I am also struck by the significant range of subtest scores. In particular:
1. The Comprehension score of 4, in contrast to the other VCI scores in the Superior range (more consistent with a VCI in the upper 120s than in the 100s). Although this is not the only skill associated with it, social reasoning is one of the skills connected with performance on this subtest. Social perception is often notably impaired in individuals with anxiety disorders. Another possible angle (and I don't enough from your description to suggest how likely this is) is that the anxiety and the putative social reasoning deficits are both related to an autistic spectrum disorder. It sounds like there may be other symptoms that could be consistent with ASD, such as inflexibility/rigidity, and sensory regulation issues.
2. The combination of low Coding, relatively low writing, and anecdotal writing refusal all would concern me, wrt written expression, including mechanics, as polarbear already stated. The VMI was in the upper end of the average range, which is less significant, from an OT standpoint, but as it is untimed, there could still be fine motor issues.
3. The math composite score is not as concerning per se. It's within the range, statistically. I would like to know if both computations and problem solving were at the same level, though, as that could be more significant. The math computation subtest involves written work...
4. Did they do the reading, math, and writing fluency subtests? I notice that her Oral Fluency (mostly retrieval fluency) is average, and comparable to Symbol Search, which suggests that the challenge with Coding is specifically fine motor speed, as opposed to untimed fine motor, or motor-free speed. Her perceptual reasoning skills are quite good, so this is more data that suggests pursuing the OT end of things. Fine-motor speed can be connected to deficits in developing automaticity, which can affect writing (lack of automaticity in letter formation and/or spelling can become major obstacles to written expression), reading (using phonetic decoding strategies on novel words), or mathematics (lack of rapid access to basic computations interferes with higher level problem-solving and multi-step computations). The latter two usually become more noticeable in later grades, for high cognitive individuals.
5. I second (third?) more in-depth writing assessment, such as with the TOWL-4 or PAL-II (I give a slight edge to the latter for this age).
