*2.2.1 Child H's profile on the WISC IV (UK)*

Child H's performance on the different subtests of the WISC IV (UK) [91] is summarised in **Table 1**, which presents the profile of standard scores obtained in the


*Note. In the above table, a standard score is a scaled score relative to a normal curve, where the average score would be a score of 10. Scores higher than 12 indicate above average performance relative to age level, indicating potential areas of cognitive strength. Scores lower than 8 indicate below average performance relative to age level, indicating potential areas of cognitive weakness. This type of profile interpretation needs to be conducted cautiously and substantiated against other information, as any scaled score is subject to measurement error.*

**Table 1.**

*Child H – profile of standard scores on WISC IV (UK) (September 2016).*

verbal comprehension, perceptual reasoning, working memory and processing speed areas of the test. This was analysed for indicators of strength and weakness in cognitive processing, as well as indicators of the strategies Child H employed in processing information of different types.

#### *2.2.2 Profile of child H on the WISC IV (UK) about here*

It was evident from the profile that Child H's performance in all areas of the IQ was in the normal range. However, there was evidence of scatter in level of performance both within and across different areas of the test, indicating that he was likely to have adapted to his difficulties at school using particular learning strategies linked to strengths and weaknesses in how he perceived, processed and remembered information (Note 7). The verbal comprehension scores indicated that Child H had welldeveloped verbal reasoning ability, and average vocabulary, comprehension, general knowledge and verbal classification abilities relative to age level. The perceptual reasoning side of the test indicated adequately developed perceptual and spatial abilities relative to age level, but weakness in non-verbal reasoning, while the scores in the working memory side indicated good short-term auditory memory as well as good sequential memory for letters and numbers.

There were, however, difficulties in the processing speed areas of the test, with weakness in symbol search and particular weakness in coding. Low scores on the 20 coding test of the WISC are often associated with difficulties in reading and spelling [92–95]. Combined with low scores in symbol search, this indicated difficulties with rate of processing symbolic information, as well as difficulties in coding information as well as recoding information from memory.

Overall the IQ profile provided evidence of scatter in the test scores indicative of strengths and weaknesses in particular types of cognitive and language processing. This will be evident from the graph presented below, in which the standard scores on the test are grouped by cognitive area (**Figure 3**).

*2.2.3 Child H profile of standard scores on WISC IV (UK) (September 2016) grouped by cognitive area here*

Overall, the indications from the profile were that Child H had particular strengths in verbal reasoning and working memory, but weaknesses affecting perceptual development as well as processing speed. Coding was a particular area of difficulty indicating needs for intervention in developing sequential working memory for words. There were also indications from the IQ that Child H's strengths in other working memory areas could be used as the basis for interventions to improve his functioning in writing and spelling.

#### *2.2.4 Child H's profile on the phonic inventories*

As Child H was in Grade 3 at school, the first of the three levels of the Phonic Inventories were also administered, and error analysis conducted. Child H's profile indicated high error scores on:


Overall, Child H's pattern of errors on the phonic inventories provided indicators of both phonological and phonic difficulties. A high incidence of errors on ending consonant blends on this instrument [96–98] is associated with learning disabilities. Number of medial vowel errors is also an indicator of learning disability both in primary school age children [99, 100] and in high school children [101].

The profile of errors on the instrument was thus used as corroborating evidence of the presence of a learning disability, while also providing evidence of specific areas of learning need. In addition, the profile was analysed to identify specific phonic errors and error types which could be targeted for instruction [102–104].

### **3. Functional classification of child H's learning difficulties**

The conclusion was that the tests of basic reading, writing and spelling skills fell well below what would be expected in terms of age level as well as Child H's overall level of cognitive performance, enabling diagnosis of a reading disorder under DSM-IV code 315.00 (Note 8), as well as a disorder of written expression in terms of the diagnostic criteria for DSM-IV code 315.2 (Note 9). As there were also attentional and focus difficulties possibly linked to anxiety and emotionality around school performance or to neurological immaturity or to a combination of both physiological and emotional factors, an additional ICD10 classification of Z 73.3 (Stress, not elsewhere classified) could be applied in working with Child C.

Based on the results from assessment, Child H was thus classified for medical aid purposes as having developmental learning difficulties affecting a number of areas of scholastic functioning. The classification provided was functional, based on the use of ICD10 indicators linked to the presence of a number of areas of difficulty, as

presented in **Tables 2** and **3** below. This was done to avoid labelling Child H as either dyslexic or dysgraphic until such time as the different types of intervention in his programme had been implemented.
