointment, and it would be something to work up to.

I didn't read this whole thread, only a few of your posts, but had a couple things to say.

DD had similar WISC IV scores (except PRI and VCI were reversed) when she was 8. PSI was 94. GAI without extended norms was 150. Psych who specialized in gifted kids said it took her an hour or hour and a half longer than other kids to do the test and the "slow processing speed" was apparent. DD is extremely slow when it comes to academic work. She can't seem to do anything academic in a timely fashion, except for the fact that she is a fast and fluent reader. It took her probably 5X longer than the rest of the class to do a cursive packet. Her spec. ed teacher was elated when she finally got it done about 2 months later than everyone else. DD has ADHD--combined type and executive dysfunnction and it is extremely obvious. That being said, she did do just the PSI part of the WISC IV a year after the original test and her score went up to, I think, 118. I don't know if that was her "real" score or if the school psych was so incompetent she didn't administer or score it properly. But if it was accurate, that was a huge jump in 1 years time. So I think you may be over-thinking the score. I would not worry about it unless your DD exhibits symptoms like my DD. Her WJ scores were also not anything that you would expect from a child who scored a 150 GAI on the WISC (110 or below was considered an extreme discrepancy in the regression tables, at least in terms of qualifying for services based on having a learning disorder).

DS had a very extreme case of vision issues when he was in kindergarten. He had a traumatic brain injury and one eye was literally stuck turned inward, and didn't track at all for months. Prism glasses would have been useless because the convergence issue was way too severe and he had extreme double vision. Like two identical clocks on the wall 5 feet apart. Two identical books side by side when he read. He would reach for a balloon ribbon and grab at air, the "double" about a foot away from where the real balloon was. He was somehow able to read fluently with an eye that didn't move even when we patched his normal eye. I don't think it was all that easy or comfortable for him but he was able to do it. So when I hear people say that their child has reading difficulty because of their visual convergence issues, I am very skeptical. His eyes are now aligned but he has obvious tracking issues when he's examined. His eyes look like they are moving independently, kind of like a lizards (this is not obvious except when he is asked to track a moving object and people are watching his eyes). He claims that he has no problems seeing the words on the page and he reads books with tiny print very quickly. Reading achievement scores are always 98th-99th percentile, similar to his cognitive ability. I am not sure if any of that info is relevant to your situation but thought I'd share our experience. Vision therapy has been suggested to me but I have no proof that his vision tracking issues are affecting him and would not shell out any money unless insurance paid for it.

"That being said, she did do just the PSI part of the WISC IV a year after the original test and her score went up to, I think, 118. I don't know if that was her "real" score or if the school psych was so incompetent she didn't administer or score it properly."

Thanks blackcat. This is useful. One thing I wonder is if there is much research on repeatability of scores like this one - in HG+ kid where there is an outlier score, esp in something like PSI. DD does try to do thinks without making mistakes, unless and until she is reassured that mistakes are fine and expected and necessary - e.g., by doing a video game where she can't maximize her score if she aims at never ever making a mistake. So I've wondered if her PSI might have been somewhat higher if she repeated it with information that she had made no mistakes but needed to go faster. (I realize this would be a non-standard administration, of course. But if she could go faster and still get a higher score, that would mean something to me, in terms of my concern.) This is pretty much like real life. Default is to be cautious, something that benefits her in some circumstances, but not all. She was also anxious and not feeling well the day she took the WISC-IV.

The psychologist who gave the WISC-IV specializes in gifted kids and this is what she does all week long, so I don't think she made a mistake in scoring or anything like that. But the info that your daughter changed scores so dramatically is reassuring. My daughter may not be a 97 percentile in PSI - given her personality, I would have been super surprised if she scored like that - but maybe it's more a situation of her needing to learn when to go fast and when to be cautious, where she can still be average or above average in speed, once she's figured out that she needs to be.

One thing that is also concerning, I suppose, is that she scored in the bottom 1% to 17% on various subtests of a number calling test at the developmental optometrist's office. I had her sort of repeat the test at home, and she is noticeably slower than I or DD#1 (I think DD#1's PSI was in "superior" range, a personal weakness).

But that doesn't necessarily point to a problem with DD#2's VISION. It could be, but it might not be.

I have a kid with a PG GAI that has had low PSI scores both times he's been tested with the WISC. In his case it is definitely more then him just being cautious, we see it play out every day with him so I don't have a reason to doubt the scores.

Where I live they won't give out composite scores, only 95% confidence intervals. The first time DS was tested (age 6.5) he was 9th%ile, the second time (age 8.75) he was 13th%tile. At first I thought - wow, that's better, at least he isn't in the single digits but when I look at the 95%CI ranges there is a lot of overlap. (74-90 for the 9th%ile and 76-93 for the 13th). It is also a 95% confidence interval not 100% so it is possible for them to get a very different score some other time. His VCI the second time around was WAY above the first round and the two ranges for the 95CI had no overlap for example.

Based on my experience I recommend using the scores as clues but if they don't match what you see in real life go with your gut. DS's second GAI score makes a lot more sense with what we experience with him. His low PSI also makes a lot of sense with our experience. Exactly how low it is and what the exact number is isn't the important bit - putting it together with our experiences so we were pointed in the right direction was.

I think you are probably right about her being overly cautious, hence the score. It probably makes a big difference on a test like that. Kids with true slow processing speed are slow in everyday life, so if you are not seeing that I don't think you need to worry about the score.

I'm curious about the number calling test you mentioned. How do you do it informally at home?

{quote=blackcat+So when I hear people say that their child has reading difficulty because of their visual convergence issues, I am very skeptical.[/quote]

Our dd who has visual challenges had a diagnosis of convergence insufficiency, as well as double vision and limited peripheral vision. Her situation is different than blackcat's ds and her issues were due to low muscle tone, not injury. Vision therapy helped her tremendously, in ways I wouldn't have recognized until we were in the thick of it. I was able to sit in on her appointments and saw the exercises she did with her therapist and at home, as well as testing over time that showed her improvement.

Sorry I don't have time to write more at the moment, but fwiw, quite a bit of what was impacting our dd were things that we couldn't see until they'd been addressed by her VT.

I'll be back later to try to explain more fully

Best wishes,

polarbear

I have a question. If she was only tested a year ago is there a reason that they did not use a WISC V and a WJ IV? The pattern should remain the same but Please keep in mind that the scores on both the tests she was given are going to be somewhat inflated because there are updated versions (and updated norms on both of these tests), I am seeing as much as twenty point differences between the old and the new. My experience is that the verbal items have a much higher ceiling and the PRI and FR do as well.

My point is that DS had very severe convergence issues and didn't have any reading issues. It ranged from very severe to very mild as his eye gradually moved back and the paralyzed nerve healed (each day after the first couple months there was a tiny bit of movement until he could fully track to the outside). So I am not sure why a convergence problem would cause reading problems in some kids but not others. That's why I'm skeptical. I'm also skeptical of VT. How do you know that your DD wouldn't have improved anyway or that the VT is what helped? Maybe there was something else going on at that time, like a good teacher, or working with her at home, or simply maturation that caused the improvement. I'm not saying that I'm positive the VT didn't do some good for your DD but when there are no decent controlled trials on a large number of kids, I am skeptical. A lot of people spend thousands of dollars on VT and don't see an improvement, or the improvement is temporary.

blackcat - I've pm'd you about the test.

sallymom - the psychologist was still using the WISC-IV because there were no extended norms for WISC-V yet (at that time anyway). her Woodcock-Johnson III reading scores were pretty low relative to the VCI and GAI, and that fact presumably wouldn't have necessarily changed even with a different IQ test (but who knows for sure). also, aeh looked for me and said that they weren't WAY out of line relative to the VCI ... but given that VCI itself may have been something of an underestimate for the reasons described before, the fact that that the difference between reading achievement and VCI didn't quite reach statistical significance isn't completely reassuring.

all: to be clear.... most people seem to lump VT all into the same category. however, there's a joint statement by American Academy of Pediatrics and the big ophthalmology organization that accepts VT as proven for convergence insufficiency. how they define that, I don't know - I believe a lot of medical folks think that the optometrists overdiagnose that as well. but anyway, if someone has a CI diagnosis, I don't think you can automatically say that using VT is unproven. with other diagnoses, though, it's different, and the medical people do in fact say that VT for these other diagnoses is unproven. Of course, everything that is now proven was at some point unproven. Apparently many sincere DOs, and intelligent parents, do feel that they see a difference that is attributable to the VT. But of course, there may be many more who don't see a difference (and the truth is, people who didn't get results are less likely to speak up - no one likes ruining someone else's hopes; I have a feeling that the "yays" are going to be way overrepresented on boards like these). And yes, even for those who do, most are going to be hard pressed to attribute it to the VT. In most cases where someone felt that there was a dramatic change, it took a pretty long time AND the child was undergoing other therapy or other changes at the same time. Still, I've heard enough stories, as have people like Linda Silverman and our psychologist, to think it was worth checking into, if not necessarily actually deciding to do the very difficult (not to mention expensive) therapy.

The biggest problem I see now is that the diagnosis that isn't now in question - convergence EXCESS - is not the one that the medical people agree could call for VT, and not the one that most children of parents who swear by VT had. (Some of those kids had both tracking problem diagnosis and convergence insufficiency, but it's less clear which one mattered in terms of the VT making a difference in the child's life. And, as I said, it appears to me that the DO either misinterpreted the tracking test, or recorded a typo that made a huge difference in the way it should be interpreted. So while possible tracking issue was one I was in fact thinking of when I sought out a DO for an evaluation - esp since her score on the cancellation structured was lower than her score on cancellation unstructured - I don't think we now even have a legitimate tracking problem diagnosis.

blackcat- not sure why a severe convergence insufficiency problem wouldn't cause some reading problems, at least if I understand what that is. Is it possible your child had learned to ignore input from one of his eyes? Also, I have read that many profoundly gifted kids with big convergence insufficiency problem still read many years above grade level, but they had other symptoms, read less than they did after treatment, etc. But I don't really know enough to have informed opinions here, just speculating.

I do appreciate everyone's sharing opinions and experiences with me.

To clarify for anyone who hasn't read more of my posts: my DD2 does have some issues - it's not like everything is perfect and I'm getting concerned ONLY over some test results. They're not terrible, esp last year (5th grade). But she is slow in real life at times, she does get stressed at times, she has occasional headaches and gets tired at times. Her reading level as measured by WJ-III is a little low, she makes occasional "careless" errors (reads questions wrong, skips a question). Her handwriting is messy (poor spacing between words esp). She used to resist writing, she used to resist reading aloud. She seems to read weird (really fast, saying that she reads at least a line at a time, maybe more). She possibly hasn't made as rapid progress in terms of choosing to read difficult material as I might have expected (but who knows really - I don't have many to compare with here).

Could these be caused by other things, including being EG / asynchrony (not related to vision) and/or just be typical 11-year-old behavior? Or something completely different, like dyslexia. Or just normal behavior (how many careless errors too many careless errors, how many headaches does the average 11-year-old get, etc.). Yeah, sure could.

This is what makes the decision hard. This and the concern that we might be missing a "window" (with vision, dyslexia, something else, who knows). If I didn't believe that there were windows, I would probably just wait and see if we have a "good" year again next year. I am leaning toward doing that again anyway - we have a lot of very difficult things coming up next year in some other ways, and not necessarily time to add another very difficult thing onto our plates.

My thought was that if we could expect to see an unmistakeable change more rapidly - say 4 to 6 weeks - we would maybe try to power through. But that doesn't seem to be the case. The long, expensive, very very troublesome therapy (both in-office and daily at home), when I can't find even one person who believes her kid was successfully treated for convergence excess, seems like too much, just in terms of costs and probable benefits.

polarbear - welcome back. when you are caught up with everything, maybe you can check in on my private messages... thank you!

All I can tell you is that he was able to compensate very well. He claimed he had double vision when his eye was not patched, and when it was patched, we were patching the normal one. The impaired one barely tracked at all, and for a while it was severely crossed inward and you could barely even see his pupil. So how was he able to read with an eye that didn't track, I have no idea but I listened to him read aloud, and he was fluent. Without the patch, I think he just looked at one of the images or closed one eye. . He claimed to have headaches, but I think that was because he fractured his skull. But who knows. It's hard to figure out what is really going on with a 5 year old, But you don't want to try something based on anecdotal evidence from just a few parents. I don't want to be a debbie downer about VT. Maybe it does work for some kids. We all want to try anything with our kids that might work. But VT is very controversial and sometimes it seems that anyone who gets evaluated by a dev. optometrist walks away with some sort of diagnosis and a prescription for vision therapy. Does anyone have normal vision? I hardly ever hear anyone say "we went to a dev. optometrist, and didn't find any problems." I am guessing many kids are referred to therapy even if they are not one of the few that it would help. Another thing that I want to mention is that DS's OT was not particularly surprised at the fact that he is reading fluently, even with eyes that appear to track independently from each other, because the eyes do not really track with reading even w/ people with normal vision. They jump from place to place.

Hi LaurieBeth - thanks for the welcome back I'm in the midst of trying to catch up on everything, but promise to catch up on your pm too asap! Definitely within the next day or too... sorry I'm a bit behind!

polarbear

blackcat, I *totally* understand your skepticism - I was very *very* skeptical myself. The reasons I considered following through with vision therapy for my dd were these: 1) It was recommended by a neuropsychologist whom I respect - she's the same dr who diagnosed my dyspraxic ds and had been highly recommended by our ped. She's a professional I knew and trusted, and who also wasn't going to benefit financially any which way in recommending vision therapy. We landed at the neurospych to begin with because my dd was struggling with what seemed like cognitive issues - she couldn't follow a multi-step direction if her life depended on it. She was also struggling in school, yet we knew from a pre-K eval that she *shouldn't* be struggling based on IQ. The neuropsych eval found her to be extremely "constant" (same close percentile range) on all but two WISC subtests - both of which relied heavily on vision. 2) at the same time that we were pursuing the neuropsych eval, our dd had been complaining that she couldn't read the board at school (it was the start of a new school year, different teacher, different handwriting, moving into a grade where more was communicated than previously via instructions written on the board. Naturally we took dd to our optometrist when she complained about not being able to read the board, and her eyesight was measured at 20/20... so we thought her vision was a-ok. Again I was skeptical of the whole VT concept in spite of np's recommendation 3) I have a friend with a dd who's ahead of my dd by a few grades in school, who I knew had gone through VT, so I called her up to ask her and she raved about what a tremendous difference it had made for her dd re reading and being able to study for school. Again, I didn't buy it - so I asked our regular optometrist, who I anticipated would say it's hogwash - and she didn't, she actually recommended it, saying that while it's definitely not proven for dyslexia/etc and is sometimes claimed to cure ADHD etc, which it absolutely isn't a cure for.... vision therapy does in fact work well for people who have vision issues related to low muscle tone (which is my dd's issue). I was very confused about why our eye dr wouldn't have already caught an issue during her exam, but she explained that her exam only included looking at the sight in each individual eye - not how the eyes work together. Soo... we decided to take a chance on VT based on our eye dr's recommendation (fwiw, she also knew the developmental optometrist and had other patients who had worked with him successfully.) And there was one last person who clinched it for me - I found out in a round-about manner that our school's librarian had been through VT too, and had benefited from it. She'd thought her near sight was going due to age changes when she hit 40, but her eye dr determined it was instead convergence issues, she went through a course of VT and the VT worked for her.

The thing that *really* convinced us, though, was the initial VT eval. I was there for the eval and was watching when they held a stick out about 4-5 feet in front of dd and asked her how many she saw, and she said 2 with complete confidence like it was the most ordinary thing int he world to see two of everything. Up until that point I'd had *no* idea that she had constant, severe, double-vision. When asked about it, she confirmed it. So that made me realize she needed *something* so we followed through with her vision therapy. FWIW, I also saw tests that illustrated the convergence issues and tests that determined the very limited extent of her peripheral vision.


The things that we saw that helped -

1) almost immediate improvement in things that we didn't realize were tied to vision. For instance, we learned pretty quickly that the reason she couldn't follow multi-step directions was that she spent so much mental effort trying to follow through on the first due to visual challenges that she'd forget about the second/third etc directions. DD confirmed this - if we asked her to pick up a book in the living room, take it to her room, then go to the kitchen, for instance, she would have a tough time picking up the book and would never get to her room. This all changed within the first few weeks of vision therapy, and she told us it was because she would get confused when she was seeing two of everything.

The other thing we noticed almost right away was she was no longer the place-at-the-table with crumbs everywhere, and she was no longer our "family clown" who bumped into everything continually.

Second thing, although she was a capable-enough reader, she wasn't reading at the level her IQ would predict, and she also didn't enjoy reading. At approximately 3 months into VT, she morphed from a kid who really didn't care about books to a kid who literally lives with her nose covered by books 24/7. Her reading speed is phenomenal, and she loves loves loves to read. She didn't undergo a personality change, she simply was finally able to see well enough to discover her love for books.

DD also never sat still before VT - there were many times we thought, and many people who also thought she must certainly have ADHD. Yet once she'd been through a few weeks of vision therapy, she could sit down and read and do school work continuously for more than a nano-second. She also no longer bent her head around in odd ways to look at her schoolwork, and she started maintaining eye contact with us (prior to VT she looked off to the side... after VT she explained the reason she always looked off to the side was to avoid seeing double heads...) The bending around in odd ways while studying was due to her brain shutting down the eyesight in one eye to compensate for double vision. We never see that any more.

Most important change perhaps - she doesn't get tired when she reads and studies anymore. We didn't really realize she was tiring before VT, but it was very obvious in hindsight. I also know quite frankly that VT wasn't a cure-all - dd still has to work to keep her eyes tracking together, but she can make them track now and it's much less work and much tiring than prior to VT.

Could it have been the result of something else - a good teacher? work at home? developmental growth. No way. She didn't have a teacher focusing on helping her learn how to read more efficiently, we were for sure not working on eyesight/reading etc at home *outside* of the exercises she did that were specifically assigned from her vision therapists. I sat in on each of her VT sessions, the therapists explained the goal of each exercise, I saw the measurements they took to evaluate progress. I didn't see any quack science (and I'm a scientist), I just saw caring professionals explain the services they delivered in a way that made sense, and I saw the exercises work over time.


I totally get this, and it's also interesting that you bring this up w/re to this one dd of mine - because this same dd has a medical issue that consumed us when she was a young toddler and in early elementary. She's not the only kid on earth with the issue, and during early elementary when she wasn't following the developmental curve with respect to outgrowing the issue that her dr predicted she should, new ideas were coming out re how to approach this issue. I will never forget being lectured by her dr when I asked could we consider one new idea with the "there have been no clinical trials to prove..."... well... by the time clinical trials had been conducted and proved/disproved the theory, my dd would be grown up and her childhood would be over. I hope I don't sound like a soapbox here, but I suppose I approach life a bit more from looking into something and determining if it makes sense.. and then if there are no clinical trials yet, so be it. I wouldn't let that stop me from something that may help and won't hurt (as long as it's affordable). We were lucky there - our insurance covered the VT. Which might be another indication, perhaps, that it has some perception of being a recognized form of treatment for vision issues caused by low muscle tone.

Sorry if I sounded like I was screaming from the top of my soapbox, I'm not. Just wanted to try to explain what we found, for our *one* dd, my only true experience with it. I definitely don't have any professional credentials to back me up ... and I do think that the cause of my dd's convergence issues was very different than your ds' issue.

Best wishes,

polarbear

Yes, polarbear, and thank you for your detailed descriptions; they show how very different your situation is from ours.

On repeated questioning, DD says she never sees double and never has blurry vision.

She seems to read well ("13th grade" overall on WJ-III at age 10.5, 10th grade Broad Reading, which even takes into account the timed portion of the reading tests), although her score was on the low end of the range of not statistically significant. She loves reading.

She doesn't think her own reading or vision is problematic in any way.

She has occasional headaches (and nausea), but it's not clear that they are correlated with near vision tasks (though I'm trying to start keeping better track of that).

All of the other problems are vague, possibly quite normal, possibly related to other issues for an EG kid, or could mean something else. And they weren't nearly as bad in 5th grade as in 4th and 3rd (although many things changed in 5th grade, and it's hard to know if this will continue).

Based on policy statements online, it appears that neither United nor Aetna will pay for vision therapy for our diagnoses (I think it may be otherwise for convergence insufficiency, in line with the American Academy of Pediatrics and opthalmology association statement of position).

When I asked how long it would take to see unmistakable improvement, DO first said 8 weeks, then said at least 8 weeks (and you know that if we miss one 20-30 minute session at home or one in-office therapy appointment, due to headaches or illness or homework or someone's birthday party or holiday or need to take DD#1 on a college search trip, they will say, "well, that's set you back...").

polarbear--thanks for your explanation. I was concerned because it seems like some parents are led down the wrong path and want to see VT as the golden ticket when the chances that vision problems are the actual problem are probably low. I think it's really important to make clear that it only helps kids with very specific eye conditions (like you just did). Like you said, I think it may be worth a try for kids who are experiencing significant difficulties with certain things, it is unclear why, there are obvious convergence or tracking issues, and insurance will pay for it. But most of the time it's out of pocket and parents may put a lot of time and resources into it, when really what the child needs is a reading tutor or stimulant meds for their ADHD (some kids do actually improve a lot on stimulants).