Interestingly, his manual dexterity is within normal limits, while otherwise fine motor skills and upper body coordination are below average.
And yes, the TOWL-4 vocabulary results are interesting. He can define words and comprehend them well, but doesn't use them as effectively, at least in writing. This is also the only truly open-response contrived writing task. Spelling and Punctuation are dictated, Logical Sentences is editing, and Sentence Combining starts with two or more stimulus sentences. Spelling and punctuation are as expected based on prior testing.
I'm more interested in the difference between his contrived conventions (Spelling and Punctuation) and his Contextual Conventions, which are in the aggregate above average/high average, which is the kind of distinction I often see in learners who have some awareness of their spelling relative deficits, and select only words they can spell for their spontaneous writing, which tends to artificially restrict their writing vocabulary. Actually, his overall spontaneous writing (self-selected extended narrative) is quite good, and generally commensurate with estimates of his cognition. Contrived writing not scored principally for conventions is also above average, especially Logical Sentences, which is the most conceptual of the writing tasks, and also requires the least original writing. He can generate complex/compound sentence structures.
Taken together, these results suggest to me that his written expression includes many intact elements, commensurate with cognition--with the exception of relative weaknesses in mechanics, and possibly some subtle expressive vocabulary vulnerabilities. And, of course, we already knew that his writing fluency was low.
This is looking more like the primary deficit is fine motor in nature, with secondary effects on mechanical/automatic writing skills (spelling, punctuation, handwriting speed, etc.). The only higher-level written expression task that wasn't up to his personal level was Vocabulary, which happens to be the task most like the homework assignment he had involving making multiple sentences from a collection of words (though this subtest allows him to add his own words, and only requires one stimulus word at a time).
