Help interpreting these WISC V results

[NYmomof4]

Hi,

Just got back the results and not sure what to make of it. Any thoughts are appreciated. 

VCI -100,  50%

VSI - 89, 23%

FRI - 97, 42%

WMI - 97, 42%

PSI - 66, 1%

FSIQ - 92, 30%

 

What's even more puzzling is if you compare to 2015 results. The 44% drop in PSI seems enormous. 

VCI -100,  50%

VSI - 92, 30%

FRI - 94, 34%

WMI - 107, 68%

PSI - 98, 45%

FSIQ - 99, 47%

What can explain such a dramatic change in Processing speed? Working memory also dropped a lot. Any suggestions for remediation are appreciated as well. 

[exercise_guru]

Wisc is jut one test. Can you give us a bit more information about your child. Age Area you have noticed growth. Things your child struggles with, diagnosis if you have them.One of the  Processing speed tests is recall of past facts. An example might be " Name all the animals in a zoo. or all breakfast foods" Working memory they often give digits and have them repeated back. I think another memory test was  they show pictures and have the child name and recall what they see . I think one of the tests my son had was a row of pictures in boxes. They were mostly nouns. I took meticulous notes so I will try to pull my folder . 

[NYmomof4]

Hi, 

DD is 15. In early elementary she seemed to struggle across the board - reading, writing, math, everything really. Evaluation done at 7 stated global development delay. Language, auditory processing, visual processing, working memory - all seemed to be weak. After much therapy, the results in 2015 rounds of evals were much better (WISC pasted above. SLP eval came average in receptive and around 30% in expressive language). No specific diagnosis. DD continued to struggle with writing and expressive language, but seemed to have caught up in reading, comprehension, and math. School qualified her for an IEP and speech therapy based on specific writing disability. We are doing another rounds of evals now, and while we are not finished yet, I got these results and was shocked by the dramatic changes in the processing speed and working memory. DD is going into 10th grade and is a B student. With a lot of hard work, she is keeping up, but school is hard. 

[PeterPan]

That processing speed could be anything. Peers pull ahead. She might have been tired. Has she started any medications since the earlier testing? Sometimes they have unintended (or unquantified, unrecognized) side effects. She could have been in a different room or had auditory distractions like a noise machine running or something.

What language testing did they do? If she's looking that bad on a really general screener like the CELF, I'll bet you'd get more dramatic numbers from something like the TNL. I would pursue private speech therapy and do more with her yourself, because that's something where you have tons of evidence that she's struggling. That's probably making everything else harder and could have affected how she did on the processing. 

Have you ever had her checked for retained reflexes? Sometimes when those are retained, it gives this cascade. Some kids get a language bump when they get the reflexes integrated. It would be worth doing, even at this time, especially at this time. Pretty soon she'll be done, out of your home, and not want to do therapy. You're down to picking your last list of what can be done.

Do you have updated audiology evals on her? Thorough APD testing? I finally took my dd out to CO (Able Kids) and get the full testing done. Certainly not the only way, but she was 19. Depends on how much things are holding her back and what she wants to do. My dd was trying to go to college and the background noise was killing her. She really likes her filter, now that she's had time to (slowly) get used to it. So your dd might have some goals where making some steps like that would help. Just depends on her plans, what she wants. Her IQ is so solidly average, it would be nice to get her language scores up and get her more functional. There's actually data on how many contact hours it takes to get language scores up 1 standard deviation with language impairment. The numbers I've read are 300-1000. Sounds terrible, but what it means is you get really good materials and you work with her yourself everyday for 30-45 minutes very faithfully. Or in the summer work 2-3 hours a day, like I've been working with my ds. You DON'T have to be brilliant to do this stuff. Your SLPs were so brilliant and professional, and they didn't even run the more detailed language testing. You only have to know one person, *her*, to be able to do intervention.

[PeterPan]

I'm sympathetic on the dropping scores thing. One of my ds' IQ parameters dropped 30 points, and that was really shocking. I really think in his case it was his language issues we were seeing. That's why I'm saying your dd's scores seem so strong IN SPITE of her disabilities, my lands. There's a lot there to work with. Her GAI (adjusted IQ) would be higher, had they calculated it. 

[NYmomof4]

PeterPan,

thank you for a thoughtful response. Some more background info: no meds, testing was done in the morning, so DD "should" have been well rested. She had a couple of speech evals done back in March. We are doing more comprehensive ones now, but here are the results that we had from the March one:

CELF-5 Core language score of 53

CASL-2 - General Language Ability Index of 34

Reflexes - we spent good 12 months following INPP Dev. Screening and Intervention program, trying to integrate reflexes. I do not think it was very successful. I see signs of Moro reflex still being retained. 

Do you think the low processing speed is due to language or visual processing challenges? 

DD plans to go on to college and I certainly support that though I am afraid it will be hard for her. She is compliant and would be open to working on something at home if it had potential to help her. We've done a ton of linguisystems workbooks in the past and scores above definitely include the SD bump  you mentioned. Do you have any specific recommendations for materials for older kids? thanks

[displace]

My thoughts were that processing speed is highly affected by adhd.  Is that a possibility?  The score could decrease a lot if the symptoms are more invasive now. People who don’t meet criteria for a diagnosis at a young age can still meet criteria as they get older. Learning disabilities can also score lower on processing speed.  Same reason, perhaps.  It may not have been as big an issue before but it is now.

[NYmomof4]

Definitely no hyperactivity or impulsive, but she might have ADD. Overall, she is very hard working, so, if she does have it, she masks it very well. 

[PeterPan]

On August 3, 2018 at 2:58 PM, NYmomof4 said:

CELF-5 Core language score of 53

CASL-2 - General Language Ability Index of 34

Do you have the report handy? Look at it again. I can't tell whether those were standard scores or percentiles. Percentiles don't matter, so if that's what those are then go back and find the standard scores or scaled scores. Standard scores would be better. What is the standard deviation right now on the CASL2 and the CELF5? I haven't looked at them in a while. If they're 15 and you have a standard score of 34, where the mean is 100, then that would be several standard deviations of discrepancy. But if the percentile is 34, it really doesn't tell you how significant that is. You need standard scores for that. So go back and look at your numbers a bit.

Also, you want to dig in on the subtests. The beauty of the CASL is the subtests, so see if your report has them and what they ran and where there are discrepancies. Again, you're looking at the standard scores, not percentiles.

Now, there's one other thing to blow your mind, since we're here crunching numbers, lol. We can google for the sensitivity and specificity for the CELF5 and the CASL2 and see what they are for those tests. It's a thing SLPs discuss now with newer tests, because the cutoff, the cut point, shouldn't necessarily be 1.5 or 2 standard deviations of discrepancy to determine disability. There will be published cutoffs for newer tests, so let's just google and see. Then you can see for YOURSELF whether there are issues indicated. 

Fwiw my ds flagged mildly with the CELF, had pockets of issues with the CASL, and yet clearly, agreed by ALL the SLPs he has worked with now, has a language disability. It just took time to get the testing to show it. He's pretty gifted, and he just had strengths that were hiding it. It was easier to mask in tests that use a lot of multiple choice or tests that provide a model. Once we got him in tests with no multiple choice and no models for the language, he was utter TOAST. So I never assume these tests are right because I've had them done and see how it rolled.

I'll go look for those numbers. Wow, I'm not finding anything for the CASL-2. Is it super brand new? LOL Ok, for the CELF-5, which my ds has had (his CASL was the original I think), that has been out longer and I found this swanky pdf. http://downloads.pearsonclinical.com/videos/CELF-5/10-21-2014/Handout-CELF-5-Reliability-and-Validity.pdf  If you zoom forward to page 17, it begins explaining specificity and sensitivity and how they determine cut scores and why it's essential to understand them. It's a new thing to be informed on this and a thing SLPs are starting to ask for in tests. It's pushing back against schools that use arbitrary cut scores, irrespective of the test. So you can see on the chart on page 18 that they're sort of inverse, that as you include more people you snag more false positives, which is why they try to find a balance there. Foo, I can't tell if they're arguing for a 1.5 cutoff for the CELF5. Anyways, at least you can see the idea.

The point is, interpret the scores and don't just assume the SLP read everything into them. It's a funny profession, because they generate scores that they don't necessarily interpret or act on. They might, but it might be just as much that the dc goes to the intervention specialist at the school and gets time and the goals get put in as reading (ELA) goals, kwim? That's what they do with my ds' language goals in his IEP. They did finally give us SLP goals for language, but a lot gets tackled by other people on the team. So then when you want to dig in and say well what do I DO, sometimes you don't get a lot of analysis or discussion, even though the scores are there, discrepant, ready to inform you. I've found a lot of things for my ds, just being willing to dig in on the data when no one else was.

So yeah, if you have more scores, toss 'em out. subtests, standard scores not percentiles, and so on.

[Crimson Wife]

The Weschler IQ tests can be far too verbally loaded even on the supposedly "non-verbal" portions for children with language-based learning disabilities. My SN child had a 2 standard deviation discrepancy between the "non-verbal" portion of the WPPSI and the completely non-verbal Leiter. Her highest sub-test on the WPPSI was lower than the lowest sub-test on the Leiter. It's actually been very useful to have the 2 sets of scores because it clearly demonstrates the extent to which the LBLD's are hampering her ability to live up to the underlying non-verbal cognitive ability.

[EKS]

I think it's fairly common to see processing speed decline as compared to peers.  My son's evaluators told me that a 1st percentile score equates to taking about twice as long as a kid at the 50th %ile to do whatever.  

[NYmomof4]

All, thanks for responses. 

PeterPan,

i am not sure I understand how percentiles are different from scores, but just in case something jumps at you, here are the actual scores. All comments are welcome.

____________________________________________________________________________________

Subtest (CELF 5)                                         Raw Score           Scaled Score       Percentile Rank

_____________________________________________________________________________________

Formulated Sentences                                   43                           10                           50

Recalling Sentences                                      60                           9                             43

Understanding Spoken Paragraphs                17                           11                           63

Semantic Relationships                                  16                           11                           63

                                                        Sum of Scaled Scores      Standard Score          Percentile Rank

Core Language Score                                      41                           101                        53

 

_______________________________________________________________________________

Subtest (CASL 2)                                                Raw Score           Scaled Score       Percentile Rank

________________________________________________________________________________

Synonyms                                                           34                           97                           42

Sentence Expression                                         39                           106                         66

Nonliteral Language                                           31                           100                        50

Meaning from Context                                        16                           91                           27

Double Meaning                                                 15                           95                           37

                                                         Sum of Standard Scores                 Index Standard                  Score Percentile Rank

General Language Ability

Index                                                        489                                                        94                                           34

[Crimson Wife]

Those are actually average language scores and in-line with what would be predicted from the verbal portion of the WISC. I don't think you are running into an issue whether there would be a huge discrepancy between the WISC and a totally non-verbal IQ test like the Leiter.

Have you read the book Bright Kids Who Cannot Keep Up by Brian Willoughby? That is all about slow processing speed and you might find it very helpful.

[PeterPan]

Scaled scores are mean of 10, usually standard deviation of 3. Standard scores are mean of 100, standard deviation varies but usually 15 or 10.

So yes, right now on those tests she's right at the mean and matching her verbal IQ scores, as Crimson said. If she has narrative language issues, that would be something to work on. Where did the 30% expressive language score come from? Did she do more tests? Keep digging in your report... 

Fwiw it IS possible to look fine on the CASL and CELF and still have issues. These tests have SIGNIFICANT flaws and they are NOT the final word. You said she was already diagnosed with global dev. delays and that the SLP is saying 30% on expressive language. So where did she get that? There's more.

Language undergirds all of academics. You can't always make everything better, but at least figuring out what it is can help you bring in supports sometimes.

Edited August 7, 2018 by PeterPan