Trying to understand test scores

[stasia74]

My 6-year-old son has ADHD and is having some issues with school.  We just had a psych/ed done and I am struggling to understand the results.  I would appreciate if anyone could shed light on the following...

 (**I don't have raw scores...just percentiles.)

WISC

VCI
Overall - 86 %ile

• Vocabulary - 50
• Similarities - 95
• Comprehension - 84
• Information (supplemental)/General Knowledge - 84

PRI
Overall - 37%ile
• Block Design - 16
• Picture Concepts - 16
• Matrix Reasoning - 84

WMI
Overall - 34%ile

• Digit Span - 63
• Letter-Number Sequencing - 16

PSI:
Overall - 13%ile
• Coding - 25
• Symbol Search - 9

For what it's worth, he also has a lot of issues with fine motor skills (especially printing/drawing, where he's significantly behind his age).  His SLP previously mentioned significant issues with word retrieval.  Because of other factors, I am wondering whether he might have some kind of auditory processing issue as well...?  Do any of these test results seem to indicate that?  Or anything else?

Thanks!  I appreciate your thoughts!

[bros]

1. Why don't you have the raw scores?
2. What state are you in?
3. Was this evaluation conducted by the school district? If so, why was an OT evaluation not conducted, along with a full and thorough evaluation by the district SLP?
4. Does he have an IEP/504?
5. Who diagnosed him with ADHD? Is he taking meds? Was he taking meds the day of the test?
6. How is his vision?
7. Any issues with birth? Normal gestation period, normal weight, everything go fine?

Now that i'm done asking the questions, based on this limited information, I would say something like dysgraphia (a disorder of written expression) may be in effect here.

[stasia74]

1. I didn't get the raw scores. Only the percentiles were in the report.
2. Ontario, Canada.
3. We did the psych/ed evaluation privately. We had an OT evaluation done through the school. He attended an SLP prior to that (again, we paid for privately).
4. We got the psych/ed in order to establish an IEP.
5. His pediatrician who specializes in ADHD (heads the ADHD clinic at the Children's hospital). Yes, he's on meds and was on them the day of the test.
6. Vision is fine, as far as I'm aware (was tested a couple of years ago).
7. Premature induction due to my raised blood pressure (36 weeks). Lost three other babies in utero in the same pregnancy (first trimester). Just under 5 lbs at birth. Apgar of 9, in NICU for 5 days due to low blood sugar. Healthy otherwise, normal development.

[healthy11]

Stasia74, I'd like to welcome you to Millermom's forum. We have members from across the globe, including Canada, Australia, the U.K., and elsewhere, although the majority are from the U.S. While our diverse locations make some of the legal discussions more confusing, we all share common goals of wanting to help our children with learning and attentional issues to reach their maximum potentials. I have a son, now in his 20's, who was diagnosed with ADHD, dyslexia, and dysgraphia when in elementary school, so I can "relate" to the kinds of concerns you have.

I hate to ask you even more questions, but it's difficult to make any conclusions without knowing a bit more. When was your son initially diagnosed with ADHD? Has he been on medication for awhile? Were any other tests given to your son by this private evaluator? Usually, some kind of achievement test is administered, along with IQ testing, although most testing of young children is considered less reliable and more variable than that given to older kids. In any case, you should go back and ask the private evaluator for raw and/or scaled scores, not just percentiles. You mentioned that your son had an OT evaluation, and has seen an SLP....do you have any results of those evaluations that you could post?

Do you know which version of the WISC your son was given? (I'm guessing it was WISC-IV, since different subtests are in the new WISC-V) I'm not sure how familiar you are with the WISC-IV, but some of the subtests do require more "hand work" and "pencil to paper" ability. The fact your son struggles with fine motor issues makes me question whether his scores for tasks such as Block Design, Coding, and Symbol Search are really representative of his ability, or if they might be lower because of his motor issues? Here's some general info:

The VCI's subtests are as follows:
• Vocabulary - straightforward questions over the meaning of words
• Similarities - asking how two concepts are alike
• Comprehension - questions about social situations or common concepts
• Information (supplemental) - general knowledge questions
• Word Reasoning (supplemental) - children are presented with one to three riddle-style clues and asked to determine what the tester is describing.
The PRI's subtests are as follows:
• Block Design - children put together red-and-white blocks in a pattern according to a displayed model. This is timed, and some of the more difficult puzzles award bonuses for speed.
• Picture Concepts - children are shown rows of pictures, and are asked to find a common bond with one picture in each row.
• Matrix Reasoning - children are shown an array of pictures with one missing square, and select the picture that fits the array from five options.
• Picture Completion (supplemental) - children are shown artwork of common objects with a missing part, and asked to identify the missing part by pointing and/or naming.
The WMI's subtests are as follows:
• Digit Span - children are orally given sequences of numbers and asked to repeat them, either as heard or in reverse order.
• Letter-Number Sequencing - children are orally given sequences of letters and numbers together, and asked to repeat them in both numerical order and alphabetical order.
• Arithmetic (supplemental) - orally administered arithmetic questions. Timed.
The PSI's subtests are as follows:
• Coding - children under 8 mark rows of shapes with different lines according to a code, children over 8 transcribe a digit-symbol code. Time-limited with bonuses for speed.
• Symbol Search - children are given rows of symbols and target symbols, and asked to mark whether or not the target symbols appear in each row.
• Cancellation (supplemental) - students are to mark lines through objects that do not belong in a page of randomly-arranged objects and one of orthogonally-arranged objects.

Based on the percentiles that you did post, it certainly seems as if your son has strengths in the verbal realm. The fact he also did quite well in Digit Span makes me think that CAPD is less likely, but then your son would not have been in a large, noisy setting when being evaluated, so his auditory performance could be quite different in a classroom. You might try to get a copy of Terri Bellis' book "When the Brain Can't Hear" and see if that gives you more information/guidance about CAPD.

[stasia74]

Hi...thanks for that!

He was diagnosed when he was 4.5, and put on medication then. First Adderall, but that seemed to make him angrier, so we switched to Biphentin (he is now at 15 mg of that) and a 5 mg Ritalin daily. At times, he has had raging issues (this was especially bad when he was 4...we seem to be back in a period of that in the last couple of weeks). He's been on Respiridone (.75/day) for the last year or so. That seems to have (mostly) controlled that issue. He has some anxiety issues (scared to go to other rooms/bathroom by himself at home, had a bout of school refusal last year (about this time) for about a month). He was in a French immersion kindergarten, so we switched him to an English program and school this year. In that respect, school seems to be going better. The pediatrician and I have discussed anxiety and ODD, but he hasn't "diagnosed" my son with that, per se.

So, the psych-ed tests: WISC-IV, WIAT-III, Connors 3 - Parent, Connors 3 - Teacher, BASC-2, Parent Rating Scale. She also used the OT Assessment (from October) and the SLP Assessment (from July 2013).

From the psych-ed report:
Cognitive Ability - overall - Avg (45th %ile)

(Plus the test specifics I already listed)

The WIAT-III results:

Subtest - Range - Age Percentile - Grade Equivalent:

Early Reading Skills - Avg - 39th - K.8
Word Reading - Avg - 30th - <1.0
Reading Comprehension - Avg - 42nd - 1.2
Numerical Operations - Avg - 50th - 1.4
Math Problem Solving - Avg - 50th - 1.4
Alphabet Writing Fluency - Avg - 27th - K.0
Spelling - Avg - 30th - K.8

Connors 3 - Parent:
very elevated: inattention, hyperactivity/impulsivity, executive functioning and defiance/aggression scales
7 of 9 DSM-V Inattention symptoms and 4 of 9 hyperactivity/impulstivity were significant problem currently
6 of 8 ODD symptoms are clinically significant at home
Strengths: curious, creative, funny, affectionate

Connors 3 - Teacher:
very elevated: hyperactivity/impulsivity, peer relations
6 of 9 DSM-V inattention symptoms and 7 of 9 hyperactivity.impulsivity are significant problem currently and impact school performance
3 of 8 ODD symptoms are clinically significant at school


BASC-2 Parent Rating Scale:
Concerns: easily upset, cries easily, seems lonely, very argumentative w parents, loses temper easily, worries a lot, easily distracted, overly active

The OT assessment was for motor and sensory processing skills:

Bruininks-Oseretsky Test of Motor Proficiency:
Fine motor precision - below avg
Fine motor integration - below avg
Manual dexterity - well below avg

McMaster Handwriting Assessment:
Near-copy printing assessment - 18.1 letters/min (Gr. 1 avg is 15-32). Poor legibility and did not accurately copy text.
Pencil grasp - extended pencil grasp, occasionally crossing thumb over the pencil; not controlled, holds pencil too loosely.

Beery-Buktenica Developmental Test of Visual Motor Integration:
Visual perception - below avg
Visual motor integration - below avg

Beery-Buktenica Developmental Test of Motor Coordination:
Motor coordination (timed) - very low range

Sensory Profile School Companion (completed by teacher):

Section Summary - Raw Score Totals:
A. Auditory: 24/50 - Definite Difference/Much More than Others
B. Visual: 32/55 - Probable Difference/More than Others
C: Movement: 44/70 - Definite Difference/Much More than Others
D: Touch: 46/60 - Probable Difference/More than Others
E: Behaviour: 47/75 - Definite Difference/Much More than others

Quadrant Summary - Raw Score Totals:
1. Registration: 53/85 - Probable Difference/More than Others
2. Seeking: 37/60 - Probable Difference/More than Others
3. Sensitivity: 42/80 - Probable Difference/More than Others
4. Avoiding: 61/85 - Probable Difference/More than Others

School Factor Summary - Raw Score Totals
1. School Factor 1 - 66/105 - Probable Difference/More than Others
2. School Factor 2 - 30/65 - Definite Difference/Much More than Others
3. School Factor 3 - 55/85 - Definite Difference/Much More than Others
4. School Factor 4 - 42/55 - Typical Performance/Similar to Others


SLP Assessment (July 2013):

CELF-P2 (pictures and verbal directions): Subtest - Standard Score - Percentile - Classification
Concepts & Following Directions - 9 - 37th - Avg
Word Classes - Receptive - 10 - 50th - Avg
Sentence Structure - 9 - 37th - Avg
Expressive Vocabulary - 8 - 25th - Avg
Word Structure - 9 - 37th - Avg
Recalling Sentences - 13 - 84th - Avg
Word Classes - Expressive - 9 - 37th - Avg

Pre-Literacy Rating Scale (Parent): 35 (not equal or greater than 64) = inadequate pre-literacy skills for age

CTOPP:
Elision - 9 - 37th - Avg.
Rapid Colour Naming - Could not score - n/a - severe difficulties
Blending Words - 12 - 75th - Avg
Sound Matching - 7 - 16th - Below Avg
Rapid Object Naming - 5 - <5th - Severe Difficulties
Non-Word Repetition - 9 - 37th - Avg
Blending Non-Words - 12 - 75th - Avg

- difficulties with rapid naming tests may indicate some word retrieval difficulties

Articulation errors: substitution of /w/ for /l/ and /f/ or /d/ for /th/

Pfew! That's about all the info I have...does that clarify anything?

[bros]

The SLP assessment is a bit old for my liking - a lot changes in even the span of a year when they are that young.

[healthy11]

It is difficult to test young children for many reasons, but even with older children, the evaluation process has been likened to "peeling an onion." It requires going through many different layers, and parents may shed tears along the way. An initial evaluation might show one thing, but as more information comes along, a child's diagnosis can evolve or change. Obviously, when assessing a child who isn't yet old enough to be attending school, there are few, if any, academic considerations. It's only later that kids are even expected to read and write and do math, and then the requirements for executive functioning come into play.

I'm not a doctor, nor a professional psychologist/evaluator, but I've been learning all I can about attention and learning disabilities ever since my son was initially diagnosed, around the same age as your son. There are some licensed SLP's on Millermom's forum, who I hope will give you their professional insights. I do have some concerns, especially because you mention that your son has been on meds for awhile, and yet recent rating scales by both teachers and parents show significant ongoing issues. It makes me wonder if he's on optimum medication(s), and/or at the optimum dosage, and/or if there really isn't more going on. I'm not sure if the Canadian healthcare system would allow your son to be seen by a psychiatrist rather than having the pediatrician provide a diagnosis? You've discussed your son's periods of rage, and I can't help but think of a condition such as bipolar. Very often ADHD is the initial diagnosis given to young children, however as mentioned above, as more information surfaces, the analysis can change. You might want to look at www.thebalancedmind.org/learn/getting-started and see if your son's behaviors are similar to those described.

I know it can feel overwhelming at times, but no matter what issues your son may have, remember he is the same child you loved before his diagnosis. Test results are just a "snapshot" of one day's performance, and influenced by many factors, including whether your son might have been tired, hungry, ill, or any number of other reasons. These test results aren't indicative of what his life as an adult will be like. (As I mentioned, my son is now in his early 20's. He's graduated from college, has a full-time job, and lives on his own...there were days I used to worry if he would get kicked out of school, or drop out, or ever have friends, and while it wasn't exactly "smooth sailing," we did the best we could with each day as it came, and that's what we still do.) Hang in there!

[michellea]

Hi and Welcome!

I hope that your neuropsychologist was able to spend time explaining the report and answering your questions. There is much info to gain beyond the scores themselves, and it would be important to hear their qualitative and quantitative impressions/ analysis along with the specific recommendations. I'll comment on some of the "themes" I see in the scores based on my experience as a mom of a son with dyslexia, dysgraphia and ADHD as well as my 10 years as a special ed advocate.

First and foremost, your son is smart! Sometimes when a student struggles, parents can wonder if it is an "intelligence" problem. Your son has good thinking ability as evidenced by high average verbal scores (thinking in words) and average perceptual reasoning scores (thinking visually). He most likely will find math (visual) more difficult than humanities. He has glitches in the IQ areas that deal with "efficiency" - his processing is weak, his working memory is variable. This is common with students with learning disabilities and or ADHD. It is harder for him to take in information efficiently and then to manipulate and create output efficiently. You mentioned some fine motor/handwriting difficulties - these troubles are apparent in the processing speed indx which includes paper and pencils tasks under timed conditions. He also scored lower on the block design - a test that requires some manual dexterity working with the blocks and has a time component. He most likely has a hard time keeping up with written output in school - difficult time with desk top tasks, maybe a hard time copying from the board, messy illegible writing. As the demands increase, he will most likely need extra time, desk top models, someone to check his agenda when he records his homework (older grades) and maybe a scribe or keyboard for writing tasks. In math, he may find it hard to line up his numbers and may benefit from lined or graph paper with extra space.

I also notice on the WISC he has variability within each index. So, while he is highly verbal (VCI at the 86 percentile), his subtest scores vary greatly from one at the 50th (dead average) to the 95 (superior). This "scatter" between scores is notable and sometimes can be a flag for a learning disability.

He is still young, so his scores on the academic areas should be considered with caution. Overall, he seems to have the age appropriate basic skills. But, I see that his language arts skills are all significantly below what one would expect from a student with as strong verbal comprehension skills as he has. Most language arts academic skills are below the 50 percentile, yet his Verbal Comprehension Index was at the 86th percentile. A difference of 15 points is considered statistically significant - his difference are around 40-50 points.

The CTOPP is a test that assesses the underlying skills needed for reading (not reading itself). He had some of the skills (blending, nonword repetition) which is encouraging. But, his scores on all rapid naming tests were very low. This can often signal a difficulty with storage and retrieval of rote information. My son is very similar. This difficulty makes it difficult to efficiently recognize letters/words and ultimately can adversely affect reading fluency. Based on these low scores and his lower academic scores in the areas of reading, writing and spelling, I suspect that your son has a reading disability (dyslexia) and would benefit from a highly structured, phonological reading program such as Orton Gillingham, Wilson, LiPS to help him learn the sound symbol relationship and how to sound out and spell words. Once he has a basic skill for decoding, his reading program should include a fluency component so that he can improve his accuracy, rate and prosody as he reads. A whole word method for teaching reading would be disastrous!

Related to this difficulty with rapid naming could be his comparatively lower expressive language scores on the CELF. He seemed to do quite well on most of the speech and language subtests. He may have a language processing difficulty that makes it harder for him to find his words, organize them and formulate what he wants to say than it is for him to understand what he hears. I do not see a huge problem - but he may need extra time to formulate his thoughts and maybe some prompting, cueing from his teachers so that he can get all of his good thought out. My son is like this - he is actually highly verbal, but he needs time to express what he is thinking. Without encouragement and probing, he is a "man of a few words". But with prompting has a lot of important (and sometimes brilliant) things to say. This difficulty with expression can also affect writing. ie - if it is hard to say it, it can be hard to write it.

Speaking of writing - based on the OT tests and the teachers comments - I would ask if he has dysgraphia - (disability in writing). If so, he would benefit from OT that helps him develop the visual integration skills and handwriting skills. For handwriting, the program "handwriting without tears" might help. As he gets older, he may find keyboarding a great strategy. My son began using a laptop for almost all written work in 6th grade. We never found a good program to help him write his math - he relied on graph/lined paper and constant reminders (even in HS) to line up his numbers and slow it down. He also gets copies of class notes - because he cannot keep up with writing during lectures.

I want to congratulate you for seeking help through the evaluations. I have met many parents that waited - hoping the problems would work themselves out. Meanwhile the child struggles and loses valuable time. I was lucky and tested my son when he was 6 and was able to get him the instruction he needed. My son is very similar to yours in his patterns of strengths and weaknesses. I cried at almost every teacher conference from Kindergarten until about 5th grade when things started to come together for him. Because he received very good and intensive special education instruction, he is now in high school taking a mix of college prep, honors and AP courses and has been accepted to college. He must work harder and longer than his peers, and he uses a number of strategies to help him compensate for his poor reading and writing skills and for his slow processing. But, he is resilient and and successful. Your son can be successful too - school might be a rollercoaster of highs and lows, but if you can get him the correct help, he will learn the strategies to be successful.

[stasia74]

Thank you all so much for your help.I greatly appreciate your thoughts! It all seems so bewildering right now. I would agree things seem to indicate dysgraphia...we're getting that indication from a number of places. I have been wondering about dyslexia, although no professionals have used that term yet. It seems to me that he struggles especially with vowels, which could (maybe?) be because most of them have a similar shape (a,o,u,). It could also be that he just needs to drill those letters phonetically? I'm not sure.

I did look into the bipolar page...I have wondered myself before whether that could be an issue, but I suspect that isn't it. There's no family history, and there don't seem to really be manic and depressive "phases" - it really seems more to me that the rage comes from frustration (which is what makes me wonder about either an expressive language delay, recall issues (word retrieval and decreased memory), or some kind of auditory processing issue).

One problem I do have is trying to get him to do the required practice for therapies. We were given a book for his speech therapy (to drill the "th" sound), and when he doesn't want to do it, he tries to throw it out, destroy it, calls the speech and language therapist stupid, etc., etc. I've actually had to hide it in the top of my closet now. We're supposed to be practicing his handwriting for the OT, but I can't even get him to sit down with it...he gets really mad that he has to have "homework" or extra help, when other kids don't. I've tried some of these kinds of activities in apps on the iPad too, but he refuses to do it if he finds it at all too much like school. Does anyone have suggestions for getting us past that? I'm really stuck there.

[bros]

OT sucks, no matter what age you are. It is always pretty annoying, and for him, if he has dysgraphia, it hurts his hands to write. He might not tell you it hurts him to write because all of the other kids complain about their hands hurting after writing a bit, so he thinks he's having the same pain, when it is really worse.

You could try to combine the two therapies - have him write a bunch of words with the 'th' sound. Maybe have him write a story with as many th words as he can - perhaps Madlibs?

[michellea]

Finding the right balance between therapies, downtime, developing interests and friendships is difficult. When my son was your son's age, I was in a huge hurry to "fix" all the issues and signed him up for OT, Vision Therapy, tutoring etc. His teachers suggested that I back off a bit- she reminded me that he worked very hard at school and was most likely exhausted by the end of the day. It took me awhile to heed her advice and to understand the wisdom. When I consult with parents I remind them that their children do not want to feel like they are "broken" or a project that has to be "fixed". If they spend all their time on their weaknesses, they will not have time to find their strengths and interests.

We found the balance by substituting "fun" activities to address therapeutic ones. During the school year he did Karate and gymnastics instead of OT and home exercises. We kept the home practice to a minimum - he needed me to be mom - not tutor. We did hire a tutor to help with some of the "homework". She came once a week during the school year, 3-4 days a week in summer for 90 minutes. I read to my son, watched National Geographic and the History Channel with him, talked, talked, talked. I encouraged him to play outside and decompress after a long day at school. He hung out with neighborhood boys. He worked very hard and he deserved time to rest, have fun, be a kid.

Your son most likely works harder than any kid in his class at school - just to keep up. Try to insure that his instruction and practice is built into his school day. I do not know the special ed laws in Canada, but in the US, the student should receive special ed as part of the school day unless the TEAM decides he or she needs a longer day. Push the school to integrate his instruction into his regular day - he will have a hard enough time completing regular homework without layering on additional practice and therapies.

And breathe. I know that it is frightening to think he will not catch up and gain the skills he needs for life. Try to keep in mind that learning is life long. Some people take the highway, some take the back roads. They can still arrive at the same place. And sometimes, the long way is more scenic and enjoyable if one can relax and enjoy the ride.