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TESTS ADMINISTERED:

Clinical Interview

Educational and Record Review

Wechsler Adult Intelligence Scale-Third Edition (W AIS-III)

Woodcock-Johnson Psycho-Educational Battery-Third Edition Tests of Achievement - Selected Subtests

Writing (Spelling, Writing Samples, Fluency, Handwriting) Rey Complex Figure Test and Recall Trial

Bender Visual-Motor Gestalt Test

Test of Written Language (TOWL-3)

BEHAVIOR OBSERVATIONS:

During the in-take interview, James presented with appropriate orientation, affect and communication skills. During verbal expressive tasks, James was articulate and confident. By contrast, James' skills did not appear automatic during the visual-spatial, grapho-motor tasks (which reduced his rate of output). During challenging tasks, James was highly persistent and did not appear to become frustrated as items became more difficult. Overall, throughout these testing sessions, James displayed good effort and motivation and appropriate rapport was established. Therefore, this evaluation appears to be a valid representation of his current level of functioning.

TEST RESULTS:

COGNITIVE ASSESSMENT:

The Wechsler Adult Intelligence Scale - Third Edition (W AIS-III) was administered to assess James' overall intellectual functioning. Assessment of these factors allows the determination of an appropriate academic expectancy level. However, several factors are not measured on intelligence tests, such as motivation, creativity, work habits, study skills or achievement in academic subjects, and should also be considered when interpreting these results. On the WAIS-III, James obtained the following standard I.Q. scores (average score = 90- 109) and percentile ranks:

Scale	Standard Score	Percentile Rank
Verbal Score	133	99th
Performance Score	111	77th
Full Scale IQ	125	95th
Index	Standard Score	Percentile Rank
Verbal Comprehension	138	99th
Perceptual Organization	109	73rd
Working Memory	102	55th
Processing Speed	114	82nd

James' Full Scale IQ score fell within the Superior range (Standard Score = 125; 95th percentile). A statistically significant 22 point discrepancy was found between James' very superior (exceptional) verbal linguistic skills (Standard Score = 133; 99th percentile) and High Average non-verbal, visual problem solving skills (Standard Score = 1 1 1; 77^th percentile).

The magnitude of this discrepancy is clinically significant (base rate = 5%) and suggests James' difficulty with tasks that require motor output and speed of work production. Furthermore, an analysis of James' subtest scores revealed notable variability (Le., ranging from the 25th to the 99th percentile) and are reflected in the large discrepancies found among his Index Factor scores. Specifically, a large, statistically significant 24 point discrepancy was found between James' very superior Verbal Comprehension Index score of 138 and relatively lower score on the Processing Speed Index of 114.

A discrepancy this large is also clinically statistically and reflects his output inefficiencies. Furthermore, a significant discrepancy of 36 points was found between James' very superior score on measure of Verbal Comprehension (Standard Score = 138) and average score on measures of Working Memory (Standard Score = 102) (base rate = <1 %).

Last, a statistically significant 29 point discrepancy was found between James' very superior score on measures of Verbal Comprehension (Standard Score = 138) compared with his relatively lower Index score on measures of Perceptual Organization (Standard Score = 109). WAIS-III subtest scaled scores (which range from 1 (lowest possible score) to 19 (highest possible score), with scores around 10 considered average) and percentile ranks are as follows:

Verbal Tests: Scaled Score Percentile Rank

Vocabulary     17                         99th

Similarities      16                         98th

Arithmetic     13                         84th

Digit Span      10                        50th

Information     16                         98th

Comprehension 17                      99th

Letter-Number Sequencing 8         25th

Performance Tests:

Picture Completion 11 63rd

Digit Symbol-Coding 12 75th

Block Design 10 50th

Matrix Reasoning 14 91st

Picture Arrangement 12 75th

Symbol Search 13 84th

Verbal Scale:

James' scores on Verbal tests, which measure the ability to comprehend and process language-based information, ranged between the 25th and 99th percentiles. James' performance was very superior (99th percentile) on a test of verbal knowledge and verbal expressive abilities that required him to orally define words (Vocabulary). James' score was also very superior on the verbal expressive test that assessed his ability to use common-sense judgment/practical reasoning (Comprehension ­

99th percentile). Similarly, he scored at the 98th percentile on a measure of his verbal abstract reasoning (Similarities). During this task, he was required to explain how pairs of seemingly different words were alike. James' score was very superior (98th percentile) on the subtest that assessed his acquired factual knowledge (Information). His score was above average (84th percentile) on a test that measured his mental arithmetic calculation skills (Arithmetic). James' score was within the Average range on a numerical, auditory task that measured his rote, auditory memory for digits (Digit Span - 50th percentile). His lowest score within this domain (25th percentile) was found on the Letter­Number Sequencing subtest that assessed his ability to sequence auditory numbers in ascending order and letters in alphabetical order.

Performance Scale:

James' scores on Performance tests, which measure visual processing and perceptual organization skills, ranged between the 50^th and 91st percentiles. James' strongest score within this domain was found to be superior on the untimed Matrix Reasoning (91 st percentile) subtest, which assessed abstract reasoning that involved continuous and discrete pattern completion, classification and analogy/serial analysis.

He scored at the upper end of the broad Average rang,e on the test that required him to arrange pictures into a logical, sequential order to tell a story (Picture Arrangement - 75th percentile). This test measures visual sequencing skills, the ability to synthesize parts into meaningful, logical wholes and the ability to use analytical and cause/effect reasoning. James also scored at 75th percentile on a timed visually-motor task (Digit Symbol - Coding) that measured his ability to copy symbols that were associated with numbers (Le., graphomotor skills). This task measures speed of eye-hand coordination, visual short-term memory, and sustained visual attention for rote learning tasks.

His score was stronger on the Incidental Learning trials when required to recall the symbol/pairs (with visual cues - the numbers given) (>50th percentile) and when required to free recall the symbols (>50th percentile). His performance was perfect on both trials.

James scored at the 50th percentile on a visual construction task (Block Design), where he was required to reproduce geometric designs with a model of outcome present. He scored within the broad Average range on a perceptual task that involved attention to visual detail and the ability to differentiate essential from non-essential information (Picture Completion - 63^rd percentile).

James' score was also above average on the other processing speed subtest that did not involve a graphomotor component and required him to visually scan paired groups of symbols for a match with the target symbol (Symbol Search - 84th percentile).

The Rey Complex Figure Test and Recall Trial was given to assess James' ability to organize and motorically reproduce complex visually represented information. On the direct copy portion of this test, which required James to copy a complex figure, his skills were found to be well below average ("<1 st percentile range"), revealing significant weaknesses on tasks that require the integration of visual memory and visual-motor dexterity skills.

This deficit could certainly impact upon the speed and automaticity of skills during pencil-and-paper and copying tasks. He lost points due to problems with spatial placement, inattention to detail, disorganization, and perceptual inaccuracies.

The Bender Visual Motor Gestalt Test was given to assess James' visual-motor integration skills. James was presented cards (one at a time) with 9 geometric designs on them that he was required to copy on a blank sheet of paper. Developmental norms indicate that individuals

without visual-motor integration deficits should be able to copy accurately all 9 designs, without error(s) by the age of approximately 11 to 12 years of age. On this test, some problems were observed with regard to integration and angulation that reduced his score (i.e., 2 scorable errors produced an age equivalent score of approximately 10-6 to 10-11 years old) During the recall portion, James was able to accurately recall/draw 5 of the 9 designs (which is average for his age - 50th percentile).

ACADEMIC ACHIEVEMENT:

The Woodcock-Johnson Psycho-Educational Battery-Achievement Tests - Third Edition (WJ-III) (Written Language Cluster) and the Test of

Written Language (TOWL-3) were administered to assess James' performance on tasks similar to classroom requirements. On the WJ-III,

James obtained the following standard scores (average = 90-109) and percentile ranks:

	Standard	Percentile
	Score	Rank
Broad Written Expression	85	16th
Spelling	89	23rd
Writing Samples	105	64th
Writing Fluency	83	13th
Handwriting	70	2nd

Overall, James' scores on broad written language subtests revealed notable variability and were considerably lower than his superior intellectual capabilities. Specifically, his score was found to be below average (13th percentile) on the writing task that measured his fluency and efficiency of output (Writing Fluency). On this task, he was required to rapidly formulate and write sentences within a seven minute time period.

By contrast, James' score was average on a structured untimed writing task (Writing Samples - 64th percentile) that required him to compose logically and grammatically appropriate sentences. During this subtest, James' handwriting did not appear automatic and very difficult to read. He lost points due to poor legibility (Handwriting - 2nd percentile).

James' score was also below average on the subtest that assessed his spelling skills (Spelling - 23rd percentile). James was asked to provide a writing sample in response to the prehistoric picture scene from the Test Written Language (TOWL-3). However, James' story was not legible, so could not be scored.

SUMMARY AND RECOMMENDATIONS:

James is currently a 19 year old student in his Sophomore year of study at Saint Mary's College of Maryland. He presents with a history of

difficulties with handwriting, fine motor skills, visual-motor processing speed and ADHD.

James received accommodations and special education services as a student in Montgomery County Public School. He continues to report problems with handwriting that impacts upon his performance on essay exams. Current test results are consistent with his previous diagnoses.

Specifically, in spite of James very superior (gifted) verbal intellectual capabilities, he revealed processing deficits on tasks that assessed visual-motor integration and output. James' scores were also found to be statistically lower on tests of perceptual organization and working memory.

Tests of James' written language revealed educational impact. His scores on the Woodcock-Johnson were considerably below his intellectual capabilities. Specifically, James' lowest scores were on measures of handwriting, writing fluency and spelling. On the Test of Written Language (TOWL-3), his handwriting deficits were to such a degree that James' story was not legible, so could not be scored.

In summary, current test data indicate James' diagnoses of visual motor

disabilities DSM-IV: 31 5.4 - Developmental Coordination Disorder and Dysgraphia DSM-IV: 315.2 - Disorder of Written Ex expression.

Specifically, a significant discrepancy was found between James' intellectual ability (Standard Score = 125) and achievement measured on the Woodcock Johnson (Broad Written Expression cluster) (Standard Score = 85). Therefore I highly recommend that James be accommodated for his disabilities be continued use of computer for all classroom exams in college as well as an standardized tests that involve written out.  He may also benefit from writing directly into test booklets vs. scantron.

James has considerable strengths to compensate for his disabilities, but requires continued accommodations to achieve at his gifted intellectual level. Specifically, James' scores were very superior to superior on tests of verbal comprehension, vocabulary, verbal concept reasoning, matrix (categorical) reasoning, and acquired factual knowledge. James ma also benefit from note taking supports ie use of lap top computer copy of another students notes/teacher notes, tape record lectures. If I can provide any additional information, I would be pleased to further discuss these findings (with permission from James).

 

 

(End of portion of document I'm sharing with you guys)

To follow that up let me give you an example of what its like to be inside my mind.  I can visualize things, images, and what not, but they tend to be superimpozed over concepts I'm already familiar with.  And if I try to take one particular portion of that image aside so that I can examine it from all angles and really get a feel for it, the image behaves as if it where a real object and collapses without its missing piece.

Also as for my writting I tend to use a sort of memory trick for how I'm able to keep entire stories going when I have trouble remembering peoples names and faces, I think in broard terms of scenes.  Once I have a scene in my head it's easy to remember because it can be summed up in a few simple words, and I know my characters well enough that once I put them into that scene, I can always trust that their lines will flow more or less naturally into that scene.

Examples: Chapter two of Pawed was bacially made up of four scenes, James buys bullets, James inspects map inside inn, and James gets ambused, James contacts Richard.  Scenes are relatively easy all things considered, but like I've said before as you can notice above when it comes to copying complex figures I'm at the bottom of the freaking barrel, and I'm okay with that because in the two hours it took me to make a really bad drawing that left me in my left arm subject to spazams of pain when I put weight on it for the next 24 hours, I could have typed a thousand words and then some.