DS was due for new testing before his recent IEP meeting, and since I've been reading here a lot lately regarding DD I've come across comments about interpretations of scores that have peaked my curiousity. DS is unusual because he was chronically ill with declining health for most of his childhood, but it wasn't until he was healthy again we began to notice changes that we tracked back to hypoxic brain injury during his treatment. So, I realize that's not the usual population discussed here, but everyone seems to know quite a bit about interpretation of scores, so it seems worth throwing out my questions. I'm trying to be vague because his diagnosis and situation is particularly unique so I hope my questions are clear enough!

What is considered an unusual "gap" in scores? Is the interpretation of scores of a child with brain injury or disabilities the same process and interpretation as any child? Is it unusual for a child to have 30-40 point gaps between scores but for the tester to say there isn't anything to indicate this is an abnormal spread? Even though he has been diagnosed and he has dysgraphia and other clear impairments in school, and there are clear indications of his diagnosis in his OT and speech tests, there isn't any mention of any areas of concern in his IQ tests. Some of the scores have always seemed unusually high in comparison to how poorly he functions in the classroom, and other scores seem low considering his recall is excellent (although it's true his exective functioning is low). I've always thought it was strange that none of his deficits are ever interpreted in the testing, because I would think they must be reflected there, and that there are never any comments about it. I would just assume that the data itself is the reflection of his strengths/deficits, except that the testor specifically writes that there aren't any red flags.

I just read that certain tests are better for ADHD, so are there tests that are more accurate or give better information for certain children or circumstances?

To answer your question - it is my understanding that a "red flag" gap in scores is usually 2 or more standard deviations (30-32 points). That said, no one can diagnose your child over the internet. Your child's tester has seen your child in person. On the other hand not everyone has a high level of interest or expertise in giftedness and also learning disability.

aeh is the test expert and the gifted community on this forum is grateful for aeh's insights.

Until aeh responds, you might find this information on General Ability Index (GAI) of interest.

What determines the clinical significance of a gap is not simply a specific score difference cut score, as many clinicians can attest to having encountered individuals with very striking score differences who have such good compensatory strategies that they are able to function at the level of their highest cognitive skill area. But in answer to your specific scenario, I would say that yes, it is statistically unusual for a child to have differences of that magnitude between scores. And the existence of relative performance deficits suggests that those cognitive differences do have clinical significance. To be fair, the diagnoses he already carries could be considered the interpretation of the clinical significance of his diverse scores on cognitive ability assessments.

On a more abstract note, some clinicians feel that it is more productive to focus on recommendations for remediating skill deficits than on the cognitive testing profile that might be associated with it. To some extent, that is a philosophical or theoretical orientation decision. I take the position that the cognitive profile can inform remediation and intervention approaches both academically and in the rest of life, but I respect the thoughtful positions of other professionals. (IOW, the absence of profile interpretation may be intentional, or it may be for less thoughtful reasons.)

I do also usually look at brain injury a little bit differently than developmental learning disabilities, though, practically speaking, of course, remediation will be much the same. I have pm'd you some additional comments.

I'm a parent, not a professional, so take my notes with a big grain of salt When my 2e ds (DCD, Dysgraphia, Expressive Language Disorder) was diagnosed, I was told (and also read while researching) that any score with a spread greater than 1.5 standard deviations was a potential red flag. When he was tested at school by a school psych, there was no mention of deviations in ability subtest scores being significant, but when tested by a neuropsychologist these deviations were noted and follow-up tests were given to determine what the cause of the deviations might be.

I don't know that there is a different standard for traumatic brain injury vs learning disabilities re the discrepancies in subtest scores; in our ds' case his DCD/etc seems to be related to family history (which we *didn't* know or realize at the time he was tested). When he was tested, his neuropsychologist felt there was a possibility he'd had an early traumatic brain injury.

Hope that helps a bit!

polarbear

I just want to chime in and share my appreciation for this board and the wonderfully generous and helpful commenters here. I don't post much but I read often; this board is a consistently helpful resource and I would be much more lost without it.

I wish there were some way to send flowers to the regulars! I particularly want to call out aeh for appreciation; s/he is clearly an expert and has donated a tremendous amount of time pro bono to helping parents understand testing and related information via reliably well-informed, clear, compassionate, and productive commentary.

Thank you, everyone - if you only could see the difference you are making/have made for the many families who read or post here!

(In lieu of actual flowers, please accept the invisible internet bouquet I am sending you all with this post. Each bouquet is quite lovely - I told the invisible internet florists to use all of your favorite kinds and to spare no expense. :D)

My DS has a 55 point gap between his highest score (visual spatial) and his dismal processing. DYSDD has a 46 point gap between her verbal comprehension and processing. His low processing score seems to be linked to his reading struggles as well-his rapid naming ability is likewise very low. DD is a great reader but both have dysgraphia and CAPD. DS has ADHD but DD does not.

I would say, based on my limited experience, that the big gap means explore all possible LDs that you might suspect. If your kid is very bright he will likely be able to compensate for hidden LDs for a while but at great cost to himself. Don't depend on the school or his teacher to be able to help. They are not great at seeing deficits and struggles in smart kids (except ADHD which seems to be the reflexive answer for everything) or conversely, see intelligence in a kid with LDs that is struggling!

Pick up "The Mislabeled Child" by Eide and Eide. With the brain injury you describe, brain-based systems that affect learning (visual and auditory processing) could easily be impaired. These deficits are subtle but very impactful for learning and commonly confused with ADHD.