I also wish there were less emphasis on the Full-Scale IQ score and much more on the individual subtest scores, which point up the areas of strength and weakness.
Because the children I evaluate are usually suspected of having some type of learning disability, the WISC-R is almost always a pleasant experience. Nearly every child scores far above his academic grades in at least some of the subtests, and he knows it. You can’t fool these kids when they’re failing, and it’s just as true when they’re succeeding. They love to find that they are good in some things and not the overall “stupid head” that their academic grades suggest. Of course, the low subtest scores are valuable, too – they yield clues to areas of weakness, which is necessary for planning remediation.
On the Information subtest of the WISC-R, Ben missed relatively easy items, such as “Where does the sun set?” Yet he was able to answer in detail a question about hieroglyphics.
He didn’t know which month comes after March and had difficulty saying the months of the year; he knew there were twelve but was able to think of only ten in scrambled order. Yet, on Similarities, which measures the ability to think and reason abstractly, he scored in the superior range, even if he stumbled in expression.
On the Picture Completion subtest, Ben spotted the missing detail of a picture instantly, but then fumbled for the word to describe it, calling the knob on a bureau a “button thing” and pointing to the missing strap of a watch and calling it “the thing … uh … I mean the watch’s belt is missing.” Because Picture Completion is not a test of verbal ability, the child only needs to point to the missing detail for the item to be scored as correct. Consequently, this did not lower Ben’s score. But difficulty with word retrieval is another indicator of learning disabilities and points up the importance of observation rather than just the numbered scores.
Picture Arrangement was more difficult for Ben. In this test he was supposed to place cut-up picture sequences in order so that they told a logical story. Ben had trouble partly because he was confused about directionality and so couldn’t tell whether trucks were coming or going, and partly because he rushed. Also, he was very innocent and insecure about social situations, and this subtest requires social awareness, the knowledge of what to do when, as well as sequencing ability.
The Arithmetic subtest of the WISC-R was also hard for Ben, not because he didn’t know how to do the problems, but because they were given orally and he couldn’t remember what was said long enough to hold the facts in his head so that he could figure out the solutions.
I tucked the papers back into Ben’s file and then turned to the notes I had made during phone calls with Phil Golden, the clinical psychologist who had referred Ben to me. Phil and I had known each other for years. We had both been on the second floor of Rea Oldenburg’s office building, and we often shared discussions of our cases. He was a big, kind, intelligent man, and I respected his work. We both believed that emotional and learning problems are usually linked in one way or another, and he referred children to me for what he called “educational therapy.” We both believed that if one person in a family is troubled or hurting, the other members will also be affected. Phil was an accomplished family therapist, and so I, too, referred cases to him.
Phil had been working with the Aylesworths for about two months at the time of my first meeting with Ben. They had contacted him because Ben’s pediatrician had insisted upon it. Ben had become increasingly withdrawn during the fall months, keeping almost entirely to himself. His grades had slipped from C’s to D’s and lower. Then one day just before Christmas, Phil told me, Jessie – Ben’s sister – had gone out into their yard and looked up to see Ben standing barefoot on the roof. She called to him, but he didn’t answer, and she ran to tell her mother.
So far, no one was sure what Ben was doing on the roof. He wouldn’t talk about it, but it was the precipitating incident that made Ben’s pediatrician insist that the Aylesworths contact Phil Golden.
The Aylesworths had planned to send only Ben, but Phil insisted that the whole family come in. They did so reluctantly, except for Jessie, a sunny seven-year-old, and Phil said that things were now moving very slowly. Ben still refused to say what he was doing on the roof. His father complained incessantly about Ben’s grades and behavior, but found one reason after another why he couldn’t keep appointments. So to Phil’s frustration he was presently seeing only Mrs. Aylesworth and the two children.
Phil said he suspected that some of Ben’s troubles in school might be due to some type of learning disability and suggested to the Aylesworths that they bring Ben to me for a diagnostic evaluation.
Mrs. Aylesworth had immediately picked up on the suggestion and called for an appointment. She had been anxious to talk and I listened to her carefully.
“Ben was fine,” she said, “till it came time for him to go to school. Everybody in the family loved him. He was his grandmother’s favourite – ‘the brightest and the best,’ she always said. Even now she thinks he’s wonderful, but that’s because she only sees him in the summer.
“Still, even though he’s never liked school, he’s never been like this before. He’s failing everything and then lying about it. Saying he’s studied when I know he’s never opened a book. Ben’s not like Jessie, his sister. She’s in second grade now, and I sometimes think she can read better than Ben.”
I was not pleased by the comparison, but this was not the time to discuss it. Instead I asked if Ben had had any previous evaluations. It seemed odd, with his continuing history of school difficulty, that someone hadn’t picked up on it.
There was a short silence, and then Mrs. Aylesworth said, “Well, actually, his third-grade teacher wanted the Child Study Team to do what she called a workup. But Ralph wouldn’t hear of it – and Ben wasn’t all that bad until this year, sixth, you know. Now he says – Ralph, I mean – he says since you’re private and not connected with the school it’s all right to go ahead. Ralph feels strongly about Ben staying in public school and getting to know all classes of people.”
I wondered if he knew “the people” called his son “Banana Brain.”
I explained in detail to Mrs. Aylesworth what I looked for in a diagnostic evaluation – the child’s intellectual potential, his levels of academic performance, styles of learning, any indication of learning disabilities, strengths, weaknesses, and how the child views himself and his world. I was surprised when she called back the next day to say that Ralph wanted to know exactly what tests I would give Ben.
I had recently composed an evaluation sheet listing the usual battery of tests I gave when there was reason to suspect some type of learning disability (see the Appendix). I mentioned this to Mrs. Aylesworth, and she immediately asked if she could stop by later in the day to pick it up.
I put the sheet in an envelope, wrote her name on the outside, and put the envelope in our mailbox. Before the day was over, she had called again to say that Ralph had looked over the test sheet and had agreed to the evaluation. And so we set up the four appointments for Ben.
Ben arrived at the side door at exactly five minutes before one o’clock on Friday. The Mercedes was already at the bottom of the driveway when I opened the door.
“I’m early,” Ben announced. He still wasn’t looking at me, but at least his gaze was up from his feet.
“Not much,” I said. “Come in.”
I closed the door and immediately realized that Ben was looking beyond me to the birds. It had snowed lightly the night before and the feeders were full, every perch taken; even the suet box had an energetic woodpecker tapping away.
Ben walked past me. “Since I’m early I’ll wait here,” he said, standing in front of the glass doors.
“All right. You can leave your jacket on the back of the chair.”
He shrugged off the navy down vest, and simultaneously the birds, sensing unfamiliar action, rose in a feather cloud and disappeared.
“Jeezus cripes,” Ben said. “What’d you tell me t
o do that for? Look at what happened.”
“Don’t worry. They’ll be back. Just stand still.”
Before I had finished speaking a chickadee landed.
“They have to be quick on a day like this – before the finches take over,” I said.
“What k-kind are those?” Ben whispered, pointing to three yellow-green birds that arrived together.
“Goldfinches, I think. But I’m no expert. So far, they’re not as mean as the purple ones, but I’m reserving my opinion. This is the first year they’ve come.”
Unexpectedly, Ben crouched down on the white wool carpet in front of the glass doors. Then he stretched out full length, hands behind his head, lying quietly, looking up at the birds. Suddenly, he clapped his hands together, and again the birds rose up and flew into the woods.
I frowned as Ben stood up. “Why did you do that? You scared them on purpose.”
Ben shrugged, eyes down. “I just wanted to see their wings from underneath. That’s all.”
“Well, next time please just wait for them to fly by themselves. They have to get used to enough going on around here without someone scaring them on purpose. Let’s go up.”
Ben sat down behind the desk without being asked.
“How many points do I have again?” Ben asked, fingering the chips.
I checked the back cover of his folder. “Nine hundred and seventy. Okay now. Has anything good happened since I saw you? I ask everyone that.” (I can never quite give up the Best and the Worst – I just modify it a little for the older kids. When I was first teaching seriously emotionally disturbed children, we didn’t start our day with show and tell. Those children had little to show and nothing to tell. But I found that if I intensified the questions to “What was the best thing that happened since I saw you – or the worst thing?” not only did they talk, but I had to set time limits. Often what they talked of was fantasy – garbage truck’s eyes, or playing with a neon sign or vacuum cleaner, whom they considered their best friend. But what was important was their desire to communicate and the willingness to use language to do it. Now, in my office, I still had to know what the children were doing, thinking, feeling before I began either testing or teaching.)
“No.” Ben’s voice was cool. “What could happen that’s good?”
My turn to shrug. “I don’t know. Maybe you went for a walk with MacArthur, maybe a good TV show, maybe something at home. Sometimes you have to learn to look for the good things.”
“Yeah. Sure.”
“All right. What was so bad?”
Ben hesitated. “School. Mom. Dad. They found out I was supposed to hand in a stupid book report. I just forgot. How’d I know the d-d-dumb teacher was gonna call Mom?”
“I can see where that would mean trouble. Pay yourself twenty-five.”
Ben registered surprise and quickly picked out a green chip. “Then D-Dad started yelling about how all I do is s-s-sit on my b-b-butt and think the world owes me a living and on and on. I don’t even know what he was t-t-talking about. Then Mom began crying while he was yelling. It was d-d-disgusting. And now I’m grounded for the weekend.” Ben folded his arms and slouched across the desk. “Not that it m-m-matters. I wasn’t g-g-going anywhere, anyway.”
“I don’t have any instant answers, Ben, but it does sound like a mess. I’m sorry.”
“How much of a mess?”
“What? Oh. About a sixty-chip mess, I’d say.”
Ben wasn’t smiling, and neither was I. But something better was happening between us, and he was using the chips to initiate communication.
“Now,” I said, “we’re up to the WISC-R Block Design in the testing, and we’ve still got a ways to go, so we need to begin. Here.” I dumped the blocks on the desk. “They’re all the same – red on some sides, white on others, and half-red, half-white on the other sides. Here’s the first card. The idea is to make the design on the card by using the blocks. Here. Watch me first.”
Ben was wonderful with the blocks. Where his fingers curled around a pencil had been awkward and unsure as he copied the Bender designs, now they moved quickly and gracefully, arranging first four and then nine blocks into the required patterns.
With each successfully completed design, Ben became a little looser and a little happier. The pulse at his temple was barely visible. Obviously, it felt good to him to be doing something well.
“Pay yourself two hundred twenty, Ben,” I said. “The next test is Vocabulary. I’ll say a word. You just tell me what it means.”
“I hate that kind of stuff. I lots of times know the word, but I d-d-don’t know how to say it. I mean I know it in my head, b-b-but when I go to say what it means … oh, I don’t know.”
“Well, just try. Remember, the words start easy and get harder, but I don’t expect you to know them all. Hat. What is a hat?”
“Thing you wear.”
I waited, but Ben didn’t elaborate.
“What is …”
“Here,” Ben said, patting his head. “You wear it here.”
Ben’s answers were all terse, and the rhythm and content of his speech were that of a much younger child. And he was right. He did get mixed up.
“What does ‘brave’ mean?”
“It’s like when you’re scared. Well, not like that. Like the opposite. You know?”
I nodded and leaned back to look at Ben, sensing that he had something more to say.
“Do you think those birds are brave?” he asked. “Like are they scared flying around up there or do they like it?”
“I think they like it,” I said. “The landing looks like the hard part.” What was it with Ben and birds? Why did he watch them with such fascination? Why did he want to see their wings from underneath?
I shook my head, both to clear it and to get back to work. To stay completely with a child like Ben, who often went off track, took concentration. Ben continued to struggle to express himself. He knew a lot more than he could put into words. When asked to define “gamble,” he replied, “Bet over money.” Then he shrugged. “Oh … I don’t know. I mean I know, but I don’t. Just forget it.”
Object Assembly, another subtest of the WISC-R, consisted of four puzzles and for Ben was as easy as or easier than Block Design. He immediately knew what the puzzle was supposed to be. He saw the gestalt, the unified whole, and efficiently put the pieces in the proper places. Ben could build from a design. He could also put isolated pieces into a meaningful whole without copying. Both of these tasks require visual awareness. Block Design is also considered to be an excellent indicator of general intelligence. Ben’s understanding of spatial relationships far exceeded his ability to express himself verbally.
Ben did only fairly well on the Comprehension subtest, which measures practical judgment and common sense. His judgment was adequate, but he often failed to gain extra points because his answers showed a lack of independence. When asked what he should do if a much smaller boy started to fight with him, his answer was, “Tell somebody – like tell your mother,” instead of thinking of a way to handle the problem himself.
Both Coding (in which the child is asked to match and copy symbols, testing the ability to learn combinations of symbols and shapes and then to reproduce them with paper and pencil) and Digit Span (which consists of repeating an increasing number of digits both forward and backward) were near disasters for Ben. He copied only a few symbols during the two-minute span – his pencil moving slowly and awkwardly – and he could repeat only four digits correctly. After that he would have the right numbers, but in the wrong sequence – or else forget them altogether. Ben’s spirits wilted as quickly as they had risen earlier; only the chips sustained him.
I put the WISC-R away and handed Ben the WRAT (Wide Range Achievement Test). “This is a short test of spelling, reading, and arithmetic,” I said. “The questions all begin easy and get harder. Try not to get down on yourself if you don’t know some. Remember, I don’t expect you to know them all. We’ll start with spell
ing.”
Ben held the pencil in his right hand in the now familiar cramped, hooked grip more usually seen on lefties. He printed the words in pale, uneven letters, reversing the b in “boy” and the d in “dress,” and erasing letters over and over again, usually making the spelling worse than before.
In the reading (word recognition) section, he skipped lines, lost his place, read “sour” as “sore” and “plot” as “pilot.”
We finished the session with arithmetic. This time it was a written arithmetic test, in contrast to the oral arithmetic on the WISC-R. This was much easier for Ben because he could actually see the problems, rather than just hear them. He worked quickly and with concentration, adding, subtracting, multiplying, dividing. He understood measurement and fractions, and although much of his computation was done on his fingers or by counting under his breath, he still scored well. He knew this stuff, and we both smiled when I said, “Okay, Ben. We’re done for the day. Pay yourself three hundred eighty and count up.”
I try to end each session with a test on which I think the child will do well. It makes it easier for them to come back next time. I don’t always guess right, so I’m pleased when I do.
Ben had large piles of chips in front of him, and he counted carefully: “One hundred, two hundred …” then his voice gradually faded and his fingers rested on the chips without moving.
“Can I ask you something?”
“Of course.”
“What kind of doctor are you, anyway?”
“I’m not a doctor, Ben. More like a teacher.”
“Well, why did they say I had to come? What do they want you to do?”
“I’m trying to find out how you learn best so I can show you how to use your strengths to help in the areas where you have trouble.”
Outside a car honked, and Ben stood up.
“That’s not true, you know,” Ben said. “You’re lying to me just like everybody else. What you’re trying to find out is whether I’m retarded or crazy or both. Right?”
A Safe Place for Joey Page 11