Sample Report for Helen
This post is dedicated to budding psychology student Helen who, at risk of being expelled on her first day, shared my controversial chapters regarding Psychology and Intelligence with her class. It is a Psychological Report that I completed at Bond University under the supervision of a highly ethical forensic psychologist and criminal barrister, Dr Gavan Palk.
The information contained in this Psychology Report is confidential and provided to X. This report is not to be copied nor disclosed to third parties without Authorisation.
Name (Examinee): X
Date of Birth: X
Chronological Age: 8 years
Date of Report: 2010
Sources of information:
- Face to face interview with mother (28/6/10; 1.5 hours)
- Interview with X (1/7/10; 1 hour)
- School reports (Grades 1, 2, 3)
- School observation (30/7/10, 3/8/10; total 4.5 hours)
- Wechsler Adult Intelligence Scale, 4th Edition (2/7/10; 2 hours)
- Wechsler Individual Achievement Test, 2nd Edition (8/7/10; 2.25 hours)
X was referred to the Bond University Psychology Clinic (BUPC) by her mother who wanted to gain an understanding of her cognitive strengths and weaknesses in order to adequately plan for her future education. Her mother requested that X be assessed for a learning disorder.
Relevant Background Information
X is an eight year old girl who lives with her biological parents and her five year old brother. X’s mother reportedly works as a teacher aid at a state special needs school, while her father works as a __. X’s brother reportedly has no learning problems at school. Mother reported that her brother had learning difficulties at school and consequently left in Grade 8. The mother said she wears glasses for long-sightedness.
Mother reported that her pregnancy with X was unremarkable and that her daughter reached her developmental milestones at the appropriate times. Mother indicated that X currently exhibits difficulty with vision, is easily distracted, is slow to learn, stares into space for long periods, has difficulty following directions, and can be talkative. Jodie reported that X gives up easily on her schoolwork, experiences periods of confusion or disorientation, feels hopeless concerning her schoolwork, is nervous, easily frustrated, requires constant supervision for her schoolwork, has difficulty learning when faced with distracters, has a poor attention span, and poor short-term memory. Mother reports that X substitutes vague words for specific words, responds better to gestures rather than to words, and has unusually loud speech. Mother reported that X’s father strictly corrects X when she uses the wrong word. X reportedly has difficulty resisting peer pressure.
X currently attends Grade 3 at xx. X is in a composite Grade 2/3 class that is share-taught by two different teachers. X was in a composite Grade 1/2 class last year. School reports indicate that X has attended this same school since Grade 1. The school recently informed Mother that X has not progressed academically beyond Grade 1. Mother stated that the school first raised concerns about X’s learning 1.5 years ago, and that since then Mother has requested that the school assess and provide intervention for X. The school reportedly placed X on an assessment waiting list one year ago, has not assessed X to date, and continually places other children with ‘more serious’ learning issues in front of X on the assessment waiting list. Mother stated that she is considering moving X to a private school where will more likely be delivered an expected service for her money.
Her mother reported that X currently exhibits difficulty reading, with arithmetic, with spelling, and with handwriting. X reportedly has difficulty paying attention and taking notes in class, remembering things like school notes, starting her homework, and asking for help when she needs it. X tends to make careless mistakes in her schoolwork. Mother has noticed that X mixes up her upper and lower case letters in sentences, and does not self-correct her work or recognise when something is not right.
X’s school reports indicate that she achieved sound to high achievement for all subjects across the second semester of Grade 1, and sound to very high achievement for all subjects for the second semester of Grade 2. X’s semester 1 report for Grade 3 reveals a dramatic drop in academic performance, with her English and Math achievement marks ranging from ‘support required’ to ‘developing,’ except for a sound achievement for speaking and listening in English.
X reported that she currently has two teachers for Grade 3, that she does not like the teacher who takes her class Monday to Wednesday, but that she likes the teacher that takes her class on Thursday and Friday. X specifically requested that a school observation takes place on a day that her favourite teacher is in attendance.
Mother reported that X enjoys cheerleading, bike riding, animals and computing. She also noted that her daughter was clumsy and tended to have accidents prior to her involvement in cheerleading.
Identification of Learning Disorders
A psychological assessment for possible learning problems typically begins with a valid administration of a comprehensive intelligence test, an achievement test, and the employment of other relevant procedures such as a school observation (Sattler & Hoge, 2006). IQ test results are compared to achievement test scores for math, reading, written expression, and/or an overall achievement score. As a rule of thumb, a discrepancy of one to 1.5 standard deviations (approximately 15 to 20 points) between the scores on an IQ test and select scores on an achievement test has traditionally qualified a child as having a severe learning disorder. This discrepancy is calculated using a mathematical formula.
Sattler and Hoge (2006) list disadvantages of this simple-sounding approach to learning disorder identification. For example, discrepancy formulas do not identify children with learning disorders who show little or no difference between achievement and IQ test scores, or who score poorly on both the IQ measure and achievement test. Therefore, students who score in the borderline IQ range (70 to 79) and similarly on achievement would not be identified as being learning disabled under this identification method. Another limitation of the discrepancy model is that lower SES children tend to obtain lower IQ test scores than do higher SES children, and so a score discrepancy may be smaller in the lower SES group. Further, discrepancy formulas have not been empirically validated. It can also be argued that children with learning disabilities may have various neuropsychological factors and cognitive-processing deficits that can limit the usefulness of IQ and achievement scores (Roid, 2003). Criticisms aside, the discrepancy model does depend on reliable and valid assessment instruments, and it does provide an objective, consistent and accountable approach to identifying learning disabilities (Sattler & Hoge, 2006). The discrepancy model depends on a sufficient relationship between the employed measures of ability (IQ) and achievement (Roid, 2003).
In addition to the significant difference between cognitive processing strengths and achievement weaknesses, children with specific learning disabilities typically show a pattern of significant difference between their cognitive processing strengths and weaknesses (Lichtenberger & Breaux, 2010).
Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV)
X was assessed on the Australian adaptation of the WISC-IV (Wechsler, 2003). The WISC-IV is an individually administered measure of cognitive ability for people aged 6 to 16 years. It is one of a series of Wechsler IQ scales, which are the most widely used intelligence tests (Flanagan & Kaufman, 2004). The WISC-IV is a reliable and suitably valid assessment tool that was standardised on Australians. The WISC-IV comprises 10 core subtests which generate composite scores including a full scale score (FSIQ), and four index scores: Verbal Comprehension (VCI), Perceptual Reasoning (PRI), Working Memory (WMI), and Processing Speed (PSI). The FSIQ has the strongest relationship with the construct of general intelligence (g), and is considered the most reliable score provided by the test.
X attended at the appointed time accompanied by her mother and brother. The WISC-IV was completed in one 1hour, 45minutes. X appeared to lose concentration the moment a task became difficult for her, and she was easily distracted. X behaved this way particularly when asked to follow multi-step auditory directions. At times X exhibited oppositional behaviour. For example, during the Digit Span task, when asked to “say just what I say,” she repeated, “Say just what I say…” and continued to parrot everything the examiner said. X seemed to answer the final subtest (Coding) by alternating between yes and no throughout the subtest. X was either answering haphazardly, or she perceived a non-existent pattern in responding. Therefore, a replacement subtest, namely Cancellation, was administered also. Despite these challenges, the writer managed to keep X on task via humour, playfulness, and assertion so that an overall valid assessment seems to have been achieved.
Test Results and Interpretation
Scores on the WISC-IV are reported as standardised indices with a mean of 100 and a standard deviation of 15. Results are also reported as percentile ranks to show what percentage of same-age peers scored above or below X’s. It is important to note that clinical judgement and other relevant information should also be considered when trying to interpret test results. Further, X’s WISC-IV results are subject to standard error of measurement. This means that results can be affected by factors such as health, motivation and interest, and X may score higher or lower if tested again on another day. To account for result variance, a score range is reported. It is best therefore to look at the confidence interval as the range in which the score is likely to fall. Table 1 displays the composite scores yielded by the WISC-IV.
Table 1: Composite Scores
|Index||Composite Score||Percentile Rank||Confidence Interval (95%)||Descriptive Category|
|Processing Speed||88||21||80-99||Low average|
|Full Scale IQ||87||19||81-94||Low average|
Full Scale IQ
X obtained a Full Scale IQ (FSIQ) score of 87, which is at the 19th percentile compared to other children her age. The confidence interval means that there is a 95% chance that X would score within the range of 81 to 94 upon re-testing. The FSIQ usually provides the single most reliable and valid score. It represents a child’s relative standing compared with her age-related peers, and provides a global estimate of her overall mental abilities. However, there is a significant difference (i.e., 100-73 = 27) between X’s perceptual reasoning and verbal comprehension scores. This indicates that her nonverbal reasoning ability is much better developed than her verbal reasoning ability. Consequently, X’s overall intellectual ability is difficult to summarise in a single score. To fully understand X, it is worth considering her verbal and nonverbal skills separately. X’s performance on the WASI-IV in relation to the general population is illustrated in Figure 1, below.
[Figure 1: Bell curve of IQ levels for the general population]
The bell curve shows the range of performance levels for the general population in regards to standardised IQ measures. Figure 1 indicates that the majority (68%) of people generally have an IQ of 85 to 115, while an IQ score of 70 to 85 is regarded as below average. X’s FSIQ of 87 is ranked in the 19th percentile, meaning her FSIQ score falls below 81% of the population. The WISC-IV classifies X’s current level of functioning in the Low Average range. Table 4 in Appendix A displays the intelligence classifications and their corresponding IQ ranges.
The Verbal Comprehension Index (VCI) is comprised of three subtests: Similarities, Vocabulary, and Comprehension. The VCI measures verbal reasoning, knowledge and concept formation that X has acquired via her education and social environment. This index requires an understanding of word meanings, ability to think with, and express material in, words (Sattler, 2009). People who score a high VCI tend to be interested in educational or intellectual activities, easily understand spoken language, construct sentences easily, and do well in verbally oriented occupations. People who achieve a low VCI typically have difficulty with these same areas (Groth-Marnat, 2009). The difference between X’s highest and lowest scaled scores within this index is not too large (i.e., not > 5 points), making her VCI a sound and interpretable estimate of her ability. X’s VCI result falls below 96% of the population (or in the 4th percentile), and is classified as Borderline. This means that X’s performance for Verbal Comprehension is significantly weaker compared to her age-related peers (see Table 5, Appendix A).
The Perceptual Reasoning Index (PRI) is comprised of three subtests: Block Design, Matrix Reasoning, and Picture Concepts. PRI is a measure of non-verbal, perceptual ability. It involves fluid reasoning, spatial processing, and visual-motor integration. It represents X’s ability to think in, and manipulate, visual images. PRI tasks involve cognitive flexibility and speed, the ability to interpret or organize visual material within a time limit, and an ability to realise abstract concepts and relationships without the use of words (Sattler, 2009). People who score a high PRI are typically good at reading maps, driving to locations, assembling objects, finding things around the house, drawing designs, and working with visual material (Groth-Marnat, 2009). Low PRI scores indicate difficulty with these same tasks, and with making quick decisions under time pressure. The difference between X’s highest and lowest scaled scores within this index is not unusually large, rendering her PRI a sound and interpretable estimate of her ability. X’s PRI falls below 88% of the population, and is classified as Low Average.
X’s working memory was measured by two subtests: Digit Span and Letter-Number Sequencing. The Working Memory Index (WMI) is a measure of short-term memory. It represents X’s ability to temporarily hold information in memory, perform an operation with it, and produce a result. Working memory is an essential component of higher-order thinking. It requires concentration, attention, motivation, numerical ability, auditory processing skills, sound executive functioning, and the ability to mentally do two things at once (Sattler, 2009). People who score a high WMI are usually good at recalling phone numbers, checking monetary change, following a set of verbal instructions, concentrating on a task without distraction, and can do two things simultaneously (Groth-Marnat, 2009). People who score low on this index typically struggle with such things as recalling and following a set of verbal instructions. X’s WMI result is interpretable. Her performance falls below 53% of the population, and is classified as Average.
X’s Processing Speed Index (PSI) is comprised of Coding and Cancellation. PSI reflects X’s speed at performing nonverbal problems. It measures X’s ability to plan, organise, and develop relevant strategies. PSI requires attention, short-term visual memory, visual-motor coordination, psychomotor speed, concentration, and numerical ability (Sattler, 2009). People who score a high PSI usually are fast problem solvers, read quickly, dial phone numbers speedily, and can locate phonebook numbers quickly. Those who score low on PSI tend to be slow at these and other tasks, including finding items on supermarket shelves, picking up objects, giving answers, and learning (Groth-Marnat, 2009). There was no difference between the two subscales, indicating that X’s PSI is a good estimate of her processing speed. X’s obtained PSI falls below 79% of the population, and is classified as Low Average.
Table 2: Subtest Results
(1 – 19)
|Verbal Comprehension||Perceptual Reasoning|
|Working Memory||Processing Speed|
Similarities required X to identify similarities between words. Similarities measured X’s verbal abstract reasoning ability, verbal concept formation, and ability to distinguish between essential and nonessential detail. A low score for this subtest indicates poor abstraction ability, literalness, and rigid thinking. The Similarities subtest is the most sensitive to left hemisphere brain damage (Groth-Marnat, 2009). X’s scaled score for Similarities falls in the 2nd percentile (or below 98% of the population) indicating far-below-average ability. (Table 4 in Appendix A lists the percentile ranks, and their corresponding IQ and scaled scores.)
Vocabulary required X to define words. X’s score reflects his language development, word knowledge, general verbal intelligence, language usage, educational background, and range of ideas, experiences and interests (Sattler, 2009). A low score suggests a limited educational background, low general intelligence, and poor language development. X’s Vocabulary score falls in the 2nd percentile, suggesting below-average ability.
Comprehension measured X’s general factual knowledge. This subtest depends on education, culture, intellectual curiosity, long-term memory, and X’s alertness to her everyday world (Sattler, 2009). A high score indicates a strong educational background, a positive attitude toward school, good verbal ability and long-term memory, and cultural interests. X’s score falls in the 25th percentile, indicating average ability.
Digit Span required X to repeat numbers verbatim, or in reverse order, as read by the examiner. It tests short-term memory and attention, and involves rote learning and concentration. This subtest is severely adversely affected by anxiety, brain damage, mental retardation and learning disorders (Groth-Marnat, 2009). X’s score for Digit Span falls in the 1st percentile, or below 99% of the population, and is indicative of far-below-average ability.
Block Design required X to copy pictured designs using coloured blocks. Block design is a strong measure of visual-spatial ability, an excellent indicator of right hemispheric functioning, and is highly independent of educational and cultural background (Groth-Marnat, 2009). This task involves concentration, visual-motor-spatial coordination, manipulative and perceptual speed. A high score indicates good capacity for visual-spatial perception, visuomotor speed, good concentration, and excellent nonverbal concept formation (Sattler, 2009). X’s Block Design score falls in the 75th percentile, indicating average ability.
Picture Concepts required X to examine rows of two to three pictures and then choose from each row the one picture that best goes together with the other selection(s) to from a concept. This subtest measures abstract, categorical reasoning based on visual-perceptual recognition processes (Sattler, 2008). It is related to reading patterns, quality of early education and general education, and visual acuity. High scores may indicate good visual-perceptual reasoning, good conceptual thinking, good ability to select appropriate relationships between objects or concepts, good ability to use abstract and logical thinking, good ability to discriminate fundamental from superficial relationships, good vision, and flexibility of thought processes. X scored in the 25th percentile for Picture Concepts, suggesting average ability.
Matrix Reasoning required X to fill in a missing design from a number of choices. It measured X’s abstract nonverbal reasoning ability. A high score indicates preference for simultaneous information processing, and excellent visual information processing. Low scores suggest poor concentration, low visual concept formation, and rigid or poor visual reasoning (Sattler, 2009). X scored in the 50th percentile, suggesting she has average ability in this area.
Coding required X to quickly copy symbols that were paired with numbers according to a key. This subtest measures visual-motor speed and short-term visual memory. High scorers tend to have excellent visuomotor ability, mental efficiency, ability to rote learn new material, and quick psychomotor reactions (Groth-Marnat, 2009). X’s score for this task indicates below-average ability, as it falls in the 9th percentile.
Cancellation is a supplemental processing speed subtest that required X to scan an arrangement of small colourful pictures of objects and animals and mark each animal within a 45 second period. This task requires visual recognition and visuosensory scanning. It involves perceptual discrimination and recognition, speed and accuracy, scanning ability, attention and concentration, short-term memory, persistence, and the ability to remain focussed (Sattler, 2004). This task may also reflect X’s fondness for animals and her ability to remain focussed on a subject of interest. X scored in the 50th percentile for this task, indicating average ability.
Analysis of discrepancy comparisons revealed significant differences between X’s index scores. X’s verbal comprehension is significantly lower than her perceptual reasoning, working memory, and processing speed. X’s Similarities subtest score was significantly lower than her Picture Concepts score, and her Coding score was significantly lower than her Cancellation score. Subtest score differences from the mean were analysed, and this found no outstanding strengths and weaknesses. These analyses suggest that X’s nonverbal reasoning skills are more developed, a finding that should play an essential role when establishing specialised interventions for X.
Wechsler Individual Achievement Test (2nd Edition)
The Wechsler Individual Achievement Test, Second Edition (WIAT-II; Wechsler, 2002) is an individually administered test of academic achievement for ages four to adults. It provides an overall summary of functioning in the areas of reading, math, written language and oral language, compared to other people of the same own age. Like the WISC-IV, raw scores for the WIAT-II can be translated into standard scores with a mean of 100 and a standard deviation of 15. Percentile ranks are also provided, as are confidence intervals for each score. A main goal of the WIAT is to investigate ability-achievement discrepancies. For this purpose the WIAT is directly linked to the WISC-IV (Sattler, 2008). The WIAT norms are cross referenced to norms on the WISC-IV, which provides the basis for examining ability-achievement discrepancies.
X completed the WIAT-IV in single two hours and 20 minute session. Rapport was easily established with X and she seemed relaxed and engaged at the start of the test. X appeared to lose concentration, and become defensive, distractible, oppositional, and provocative when a task seemed too difficult for her. For example X flipped the examination booklet over, and attempted to read the answers to questions. X bluntly refused to attempt a task when it involved multi-step auditory instructions. The writer managed to encourage X to attempt the tasks she found difficult, except for a single question in the Written Expression subtest which involved the lengthiest and most complex verbal instruction. X refused to take breaks, so three short breaks were enforced. Despite these issues, a valid assessment appears to have been achieved.
Table 3: Summary of WIAT-III Composite Results
|Composite||Standard Score||Percentile Rank||Confidence Interval (95%)||Qualitative Description|
|Reading||75||5th||69 – 81||Below average|
|Mathematics||93||32nd||85 – 101||Average|
|Written Language||82||12th||74 – 90||Below average|
|Oral Language||108||70th||97 – 119||Average|
|Total Achievement||83||13th||78 – 88||Below average|
Test Results and Interpretation
X’s Total Achievement score on the WIAT-II is at the 13th percentile, indicating that her overall acaedmic achievement sits below 87% of her age peers. There is a 95 percent chance that if tested again on the same instrument, X would achieve a score between 78 and 88 for this same composite. X’s Total Achievement score is classified as below average.
This composite measured different aspects of X’s reading (Lichtenberger & Breaux, 2010). It is comprised of the following three subtests: Word Reading measured X’s emerging literacy and recognition of regular and irregular words. X’s standard score of 80 on this subtest sits in the 9th percentile. Reading Comprehension assessed X’s word knowledge and reasoning in reading sentences and short paragraphs. It measured X’s ability to understand what she reads and to respond by verbally answering questions about the passage. X’s standard score of 74 sits in the 4th percentile. Pseudoword Decoding assessed X’s ability to apply phonetic decoding skills to the reading of nonsense words. This subtest is a good indication of reading problems such as dyslexia. X’s standard score of 72 sits in the 3rd percentile, or below 97% of her age peers.
This composite assessed X’s mathematical skills. It is comprised of the following two subtests. Numerical Operations assessed X’s ability to identify and write numbers, count, and to solve written calculation problems. X’s standard score of 97 sits in the 42nd percentile. Maths Reasoning verbally presented math problems with visual cues to X. It required X to count, identify geometric shapes, solve single and multi-step word problems, tell time, use money, and use measurement. X’s standard score of 88 sits in the 21st percentile.
This composite measured X’s written language skills. It is made up of to subtests. Spelling measures X’s ability to spell dictated letters, letter blends, and words. X’s standard score of 80 sits in the 9th percentile. Written Expression evaluates X’s process of descriptive and narrative writing, not just the product. This approach is more likely to produce writing from individuals who are reluctant to write. It also allows for the evaluation of writing at all language levels, to identify where the writing process breaks down. X’s standard score of 87 sits in the 19th percentile.
This composite measured X’s word knowledge. It comprises the following two subtests. Listening Comprehension evaluated X’s ability to listen for details in order to identify a word or sentence, and to generate words that match pictures paired with a verbal description. X’s standard score of 102 sits in the 55th percentile. Oral Expression was designed to screen for underlying language-based deficits that require more comprehensive language assessment. It measures X’s general ability to use oral language to communicate effectively. X’s standard score of 112 sits in the 79th percentile. X’s score on this subtest was elevated by her performance on a task that required her to list animals.
Ability/Achievement Discrepancy Analysis
As previously noted, there is a significant difference between X’s verbal and nonverbal IQ scores. The FSIQ is still valid for predicting achievement among subjects with large verbal-perceptual discrepancies. This is because the correlation of FSIQ with the WIAT-II is higher for individuals with large VCI-PRI differences (i.e., 15 or more points) than for individuals without large discrepancies (Weiss, Saklofske, Prifitera & Holdnack, 2006). Consequently, X’s FSIQ was employed in a discrepancy analysis between her ability and achievement scores. This analysis revealed significant differences between X’s ability and her achievement in reading and oral language. Table 6 in Appendix A details these results.
Observations were booked with the Primary School’s guidance officer for two separate days, to compare X’s academic performance and behaviour under her two share teachers. The writer attended the first scheduled observation day only to discover that X’s Thursday/Friday teacher had not been informed of this observation date. On the second scheduled observation day, X’s Monday-Wednesday teacher was absent – a relief teacher took the class instead. Nevertheless, relevant information was gathered from X’s teacher, reading intervention teachers, plus the school’s learning intervention coordinator. X was observed while participating in reading intervention, science, art, and language lessons. There were 24 children in X’s class.
X’s regular two-day teacher stated that she also taught X in Grade 1. This woman expressed a number of concerns regarding X’s academic performance, but added that X is not struggling as much as others in the class, and that the academic standard of the class was generally low. The teacher stated that the class were generally well behaved. The teacher stated that X tends not to comprehend at a deep, abstract level. The teacher stated that she has noticed little improvement in X’s literacy since Grade 1. Her teacher stated that X turns red, coy, embarrassed and talks in a baby voice when she is asked to do something she finds difficult. X’s writing generally appears immature for her age. X’s teacher stated that X tends to blend in with her classmates and becomes complacent.
Examples of X’s spelling tests indicate that X scored higher in February of this year compared to a recent test. These test results also demonstrate X’s general difficulty with Grade 3 language work. For example, X tends to confuse short vowels such as “a” with “e” and “o.” She confuses phonemes such as “ch” with “sh.” X also misspells basic words such as “fen” instead of “fan,” and she writes “runned” instead of “he ran.”
During a lesson, X was observed volunteering responses to the teacher’s questions. X was also observed during a reading intervention class on this day. The teacher aide stated that X had been receiving this particular one-on-one intervention for two weeks. X seemed to socialise well with her peers.
During the second observation day, X appeared easily distracted and did not engage in academic work when given the choice. X’s reading intervention teacher showed a record of X’s response to reading intervention since February of this year. This describes X as being off-task, non-compliant, skipping over words, not listening to herself while reading, and reading in the same tone. This teacher aide concluded that X can read well when she wants to.
During an interview with the learning intervention coordinator, this teacher described X as having a passive learning style. She stated that the school noticed X was not participating academically in her Grade 1 class. She stated that X was “not caught” during the Grade 2 diagnostic test, likely due to the test being outdated. This teacher explained that abstract concepts are introduced in Grade 3, and that X tends not to grasp the abstract but operates on a more concrete level consistent with a younger child.
The discrepancy between X’s ability and achievement results suggest the possible presence of a learning disorder. Common learning disabilities include auditory processing weaknesses, dyslexia, attention deficit/hyperactivity disorder (ADHD), and visual processing deficits. The possibility that X has one or more of these learning disorders will be discussed.
X does exhibit a number of inattention symptoms of ADHD; however, her behaviours may be better accounted for by another problem. X’s low score on the WIAT Pseudoword Decoding subtest is associated with dyslexia. X’s nonverbal IQ score was significantly higher than her verbal IQ score, and this pattern is associated with an auditory processing weakness. This pattern could also be indicative of a right hemispheric preference. Silverman (2002) coined the term ‘visual-spatial learner’ (VSL) to describe the latter profile, and she found that right hemispheric preference, dyslexia, and auditory processing problems often occur together within these individuals.
X indicated the following symptoms of a visual processing deficit. She demonstrated difficulty with WISC-IV Coding, a test of visual-motor planning, and with completing Symbol Search, a test of visual discrimination. Her responses to these tests may have been hindered by a visual problem, and this is despite X’s visual processing strengths as indicated by her Block Design score. Further supporting this hypothesis is reports that X experiences vision problems, and her history of clumsiness. However, the evidence for the presence of an auditory processing disorder is greater at this stage.
X has exhibited the following symptoms of a central auditory processing disorder: a loud voice, reading with little vocal intonation, mispronouncing and misspelling words or sounds, vagueness, difficulty remembering multi-step auditory directions, distractibility in an open classroom situation, difficulty taking notes in class. Also, X’s four lowest scores on the WISC-IV all depend on auditory acuity and auditory sequential processing. Her lowest score was on Digit Span, a test of auditory short-term memory for non-meaningful number sequences. While X may be able to hear clearly, her brain’s ability to process what is heard may be adversely affected. Therefore, a basic hearing test may not detect a central auditory processing disorder.
X’s assessment results indicate that she has stronger right hemispheric functioning, and less developed left hemispheric functioning. This pattern is indicative of a visual-spatial learning preference. X exhibits the following VSL characteristics (Silverman, 2002): a slow processor, is sensitivity to teacher’s attitudes, produces uneven grades, demonstrates poor spelling and handwriting, forgets what she hears, is disorganised, daydreams, and she hates writing assignments. The implications of having a right hemispheric preference are discussed next.
Both brain hemispheres are required for language comprehension and communication, yet each side performs a different function. The left hemisphere analyses sound patterns, thus enabling it to understand and produce speech. The right hemisphere can only understand whole words, not phonemes. Phonemes are abstract and so cannot be visualised by the right hemisphere. This is consistent with reports that X confuses phonemes (e.g., “ch” and “sh”). Phonemes are non-meaningful sound bites that are arranged sequentially into words by the left hemisphere. The right hemisphere can only deal with meaningful information. The WIAT-II Pseudoword Decoding task requires the processing of non-meaningful material, which might explain why X scored lowest on this.
The left hemisphere enables rapid word retrieval, and the ability to string words into sentences. Recognition of syntax, tense and grammar are also left hemisphere tasks that cannot be easily visualised in the right hemisphere. This is why the right hemisphere cannot tell the difference between the following two sentences: “The boy chased the dog,” and “The boy was chased by the dog.” The right hemisphere also cannot differentiate between, “The boy chased the dog,” and “The boy chases the dog,” because the right hemisphere does not grasp the concept of time. The right hemisphere also has difficulty visualising absence as implied by the words “no” and “not.” X would therefore likely find the sentence, “The shirt is clean,” easier to visualise and understand than, “The shirt is not dirty.” Spelling is another left hemisphere skill, and it is highly correlated with the WISC-IV Digit Span subtest – an auditory-sequential task that X scored very low on. Therefore, a poorly developed left hemisphere may explain X’s performance on her spelling test, the WIAT-II Reading and Written Language subtests, and the WISC-IV Similarities, Vocabulary, and Comprehension subtests.
The right hemisphere is better at understanding the meaning of whole written or spoken words, recognising faces and facial expression, understanding maps, and completing puzzles. This fits with X’s higher scores on the WISC-IV Block Design, Matrix Reasoning, and Cancellation subtests, which involve visual-spatial processing. The right hemisphere is also important for task motivation and emotional experience. Thus students with a right hemispheric preference respond most favourable to learning when emotionally engaged in a task, and also when they are positively, emotionally engaged with their teacher. This may explain X’s demonstrated tendency to perform better on assessment tasks involving animal pictures or descriptions.
Visual-spatial learners tend to lack verbal fluency or processing speed. This may explain X’s low Processing Speed index score on the WISC-IV. A lack of speed can make a capable child seem incapable, and can affect the child’s self-concept. X’s test behaviour, teacher reports, and school observations indicate that she is embarrassed by her academic performance, and that she might prefer to be perceived as naughty, or as the class clown, rather than as incapable. When asked to engage in an academic task that she finds difficult or unappealing, X becomes resistant and defensive. The tasks she appears to dislike most are those that depend heavily on left hemispheric processing. Expecting X to perform well on auditory-sequential tasks sets her up for failure, considering it may be neurologically impossible for her to perform well on these tasks. Schools have traditionally catered for auditory-sequential learners who usually comprise about two-thirds of the average classroom. X would likely be a challenge to any person who provides her with auditory-sequential tasks, or tasks that fail to tap into her interests.
X’s current school appears to be under-resourced and struggling to cope with a large number of learning disordered children. This notion is supported by reports that X has not been individually assessed by the school for 1.5 years, that a considerable portion of her class are performing below X, and that X scored lowest on the WISC-IV tasks that rely on quality of schooling. X appears to have been lost in the needy crowd, so to speak.
Summary and Recommendations
X is an 8-year-old girl who currently resides with her biological parents, and younger brother. X was referred to the Bond University Psychology Clinic by her mother who wishes to understand X’s cognitive functioning, and to help determine whether X might have a learning disorder. A valid WISC-IV assessment found that X’s cognitive development appears to be uneven, with her nonverbal IQ of 100 being significantly higher than her verbal IQ of 73. X’s cognitive functioning is limited such that 81% of her age peers would have a higher capacity in this same area, while her processing speed is low average and falls below 79% of her age peers. X’s general academic achievement is also limited and falls below 87% of her age peers. These results are consistent with reports from X’s parents and teachers, and an observation of her at school. X meets provisional diagnosis of a borderline learning disorder. It is important to rule out possible hearing and vision problems. The following are some recommendations pertaining to X:
- It is recommended that X undergo a complete audiological evaluation, including a central auditory processing battery.
- X may also benefit from undergoing a comprehensive behavioural optometric assessment including an evaluation of the more complex aspects of vision including binocular coordination, peripheral awareness, eye-tracking skills, and hand-eye coordination.
- It is recommended that X receives academic intervention tailored to her asynchronous hemispheric development. For example, helping her build a sight vocabulary of whole words instead of teaching her isolated speech sounds (phonemic awareness), avoiding rote memorisation of non-meaningful material, teaching concepts visually, and employing visual memory triggers such as colour-coding, diaries, and sticky notes.
- X would perhaps benefit from a more consistent educational environment including a single class teacher who is able to monitor her daily. This might reduce the chance of X’s learning problems going unnoticed in the future.
- If a processing problem is detected, X would likely benefit from a small class size. Regardless of the number of teachers supervising a class, the practise of having a combined class size of approximately 50 children in the one room, for instance, disables a child with sensory, auditory, or visual processing deficits from concentrating and coping.
Thank you for referring X to the Bond University Psychology Clinic. Please contact our service with any questions pertaining to the content of this assessment report, or to arrange further psychological assessment.
BVA, BSc, G.DipPsych